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Sample records for shoulder anatomical arthroplasty

  1. Sleep Disturbance and Anatomic Shoulder Arthroplasty.

    Science.gov (United States)

    Morris, Brent J; Sciascia, Aaron D; Jacobs, Cale A; Edwards, T Bradley

    2017-05-01

    Sleep disturbance is commonly encountered in patients with glenohumeral joint arthritis and can be a factor that drives patients to consider surgery. The prevalence of sleep disturbance before or after anatomic total shoulder arthroplasty has not been reported. The authors identified 232 eligible patients in a prospective shoulder arthroplasty registry following total shoulder arthroplasty for primary glenohumeral joint arthritis with 2- to 5-year follow-up. Sleep disturbance secondary to the affected shoulder was characterized preoperatively and postoperatively as no sleep disturbance, frequent sleep disturbance, or nightly sleep disturbance. A total of 211 patients (91%) reported sleep disturbance prior to surgery. Patients with nightly sleep disturbance had significantly worse (Psleep disturbance, with 186 patients (80%) reporting no sleep disturbance (Psleep disturbance group had significantly greater patient-reported outcome scores and range of motion following surgery compared with the other sleep disturbance groups for nearly all outcome measures (P≤.01). Patients have significant improvements in sleep after anatomic shoulder arthroplasty. There was a high prevalence of sleep disturbance preoperatively (211 patients, 91%) compared with postoperatively (46 patients, 20%). [Orthopedics. 2017; 40(3):e450-e454.]. Copyright 2017, SLACK Incorporated.

  2. Radiographic analysis of shoulder anatomical arthroplasty

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

    2008-10-15

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

  3. Injury to the axillary nerve after reverse shoulder arthroplasty: an anatomical study.

    Science.gov (United States)

    Lädermann, A; Stimec, B V; Denard, P J; Cunningham, G; Collin, P; Fasel, J H D

    2014-02-01

    Subclinical neurological lesions after reverse shoulder arthroplasty are frequent, mainly those involving the axillary nerve. One of the major reported risk factors is postoperative lengthening of the arm. The purpose of this study was to evaluate the anatomical relationship between the axillary nerve and prosthetic components after reverse shoulder arthroplasty. The study hypothesis was that inferior overhang of the glenosphere relative to glenoid could put this nerve at risk. Eleven fresh frozen shoulder specimens were dissected after having undergone reverse shoulder arthroplasty using a classic deltopectoral approach. The mean distance from the inferior border of the glenoid to the inferior edge of the glenosphere was 6.0±4.3mm (range, 1.0 to 16.2mm). The axillary nerve was never closer than 15mm to the glenosphere. The main anterior branch of the axillary nerve was in close contact with the posterior metaphysis or humeral prosthetic implant. The mean distance between the nerve and the humeral implants was 5.2±2.1mm (range, 2.0 to 8.1mm). The proximity of the axillary nerve to the posterior metaphysis or humeral implants may be a risk factor for axillary nerve injury after reverse shoulder arthroplasty. This study quantifies the proximity of the axillary nerve to the implant after reverse shoulder arthroplasty. Basic science study, cadaver study. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  4. Kinematic analysis of the shoulder complex after anatomic and reverse total shoulder arthroplasty: A cross-sectional study.

    Science.gov (United States)

    Roren, Alexandra; Nguyen, Christelle; Palazzo, Clémence; Fayad, Fouad; Revel, Michel; Gregory, Thomas; Poiraudeau, Serge; Roby-Brami, Agnès; Lefèvre-Colau, Marie-Martine

    2017-06-01

    The movement of the arm relative to the trunk results from coordinated 3D glenohumeral and scapulothoracic movements. Changes in scapula kinematics may occur after total shoulder arthroplasty and could affect clinical and functional outcomes. To assess the 3D movement of the scapula during arm elevation after anatomic and reverse total shoulder arthroplasty. This was a single-centre, non-randomized, controlled cross-sectional study. Patients with anatomic (n = 14) and reverse total shoulder arthroplasty (n = 9) were prospectively enrolled and were compared to age-matched asymptomatic controls (n = 23). 3D scapular kinematics were assessed by a non-invasive, electromagnetic method during arm abduction and flexion. 3D scapular rotations and 3D linear displacements of the barycentre (geometrical centre) at rest and at 30°, 60° and 90° arm elevation; as well as scapulohumeral rhythm were analysed. Participant groups were compared using one-way ANOVA and Bonferroni post-hoc testing for normally distributed data, and Mann-Whitney U test for non-normally distributed data. Total range of scapular lateral rotation and barycentre displacement were increased, and scapulohumeral rhythm was reduced, in patients with anatomic and reverse total shoulder arthroplasty compared with age-matched controls; however, the global scapular kinematic pattern was preserved. For patients after total shoulder arthroplasty, the increased contribution of the scapula to arm elevation is consistent with a compensatory mechanism for the reduced glenohumeral mobility. The stability of the global scapula kinematic pattern reflects its mechanical and neuromotor strength. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Conversions from anatomic shoulder replacements to reverse total shoulder arthroplasty: do the indications for initial surgery influence the clinical outcome after revision surgery?

    Science.gov (United States)

    Holschen, Malte; Franetzki, Bastian; Witt, Kai-Axel; Liem, Dennis; Steinbeck, Jörn

    2017-02-01

    The most frequent indications for anatomic shoulder replacement are glenohumeral osteoarthritis and fractures of the humeral head. If anatomic shoulder prostheses fail, reverse total shoulder arthroplasty is often the only remaining treatment option. This study evaluates the influence of indications for primary shoulder arthroplasty on the clinical outcome after conversion to reverse total shoulder arthroplasty. From 2010 to 2012, 44 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months (14-36 months). Twenty-three of them had received an initial shoulder replacement because of osteoarthritis, while the remaining 21 patients had been treated for a fracture of the humeral head. At follow-up, patients were assessed with X-rays, constant-, and ASES scores. The total number of observed complications was higher in patients revised because of failed fracture arthroplasty (24 vs. 9%). Patients initially treated for osteoarthritis achieved a higher ASES score (71 vs. 59 points; p = 0.048). The normalized constant score was not different between the two observed groups (osteoarthritis 73% vs. fracture 67%: p = 0.45). Complications occurred more often in patients who had initially suffered from a fracture of the humeral head (fracture 23.8% vs. osteoarthritis 8.7%). Scapular notching was more frequent after initial fracture arthroplasty (33 vs. 14%). Indications for initial shoulder replacement have an influence on the clinical outcome after conversion to reverse total shoulder arthroplasty. Patients initially treated for a fracture of the humeral head have a lower subjective outcome and a higher complication rate in comparison with patients initially treated for osteoarthritis. IV (Retrospective study).

  6. Anatomical total shoulder arthroplasty used for glenohumeral osteoarthritis has higher survival rates than hemiarthroplasty

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V; Hole, Randi; Metlie, Trygve

    2018-01-01

    OBJECTIVE: To report the10-year survival rates of different shoulder arthroplasty types used for glenohumeral osteoarthritis. DESIGN: Data from 2004-2013 was prospectively collected by the national shoulder arthroplasty registers in Denmark, Norway and Sweden and merged into a harmonized dataset ...

  7. Stemless shoulder arthroplasty: current status.

    Science.gov (United States)

    Churchill, R Sean

    2014-09-01

    Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component. Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed. Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up.. Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  8. The risk of suprascapular and axillary nerve injury in reverse total shoulder arthroplasty: An anatomic study.

    Science.gov (United States)

    Leschinger, Tim; Hackl, Michael; Buess, Eduard; Lappen, Sebastian; Scaal, Martin; Müller, Lars Peter; Wegmann, Kilian

    2017-10-01

    Implantation of a reverse total shoulder arthroplasty (rTSA) places the axillary and suprascapular nerves at risk. The aim of this anatomic study was to digitally analyse the location of these nerves in relation to bony landmarks in order to predict their path and thereby help to reduce the risk of neurological complications during the procedure. A total of 22 human cadaveric shoulder specimens were used in this study. The axillary and suprascapular nerves were dissected, and radiopaque threads were sutured onto the nerves without mobilizing the nerves from their native paths. Then, 3D X-ray scans of the specimens were performed, and the distance of the nerves to bony landmarks at the humerus and the glenoid were measured. The distance of the inferior glenoid rim to the axillary nerve averaged 13.6mm (5.8-27.0mm, ±5.1mm). In the anteroposterior direction, the distance between the axillary nerve and the humeral metaphysis averaged 8.1mm (0.6-21.3mm, ±6.5mm). The distance of the glenoid centre to the suprascapular nerve passing point under the transverse scapular ligament measured 28.4mm (18.9-35.1mm, ±3.8mm) in the mediolateral direction and 10.8mm (-4.8 to 25.3mm, ±6.1mm) in the anteroposterior direction. The distance to the spinoglenoid notch was 16.6mm (11.1-24.9mm, ±3.4mm) in the mediolateral direction and -11.8mm posterior (-19.3 to -4.7mm, ±4.7mm) in the anteroposterior direction. Implantation of rTSA components endangers the axillary nerve because of its proximity to the humeral metaphysis and the inferior glenoid rim. Posterior and superior drilling and extraosseous screw placement during glenoid baseplate implantation in rTSA place the suprascapular nerve at risk, with safe zones to the nerve passing the spinoglenoid notch of 11mm and to the suprascapular notch of 19mm. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Mortality after shoulder arthroplasty

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...... common, and for fracture patients in particular, close postoperative monitoring of pulmonary, cardiac, and abdominal conditions seems important....

  10. Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation.

    Science.gov (United States)

    Denard, Patrick J; Raiss, Patric; Gobezie, Reuben; Edwards, T Bradley; Lederman, Evan

    2018-02-05

    Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings. The purpose of this report is to review the current literature on press-fit fixation of the humeral component during total shoulder arthroplasty and propose minimum requirements for radiographic descriptions of stress shielding. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. Revision to reverse shoulder arthroplasty with retention of the humeral component

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    Werner, Birgit S; Boehm, Dorota; Gohlke, Frank

    2013-01-01

    Background Revision in failed shoulder arthroplasty often requires removal of the humeral component with a significant risk of fracture and bone loss. Newer modular systems allow conversion from anatomic to reverse shoulder arthroplasty with retention of a well-fixed humeral stem. We report on a prospectively evaluated series of conversions from hemiarthroplasty to reverse shoulder arthroplasty. Methods In 14 cases of failed hemiarthroplasty due to rotator cuff deficiency and painful pseudopa...

  12. ANALYSIS OF LONG-TERM RESULTS OF SHOULDER ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    D. V. Nenashev

    2012-01-01

    Full Text Available The retrospective analysis of 97 shoulder arthroplasties during 1998 to 2009 was performed. The hemiarthroplasty were fulfilled in 92 patients and total shoulder replacement in 5 patients. Total rate good and satisfactory results consists 32,0%, poor results - 68,0% (66 patients, include 5 patients with total shoulder arthroplasty. The lower level of good results was revealed in patients with chronic fractures and fracture-dislocations of shoulder. It related with changes bones of shoulder and muscles of shoulder (rotator cuff. In the studied group of patients there was no proper pre-operative diagnostics of the rotator cuff, articular surface of the scapula, which shows the need for careful preoperative examination to determine the indications for shoulder arthroplasty and select the type of prosthesis. Unsatisfactory results of total arthroplasty related to screw migration (in case of the transacromion approach and to the development of subacromial impingement. The conclusion about the need to narrow the indications for use of the scapular component «Ortho-P». The authors showed preference to cemented implants without a metal base. It is necessary to introduce in practice the anatomic implants of the third generation allowing the fullest play the anatomy and biomechanics of the shoulder joint.

  13. Arthroscopic Repair of Recurrent Posterior Shoulder Subluxation After Total Shoulder Arthroplasty: A Case Report.

    Science.gov (United States)

    Grieshaber-Bouyer, Ricardo; Gerber, Christian

    2017-01-01

    A 53-year-old man presented with osteoarthritis (Walch biconcave [B2] glenoid retroversion, 22°; glenohumeral subluxation index, 65%) and a partial rupture of the supraspinatus tendon in the left shoulder. Following anatomic total joint replacement, he developed disabling recurrent posterior subluxation despite a stable prosthesis and a correctly centered glenoid head, as observed with postoperative radiography and computed tomography. In order to avoid bone loss and the complications associated with revision arthroplasty, we performed arthroscopic reefing of the posterior capsule as an experimental minimally invasive treatment. The reduction in capsular volume successfully stabilized the shoulder for approximately 9 years; thereafter, the recurrence of instability ultimately required the conversion to a reverse prosthesis. Arthroscopic capsular reefing proved to be an effective treatment for posterior shoulder subluxations after total shoulder arthroplasty, and can be considered to avoid revision arthroplasty in young patients with a stable and correctly centered prosthesis.

  14. Return to sports after shoulder arthroplasty

    Science.gov (United States)

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-01-01

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

  15. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

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

    1989-01-01

    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......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...... 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....

  16. Shoulder arthroplasty for sequelae of poliomyelitis.

    Science.gov (United States)

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

    2016-05-01

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

  17. Use of reverse total shoulder arthroplasty in the Medicare population.

    Science.gov (United States)

    Day, Judd S; Paxton, E Scott; Lau, Edmund; Gordon, Victoria A; Abboud, Joseph A; Williams, Gerald R

    2015-05-01

    Reverse shoulder arthroplasty (RSA) has been Food and Drug Administration approved in the United States since 2004 but did not obtain a unique code until 2010. Therefore, the use of this popular procedure has yet to be reported. The purpose of this study was to examine the use and reimbursement of RSA compared with total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (SHA). We analyzed the 100% sample of the 2011 Medicare Part A claims data for patients aged 65 years or older. Patient demographic characteristics, diagnoses, provider information, reimbursements, and lengths of stay were extracted from the claims data. In 2011, a total of 31,002 shoulder arthroplasty procedures were performed; 37% were RSAs, 42% were TSAs, and 21% were SHAs. Osteoarthritis was the primary diagnosis code in 91% of TSAs, 37% of SHAs, and 45% of RSAs. A primary diagnosis of osteoarthritis with no secondary code for rotator cuff tear was found in 22% of patients undergoing RSA. The mean length of stay for RSA (2.6 days; SD, 2.1 days) was longer than that for TSA (2.1 days; SD, 1.5 days) and shorter than that for SHA (3.5 days; SD, 3.6 days) (P SHAs. Seventy percent of RSAs were implanted by surgeons who performed more RSAs than TSAs and SHAs combined. RSA is performed with similar frequency to TSA and almost twice as much as SHA in the Medicare population. Lower-volume surgeons perform most RSAs, and a majority of surgeons perform more RSAs than all anatomic shoulder arthroplasties combined. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Long-term survivorship of stemless anatomical shoulder replacement.

    Science.gov (United States)

    Beck, Sascha; Beck, Verena; Wegner, Alexander; Dudda, Marcel; Patsalis, Theodor; Jäger, Marcus

    2018-01-24

    Like in many other joints, current shoulder replacement designs aim at bone preservation. According to the literature available, stemless total shoulder arthroplasty (TSA) compares favourably with stemmed designs in terms of function and survivorship of the implant. However, long-term results of stemless shoulder arthroplasty are still missing. Therefore, the aim of the present study was to evaluate long-term results of stemless anatomical TSA. Between 2006 and 2009, 51 shoulders in 46 patients were resurfaced using the Biomet Total Evolutive Shoulder System (TESS). Thirty-one shoulders in 26 patients who were aged 66.7 ± 10.0 (range 34-82) years were available for review at a mean follow-up of 94.7 ± 11.3 (76-124) months. The implant survival rate was 93.5% at eight years. The overall revision rate of the TESS implant was 9.7%. Radiolucent lines were found on the glenoid side of the TESS arthroplasty in 90.9% of the cases. All stemless humeral corolla implants showed solid fixation at follow-up. Clinical scores significantly improved at long-term follow-up (VAS from 8.1 ± 0.9 to 1.0 ± 1.2, p < 0.001; Quick-DASH from 67.9 ± 13.5 to 18.7 ± 16.5, p < 0.001 and Constant score from 14.7 ± 6.1 to 68.8 ± 13.2, p < 0.001). Stemless TSA has stood the test of time at eight years in terms of clinical scores, radiographic loosening, complication rates and implant survivorship.

  19. Pain Management Strategies in Shoulder Arthroplasty.

    Science.gov (United States)

    Codding, Jason L; Getz, Charles L

    2018-01-01

    Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Risk factors for blood transfusion after shoulder arthroplasty.

    Science.gov (United States)

    Padegimas, E M; Clyde, C T; Zmistowski, B M; Restrepo, C; Williams, G R; Namdari, S

    2016-02-01

    Currently, there is little information about the need for peri-operative blood transfusion in patients undergoing shoulder arthroplasty. The purpose of this study was to identify the rate of transfusion and its predisposing factors, and to establish a blood conservation strategy. We identified all patients who had undergone shoulder arthroplasty at our hospital between 1 January 2011 and 31 December 2013. The rate of transfusion was determined from the patient's records. While there were exceptions, patients typically underwent transfusion if they had a level of haemoglobin of transfusion. High- and low-risk cohorts for transfusion were identified from a receiver operating characteristic (ROC) curve. Of 1174 shoulder arthroplasties performed on 1081 patients, 53 cases (4.5%) required transfusion post-operatively. Predictors of blood transfusion were a lower pre-operative haematocrit (p transfusion. In total 48 of the 436 (11%) shoulder arthroplasties with a pre-operative haematocrit transfusion compared with five of the 738 (0.70%) shoulder arthroplasties with a haematocrit above this level. We found that transfusion was needed less frequently than previously described for shoulder arthroplasty. Patients with a pre-operative haematocrit blood transfusion, while those with a haematocrit above this level are unlikely to require transfusion. The rate of transfusion after shoulder arthroplasty is under 5%, and those with a pre-operative haematocrit greater than or equal to 39.6% have a very low likelihood (transfusion. ©2016 The British Editorial Society of Bone & Joint Surgery.

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  2. Geometrical analysis of stemless shoulder arthroplasty: a radiological study of seventy TESS total shoulder prostheses.

    Science.gov (United States)

    Kadum, Bakir; Hassany, Hamid; Wadsten, Mats; Sayed-Noor, Arkan; Sjödén, Göran

    2016-04-01

    The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy. This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint. Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1 ± 2 mm (range -3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was -1 ± 3 mm (range -9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was -3 ± 12° (range -26 to 20°). Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.

  3. Hierarchy of stability factors in reverse shoulder arthroplasty.

    Science.gov (United States)

    Gutiérrez, Sergio; Keller, Tony S; Levy, Jonathan C; Lee, William E; Luo, Zong-Ping

    2008-03-01

    Reverse shoulder arthroplasty is being used more frequently to treat irreparable rotator cuff tears in the presence of glenohumeral arthritis and instability. To date, however, design features and functions of reverse shoulder arthroplasty, which may be associated with subluxation and dislocation of these implants, have been poorly understood. We asked: (1) what is the hierarchy of importance of joint compressive force, prosthetic socket depth, and glenosphere size in relation to stability, and (2) is this hierarchy defined by underlying and theoretically predictable joint contact characteristics? We examined the intrinsic stability in terms of the force required to dislocate the humerosocket from the glenosphere of eight commercially available reverse shoulder arthroplasty devices. The hierarchy of factors was led by compressive force followed by socket depth; glenosphere size played a much lesser role in stability of the reverse shoulder arthroplasty device. Similar results were predicted by a mathematical model, suggesting the stability was determined primarily by compressive forces generated by muscles.

  4. Avulsive axillary artery injury in reverse total shoulder arthroplasty.

    Science.gov (United States)

    Wingert, Nathaniel C; Beck, John D; Harter, G Dean

    2014-01-01

    In addition to neurologic injuries such as peripheral nerve palsy, axillary vessel injury should be recognized as a possible complication of reverse total shoulder arthroplasty. Limb lengthening associated with Grammont-type reverse total shoulder arthroplasty places tension across the brachial plexus and axillary vessels and may contribute to observed injuries. The Grammont-type reverse total shoulder arthroplasty prosthesis reverses the shoulder ball and socket, shifts the shoulder center of rotation distal and medial, and lengthens the arm. This alteration of native anatomy converts shearing to compressive glenohumeral joint forces while augmenting and tensioning the deltoid lever arm. Joint stability is enhanced; shoulder elevation is enabled in the rotator cuff–deficient shoulder. Arm lengthening associated with reverse total shoulder arthroplasty places a longitudinal strain on the brachial plexus and axillary vessels. Peripheral nerve palsies and other neurologic complications of reverse total shoulder arthroplasty have been documented. The authors describe a patient with rotator cuff tear arthropathy and a history of radioulnar synostosis who underwent reverse total shoulder arthroplasty complicated by intraoperative injury to the axillary artery and postoperative radial, ulnar, and musculocutaneous nerve palsies. Following a seemingly unremarkable placement of reverse shoulder components, brisk arterial bleeding was encountered while approximating the incised subscapularis tendon in preparation for wound closure. Further exploration revealed an avulsive-type injury of the axillary artery. After an unsuccessful attempt at primary repair, a synthetic arterial bypass graft was placed. Reperfusion of the right upper extremity was achieved and has been maintained to date. Postoperative clinical examination and electromyographic studies confirmed ongoing radial, ulnar, and musculocutaneous neuropathies.

  5. Shoulder replacement - discharge

    Science.gov (United States)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [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)

    2012-07-15

    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.

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

    International Nuclear Information System (INIS)

    Sheridan, B.D.; Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P.

    2012-01-01

    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.

  8. Resilience correlates with outcomes after total shoulder arthroplasty.

    Science.gov (United States)

    Tokish, John M; Kissenberth, Michael J; Tolan, Stefan J; Salim, Tariq I; Tadlock, Josh; Kellam, Thomas; Long, Catherine D; Crawford, Ashley; Lonergan, Keith T; Hawkins, Richard J; Shanley, Ellen

    2017-05-01

    Resilience, characterized by an ability to bounce back or recover from stress, is increasingly recognized as a psychometric property affecting many outcomes' domains including quality of life, suicide risk in active-duty military personnel, and recovery in cancer patients. This study examines the correlation between resilience, as measured by the Brief Resilience Scale (BRS), and traditional outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Penn scores in patients undergoing total shoulder arthroplasty (TSA). Seventy patients undergoing primary anatomic TSA were followed up for a minimum of 2 years (mean, 30 ± 3 months). Patients were stratified into groups a priori, based on deviation from the mean of the BRS score, into low-resilience (LR), normal-resilience (NR), and high-resilience (HR) patients, and outcome scores were calculated for each group. Postoperative BRS scores significantly correlated with ASES, Penn, and SANE scores (r = 0.41-0.44, P resilience group, the LR group had a Penn score that was 34 points lower than that in the HR group. Likewise, the LR group had a SANE score that averaged 40 points lower than that in the HR group (SANE score of 53 points in LR group and 92 points in HR group, P = .05). When we evaluated ASES subscores, it appeared that the pain subscale was responsible for most of the difference between the LR and HR groups (29 points and 48 points [out of 50 points], respectively; P = .03). Resilience is a major predictor of postoperative outcomes after TSA. Patients who are classified as having LR have outcome scores that are 30 to 40 points lower on traditional outcome scales than patients with HR. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants.

    Science.gov (United States)

    Holschen, M; Franetzki, B; Witt, K-A; Liem, D; Steinbeck, J

    2017-08-01

    Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants. From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months. Patients were assessed with X-rays, Constant- and ASES Score and a questionnaire about their subjective satisfaction. The total number of observed complications was seven (16%). Ninety-eight percent of the patients were satisfied with their clinical result. Patients achieved a mean normalized constant score of 70.2% and a mean ASES Score of 65.3. Patients with stemless primary implants achieved a higher normalized constant score than patients with stemmed primary implants (82 vs. 61.8%; p = 0009). Reverse total shoulder arthroplasty provides satisfactory clinical results and a high patient satisfaction in revision shoulder arthroplasty. The complication rate needs to be considered and discussed with the patient prior to surgery. Presence or absence of a stem of revised shoulder arthroplasties interferes with the outcome. LEVEL OF EVIDENCE IV: (Retrospective study).

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

    Energy Technology Data Exchange (ETDEWEB)

    Sheridan, B.D., E-mail: bdsheridan@hotmail.com [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)

    2012-07-15

    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.

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

    International Nuclear Information System (INIS)

    Sheridan, B.D.; Ahearn, N.; Tasker, A.; Wakeley, C.; Sarangi, P.

    2012-01-01

    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.

  12. Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads

    NARCIS (Netherlands)

    de Toledo, Joelly Mahnic; Loss, Jefferson Fagundes; Janssen, Thomas W.; van der Scheer, Jan W.; Alta, Tjarco D.; Willems, W. Jaap; Veeger, DirkJan (H. E. J)

    2012-01-01

    Background: Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe

  13. [Reversed total shoulder arthroplasty in rotator cuff defect arthropathy].

    Science.gov (United States)

    Patzer, T

    2018-03-07

    In a progredient rotator cuff tear with tendon retraction, fatty infiltration and atrophy of rotator cuff muscles the humerus cannot be centered and stabilized sufficiently in the glenohumeral joint. This leads to rotator cuff defect arthropathy as an eccentric osteoarthritis with acetabularization and wear of the acromion, as well as of the glenoid. A painful pseudoparalysis of the shoulder indicates the implantation of a reversed total shoulder arthroplasty (rTSA) to reduce pain and restore active motion. The rTSA improves the motoric function of the deltoid muscle by medialization and caudalization of the center of rotation via an optimized lever arm and is also indicated in cranio-caudally centered osteoarthritis with static posterior humeral decentration due to a bi-concavely eroded glenoid. Currently, humeral anatomical resection with an inclination of 135° and a humeral retrotorsion of 20-40°, in rTSA in contrast to 155° inclination, has been shown to lead to better glenohumeral motion without loss of stability. Additionally, a reduced glenohumeral offset should be restored by especially bony lateral augmentation of the glenoid. In a pre-operatively positive lag sign for external rotation caused by a rupture of the infraspinatus/teres minor tendon, a lateral latissimus/teres major muscle tendon transfer in rTSA can optimize active external rotation. The tendon of the subscapularis muscle should be re-fixated in the deltopectoral approach for rTSA whenever possible for better anterior stability of the glenohumeral joint. Larger diameters of the glenospheres have been shown to have more stability and better motion. Humeral metaphyseal metal liners with corresponding polyethylene glenospheres can avoid osteolysis of the inferior scapular neck caused by polyethylene debris due to impingement of the humeral liner at the scapular neck.

  14. Long-term activity restrictions after shoulder arthroplasty: an international survey of experienced shoulder surgeons.

    Science.gov (United States)

    Magnussen, Robert A; Mallon, William J; Willems, W Jaap; Moorman, Claude T

    2011-03-01

    Shoulder arthroplasty is being performed with increasing frequency, and patients' athletic participation after shoulder arthroplasty is on the rise. However, little data exist regarding appropriate long-term activity restrictions. We hypothesize that European and North American surgeons both recommend increasing long-term activity restrictions, moving from hemiarthroplasty to total shoulder arthroplasty (TSA) to reverse total shoulder arthroplasty (RTSA), and that both groups impose similar restrictions on their patients. An online survey was sent to members of the American Shoulder and Elbow Surgeons (ASES) and the European Society for Surgery of the Shoulder and Elbow (SECEC). Participants received a list of 37 activities and classified their postoperative recommendations for each activity as allowed, allowed with experience, not allowed, or undecided. The participation rate was 18%, including 47 North American surgeons and 52 European surgeons. All patients were allowed to participate in nonimpact activities, including jogging/running, walking, stationary bicycling, and ballroom dancing. Sports requiring light upper extremity involvement, including low-impact aerobics, golf, swimming, and table tennis, were allowed after hemiarthroplasty and TSA, and were allowed with experience after RTSA. Sports with fall potential, including downhill skiing, tennis, basketball, and soccer, were allowed with experience after hemiarthroplasty and TSA, and undecided or not allowed after RTSA. Higher-impact sports, such as weightlifting, waterskiing, and volleyball, were undecided after hemiarthroplasty and TSA and were not allowed after RTSA. European surgeons were more conservative than American surgeons in their recommendations after hemiarthroplasty and TSA, but good agreement between the 2 groups was noted regarding restrictions after RTSA. Restrictions should be based on the type of arthroplasty performed and patients' preoperative experience. Copyright © 2011 Journal of

  15. Periprosthetic Joint Infection of Shoulder Arthroplasties: Diagnostic and Treatment Options

    Directory of Open Access Journals (Sweden)

    Bernd Fink

    2017-01-01

    Full Text Available Periprosthetic joint infection (PJI is one of the most frequent reasons for painful shoulder arthroplasties and revision surgery of shoulder arthroplasties. Cutibacterium acnes (Propionibacterium acnes is one of the microorganisms that most often causes the infection. However, this slow growing microorganism is difficult to detect. This paper presents an overview of different diagnostic test to detect a periprosthetic shoulder infection. This includes nonspecific diagnostic tests and specific tests (with identifying the responsible microorganism. The aspiration can combine different specific and nonspecific tests. In dry aspiration and suspected joint infection, we recommend a biopsy. Several therapeutic options exist for the treatment of PJI of shoulder arthroplasties. In acute infections, the options include leaving the implant in place with open debridement, septic irrigation with antibacterial fluids like octenidine or polyhexanide solution, and exchange of all removable components. In late infections (more than four weeks after implantation the therapeutic options are a permanent spacer, single-stage revision, and two-stage revision with a temporary spacer. The functional results are best after single-stage revisions with a success rate similar to two-stage revisions. For single-stage revisions, the microorganism should be known preoperatively so that specific antibiotics can be mixed into the cement for implantation of the new prosthesis and specific systemic antibiotic therapy can be applied to support the surgery.

  16. Reverse shoulder arthroplasty in patients with os acromiale.

    Science.gov (United States)

    Aibinder, William R; Schoch, Bradley S; Cofield, Robert H; Sperling, John W; Sánchez-Sotelo, Joaquin

    2017-09-01

    Os acromiale has been reported in up to 15% of the general population. Reverse total shoulder arthroplasty (RTSA) increases deltoid tension, which could potentially lead to excessive stress on a pre-existent os acromiale. The purpose of this study was to determine the outcome and complications of primary RTSA in patients with radiographic evidence of an os acromiale. Between 2005 and 2013, 25 shoulders underwent primary RTSA with an associated os acromiale, which was classified preacromion (3), mesoacromion (20), and meta-acromion (2). All patients were observed for a minimum of 2 years or until reoperation. Mean follow-up time was 30.8 (range, 1-81.4) months. Outcomes included pain scores, range of motion, patient satisfaction, American Shoulder and Elbow Surgeons scores, and radiographic outcomes. RTSA led to an improvement in pain scores in 24 of 25 shoulders. Mean elevation, external rotation, and internal rotation were improved at final follow-up (124°, 46°, and L4, respectively). Three patients required reoperation, including revision surgery for dislocation (2) and excision of a painful os acromiale (1). Postoperative tilting of the os acromiale was noted in 7 shoulders (28%). There was no statistically significant difference in any outcome measures between shoulders with and shoulders without postoperative tilt of the os acromiale. The outcome of RTSA does not seem to be negatively affected by the presence of an os acromiale. Pain around an os acromiale after RTSA is rare. Inferior tilting is observed in approximately one-third of the shoulders after RTSA and does not seem to change the overall outcome. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

    DEFF Research Database (Denmark)

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

    1991-01-01

    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......-system and classified into four groups. Pain relief was satisfactory in the acute group, but was unpredictable in the chronic group. The results in the acute group were significantly superior (P less than .05). In the acute group, 3 (20%) patients had an excellent result and 6 patients (40%) had a good result, compared...... 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...

  18. Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty.

    Science.gov (United States)

    von Engelhardt, Lars V; Manzke, Michael; Breil-Wirth, Andreas; Filler, Timm J; Jerosch, Joerg

    2017-10-18

    To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system. Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD ® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes ( P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring. TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut.

  19. Periprosthetic humeral fractures after reverse shoulder arthroplasty. Case report.

    Science.gov (United States)

    Wajnsztejn, Andre; Foni, Noel Oizerovici; Oizerovici, Dan; Pires, Robinson Esteves Santos; Ejnisman, Benno

    2017-09-21

    Periprosthetic fractures is a severe complication after joint replacement. The rapidly increase of reverse shoulder arthroplasty surgeries, periprosthetic humeral fractures, which are described as rare, may increase in the near future. We report the case of displaced humeral fracture bellow the stem of reverse shoulder prosthesis. The patient was an 85-year-old woman who had a total shoulder replacement 6 years previously. The surgical solution consisted of plate osteossynthesis and cerclage. This report describes an unprecedented case in Brazilian literature; and gives an overview of the existing literature including this injury classification. RESUMO As fraturas periprotéticas do ombro representam uma grave complicação após a substituição da articulação. Devido ao rápido aumento do número de cirurgias de artroplastia reversa no ombro, as fraturas periprótese do úmero, descritas como raras, podem aumentar no futuro próximo. Descrevemos um caso de fratura desviada do úmero abaixo do componente umeral de uma artroplastia reversa. A paciente era uma mulher de 85 anos de idade, que tinha uma artroplastia reversa do ombro há 6 anos. O tratamento cirúrgico consistiu em osteossíntese com placa, parafusos e cerclagem. Os objetivos do presente trabalho foram reportar um caso inédito na literatura brasileira, e revisar a literatura existente e as classificações da lesão.

  20. An analysis of proximal humerus morphology with special interest in stemless shoulder arthroplasty.

    Science.gov (United States)

    Reeves, Jacob M; Johnson, James A; Athwal, George S

    2018-04-01

    Shoulder arthroplasty evolution has resulted in the shortening of traditional stemmed humeral components. Newer stemless implants rely on structures that maintain fixation in the metaphyseal region of the proximal humerus. Whereas the overall morphology of the proximal humerus is well understood, the advent of stemless implants requires that additional geometric measures be assessed. This study's purpose was to introduce new anatomic measures to assist with the design of stemless implants. Using computed tomography data from 98 subjects (nonarthritic [n = 41], B2 osteoarthritic [n = 26], and symmetric osteoarthritic [n = 31]), shifts in proximal canal direction, bounding diameters along the canal, and canal depth beneath the center of the humeral resection plane were quantified. Traditional articular aspect ratio terms (ie, resection diameter, humeral head height) were also quantified. All measures were reported relative to a humeral coordinate system relevant to stemless implants. Humeral depth, gender, and osteoarthritis were found to have effects on the measured parameters. Of these factors, gender was the most prominent, as men presented with significantly larger canal diameters and depths than women did (P < .001). Osteoarthritis had less of a significant impact on results (P < .001), with the attributed differences in canal path direction and articular aspect ratio being small in absolute value. Canal diameter was found to change significantly as a function of depth beneath the resection plane (P < .001). This work quantified 3 new morphologic terms relevant to proximal humerus stemless arthroplasty. Together, these outcome measures help define the spatial limits for stemless humeral arthroplasty in an implant-relevant coordinate system. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. Intraoperative CT navigation for glenoid component fixation in reverse shoulder arthroplasty

    Directory of Open Access Journals (Sweden)

    Ashok S Gavaskar

    2013-01-01

    Full Text Available CT navigation has been shown to improve component positioning in total shoulder arthroplasty. The technique can be useful in achieving strong initial fixation of the metal backed glenoid in reverse shoulder arthroplasty. We report a 61 years male patient who underwent reverse shoulder arthroplasty for rotator cuff arthropathy. CT navigation was used intraoperatively to identify best possible glenoid bone and to maximize the depth of the fixation screws that anchor the metaglene portion of the metal backed glenoid component. Satisfactory positioning of screws and component was achieved without any perforation or iatrogenic fracture in the scapula. CT navigation can help in maximizing the purchase of the fixation screws that dictate the initial stability of the glenoid component in reverse shoulder arthroplasty. The technique can be extended to improve glenoid component position [version and tilt] with the availability of appropriate software.

  2. Hip-inspired implant for revision of failed reverse shoulder arthroplasty with severe glenoid bone loss

    OpenAIRE

    Uri, Ofir; Bayley, Ian; Lambert, Simon

    2014-01-01

    Background and purpose Glenoid reconstruction and inverted glenoid re-implantation is strongly advocated in revisions of failed reverse shoulder arthroplasty (RSA). Nevertheless, severe glenoid deficiency may preclude glenoid reconstruction and may dictate less favorable solutions, such as conversion to hemiarthropasty or resection arthropasty. The CAD/CAM shoulder (Stanmore Implants, Elstree, UK), a hip arthroplasty-inspired implant, may facilitate glenoid component fixation in these challen...

  3. Assessment of painful total shoulder arthroplasty using computed tomography arthrography.

    Science.gov (United States)

    Mallo, Gregory C; Burton, Lauren; Coats-Thomas, Margaret; Daniels, S David; Sinz, Nathan J; Warner, Jon J P

    2015-10-01

    This study assessed the accuracy of computed tomography (CT) arthrography when evaluating glenoid component stability in the setting of postarthroplasty shoulder pain. We retrospectively reviewed all patients presenting to the clinic during a 5.5-year period to identify those with a painful shoulder arthroplasty more than 1 year after the index procedure. We excluded reverse and hemiarthroplasty procedures, patients with a clearly identifiable cause for pain, such as rotator cuff insufficiency or gross component loosening as seen on plain radiographs, and those with culture-positive aspiration. There were 14 patients with suspected glenoid component loosening but inconclusive plain radiographs. Each of the 14 patients underwent a CT arthrogram that was evaluated by the senior author (J.J.P.W.) for the presence or absence of contrast material underneath the polyethylene component. Operative reports and surgical videos from subsequent arthroscopy were reviewed to assess glenoid component stability as determined by direct arthroscopic visualization. CT arthrography suggested glenoid component loosening in 8 of 14 patients (57.1%), and arthroscopic inspection identified loosening in 10 of 14 patients (71.4%). In 3 of 10 patients (30%), CTA suggested a well-fixed glenoid component, but gross loosening was identified during arthroscopy. In this study, CTA yielded a sensitivity of 70%, a specificity of 75%, a positive predictive value of 87.5%, and a negative predictive value of 50.0%. CTA had a low negative predictive value (50%), and therefore, the prediction of component stability based on the absence of contrast between the glenoid component and the bone-cement interface does not always reflect true stability. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  4. A reverse shoulder arthroplasty with increased offset for the treatment of cuff-deficient shoulders with glenohumeral arthritis.

    Science.gov (United States)

    Middleton, C; Uri, O; Phillips, S; Barmpagiannis, K; Higgs, D; Falworth, M; Bayley, I; Lambert, S

    2014-07-01

    Inherent disadvantages of reverse shoulder arthroplasty designs based on the Grammont concept have raised a renewed interest in less-medialised designs and techniques. The aim of this study was to evaluate the outcome of reverse shoulder arthroplasty (RSA) with the fully-constrained, less-medialised, Bayley-Walker prosthesis performed for the treatment of rotator-cuff-deficient shoulders with glenohumeral arthritis. A total of 97 arthroplasties in 92 patients (53 women and 44 men, mean age 67 years (standard deviation (sd) 10, (49 to 85)) were retrospectively reviewed at a mean follow-up of 50 months ((sd 25) (24 to 96)). The mean Oxford shoulder score and subjective shoulder value improved from 47 (sd 9) and 24 points (sd 18) respectively before surgery to 28 (sd 11) and 61 (sd 24) points after surgery (p rest decreased from 5.3 (sd 2.8) to 1.5 (sd 2.3) (p shoulders. Compared with other designs of RSA, it offers a modest improvement in forward elevation, but restores external rotation to some extent and prevents scapular notching. A longer follow-up is required to assess the survival of the prosthesis and the clinical performance over time. ©2014 The British Editorial Society of Bone & Joint Surgery.

  5. Is it feasible to merge data from national shoulder registries? A new collaboration within the Nordic Arthroplasty Register Association

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...... in case of revision (date, reason for revision, and new arthroplasty brand). From 2004 to 2013, there were 19,857 primary arthroplasties reported. The most common indications were osteoarthritis (35%) and acute fracture (34%). The number of arthroplasties and especially the number 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 set; however, the set...

  6. Persisting Racial Disparities in Total Shoulder Arthroplasty Utilization and Outcomes.

    Science.gov (United States)

    Singh, Jasvinder A; Ramachandran, Rekha

    2016-06-01

    The purpose was to study whether racial disparities in total shoulder arthroplasty (TSA) utilization and outcomes have declined over time. We used the US Nationwide Inpatient Sample from 1998 to 2011. We used chi-squared test to compare characteristics, Cochran-Armitage test to compare utilization rates, and Cochran-Armitage test and logistic regression to compare time-trends in outcomes by race. From 1998 to 2011, 176,141 Whites and 7694 Blacks underwent TSA. Compared to Whites, Blacks who underwent TSA were younger (69.1 vs. 64.2 years; p racial disparities increased from 1998 to 2011 (p disparities did not change over time (p = 0.31). These disparities in utilization were borderline significant in adjusted analyses. There were no racial differences in proportion discharged to inpatient medical facility in 1998-2000, 15.2 vs. 15.0 % (p = 0.95), and in 2009-2011, 12.3 vs. 11.1 % (p = 0.37), respectively. We found increasing racial disparities in TSA utilization. Some disparities in outcomes exist as well. Patients, surgeons, and policy-makes should be aware of these findings and take action to reduce racial disparities.

  7. Failed Reverse Total Shoulder Arthroplasty Caused by Recurrent Candida glabrata Infection with Prior Serratia marcescens Coinfection

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2014-01-01

    Full Text Available This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected with Candida glabrata and Serratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, the C. glabrata infection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement. His surgical and pharmacologic treatment concluded with (1 placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained, and (2 chronic use of daily oral fluconazole. We located only three reported cases of Candida species causing infection in shoulder arthroplasties (two C. albicans, one C. parapsilosis. To our knowledge, a total shoulder arthroplasty infected with C. glabrata has not been reported, nor has a case of a C. glabrata and S. marcescens periprosthetic coinfection in any joint. In addition, it is well known that S. marcescens infections are uncommon in periprosthetic joint infections.

  8. Hip-inspired implant for revision of failed reverse shoulder arthroplasty with severe glenoid bone loss

    Science.gov (United States)

    2014-01-01

    Background and purpose Glenoid reconstruction and inverted glenoid re-implantation is strongly advocated in revisions of failed reverse shoulder arthroplasty (RSA). Nevertheless, severe glenoid deficiency may preclude glenoid reconstruction and may dictate less favorable solutions, such as conversion to hemiarthropasty or resection arthropasty. The CAD/CAM shoulder (Stanmore Implants, Elstree, UK), a hip arthroplasty-inspired implant, may facilitate glenoid component fixation in these challenging revisions where glenoid reconstruction is not feasible. We questioned (1) whether revision arthroplasty with the CAD/CAM shoulder would alleviate pain and improve shoulder function in patients with failed RSA, not amenable to glenoid reconstruction, (2) whether the CAD/CAM hip-inspired glenoid shell would enable secure and durable glenoid component fixation in these challenging revisions. Patients and methods 11 patients with failed RSAs and unreconstructable glenoids underwent revision with the CAD/CAM shoulder and were followed-up for mean 35 (28–42) months. Clinical outcomes included the Oxford shoulder score, subjective shoulder value, pain rating, physical examination, and shoulder radiographs. Results The average Oxford shoulder score and subjective shoulder value improved statistically significantly after the revision from 50 to 33 points and from 17% to 48% respectively. Pain rating at rest and during activity improved significantly from 5.3 to 2.3 and from 8.1 to 3.8 respectively. Active forward flexion increased from 25 to 54 degrees and external rotation increased from 9 to 21 degrees. 4 patients required reoperation for postoperative complications. No cases of glenoid loosening occurred. Interpretation The CAD/CAM shoulder offers an alternative solution for the treatment of failed RSA that is not amenable to glenoid reconstruction. PMID:24650026

  9. Patient reported activities after reverse total shoulder arthroplasty in rotator cuff arthropathy patients.

    Science.gov (United States)

    Alcobía-Díaz, B; Lópiz, Y; García-Fernández, C; Rizo de Álvaro, B; Marco, F

    Reverse total shoulder arthroplasty in rotator cuff arthropathy patients, improves anteversion and abduction, but not rotational, outcomes. The main aim of this study is to determine its repercussions on daily life activities in our patients. Between 2009 and 2011 we implanted 210 shoulder arthroplasties, 126 of them were reverse total shoulder arthroplasty in a rotator cuff arthropathy context. About 88% were women, with a mean age at time of surgery of 81 years, 95% were retired. The mean follow up was 53 months. The Constant scale, Visual Analogue Scale, Charlson Comorbidity Index, range of motion were measured for each patient and whether they could manage 40 daily life activities by means of a new questionnaire, classifying them according toshoulder functional demand. Mean normalized by sex and age Constant value was 81.2%. Mean Visual Analogue Scale and Charlson Index were 3.56 and 1.69 respectively. Improvement in anteversion and abduction, not in rotational range of motion. Limitation was found in low and high functional demand activities in 20% and 51% respectively, especially those which involved internal rotation. Reverse total shoulder arthroplasty treatment for RCA in the elderly, achieves adequate pain management and good functional outcomes. Nevertheless, an important risk of DLA limitation must be accepted in those which involve internal rotation or shoulder high functional demand. Copyright © 2017 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. 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

    2011-01-01

    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....

  11. Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle

    Energy Technology Data Exchange (ETDEWEB)

    Prescher, Andreas E-mail: dkeyserlingk@post.klinikum.rwth-aachen.de

    2000-08-01

    This paper summarizes the anatomical basics of the shoulder, their variations, and precise definitions, including differential diagnoses. It also describes the characteristic degenerative changes caused by aging. A typical variation (7-15%) is the os acromiale, which forms the triangular epiphysis of the scapular spine. This abnormality must be differentiated from a fracture of the acromion or a pseudarthrosis. Because ossification of the acromion is complete after age 25, the os acromiale should be diagnosed only after this age. The shape of the acromion is a further important feature. In a recent anatomical study, the following frequencies of the Bigliani-types of the acromial shape were anatomically determined - type 1 (flat), 10.2% and type 2 (curved), 89.8%. Type 3 (hooked) was not observed, which indicates that this type is probably a misinterpretation of the so-called acromial spur. Minor dehiscences and perforations in the infraspinate or supraspinate fossa should not be confused with malignant osteolyses. The scapula has three ligaments of its own, (1) the coracoacromial ligament and its osseous fixations form an osteofibrous arch above the shoulder joint, which plays a part in impingement syndrome; (2) the superior transverse scapular ligament or its ossified correlate arches the scapular incisure and can cause a typical compression syndrome of the suprascapular nerve; (3) the inferior transverse scapular ligament is of no great clinical importance. Two intraarticular structures (glenoid labrum and tendon of the long bicipital head) must be mentioned. The glenoid labrum consists of dense connective tissue and surrounds the margin of the glenoid cavity. Two areas exhibit specialized conditions, cranial at the supraglenoid tubercle an intimate relationship exists to the tendon of the long bicipital head and in about 55% of cases, the labrum is stretched over the glenoid rim at the ventral side. At the area of the biceps-tendon-labrum complex, so-called SLAP

  12. Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle

    International Nuclear Information System (INIS)

    Prescher, Andreas

    2000-01-01

    This paper summarizes the anatomical basics of the shoulder, their variations, and precise definitions, including differential diagnoses. It also describes the characteristic degenerative changes caused by aging. A typical variation (7-15%) is the os acromiale, which forms the triangular epiphysis of the scapular spine. This abnormality must be differentiated from a fracture of the acromion or a pseudarthrosis. Because ossification of the acromion is complete after age 25, the os acromiale should be diagnosed only after this age. The shape of the acromion is a further important feature. In a recent anatomical study, the following frequencies of the Bigliani-types of the acromial shape were anatomically determined - type 1 (flat), 10.2% and type 2 (curved), 89.8%. Type 3 (hooked) was not observed, which indicates that this type is probably a misinterpretation of the so-called acromial spur. Minor dehiscences and perforations in the infraspinate or supraspinate fossa should not be confused with malignant osteolyses. The scapula has three ligaments of its own, (1) the coracoacromial ligament and its osseous fixations form an osteofibrous arch above the shoulder joint, which plays a part in impingement syndrome; (2) the superior transverse scapular ligament or its ossified correlate arches the scapular incisure and can cause a typical compression syndrome of the suprascapular nerve; (3) the inferior transverse scapular ligament is of no great clinical importance. Two intraarticular structures (glenoid labrum and tendon of the long bicipital head) must be mentioned. The glenoid labrum consists of dense connective tissue and surrounds the margin of the glenoid cavity. Two areas exhibit specialized conditions, cranial at the supraglenoid tubercle an intimate relationship exists to the tendon of the long bicipital head and in about 55% of cases, the labrum is stretched over the glenoid rim at the ventral side. At the area of the biceps-tendon-labrum complex, so-called SLAP

  13. Infections after shoulder arthroplasty are correlated with higher anesthetic risk score: a case-control study in Brazil

    Directory of Open Access Journals (Sweden)

    Leonardo Hideto Nagaya

    2017-11-01

    Conclusion: This study provides evidence suggesting that patient-related known factors such as higher ASA score predisposes to shoulder arthroplasty-associated infection. Furthermore, unusual pathogens associated with PSI were identified.

  14. Insurance status affects postoperative morbidity and complication rate after shoulder arthroplasty.

    Science.gov (United States)

    Li, Xinning; Veltre, David R; Cusano, Antonio; Yi, Paul; Sing, David; Gagnier, Joel J; Eichinger, Josef K; Jawa, Andrew; Bedi, Asheesh

    2017-08-01

    Shoulder arthroplasty is an effective procedure for managing patients with shoulder pain secondary to end-stage arthritis. Insurance status has been shown to be a predictor of patient morbidity and mortality. The current study evaluated the effect of patient insurance status on perioperative outcomes after shoulder replacement surgery. Data between 2004 and 2011 were obtained from the Nationwide Inpatient Sample. Analysis included patients undergoing shoulder arthroplasty (partial, total, and reverse) procedures determined by International Classification of Disease, 9th Revision procedure codes. The primary outcome was medical and surgical complications occurring during the same hospitalization, with secondary analyses of mortality and hospital charges. Additional analyses using the coarsened exact matching algorithm were performed to assess the influence of insurance type in predicting outcomes. A data inquiry identified 103,290 shoulder replacement patients (68,578 Medicare, 27,159 private insurance, 3544 Medicaid/uninsured, 4009 other). The overall complication rate was 17.2% (n = 17,810) and the mortality rate was 0.20% (n = 208). Medicare and Medicaid/uninsured patients had a significantly higher rate of medical, surgical, and overall complications compared with private insurance using the controlled match data. Multivariate regression analysis found that having private insurance was associated with fewer overall medical complications. Private insurance payer status is associated with a lower risk of perioperative medical and surgical complications compared with an age- and sex-matched Medicare and Medicaid/uninsured payer status. Mortality was not statistically associated with payer status. Primary insurance payer status should be considered as an independent risk factor during preoperative risk stratification for shoulder arthroplasty procedures. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All

  15. Shoulder arthroplasty with the Neer Mark-II prosthesis

    DEFF Research Database (Denmark)

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

    1988-01-01

    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 m...

  16. Does arm lengthening affect the functional outcome in onlay reverse shoulder arthroplasty?

    Science.gov (United States)

    Werner, Birgit S; Ascione, Francesco; Bugelli, Giulia; Walch, Gilles

    2017-12-01

    The concept of onlay design reverse shoulder arthroplasty has been introduced to overcome complications observed with the traditional Grammont-type prosthesis. The aim of this study was to determine the influence of arm lengthening on the short-term clinical outcome in onlay reverse shoulder arthroplasty and investigate the effect of humeral tray offset positioning on arm lengthening and range of motion. We retrospectively evaluated 56 patients undergoing reverse shoulder arthroplasty with the Aequalis Ascend Flex prosthesis (Tornier, Bloomington, MN, USA) at a minimum 2 years' follow-up. Arm lengthening was determined using bilateral scaled radiographs of the entire humerus. The Constant score and active range of motion were documented preoperatively and postoperatively. The relationship between arm lengthening, humeral tray offset position, and functional outcome was analyzed. The Constant score improved from 25.5 ± 9.5 points to 71.5 ± 13.8 points at a mean follow-up of 30.1 ± 5.2 months. Mean postoperative anterior elevation was 145.2° ± 21.1°, and external rotation was 30.7° ± 20.3°. Arm lengthening exceeding 2.5 cm was related to a decrease in anterior elevation. We found a relationship between arm lengthening averaging 2.2 ± 1.7 cm and increased Constant score values. Humeral tray positioning demonstrated no influence on the functional outcome. There was a trend toward increased arm lengthening in lateral offset positioning. Onlay reverse shoulder arthroplasty yields good short-term clinical results. In our population, arm lengthening averaging 1 to 2.5 cm was found to be the best compromise on postoperative range of motion. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  17. Shoulder arthroplasty with the Neer Mark-II prosthesis

    DEFF Research Database (Denmark)

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

    1988-01-01

    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....

  18. Evidence-based thresholds for the volume-value relationship in shoulder arthroplasty: outcomes and economies of scale.

    Science.gov (United States)

    Ramkumar, Prem N; Navarro, Sergio M; Haeberle, Heather S; Ricchetti, Eric T; Iannotti, Joseph P

    2017-08-01

    Whereas several studies suggest that high-volume surgeons and hospitals deliver superior patient outcomes with greater cost efficiency, no evidence-based thresholds separating high-volume surgeons and hospitals from those that are low or medium volume exist in shoulder arthroplasty. The objective of this study was to establish meaningful thresholds that take outcomes and cost into consideration for surgeons and hospitals performing shoulder arthroplasty. Using 9546 patients undergoing primary shoulder arthroplasty for osteoarthritis from an administrative database, we created and applied 4 models using stratum-specific likelihood ratio (SSLR) analysis of a receiver operating characteristic (ROC) curve. We generated 4 sets of thresholds predictive of adverse outcomes, namely, increased length of stay (LOS) and increased cost for both surgeon and hospital volume. SSLR analysis of the 4 ROC curves by surgeon volume produced 3 volume categories. LOS and cost by annual shoulder arthroplasty surgeon volume produced the same strata: 0-4 (low), 5-14 (medium), and 15 or more (high). LOS and cost by annual shoulder arthroplasty hospital volume produced the same strata: 0-3 (low), 4-14 (medium), and 15 or more (high). LOS and cost decreased significantly (P economies of scale in shoulder arthroplasty by demonstrating a direct relationship between volume and value through SSLR analysis of ROC curves for risk-based volume stratification using meaningful volume definitions for low-, medium-, and high-volume surgeons and hospitals. The described volume-value relationship offers patients, surgeons, hospitals, and other stakeholders meaningful thresholds for the optimal delivery of shoulder arthroplasty. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Interscalene brachial plexus block for outpatient shoulder arthroplasty: Postoperative analgesia, patient satisfaction and complications

    Directory of Open Access Journals (Sweden)

    Shah Anand

    2007-01-01

    Full Text Available Background: Shoulder arthroplasty procedures are seldom performed on an ambulatory basis. Our objective was to examine postoperative analgesia, nausea and vomiting, patient satisfaction and complications of ambulatory shoulder arthroplasty performed using interscalene brachial plexus block (ISB. Materials and Methods: We prospectively examined 82 consecutive patients undergoing total and hemi-shoulder arthroplasty under ISB. Eighty-nine per cent (n=73 of patients received a continuous ISB; 11% (n=9 received a single-injection ISB. The blocks were performed using a nerve stimulator technique. Thirty to 40 mL of 0.5% ropivacaine with 1:400,000 epinephrine was injected perineurally after appropriate muscle twitches were elicited at a current of less than 0.5% mA. Data were collected in the preoperative holding area, intraoperatively and postoperatively including the postanesthesia care unit (PACU, at 24h and at seven days. Results: Mean postoperative pain scores at rest were 0.8 ± 2.3 in PACU (with movement, 0.9 ± 2.5, 2.5 ± 3.1 at 24h and 2.8 ± 2.1 at seven days. Mean postoperative nausea and vomiting (PONV scores were 0.2 ± 1.2 in the PACU and 0.4 ± 1.4 at 24h. Satisfaction scores were 4.8 ± 0.6 and 4.8 ± 0.7, respectively, at 24h and seven days. Minimal complications were noted postoperatively at 30 days. Conclusions: Regional anesthesia offers sufficient analgesia during the hospital stay for shoulder arthroplasty procedures while adhering to high patient comfort and satisfaction, with low complications.

  20. Liposomal Bupivacaine vs Interscalene Nerve Block for Pain Control After Shoulder Arthroplasty: A Retrospective Cohort Analysis.

    Science.gov (United States)

    Hannan, Casey V; Albrecht, Matthew J; Petersen, Steve A; Srikumaran, Uma

    The aim of this study was to compare liposomal bupivacaine and interscalene nerve block (ISNB) for analgesia after shoulder arthroplasty. We compared 37 patients who received liposomal bupivacaine vs 21 who received ISNB after shoulder arthroplasty by length of hospital stay (LOS), opioid consumption, and postoperative pain. Pain was the same in both groups for time intervals of 1 hour and 8 to 14 hours postoperatively. Compared with ISNB patients, liposomal bupivacaine patients reported less pain at 18 to 24 hours (P = .001) and 27 to 36 hours (P = .029) and had lower opioid consumption on postoperative days 2 (P = .001) and 3 (P = .002). Mean LOS for liposomal bupivacaine patients was 46 ± 20 hours vs 57 ± 14 hours for ISNB patients (P = .012). Sixteen of 37 liposomal bupivacaine patients vs 2 of 21 ISNB patients were discharged on the first postoperative day (P = .010). Liposomal bupivacaine was associated with less pain, less opioid consumption, and shorter hospital stays after shoulder arthroplasty compared with ISNB.

  1. Evaluation of fever in the immediate post-operative period following shoulder arthroplasty.

    Science.gov (United States)

    Saltzman, B M; Mayo, B C; Bohl, D D; Frank, R M; Cole, B J; Verma, N N; Nicholson, G P; Romeo, A A

    2017-11-01

    To determine the incidence and timing of post-operative fevers following shoulder arthroplasty and the resulting investigations performed. A retrospective review was conducted of all patients undergoing shoulder arthroplasty over a nine-year period. The charts of all patients with a post-operative fever (≥ 38.6°C) were reviewed and the results of all investigations were analysed. A total of 2167 cases (in 1911 patients) were included of whom 92 (4.2%) had a documented fever. Obese cases had a significantly greater risk for fever (relative risk 1.53; 95% confidence interval 1.02 to 2.32; p = 0.041). Investigations were performed in 43/92 cases (46.7%), with a diagnosis being made in six cases (6.6% of the total, two of whom had their diagnosis made post-discharge). Around one in 25 cases develop a fever following shoulder arthroplasty; most have no infective aetiology. These patients may be being over-investigated; investigations should be performed in patients with persistent fever or on those with an identifiable source of infection on clinical examination. Cite this article: Bone Joint J 2017;99-B:1515-19. ©2017 The British Editorial Society of Bone & Joint Surgery.

  2. How does scapula motion change after reverse total shoulder arthroplasty? - a preliminary report

    Directory of Open Access Journals (Sweden)

    Kim Myung-Sun

    2012-10-01

    Full Text Available Abstract Background Arm elevation is composed of glenohumeral and scapulothoracic motion. Many reports have addressed changes of scapular position across a spectrum of shoulder disease. However, no study has examined changes in scapular position after reverse total shoulder arthroplasty (RTSA. The purpose of this study was to evaluate the changes in scapular position after RTSA compared to patients’ contralateral, nonoperated shoulder. Methods Seven patients that underwent RTSA for cuff tear arthropathy from July 2007 to October 2008 were enrolled. The distance between the long axis of the thoracic spine and the inferior pole of the scapula (lateralization of the scapula was measured on shoulder A-P radiographs at 0 degrees (the neutral position and at 30, 60, 90, and 120 degrees of shoulder abduction. In addition, the angle between the long axis of the thoracic spine and medial border of the scapula was measured and compared with the patients’ contralateral shoulder. Results Scapulohumeral rhythm was 2.4:1 on the operated shoulder and 4.1:1 on the nonoperated, contralateral shoulder at 120 degrees of abduction. The distance between the line of the interspinous process of upper thoracic vertebra and the inferior pole of the scapula showed a negative slope at 0 to 30 degrees abduction on the operated side, but beyond 30 degrees of abduction, this distance showed a more sudden increase than in the contralateral shoulder. The angle between the vertical vertebral line and the scapular medial border also showed greater increase beyond 30 degrees abduction on the operated limb. Conclusions The pattern of scapular position after RTSA, was found to differ from that of the contralateral shoulder, and showed a more scapular upward rotation.

  3. Heterotopic ossification of the long head of the triceps after reverse total shoulder arthroplasty.

    Science.gov (United States)

    Ko, Jia-Wei Kevin; Tompson, Jeffrey D; Sholder, Daniel S; Black, Eric M; Abboud, Joseph A

    2016-11-01

    Heterotopic ossification (HO) around shoulder arthroplasty is a frequent finding with unclear clinical relevance. This study evaluated the incidence, relevance, and predisposing factors of HO in the long head of the triceps tendon after reverse shoulder arthroplasty. Retrospective chart review was conducted to identify patients who had a reverse shoulder arthroplasty performed between 2008 and 2012. Patient demographics, implant types, and diagnoses were noted. Three fellowship-trained shoulder/elbow surgeons independently evaluated postoperative Grashey radiographs using a novel classification system. Within a 164-patient cohort, the overall HO rate in the long head of the triceps tendon was 61.6%; 23.2% of osteophytes were considered impinging, 14.6% had notching, 14.0% were free-floating, and 3.0% appeared ankylosed. Although not statistically significant, revision surgery had a higher rate of HO (68.3%) compared with primary surgery (59.4%). There was no difference in HO rates between diagnoses or implant types. Male and female HO rates were 74.0% and 56.1%, respectively (P = .0304). Between patients with and without HO, forward elevation was 121° compared with 133° (P = .0087) and external rotation was 19° compared with 25° (P = .0266); however, HO size did not significantly affect motion. Using our novel classification scheme, HO was a common finding in this series. Men had a higher rate of HO formation, and HO formation was associated with worse postoperative motion. Further study is needed to fully characterize the clinical implications of HO involving the long head of the triceps tendon and to explore potential preventive measures. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  4. Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty.

    Science.gov (United States)

    Dowdle, S Blake; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M

    2017-09-01

    The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT). For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects. Cohort study (diagnosis); Level of evidence, 3. Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form-36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO. The PROMIS PF demonstrated excellent correlation with the SF-36 PF ( r = 0.81, P ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4. These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased question burden with no ceiling effects.

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

    Science.gov (United States)

    Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S; Zebis, Mette K

    2011-07-22

    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. Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. ISRCTN60264809.

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

    Science.gov (United States)

    2011-01-01

    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 nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809 PMID:21777478

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

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2011-07-01

    Full Text Available 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 nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%. In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%. In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809

  8. Reverse shoulder arthroplasty in acute fractures of the proximal humerus

    DEFF Research Database (Denmark)

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

    2013-01-01

    arthroplasty (RSA) has been suggested. We aimed to review clinical studies reporting benefits and harms of RSA in acute fractures. A systematic review. We included 18 studies containing 430 RSA in acute fractures. We found no randomized clinical trials. Four studies compared outcome after RSA with a historical......, and baseplate failure. Scapular notching was reported in 11 studies with a median value of 25% (range 0-94). Heterogeneity of study designs and lack of primary data precluded statistical pooling of data. No high quality evidence was identified. Based on the available evidence the use of RSA in acute fractures...... is questionable. The complication rate was high and the clinical implications of long term scapular notching are worrying. Randomized studies with long term follow up using the latest techniques of tubercular reinsertion in RSA toward HA should be encouraged....

  9. Reliability and accuracy of digital templating for the humeral component of total shoulder arthroplasty.

    Science.gov (United States)

    Lee, Christopher S; Davis, Shane M; Lane, Christianne J; Koonce, Ryan C; Hartman, Andrew P; Ball, Kenneth; Esch, James C

    2015-01-01

    This experimental study evaluated the interobserver reliability and accuracy of pre-operative digital templating for humeral head size, stem size and neck angle for total shoulder arthroplasty. Twenty-five patients underwent a total shoulder arthroplasty with a single prosthesis. Four independent, blinded surgeons (two experienced shoulder surgeons and two PGY-6 fellows) used pre-operative radiographs and templating software to generate templates of the humeral head, stem and neck for each patient. Interobserver reliability was calculated using weighted kappa (κ) analysis. Accuracy was assessed by comparing templates to actual implant sizes. Interobserver reliability was fair to substantial (κ = 0.26 to 0.71) for head size, fair to substantial (κ = 0.39 to 0.72) for stem size and slight to fair (κ = 0.16 to 0.34) for neck angle. Templated head size, stem size and neck angle had accuracies of 53%, 77% and 68% within one size variation, respectively. Experience did not affect accuracy (p = 0.11 to 0.48). Digital templating is not a useful guide for pre-operative surgical planning and should not be used to select a prosthesis.

  10. Complex Scapular Winging following Total Shoulder Arthroplasty in a Patient with Ehlers-Danlos Syndrome

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2015-01-01

    Full Text Available This is a unique case of a female patient with features of classical and hypermobile types of Ehlers-Danlos syndrome (EDS who developed complex scapular winging from spinal accessory and long thoracic neuropathies. These neurological problems became manifest after an uncomplicated total shoulder arthroplasty (TSA. The patient had a complex postoperative course with extensive work-up in addition to revision shoulder surgery and manipulations to treat shoulder stiffness. It was eventually suspected that the periscapular nerve impairments occurred during physical therapy sessions after her TSA. This interpretation was further supported by genetic evidence that, in addition to EDS, the patient had an unrecognized genetic propensity for nerve palsies from stretch or pressure (“hereditary neuropathy with liability to pressure palsies” (HNPP. By two years after the TSA the neuropathies had only partially improved, leaving the patient with persistent scapular winging and shoulder weakness. With this case we alert surgeons and physical therapists that patients with EDS can have not only a complicated course after TSA, but rare concurrent conditions that can further increase the propensity of neurological injuries that result in compromised shoulder function.

  11. Dynamic contrast-enhanced ultrasound and elastography assess deltoid muscle integrity after reverse shoulder arthroplasty.

    Science.gov (United States)

    Fischer, Christian; Krammer, Daniel; Hug, Andreas; Weber, Marc-André; Kauczor, Hans-Ulrich; Krix, Martin; Bruckner, Thomas; Kunz, Pierre; Schmidmaier, Gerhard; Zeifang, Felix

    2017-01-01

    The outcome after reverse shoulder arthroplasty (RSA) depends on the condition of the deltoid muscle, which we assessed with new ultrasound modalities and electromyography (EMG). Contrast-enhanced ultrasound (CEUS) and acoustic radiation force impulse (ARFI) were applied to assess perfusion and elasticity of the deltoid muscle compared with the clinical and functional outcome. The study recruited 64 patients (mean age, 72.9 years) treated with RSA between 2004 and 2013. The deltoid muscle was examined with EMG and ultrasound imaging. Functional scores such as Constant score and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score were assessed. Among other CEUS parameters, the wash-in perfusion index, time to peak, and rise time were compared between the operated-on and contralateral shoulders as well as between patients with above-average and below-average outcome. The stiffness of the deltoid muscle was analyzed with ARFI. After RSA, deltoid perfusion (wash-in perfusion index, Δ = -12% ± 22%, P = .0001) and shoulder function (Constant score, Δ = -14 ± 24, P Deltoid perfusion was higher in patients with above-average outcome (rise time, Δ = 33% ± 13%, P = .038). The operated-on deltoid muscles showed higher stiffness than the contralateral muscles (ARFI, Δ = 0.2 ± 0.9 m/s, P = .0545). EMG excluded functionally relevant axillary nerve injuries in the study population. CEUS revealed reduced mean perfusion of the deltoid muscle after RSA. Reduced perfusion was associated with limited range of motion and below-average outcome. Functional shoulder impairment after RSA might be predicted by noninvasive CEUS as a surrogate parameter for the integrity of the deltoid muscle. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. High Satisfaction and Return to Sports After Total Shoulder Arthroplasty in Patients Aged 55 Years and Younger.

    Science.gov (United States)

    Garcia, Grant H; Liu, Joseph N; Sinatro, Alec; Wu, Hao-Hua; Dines, Joshua S; Warren, Russell F; Dines, David M; Gulotta, Lawrence V

    2017-06-01

    Young, active candidates for total shoulder arthroplasty (TSA) are a unique group of patients. Not only do they demand longevity and improved function, but they also desire a return to physical activities. To determine the rate of return to sports in patients aged ≤55 years undergoing TSA. Case series; Level of evidence, 4. This was a retrospective review of consecutive patients who underwent anatomic TSA at a single institution. Exclusion criteria included age at the time of surgery >55 years and sports questionnaire, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) score. From 70 eligible patients, 59 patients (61 shoulders) were included with an average follow-up of 61.0 months (range, 25-103 months) and average age at the time of surgery of 48.9 years (range, 25-55 years). The average VAS score improved from 5.6 to 0.9 ( P sports. Moreover, patients in 96.4% of shoulders (55/57) restarted at least 1 sport at an average of 6.7 months. Direct rates of return were as follows: fitness sports (97.2%), golf (93.3%), singles tennis (87.5%), swimming (77.7%), basketball (75.0%), and flag football (66.7%). Patients in 47 shoulders (82.4%) returned to a similar or higher level of sports; 90.3% returned to high-demand sports, and 83.8% returned to high upper extremity sports. There was no significant difference in rates of return to sports by body mass index, sex, age, preoperative diagnosis, revision status, and dominant extremity. In patients aged ≤55 years undergoing TSA, there was a 96.4% rate of return to ≥1 previous sports at an average of 6.7 months. Furthermore, at an average follow-up of 61.0 months, no patients needed revision of their glenoid component, despite an 83.8% rate of return to high upper extremity sports. While caution should still be advised in young, active patients undergoing TSA, these results demonstrate a high satisfaction rate and improved ability to return to most sports after surgery.

  13. Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: Results and complications.

    Science.gov (United States)

    Villodre-Jiménez, J; Estrems-Díaz, V; Diranzo-García, J; Bru-Pomer, A

    The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Proprioception 3 years after shoulder arthroplasty in 3D motion analysis: a prospective study.

    Science.gov (United States)

    Maier, Michael W; Niklasch, Mirjam; Dreher, Thomas; Wolf, Sebastian I; Zeifang, Felix; Loew, Markus; Kasten, Philip

    2012-07-01

    This prospective study evaluated the development of proprioception over the course of 3 years after shoulder arthroplasty. Twenty-one patients were enrolled who underwent total shoulder arthroplasty (n = 10) or hemiarthroplasty (HEMI) (n = 11) for shoulder osteoarthritis. All patients were examined 1 day before the operation, 6 months and 3 years after surgery in a motion analysis study with an active angle-reproduction (AAR) test. Overall proprioception measured by the AAR deteriorated significantly 3 years after surgery [from 6.6° (SD 3.1) to 10.3° (SD 5.7); p = 0.017] and was significantly worse than in the control group [10.3° (SD 5.7) vs. 7.8° (SD 2.3); p = 0.030). In the HEMI subgroup, 3 years after shoulder replacement, there is a significant deterioration of proprioception at 30° of external rotation [from 3.1° (SD 3.5) to 12.8° (SD 10.7); p = 0.031]. On average, in the TSA subgroup proprioception deteriorated from 7.1° (SD 3.1) to 8.6° (SD 1.4) and in the HEMI subgroup from 6.1° (SD 2.1) to 12.4° (SD 8.3). The comparison of postoperative impairment of proprioception between the TSA and HEMI subgroup showed significantly worse proprioception for the HEMI subgroup at 30° of external rotation [9.8° (SD 10.1) vs. 1.6° (SD 6.3) in the TSA group; p = 0.046]. In conclusion, proprioception that was measured by an AAR test remained unchanged or deteriorated 3 years after shoulder arthroplasty. The postoperative deterioration of proprioception was more distinctive in HEMI than in TSA group.

  15. Long-term humeral complications after Grammont-style reverse shoulder arthroplasty.

    Science.gov (United States)

    Ascione, Francesco; Domos, Peter; Guarrella, Vincenzo; Chelli, Mikaël; Boileau, Pascal; Walch, Gilles

    2018-01-04

    Recent experiences with Grammont reverse shoulder arthroplasty (RSA) have revealed some problems related to the biomechanical changes of the shoulder and humeral stem complications. We analyzed humeral complications in a long-term follow-up of a large series of RSAs, searching for correlations between these and the initial etiology, the follow-up duration, and the clinical outcomes. Preoperative and postoperative clinical and radiologic assessments of 1035 RSAs with a minimum 5-year follow-up (implanted in 7 specialized shoulder centers between 1993 and 2010) were retrospectively collected. Postoperative humeral complications, managed conservatively or surgically, were radiographically documented. Overall, a 3.3% rate of postoperative humeral complications was found in our database. We identified 17 cases (1.6%) with postoperative humeral fractures, 15 cases (1.4%) with aseptic humeral loosening, and 3 cases (0.3%) with humeral stem disassembly. The humeral complications were more frequent in RSAs implanted for tumors, fracture sequelae, and revision for failed arthroplasty. Humeral complications after RSA are not rare, increase with longer follow-up, and have a negative impact on functional outcomes. Postoperative humeral fractures are more frequent in elderly patients, operated on through a superior approach, and after cemented stem implantation. In the absence of associated humeral loosening, conservative treatment should be preferred. Proximal humeral bone loss (due to revisions and tumors) is the most significant risk factor for humeral loosening. Implant unscrewing was initially related to a technological problem, which has been solved, and this complication has disappeared. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. Inconsistent selection of outcomes and measurement devices found in shoulder arthroplasty research: An analysis of studies on ClinicalTrials.gov.

    Directory of Open Access Journals (Sweden)

    Matthew Thomas Sims

    Full Text Available Recent evidence suggests a lack of standardization of shoulder arthroplasty outcomes. This issue is a limiting factor in systematic reviews. Core outcome set (COS methodology could address this problem by delineating a minimum set of outcomes for measurement in all shoulder arthroplasty trials.A ClinicalTrials.gov search yielded 114 results. Eligible trials were coded on the following characteristics: study status, study type, arthroplasty type, sample size, measured outcomes, outcome measurement device, specific metric of measurement, method of aggregation, outcome classification, and adverse events.Sixty-six trials underwent data abstraction and data synthesis. Following abstraction, 383 shoulder arthroplasty outcomes were organized into 11 outcome domains. The most commonly reported outcomes were shoulder outcome score (n = 58, pain (n = 33, and quality of life (n = 15. The most common measurement devices were the Constant-Murley Shoulder Outcome Score (n = 38 and American Shoulder and Elbow Surgeons Shoulder Score (n = 33. Temporal patterns of outcome use was also found.Our study suggests the need for greater standardization of outcomes and instruments. The lack of consistency across trials indicates that developing a core outcome set for shoulder arthroplasty trials would be worthwhile. Such standardization would allow for more effective comparison across studies in systematic reviews, while at the same time consider important outcomes that may be underrepresented otherwise. This review of outcomes provides an evidence-based foundation for the development of a COS for shoulder arthroplasty.

  17. Effect of lateralized design on muscle and joint reaction forces for reverse shoulder arthroplasty.

    Science.gov (United States)

    Liou, William; Yang, Yang; Petersen-Fitts, Graysen R; Lombardo, Daniel J; Stine, Sasha; Sabesan, Vani J

    2017-04-01

    Manufacturers of reverse shoulder arthroplasty (RSA) implants have recently designed innovative implants to optimize performance in rotator cuff-deficient shoulders. These advancements are not without tradeoffs and can have negative biomechanical effects. The objective of this study was to develop an integrated finite element analysis-kinematic model to compare the muscle forces and joint reaction forces (JRFs) of 3 different RSA designs. A kinematic model of a normal shoulder joint was adapted from the Delft model and integrated with the well-validated OpenSim shoulder model. Static optimizations then allowed for calculation of the individual muscle forces, moment arms, and JRFs relative to net joint moments. Three-dimensional computer models of 3 RSA designs-humeral lateralized design (HLD), glenoid lateralized design, and Grammont design-were integrated, and parametric studies were performed. Overall, there were decreases in deltoid and rotator cuff muscle forces for all 3 RSA designs. These decreases were greatest in the middle deltoid of the HLD model for abduction and flexion and in the rotator cuff muscles under both internal rotation and external rotation. The JRFs in abduction and flexion decreased similarly for all RSA designs compared with the normal shoulder model, with the greatest decrease seen in the HLD model. These findings demonstrate that the design characteristics implicit in these modified RSA prostheses result in mechanical differences most prominently seen in the deltoid muscle and overall JRFs. Further research using this novel integrated model can help guide continued optimization of RSA design and clinical outcomes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Clinical and radiological outcome of the Total Evolutive Shoulder System (TESS®) reverse shoulder arthroplasty: a prospective comparative non-randomised study.

    Science.gov (United States)

    Kadum, Bakir; Mukka, Sebastian; Englund, Erling; Sayed-Noor, Arkan; Sjödén, Göran

    2014-05-01

    The aims of this study were to assess the function and quality of life after the Total Evolutive Shoulder System (TESS) reverse shoulder arthroplasty (RSA), to evaluate the radiological stability of the stemless version and to address the effect of arm lengthening and scapular notching (SN) on the outcome. This was a prospective comparative non-randomised study. A total of 37 consecutive patients (40 shoulders) underwent TESS RSA between October 2007 and January 2012; 16 were stemless and 26 were stemmed. At a mean follow-up of 39 months (15-66), we evaluated range of motion (ROM), pain and functional outcome with QuickDASH and quality of life with EQ-5D score. Radiologically, component positioning, signs of loosening, SN and arm length difference were documented. We found a significant improvement in functional outcome and reduction of pain in both stemmed and stemless groups. No humeral loosening was evident, but there were four glenoid loosenings. In 12 shoulders that developed SN, seven already had scapular bone impression (SBI) evident on initial post-operative radiographs. Glenoid overhang seemed to decrease the risk of SN. Arm lengthening was associated with better EQ-5D but did not influence ROM or functional outcome. Reverse shoulder arthroplasty markedly improved shoulder function. SN is of concern in RSA, but proper positioning of the glenoid component may prevent its development.

  19. Moment arms of the muscles crossing the anatomical shoulder

    Science.gov (United States)

    Ackland, David C; Pak, Ponnaren; Richardson, Martin; Pandy, Marcus G

    2008-01-01

    The objective of the present study was to determine the instantaneous moment arms of 18 major muscle sub-regions crossing the glenohumeral joint during coronal-plane abduction and sagittal-plane flexion. Muscle moment-arm data for sub-regions of the shoulder musculature during humeral elevation are currently not available. The tendon-excursion method was used to measure instantaneous muscle moment arms in eight entire upper-extremity cadaver specimens. Significant differences in moment arms were reported across sub-regions of the deltoid, pectoralis major, latissimus dorsi, subscapularis, infraspinatus and supraspinatus (P shoulder muscles of broad origins into sub-regions highlighted distinct functional differences across those sub-regions. Most significantly, we found that the superior sub-region of the pectoralis major had the capacity to exert substantial torque in flexion, whereas the middle and inferior sub-regions tended to behave as a stabilizer and extensor, respectively. Knowledge of moment arm differences between muscle sub-regions may assist in identifying the functional effects of muscle sub-region tears, assist surgeons in planning tendon reconstructive surgery, and aid in the development and validation of biomechanical computer models used in implant design. PMID:18691376

  20. Patient-reported outcome and risk of revision after shoulder replacement for osteoarthritis. 1,209 cases from the Danish Shoulder Arthroplasty Registry, 2006-2010.

    Science.gov (United States)

    Rasmussen, Jeppe V; Polk, Anne; Brorson, Stig; Sørensen, Anne Kathrine; Olsen, Bo S

    2014-04-01

    We used patient-reported outcome and risk of revision to compare hemiarthroplasty (HA) with total shoulder arthroplasty (TSA) and stemmed hemiarthroplasty (SHA) with resurfacing hemiarthroplasty (RHA) in patients with glenohumeral osteoarthritis. We included all patients reported to the Danish Shoulder Arthroplasty Registry (DSR) between January 2006 and December 2010. 1,209 arthroplasties in 1,109 patients were eligible. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome 1 year postoperatively. For simplicity of presentation, the raw scores were converted to a percentage of the maximum score. Revision rates were calculated by checking reported revisions to the DSR until December 2011. WOOS and risk of revision were adjusted for age, sex, previous surgery, and type of osteoarthritis. There were 113 TSAs and 1096 HAs (837 RHAs and 259 SHAs). Patients treated with TSA generally had a better WOOS, exceeding the predefined minimal clinically important difference, at 1 year (mean difference 10, p < 0.001). RHA had a better WOOS than SHA (mean difference 5, p = 0.02), but the difference did not exceed the minimal clinically important difference. There were no statistically significant differences in revision rate or in adjusted risk of revision between any of the groups. Our results are in accordance with the results from other national shoulder registries and the results published in systematic reviews favoring TSA in the treatment of glenohumeral osteoarthritis. Nonetheless, this registry study had certain limitations and the results should be interpreted carefully.

  1. Proximal stress shielding is decreased with a short stem compared with a traditional-length stem in total shoulder arthroplasty.

    Science.gov (United States)

    Denard, Patrick J; Noyes, Matthew P; Walker, J Brock; Shishani, Yousef; Gobezie, Reuben; Romeo, Anthony A; Lederman, Evan

    2018-01-01

    This study compared the outcome and radiographic humeral adaptations after placement of a traditional-length (TL) or short-stem (SS) humeral component during total shoulder arthroplasty (TSA). The hypothesis was there would be no difference in outcome or radiographic adaptations. A multicenter retrospective review was performed of primary TSAs performed with a TL or SS press-fit humeral component. The stems were identical in geometry and coating, with the only variable being stem length. Functional outcome and radiographs were reviewed at a minimum of 2 years postoperatively in 58 TL stems and 56 SSs. There were significant improvements in all range of motion and functional outcome from baseline (P  .05). TL stems were placed in anatomic alignment 98% of the time compared with 86% of the SS cases (P = .015), but alignment did not influence outcome. Cortical thinning was more common in the medial metaphysis with the TL stem (74%) than with the SS (50%; P = .008). Partial calcar osteolysis was seen in 31% of TL stems and in 23% of SSs (P = .348). There was no difference in loosening or shift between the 2 groups. There is no difference in functional outcome at short-term follow-up between a TL stem and a SS in TSA. The pattern of radiographic adaptations may differ based on stem length. Further study is needed to evaluate the mid- to long-term differences, particularly with regard to calcar osteolysis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

    Science.gov (United States)

    Sun, Chuan-Xiu; Zhang, Lu; Mi, Li-Dong; Du, Guang-Yu; Sun, Xue-Gang; He, Sheng-Wei

    2017-01-01

    Abstract Objective: This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty. Methods: A systematic search was performed in Embase (1980–2017.04, embase.com), Medline (1966–2017.04, medline.com), PubMed (1966–2017.04, pubmed.com), ScienceDirect (1985–2017.04, sciencedirect.com), and Web of Science (1950–2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software. Results: In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] −172.16, 95% confidence interval [CI] −35.46 to −308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI −0.12 to 0.22, P = .89, d = 0.19), length of stay (MD −0.06, 95% CI −0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53). Conclusion: Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required. PMID:28562553

  3. Patient Activity Levels After Reverse Total Shoulder Arthroplasty: What Are Patients Doing?

    Science.gov (United States)

    Garcia, Grant H; Taylor, Samuel A; DePalma, Brian J; Mahony, Gregory T; Grawe, Brian M; Nguyen, Joseph; Dines, Joshua S; Dines, David M; Warren, Russell F; Craig, Edward V; Gulotta, Lawrence V

    2015-11-01

    The indications for reverse total shoulder arthroplasty (RTSA) continue to expand, which has resulted in younger patients who want to remain active after RTSA. Little information is available to manage expectations of both physicians and patients for return to sporting activities. To determine the rate of return to sporting activities and assess average time to return to sports after RTSA. Case series; Level of evidence, 4. This was a retrospective review of consecutive RTSA patients collected from our institution's shoulder arthroplasty registry. All patients who played sports preoperatively and had a minimum of 1-year follow-up were included. Final follow-up consisted of an additional patient-reported questionnaire with questions regarding physical fitness and sporting activities. Each patient also completed an assessment with the American Shoulder and Elbow Society (ASES) Shoulder Score and a visual analog scale (VAS) for pain. Seventy-six patients played a sport preoperatively and met inclusion and exclusion criteria. The average follow-up was 31.6 months (range, 12-65 months), and average age was 74.8 years (range, 49.9-92.6 years). Average VAS pain scores improved from 6.57 to 0.63 (P sport. Average time to return to full sports was 5.3 months. Fitness sports had the highest direct rate of return (81.5%), followed by swimming (66.7%), running (57.1%), cycling (50.0%), and golf (50%). Postoperatively, 41.1% of patients reported improved physical fitness; 88.2% felt that their sports outcome was good to excellent, and 93.4% felt that their surgical outcome was good to excellent. Patients undergoing RTSA had an 85% rate of return to 1 or more sporting activities at an average of 5.3 months after surgery. Age greater than 70 years was a significant predictor of decreased return to activities. The present study offers valuable information to help manage patient and surgeon expectations. © 2015 The Author(s).

  4. How accurate is anatomic limb alignment in predicting mechanical limb alignment after total knee arthroplasty?

    Science.gov (United States)

    Lee, Seung Ah; Choi, Sang-Hee; Chang, Moon Jong

    2015-10-27

    Anatomic limb alignment often differs from mechanical limb alignment after total knee arthroplasty (TKA). We sought to assess the accuracy, specificity, and sensitivity for each of three commonly used ranges for anatomic limb alignment (3-9°, 5-10° and 2-10°) in predicting an acceptable range (neutral ± 3°) for mechanical limb alignment after TKA. We also assessed whether the accuracy of anatomic limb alignment was affected by anatomic variation. This retrospective study included 314 primary TKAs. The alignment of the limb was measured with both anatomic and mechanical methods of measurement. We also measured anatomic variation, including the femoral bowing angle, tibial bowing angle, and neck-shaft angle of the femur. All angles were measured on the same full-length standing anteroposterior radiographs. The accuracy, specificity, and sensitivity for each range of anatomic limb alignment were calculated and compared using mechanical limb alignment as the reference standard. The associations between the accuracy of anatomic limb alignment and anatomic variation were also determined. The range of 2-10° for anatomic limb alignment showed the highest accuracy, but it was only 73 % (3-9°, 65 %; 5-10°, 67 %). The specificity of the 2-10° range was 81 %, which was higher than that of the other ranges (3-9°, 69 %; 5-10°, 67 %). However, the sensitivity of the 2-10° range to predict varus malalignment was only 16 % (3-9°, 35 %; 5-10°, 68 %). In addition, the sensitivity of the 2-10° range to predict valgus malalignment was only 43 % (3-9°, 71 %; 5-10°, 43 %). The accuracy of anatomical limb alignment was lower for knees with greater femoral (odds ratio = 1.2) and tibial (odds ratio = 1.2) bowing. Anatomic limb alignment did not accurately predict mechanical limb alignment after TKA, and its accuracy was affected by anatomic variation. Thus, alignment after TKA should be assessed by measuring mechanical alignment rather than anatomic

  5. Low preoperative Constant score is a negative predictive factor for postoperative proprioception after total shoulder arthroplasty in osteoarthritis.

    Science.gov (United States)

    Maier, Michael W; Lauer, Sarah; Wolf, Sebastian I; Dreher, Thomas; Klotz, Matthias C; Zeifang, Felix; Rickert, Markus

    2015-02-01

    Shoulder proprioception in patients with glenohumeral osteoarthritis and the effect of total shoulder arthroplasty (TSA) on proprioception have been evaluated previously. Measuring proprioception with an active angle reproduction (AAR) test, proprioception remained unchanged or deteriorated in a short follow-up period after shoulder replacement. Therefore, the purpose of this prospective study was to evaluate the influence of the preoperative Constant score (CS) on postoperative proprioceptive outcome after TSA in patients with primary osteoarthritis to address the question of whether the preoperative state of shoulder function influences postoperative proprioceptive outcome. Twenty-four patients who received total shoulder arthroplasty (TSA) (n = 24) for primary osteoarthritis of the shoulder were enrolled. After retrospectively analyzing the preoperative CS for 120 patients with primary osteoarthritis of the shoulder who received TSA, the patient group was divided into three subgroups according to preoperative functional assessment of the shoulder using the CS. Group one consisted of patients with CS 30). In all patients proprioception was examined 1 day before the operation and 3 months after surgery by 3D motion analysis with an AAR test and also CS. Postoperatively, proprioception in group one (CS proprioception [6.9° (SD 3.3)] was found in the group that had the best preoperative CS (group three, CS > 30). In conclusion, a low preoperative CS is a negative predictive factor for postoperative proprioception after TSA. We should keep that in mind when determining the best timepoint for shoulder replacement in patients with glenohumeral osteoarthritis.

  6. Does exchange arthroplasty of an infected shoulder prosthesis provide better eradication rate and better functional outcome, compared to a permanent spacer or resection arthroplasty? a systematic review.

    Science.gov (United States)

    George, D A; Volpin, A; Scarponi, S; Haddad, F S; Romanò, C L

    2016-02-01

    The best surgical modality for treating chronic periprosthetic shoulder infections has not been established, with a lack of randomised comparative studies. This systematic review compares the infection eradication rate and functional outcomes after single- or two-stage shoulder exchange arthroplasty, to permanent spacer implant or resection arthroplasty. Full-text papers and those with an abstract in English published from January 2000 to June 2014, identified through international databases, such as EMBASE and PubMed, were reviewed. Those reporting the success rate of infection eradication after a single-stage exchange, two-stage exchange, resection arthroplasty or permanent spacer implant, with a minimum follow-up of 6 months and sample size of 5 patients were included. Eight original articles reporting the results after resection arthroplasty (n = 83), 6 on single-stage exchange (n = 75), 13 on two-stage exchange (n = 142) and 8 papers on permanent spacer (n = 68) were included. The average infection eradication rate was 86.7 % at a mean follow-up of 39.8 months (SD 20.8) after resection arthroplasty, 94.7 % at 46.8 months (SD 17.6) after a single-stage exchange, 90.8 % at 37.9 months (SD 12.8) after two-stage exchange, and 95.6 % at 31.0 months (SD 9.8) following a permanent spacer implant. The difference was not statistically significant (p = 0.650). Regarding functional outcome, patients treated with single-stage exchange had statistically significant better postoperative Constant scores (mean 51, SD 13) than patients undergoing a two-stage exchange (mean 44, SD 9), resection arthroplasty (mean 32, SD 7) or a permanent spacer implant (mean 31, SD 9) (p = 0.029). However, when considering studies comparing pre- and post-operative Constant scores, the difference was not statistically significant. This systematic review failed to demonstrate a clear difference in infection eradication and functional improvement between all four

  7. Ninety day mortality and its predictors after primary shoulder arthroplasty: an analysis of 4,019 patients from 1976-2008

    Directory of Open Access Journals (Sweden)

    Singh Jasvinder A

    2011-10-01

    Full Text Available Abstract Background Examine 90-day postoperative mortality and its predictors following shoulder arthroplasty Methods We identified vital status of all adults who underwent primary shoulder arthroplasty (Total shoulder arthroplasty (TSA or humeral head replacement (HHR at the Mayo Clinic from 1976-2008, using the prospectively collected information from Total Joint Registry. We used univariate logistic regression models to assess the association of gender, age, body mass index, American Society of Anesthesiologist (ASA class, Deyo-Charlson comorbidity index, an underlying diagnosis and implant fixation with odds of 90-day mortality after TSA or HHR. Multivariable models additionally adjusted for the type of surgery (TSA versus HHR. Adjusted Odds ratio (OR with 95% confidence interval (CI were calculated. Results Twenty-eight of the 3, 480 patient operated died within 90-days of shoulder arthroplasty (0.8%. In multivariable-adjusted analyses, the following factors were associated with significantly higher odds of 90-day mortality: higher Deyo-Charlson index (OR, 1.54; 95% CI:1.39, 1.70; p Conclusions 90-day mortality following shoulder arthroplasty was low. An underlying diagnosis of tumor, higher comorbidity and higher ASA class were risk factors for higher 90-day mortality, while higher BMI was protective. Pre-operative comorbidity management may impact 90-day mortality following shoulder arthroplasty. A higher unadjusted mortality in patients undergoing TSA versus HHR may indicate the underlying differences in patients undergoing these procedures.

  8. Is there value in retrospective 90-day bundle payment models for shoulder arthroplasty procedures?

    Science.gov (United States)

    Odum, Susan M; Hamid, Nady; Van Doren, Bryce A; Spector, Leo R

    2017-12-07

    The Centers for Medicare & Medicaid Services Bundled Payments for Care Improvement (BPCI) initiative was implemented as part of the Affordable Care Act. We implemented a retrospective payment model 2 for a 90-day total shoulder arthroplasty (TSA) episode to assess the value of TSA BPCI at our private practice. Expenditures and postacute event rates of 132 fee-for-service (FFS) patients who underwent a TSA operation between 2009 and 2012 were compared with 333 BPCI patients who had a TSA operation in 2015. The 90-day postacute events included an inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), and home health (HH) admissions and readmissions. Expenditures were converted to 2016 dollars using the Consumer Price Index. Wilcoxon tests and multivariate generalized estimating equation were used to assess independent cost-drivers. The median FFS expenditure was $21,157 (interquartile range, $16,894-$30,748) compared with $17,894 (interquartile range, $15,796-$20,894) for BPCI (P spending, which resulted in decreased costs of performing TSA surgery. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Reverse shoulder arthroplasty in young patient with achondroplasia - Ten year follow up: Case report.

    Science.gov (United States)

    van den Broek, M; Verborgt, O; Declercq, G

    2017-11-01

    Skeletal dysplasia in achondroplasia can affect all body joints - including the glenohumeral joint - and is prone to develop to degenerative osteoarthritis (OA). This may cause pain and mobility problems at young age. Surgical treatment is challenging due to the dysplastic anatomy of the shoulder joint - with a dysplastic deformed short humerus, a small, hypoplastic medialized glenoid and lateralized acromion - and the long life expectancy of these patients. The indications for reverse shoulder arthroplasty (RSA) evolved during years with rotator cuff tears and rotator cuff arthropathy in combination with or without glenohumeral OA as the main indicator, with good short to mid-term results. Long term results of RSA are rarely found in literature, especially in young patients. The use of a RSA in glenohumeral OA with an intact rotator cuff has rarely been reported. In this case report we present the ten-year clinical and radiographic results of a RSA for the treatment of degenerative OA with glenohumeral dysplasia in a young patient with achondroplasia. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  10. Ten-Year Outcome Comparison of the Anatomical Graduated Component and Vanguard Total Knee Arthroplasty Systems.

    Science.gov (United States)

    Faris, Philip M; Ritter, Merrill A; Davis, Kenneth E; Priscu, Hana M

    2015-10-01

    The development of a new total knee system as a successor prosthesis in total knee arthroplasty (TKA) requires clinical outcome improvement. 10,843 TKAs were performed of which 9169 utilized the Anatomical Graduated Component (AGC) and 1674 utilized the Vanguard prosthesis (both Biomet, Warsaw, IN). Survival rates at ten years postoperatively for the AGC and Vanguard were 98.7% and 98.4% (P=.4897) respectively. The top reasons for component failure were loosening (AGC: 0.29%, Vanguard: 0.30%), polyethylene wear, and instability (AGC: 0.13%, Vanguard: 0.12%). These results reveal similar outcomes in both designs, with relatively few revisions and high survival rates at ten years postoperatively. This abstract offers data concerning the usefulness of the Vanguard Total Knee System as a successor to the Anatomical Graduated Component. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Changes in Psychological Status and Health-Related Quality of Life Following Total Shoulder Arthroplasty.

    Science.gov (United States)

    Cho, Chul-Hyun; Song, Kwang-Soon; Hwang, Ilseon; Coats-Thomas, Margaret S; Warner, Jon J P

    2017-06-21

    There has been little documentation of the effects of total shoulder arthroplasty (TSA) on psychological status and health-related quality of life (HRQoL). We investigated changes in psychological status (depression and anxiety) and HRQoL following TSA and assessed the effect of preoperative psychological status on postoperative clinical and functional outcome. We hypothesized that TSA would improve both psychological status and HRQoL. We prospectively enrolled 46 patients undergoing TSA for osteoarthritis. Preoperatively and at 3, 6, and 12 months postoperatively, all of the subjects completed the visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons Scale (ASES), the Subjective Shoulder Value (SSV) measure, the Hospital Anxiety and Depression Scale (HADS), and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-BREF). From 3 months after surgery, significant improvement in HADS-depression, HADS-anxiety, and WHOQOL-BREF scores as well as in the other outcome measures of VAS pain score, ASES score, and SSV were observed. The prevalence of depression and anxiety decreased from a rate of 15.2% and 19.5%, respectively, preoperatively to a rate of 6.5% for each at 12 months postoperatively. Preoperative HADS-depression and HADS-anxiety scores did not correlate with any of the clinical and functional outcome measures at 12 months after surgery. This study showed significant improvement in psychological status and HRQoL as well as in pain and functional ability from 3 months after TSA in patients with osteoarthritis. Preoperative depression and anxiety did not predict poor postoperative outcome. Our findings suggest that TSA offers an excellent chance of improving psychological status and HRQoL. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  12. Biomechanical effects of humeral neck-shaft angle and subscapularis integrity in reverse total shoulder arthroplasty.

    Science.gov (United States)

    Oh, Joo Han; Shin, Sang-Jin; McGarry, Michelle H; Scott, Jonathan H; Heckmann, Nathanael; Lee, Thay Q

    2014-08-01

    The variability in functional outcomes and the occurrence of scapular notching and instability after reverse total shoulder arthroplasty remain problems. The objectives of this study were to measure the effect of reverse humeral component neck-shaft angle on impingement-free range of motion, abduction moment, and anterior dislocation force and to evaluate the effect of subscapularis loading on dislocation force. Six cadaveric shoulders were tested with 155°, 145°, and 135° reverse shoulder humeral neck-shaft angles. The adduction angle at which bone contact occurred and the internal and external rotational impingement-free range of motion angles were measured. Glenohumeral abduction moment was measured at 0° and 30° of abduction, and anterior dislocation forces were measured at 30° of internal rotation, 0°, and 30° of external rotation with and without subscapularis loading. Adduction deficit angles for 155°, 145°, and 135° neck-shaft angle were 2° ± 5° of abduction, 7° ± 4° of adduction, and 12° ± 2° of adduction (P angles of humeral rotation and abduction moments were not statistically different between the neck-shaft angles. The anterior dislocation force was significantly higher for the 135° neck-shaft angle at 30° of external rotation and significantly higher for the 155° neck-shaft angle at 30° of internal rotation (P angle was more prone to scapular bone contact during adduction but was more stable at the internally rotated position, which was the least stable humeral rotation position. Subscapularis loading gave further anterior stability with all neck-shaft angles at all positions. Published by Mosby, Inc.

  13. Sequential 3-dimensional computed tomography analysis of implant position following total shoulder arthroplasty.

    Science.gov (United States)

    Ricchetti, Eric T; Jun, Bong-Jae; Cain, Richard A; Youderian, Ari; Rodriguez, Eric J; Kusin, David; Subhas, Naveen; Patterson, Thomas E; Iannotti, Joseph P

    2018-02-07

    Detection of postoperative component position and implant shift following total shoulder arthroplasty (TSA) can be challenging using routine imaging. The purpose of this study was to evaluate glenoid component position over time using 3-dimensional computed tomography (CT) analysis with minimum 2-year follow-up. Twenty patients underwent primary TSA with sequential CT scanning of the shoulder: a preoperative study, an immediate postoperative study within 2 weeks of surgery, and a postoperative study performed at minimum 2-year follow-up (CT3). Postoperative glenoid component position and central peg osteolysis were assessed across the immediate postoperative CT scan and CT3. Glenoids with evidence of component shift and/or grade 1 central peg osteolysis on CT3 were considered at risk of loosening. Of the patients, 7 (35%) showed evidence of glenoid components at risk of loosening on CT3, 6 with component shift (3 with increased inclination alone, 1 with increased retroversion alone, and 2 with both increased inclination and retroversion). Significantly more patients with glenoid component shift had grade 1 central peg osteolysis on CT3 compared with those without shift (83% vs 7%, P = .002). One clinical failure occurred, with the patient undergoing revision to reverse TSA for rotator cuff deficiency. Three-dimensional CT imaging analysis following TSA identified changes in glenoid component position over time, with inclination being the most common direction of shift and grade 1 central peg osteolysis commonly associated with shift. These findings raise concern for glenoids at risk of loosening, but further follow-up is needed to determine the long-term clinical impact of these findings. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Fixation of an Anatomically Designed Cementless Stem in Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Shigeru Nakamura

    2012-01-01

    Full Text Available Purpose. The Anatomic Fiber Metal plus stem (Zimmer is one of the anatomically designed cementless stems to achieve stable fixation by metaphyseal fit. We studied outcomes of cementless total hip arthroplasty using this stem and possible effects of metaphyseal fit on outcomes. Methods. The cementless total hip arthroplasty using this stem was performed for 155 hips. One hundred and thirty-seven hips of 122 patients were followed for 5 to 16 (mean, 9.7 years and entered into the study. The metaphyseal fit was defined as good or poor in an anteroposterior radiograph after surgery. We studied the fixation of the stem and bone reaction on an anteroposterior radiograph at the final followup. Results. Twelve hips had revision, six acetabular components and six acetabular liners. No stem was revised. The biological fixation of the stem was bone ingrown fixation for 136 hips and unstable for one. The metaphyseal fit was good for 83 hips and poor for 54 hips. There were no differences for stem fixation and bone reaction between the two groups. Conclusions. The fixation of the stem was stable at a mean followup of 9.7 years independently from metaphyseal fit.

  15. Mechanics and complications of reverse shoulder arthroplasty: morse taper failure analysis and prospective rectification

    International Nuclear Information System (INIS)

    Hoskin, HLD; Furie, E; Ganey, TM; Schlatterer, DR; Collins, W

    2017-01-01

    Since Sir John Charnley began his monumental hip arthroplasty work in 1958, clinical researchers have been incrementally improving longevity and functionality of total joint systems, although implant failure occurs on occasion. The purpose of this study is to report the fracture of the humeral tray Morse taper of a reverse total shoulder system (RTSS), which to date has not been reported with metallurgic analysis for any RTSS. There was no reported antecedent fall, motor vehicle collision, or other traumatic event prior to implant fracture in this case. Analysis was performed on the retrieved failed implant by Scanning Electron Microscopy (SEM) and Electron Dispersion Spectroscopy (EDS) in an attempt to determine the failure method, as well as to offer improvements for future implants. At the time of revision surgery all explants were retained from the left shoulder of a 61-year old male who underwent a non-complicated RTSS 4 years prior. The explants, particularly the cracked humeral tray, were processed as required for SEM and EDS. Analysis was performed on the failure sites in order to determine the chemical composition of the different parts of the implant, discover the chemical composition of the filler metal used during the electron beam welding process, and to detect any foreign elements that could suggest corrosion or other evidence of failure etiology. Gross visual inspection of all explants revealed that implant failure was a result of dissociation of the taper from the humeral tray at the weld, leaving the Morse taper embedded in the humeral stem while the tray floated freely in the patient’s shoulder. SEM further confirmed the jagged edges noted grossly at the weld fracture site, both suggesting failure due to torsional forces. EDS detected elevated levels of carbon and oxygen at the fracture site on the taper only and not on the humeral tray. In order to determine the origin of the high levels of C and O, it was considered that in titanium alloys, C

  16. Mechanics and complications of reverse shoulder arthroplasty: morse taper failure analysis and prospective rectification

    Science.gov (United States)

    Hoskin, HLD; Furie, E.; Collins, W.; Ganey, TM; Schlatterer, DR

    2017-05-01

    Since Sir John Charnley began his monumental hip arthroplasty work in 1958, clinical researchers have been incrementally improving longevity and functionality of total joint systems, although implant failure occurs on occasion. The purpose of this study is to report the fracture of the humeral tray Morse taper of a reverse total shoulder system (RTSS), which to date has not been reported with metallurgic analysis for any RTSS. There was no reported antecedent fall, motor vehicle collision, or other traumatic event prior to implant fracture in this case. Analysis was performed on the retrieved failed implant by Scanning Electron Microscopy (SEM) and Electron Dispersion Spectroscopy (EDS) in an attempt to determine the failure method, as well as to offer improvements for future implants. At the time of revision surgery all explants were retained from the left shoulder of a 61-year old male who underwent a non-complicated RTSS 4 years prior. The explants, particularly the cracked humeral tray, were processed as required for SEM and EDS. Analysis was performed on the failure sites in order to determine the chemical composition of the different parts of the implant, discover the chemical composition of the filler metal used during the electron beam welding process, and to detect any foreign elements that could suggest corrosion or other evidence of failure etiology. Gross visual inspection of all explants revealed that implant failure was a result of dissociation of the taper from the humeral tray at the weld, leaving the Morse taper embedded in the humeral stem while the tray floated freely in the patient’s shoulder. SEM further confirmed the jagged edges noted grossly at the weld fracture site, both suggesting failure due to torsional forces. EDS detected elevated levels of carbon and oxygen at the fracture site on the taper only and not on the humeral tray. In order to determine the origin of the high levels of C and O, it was considered that in titanium alloys, C

  17. Placement of the stemless humeral component in the Total Evolutive Shoulder System (TESS).

    Science.gov (United States)

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

    2010-12-01

    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.

  18. Liposomal bupivacaine versus indwelling interscalene nerve block for postoperative pain control in shoulder arthroplasty: a prospective randomized controlled trial.

    Science.gov (United States)

    Abildgaard, Jeffrey T; Lonergan, Keith T; Tolan, Stefan J; Kissenberth, Michael J; Hawkins, Richard J; Washburn, Richard; Adams, Kyle J; Long, Catherine D; Shealy, E Carlisle; Motley, Jay R; Tokish, John M

    2017-07-01

    Pain management strategies following shoulder arthroplasty vary significantly. Liposomal bupivacaine (LB) is an extended-release delivery of a phospholipid bilayer encapsulating bupivacaine that can result in drug delivery up to 72 hours. Prior studies in lower extremity surgery demonstrated efficacy of LB in comparison to a single-shot peripheral nerve block; however, no study has investigated LB in a total shoulder arthroplasty population. Therefore, this study compared LB vs. an indwelling interscalene nerve block (IINB). This is a prospective, randomized study of 83 consecutive shoulder arthroplasty patients; 36 patients received LB and a "bridge" of 30 mL of 0.5% bupivacaine, and 47 patients received an IINB. Postoperative visual analog scale pain levels, opiate consumption measured with oral morphine equivalents, length of hospital stay, and postoperative complications were recorded. Continuous variables were compared using an analysis of variance with significance set at P < .05. Visual analog scale pain scores were statistically higher in the LB cohort immediately postoperatively in the postanesthesia care unit (7.25 vs. 1.91; P = .000) as well as for the remainder of postoperative day 0 (4.99 vs. 3.20; P = .005) but not for the remainder of admission. Opiate consumption was significantly higher among the LB cohort in the postanesthesia care unit (31.79 vs. 7.47; P = .000), on postoperative day 0 (32.64 vs. 15.04; P = .000), and for the total hospital admission (189.50 vs. 91.70, P = .000). Complication numbers and length of stay were not statistically different. Use of an IINB provides superior pain management in the immediate postoperative setting as demonstrated by decreased narcotic medication consumption and lower subjective pain scores. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Reverse shoulder arthroplasty patient personalized rehabilitation protocol. Preliminary results according to prognostic groups.

    Science.gov (United States)

    Romano, Alfonso Maria; Oliva, Francesco; Nastrucci, Guglielmo; Casillo, Pasquale; Di Giunta, Angelo; Susanna, Massimiliano; Ascione, Francesco

    2017-01-01

    Rehabilitation after Reverse Shoulder Arthroplasty (RSA) is still object of discussion with no based evidence guidelines. The aim of this study was to test a personalized rehabilitation protocol for three different patients groups according to clinical and intraoperative parameters that can affect final outcomes after RSA. We retrospectively evaluated a consecutive series of 112 patients who underwent to RSA between 2013 and 2015. The average follow-up was 29.2 months. A preoperative and postoperative clinical and radiographic assessment was performed. According to clinical, radiographic and intraoperative parameters, we selected three groups dedicating each one a specific level of post surgical care. A statistically significant improvement was achieved from preoperative evaluation, regarding all analysed parameters. Notable improvements were reported in high care group: elevation improved of 63.9° despite of Group A 55.5° and Group B 54.5° and it resulted statistically significant ( p 0.05). Our study shows that a personalized rehabilitation protocol can be effective improving clinical outcomes and decreasing complications rate, particularly in difficult management patients. Therapeutic Level IV.

  20. Anatomical Findings in Patients Undergoing Total Hip Arthroplasty for Idiopathic Femoral Head Osteonecrosis.

    Science.gov (United States)

    Ollivier, Matthieu; Lunebourg, Alexandre; Abdel, Matthew P; Parratte, Sébastien; Argenson, Jean-Noël

    2016-04-20

    Osteonecrosis of the femoral head has a host of etiologies. However, in 30% of the cases, no underlying etiology is identified and the process is considered "idiopathic." Our hypothesis was that osseous anatomical abnormalities might be frequently found in patients with femoral head osteonecrosis. A retrospective, 1:2 matched, case-control study was undertaken to compare ninety patients with idiopathic osteonecrosis who had undergone lower-limb computed tomography (CT) prior to undergoing total hip arthroplasty with 180 control patients matched for age, sex, and body mass index (BMI) who had undergone lower-limb computed tomography scanning at our radiology department for any reason except articular or bone disease. Preoperative CT scans were performed for all patients to evaluate femoral offset, femoral neck-shaft angle, femoral neck version, femoral head diameter, acetabular coverage estimated with use of the lateral center-edge angle, acetabular version, and acetabular diameter. The mean age was forty-five years, 69% of the patients were men, and the mean BMI was 26 kg/m2. Anatomical "abnormalities" associated with osteonecrosis were determined to be a femoral neck-shaft angle of femoral neck version of >17° (LR = 3.8), a lateral center-edge angle of osteonecrosis but only 11% of the control cases (LR = 6). This 1:2 matched, anatomical study suggests that acetabular and femoral anatomical factors, in isolation or combination, can be found in a large percentage of cases of "idiopathic" osteonecrosis. In this study, isolated or combined abnormalities of the hip were observed in the group of patients with osteonecrosis. Those elements may help surgeons to understand the process underlying idiopathic osteonecrosis and thus require further investigation. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  1. Definition of anatomical zero positions for assessing shoulder pose with 3D motion capture during bilateral abduction of the arms.

    Science.gov (United States)

    Rettig, Oliver; Krautwurst, Britta; Maier, Michael W; Wolf, Sebastian I

    2015-12-09

    Surgical interventions at the shoulder may alter function of the shoulder complex. Clinically, the outcome can be assessed by universal goniometry. Marker-based motion capture may not resemble these results due to differing angle definitions. The clinical inspection of bilateral arm abduction for assessing shoulder dysfunction is performed with a marker based 3D optical measurement method. An anatomical zero position of shoulder pose is proposed to determine absolute angles according to the Neutral-0-Method as used in orthopedic context. Static shoulder positions are documented simultaneously by 3D marker tracking and universal goniometry in 8 young and healthy volunteers. Repetitive bilateral arm abduction movements of at least 150° range of motion are monitored. Similarly a subject with gleno-humeral osteoarthritis is monitored for demonstrating the feasibility of the method and to illustrate possible shoulder dysfunction effects. With mean differences of less than 2°, the proposed anatomical zero position results in good agreement between shoulder elevation/depression angles determined by 3D marker tracking and by universal goniometry in static positions. Lesser agreement is found for shoulder pro-/retraction with systematic deviations of up to 6°. In the bilateral arm abduction movements the volunteers perform a common and specific pattern in clavicula-thoracic and gleno-humeral motion with maximum shoulder angles of 32° elevation, 5° depression and 45° protraction, respectively, whereas retraction is hardly reached. Further, they all show relevant out of (frontal) plane motion with anteversion angles of 30° in overhead position (maximum abduction). With increasing arm anteversion the shoulder is increasingly retroverted, with a maximum of 20° retroversion. The subject with gleno-humeral osteoarthritis shows overall less shoulder abduction range of motion but with increased out-of-plane movement during abduction. The proposed anatomical zero definition

  2. Proper shoulder position for subclavian venipuncture: a prospective randomized clinical trial and anatomical perspectives using multislice computed tomography.

    Science.gov (United States)

    Kitagawa, Norihito; Oda, Mayuko; Totoki, Tadahide; Miyazaki, Noriaki; Nagasawa, Ichiroh; Nakazono, Takahiko; Tamai, Tsutomu; Morimoto, Masatoshi

    2004-12-01

    Although the Trendelenburg position and shoulder bracing are recommended for safe subclavian venipuncture, the optimal shoulder position remains unclear. The current study observed spatial relations between the subclavian vein and surrounding structures using multislice computed tomography to determine optimal shoulder position for safe subclavian venipuncture and then conducted a small follow-up clinical trial to confirm these findings. Thoracic multislice computed tomography was performed for seven adult volunteers at three shoulder positions: elevated (up); neutral; and lowered caudally (down). Overlap and distance between the clavicle and the subclavian vein and the diameter of the subclavian vein were measured. Anatomical relations between the subclavian artery and vein were also observed. The success rate for subclavian venipuncture was then compared between the up and down shoulder positions in 30 patients. In the multislice computed tomography study, the mean overlap ratios between clavicle and subclavian vein in the up, neutral, and down positions were 33.5, 36.9, and 40.0%, respectively. Overlap increased with lower shoulder position (up venipuncture was significantly higher in the down position compared with the up position (P = 0.003). Lowered shoulder position increases both overlap and proximity between the clavicle and the subclavian vein, producing a more constant relation between the clavicle and the subclavian vein, without affecting vein diameter. Proper use of a lowered shoulder position should thus increase the safety and reliability of subclavian venipuncture compared with other shoulder positions.

  3. Blood transfusion in primary total shoulder arthroplasty: incidence, trends, and risk factors in the United States from 2000 to 2009.

    Science.gov (United States)

    Ryan, Devon J; Yoshihara, Hiroyuki; Yoneoka, Daisuke; Zuckerman, Joseph D

    2015-05-01

    Total shoulder arthroplasty (TSA) may be associated with substantial blood loss, and some patients require perioperative blood transfusion. Possible blood transfusion methods include predonated autologous blood transfusion, perioperative autologous blood transfusion, and allogeneic blood transfusion (ALBT). The purposes of the present study were to assess the incidence and recent trends over time of blood transfusion in TSA and analyze patient and hospital characteristics that affect the risk of ALBT. This study used national hospital discharge data from the National Inpatient Sample between 2000 and 2009. The data were used to generate the overall blood transfusion rate, and linear regression was used to assess trends in transfusion patterns over time. Logistic regression analysis was performed to analyze which patient and hospital characteristics independently influence the likelihood that a given patient undergoes ALBT. The overall blood transfusion rate (ie, the proportion of patients who received at least 1 transfusion of any kind) was 6.7%. This rate increased over time, from 4.9% in 2000 to 7.1% in 2009 (P blood transfusion rate in TSA found in the present study may be related to factors specific to TSA, such as the introduction of reverse total shoulder arthroplasty during the study period. A variety of patient and hospital characteristics contribute to the risk of undergoing ALBT. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  4. Hip-inspired implant for revision of failed reverse shoulder arthroplasty with severe glenoid bone loss. Improved clinical outcome in 11 patients at 3-year follow-up.

    Science.gov (United States)

    Uri, Ofir; Bayley, Ian; Lambert, Simon

    2014-04-01

    Glenoid reconstruction and inverted glenoid re-implantation is strongly advocated in revisions of failed reverse shoulder arthroplasty (RSA). Nevertheless, severe glenoid deficiency may preclude glenoid reconstruction and may dictate less favorable solutions, such as conversion to hemiarthropasty or resection arthropasty. The CAD/CAM shoulder (Stanmore Implants, Elstree, UK), a hip arthroplasty-inspired implant, may facilitate glenoid component fixation in these challenging revisions where glenoid reconstruction is not feasible. We questioned (1) whether revision arthroplasty with the CAD/CAM shoulder would alleviate pain and improve shoulder function in patients with failed RSA, not amenable to glenoid reconstruction, (2) whether the CAD/CAM hip-inspired glenoid shell would enable secure and durable glenoid component fixation in these challenging revisions. 11 patients with failed RSAs and unreconstructable glenoids underwent revision with the CAD/CAM shoulder and were followed-up for mean 35 (28-42) months. Clinical outcomes included the Oxford shoulder score, subjective shoulder value, pain rating, physical examination, and shoulder radiographs. The average Oxford shoulder score and subjective shoulder value improved statistically significantly after the revision from 50 to 33 points and from 17% to 48% respectively. Pain rating at rest and during activity improved significantly from 5.3 to 2.3 and from 8.1 to 3.8 respectively. Active forward flexion increased from 25 to 54 degrees and external rotation increased from 9 to 21 degrees. 4 patients required reoperation for postoperative complications. No cases of glenoid loosening occurred. The CAD/CAM shoulder offers an alternative solution for the treatment of failed RSA that is not amenable to glenoid reconstruction.

  5. The TESS reverse shoulder arthroplasty without a stem in the treatment of cuff-deficient shoulder conditions: clinical and radiographic results.

    Science.gov (United States)

    Teissier, Philippe; Teissier, Jacques; Kouyoumdjian, Pascal; Asencio, Gérard

    2015-01-01

    Reverse total shoulder arthroplasty (RSA) is a recent concept that enables good functional outcomes in cases of massive rotator cuff tear and cuff tear arthropathy. Design parameters influence the functional results and complications. The purpose of this study is to present the results of a novel RSA, the Total Evolutive Shoulder System (TESS; Biomet, Warsaw, IN, USA), based on a reverse corolla without a stem. We enrolled 101 patients with 105 RSAs in a prospective study, with a minimum follow-up period of 24 months. The analysis concerned 91 RSAs in 87 patients (61 men and 26 women), with a mean age of 73 years, at a mean follow-up of 41 months (range, 24-69 months). Ninety-six percent of patients rated their satisfaction as good or excellent. Mean flexion was 143° (range, 90°-170°), and mean external rotation was 39° (range, 20°-70°). The Constant score improved from 40 points preoperatively to 68 points at last follow-up (P TESS RSA provided encouraging midterm results with favorable outcomes and a low rate of complications. The stemless TESS with a reverse corolla is a reliable, less invasive system. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  6. Healing and functional outcome of a subscapularis peel repair with a stem-based repair after total shoulder arthroplasty.

    Science.gov (United States)

    Gobezie, Reuben; Denard, Patrick J; Shishani, Yousef; Romeo, Anthony A; Lederman, Evan

    2017-09-01

    The purpose of this study was to evaluate functional outcome and healing of a subscapularis peel with a stem-based repair after total shoulder arthroplasty (TSA). The hypothesis was that the repair would lead to subscapularis healing in the majority of cases. A prospective analysis was performed on a consecutive series of TSAs. Range of motion and functional outcome were assessed according to American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, Simple Shoulder Test, and visual analog scale scores at a minimum follow-up of 1 year. Belly-press and lift-off tests were also performed. An ultrasound evaluation assessed subscapularis healing at final follow-up. At a mean follow-up of 15 months, 60 patients (mean age, 64 years) were examined. Mean forward flexion improved from 115° to 137°. External rotation at the side improved from 27° to 52°, and internal rotation improved from L4 to L2 (P 90% postoperative healing of the subscapularis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Liposomal bupivacaine versus interscalene nerve block for pain control after shoulder arthroplasty: A meta-analysis.

    Science.gov (United States)

    Yan, Zeng; Chen, Zong; Ma, Chuangen

    2017-07-01

    Postoperative pain control after total shoulder arthroplasty (TSA) can be challenging. Liposomal bupivacaine and interscalene nerve block are 2 common pain control protocol for TSA patients. However, whether liposomal bupivacaine was superior than interscalene nerve block was unknown. This meta-analysis aimed to illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for pain control in patients undergoing TSA. In May 2017, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for TSA in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved. The endpoints were the visual analogue scale (VAS) at 4 hours, 8 hours, 12 hours, 24 hours, and 2 weeks, total morphine consumption at 24 hours, and the length of hospital stay. Software of Stata 12.0 was used for pooling the final outcomes. Five clinical studies with 573 patients (liposomal bupivacaine group = 239, interscalene nerve block group = 334) were ultimately included in the meta-analysis. There was no significant difference between the VAS at 4 hours, 8 hours, and 2 weeks between liposomal bupivacaine group and interscalene nerve block group (P > .05). Compared with interscalene nerve block group, liposomal bupivacaine was associated with a reduction of VAS score at 12 hours, 24 hours by appropriately 3.31 points and 6.42 points respectively on a 100-point VAS. Furthermore, liposomal bupivacaine was associated with a significantly reduction of the length of hospital stay by appropriately by 0.16 days compared with interscalene nerve block group. Current meta-analysis indicates that compared with interscalene nerve block, liposomal bupivacaine had comparative effectiveness on reducing both pain scores and the length of hospital stay. However, studies with more patients and better-designed methods are needed to

  8. Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty.

    Science.gov (United States)

    Denard, Patrick J; Noyes, Matthew P; Walker, J Brock; Shishani, Yousef; Gobezie, Reuben; Romeo, Anthony A; Lederman, Evan

    2018-02-01

    The purpose of this study was to compare the radiographic changes of the humerus in the short term after total shoulder arthroplasty with two different short-stem humeral components. The hypothesis was that there would be no difference in radiographic changes or functional outcome based on component type. A retrospective review was conducted of primary total shoulder arthroplasties performed with a short press-fit humeral component. Group A included a collarless humeral stem with an oval geometry and curved stem (Ascend or Ascend Flex; Wright Medical, Memphis, TN, USA). Group B included a humeral stem with a metaphyseal collar, rectangular geometry, and straight stem (Apex; Arthrex, Inc., Naples, FL, USA). Radiographic changes and functional outcome were evaluated at a minimum of 2 years postoperatively. There were 42 patients in group A and 35 patients in group B available for analysis. There was no difference in functional outcome between the groups. In group A, the mean total radiographic change score of the humerus was 3.9, with changes classified as low in 38% and high in 62%. In group B, the mean total radiographic change score of the humerus was 2.5, with changes classified as low in 77% and high in 23% (P < .001). Medial calcar osteolysis was present in 71% of group A compared with 28.5% of group B (P < .001). At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. However, bone adaptive changes and the rate of medial calcar osteolysis are significantly different. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. The incidence and risk factors for blood transfusion in revision shoulder arthroplasty: our institution's experience and review of the literature.

    Science.gov (United States)

    Ahmadi, Shahryar; Lawrence, Thomas M; Sahota, Shawn; Schleck, Cathy D; Harmsen, William S; Cofield, Robert H; Sperling, John W

    2014-01-01

    The purposes of this study were to determine the incidence of blood transfusion after revision shoulder arthroplasty and to assess risk factors associated with an increased risk of transfusion. Between 1994 and 2008, 566 consecutive revision shoulder procedures were performed at our institution, which formed the basis of this study. The patient's age, sex, body mass index, comorbidities, preoperative and postoperative hemoglobin level, details of the surgery, operative time, and transfusion details were documented retrospectively from medical records. Overall, 11.3% of patients (64 of 566) required a transfusion. An increased transfusion rate was associated with age (odds ratio [OR] per 10 years, 1.5 [95% confidence interval (CI), 1.2 to 2.0]; P = .002), operative time (≤ 5 hours vs >5 hours) (OR, 3.3 [95% CI, 1.9 to 5.8]; P revision surgery are associated with higher postoperative transfusion rates. These factors should be taken into consideration to more accurately predict the need for transfusion and modify preoperative blood-ordering protocols. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  10. Towards Human Capture Movement: Estimation of Anatomical Movements of the Shoulder

    Directory of Open Access Journals (Sweden)

    B. B. Salmerón-Quiroz

    2013-01-01

    Full Text Available In this paper we focus on the human arm motion capture, which is motivated by the requirements in physical rehabilitation and training of stroke patients in the same way as monitoring of elderly person activities. The proposed methodology uses a data fusion of low-cost and low-weight MEMS sensors jointly to an a priori knowledge of the arm anatomy. The main goal is to estimate the arm position, the anatomical movements of the shoulder and its accelerations. We propose a discrete optimization based-approach which aims to search the optimal attitude ambiguity directly without decorrelation of ambiguity, and to computing the baseline vector consequently. The originality of this paper is to apply the discrete optimization to track the desired trajectory of a nonlinear system such as the Human Movement in the presence of uncertainties. The global asymptotic convergence of the nonlinear observer is guaranteed. Extensive tests of the presented methodology with real world data illustrate the effectiveness of the proposed procedure.

  11. What Are the Complications, Survival, and Outcomes After Revision to Reverse Shoulder Arthroplasty in Patients Older Than 80 Years?

    Science.gov (United States)

    Alentorn-Geli, Eduard; Clark, Nicholas J; Assenmacher, Andrew T; Samuelsen, Brian T; Sánchez-Sotelo, Joaquín; Cofield, Robert H; Sperling, John W

    2017-11-01

    By the time patients with a failed shoulder arthroplasty require revision surgery, a substantial number are older than 80 years. The risk of complications of revision arthroplasty in this elderly population is largely unknown and needs to be considered when contemplating whether these patients are too frail for revision surgery. (1) What are the 90-day medical and surgical complications after revision to reverse shoulder arthroplasty (RSA) in patients older than 80 years? (2) What are the 2- and 5-year survival rates after revision? (3) Was there an improvement in pain at rest or with activity, range of motion (ROM), and strength after revision surgery? Between 2004 and 2013, 38 patients who were older than 80 years (84 ± 3 years) underwent revision surgery to a RSA. Of those, five were lost to followup before 2 years, and two had died within 2 years of revision surgery, leaving 31 for analysis of our survivorship, pain, ROM, and strength endpoints at a minimum of 2 years or until revision surgery had occurred (mean, 28 months; range, 1-77 months); all 38 patients were included for purposes of evaluating medical and surgical complications at 90 days. During the period in question, our general indication for using RSA included failure of previous shoulder arthroplasty because of instability, glenoid loosening with bone loss, or rotator cuff insufficiency. The indication for revision to RSA did not change during the study period. The index procedure (revision to RSA at the age of 80 years or older) was the first revision arthroplasty in 33 (87%) patients and the second in five (13%) patients. We tallied 90-day medical and surgical complications by performing a retrospective chart and institutional joint registry review. The cumulative incidence of implant loosening (implant migration or tilting, or complete radiolucent lines present) and revision surgery was calculated at 2 and 5 years using competing risk of death method. Pain levels at rest or with activity (rated

  12. Short-term results of the reverse Total Evolutive Shoulder System (TESS) in cuff tear arthropathy and revision arthroplasty cases.

    Science.gov (United States)

    von Engelhardt, Lars Victor; Manzke, Michael; Filler, Timm J; Jerosch, Joerg

    2015-07-01

    The aim of this study was to evaluate the clinical and radiological outcome of the Total Evolutive Shoulder System (TESS) in patients with cuff tear arthropathy and patients in need of a revision arthroplasty. In this sequential study, 67 patients (56 non-stemmed, 11 stemmed) were evaluated after a mean follow-up of 17.5 months. The relative Constant and DASH scores, radiological joint geometry changes, complications and postoperative problems, which are not likely to affect the outcome, were evaluated. A significant increase was noticed for the relative Constant (11.3 vs. 78.8 %) and DASH scores (73.7 vs. 31.8) without significant differences between both etiology groups. Complication rates were similar to previous studies. An aseptic loosening of the non-stemmed humeral component was not noticed in the cuff tear arthropathy group, whereas one case with a loosening was noticed in the revision arthroplasty group. With nine cases (13.4 %), scapular notching rates were very low. On average, the acromiohumeral distance increased by 17 mm and the humeral offset by 13.9 mm; the height of the center of rotation decreased by 4.6 mm and the lateral glenohumeral offset by 6.1 mm, p TESS system provided adequate distalization and medialization of the humerus and the center of rotation. This corresponds to a good clinical outcome. The use of the surgical opportunity to implant the prosthesis with a relatively low neck-shaft angle might explain the low rates of scapular notching in our series. Regarding the case with a loosening of the humeral component, the surgeon should carefully indicate a stemless version for metaphyseal press-fit fixation in patients with revision arthroplasty.

  13. Outcome of Revision Shoulder Arthroplasty After Resurfacing Hemiarthroplasty in Patients with Glenohumeral Osteoarthritis

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V; Olsen, Bo S; Al-Hamdani, Ali

    2016-01-01

    hemiarthroplasty was 62 points (interquartile range, 40 to 88 points). Of the 80 cases that had follow-up, 33 (41%) had an unacceptable outcome, defined as a WOOS of ≤50 points. Of the 107 cases that required a revision surgical procedure, 11 arthroplasties (10%) required a further revision surgical procedure...

  14. Accuracy of glenoid component placement in total shoulder arthroplasty and its effect on clinical and radiological outcome in a retrospective, longitudinal, monocentric open study.

    Directory of Open Access Journals (Sweden)

    Thomas M Gregory

    Full Text Available BACKGROUND: The success of Total Shoulder Arthroplasty (TSA is believed to depend on the restoration of the natural anatomy of the joint and a key development has been the introduction of modular humeral components to more accurately restore the patient's anatomy. However, there are no peer-reviewed studies that have reported the degree of glenoid component mal-position achieved in clinical practice and the clinical outcome of such mal-position. The main purpose of this study was to assess the accuracy of glenoid implant positioning during TSA and to relate it to the radiological (occurrence of radiolucent lines and osteolysis on CT and clinical outcomes. METHODS: 68 TSAs were assessed with a mean follow-up of 38+/-27 months. The clinical evaluation consisted of measuring the mobility as well as of the Constant Score. The radiological evaluation was performed on CT-scans in which metal artefacts had been eliminated. From the CT-scans radiolucent lines and osteolysis were assessed. The positions of the glenoid and humeral components were also measured from the CT scans. RESULTS: Four position glenoid component parameters were calculated The posterior version (6°±12°; mean ± SD, the superior tilt (12°±17°, the rotation of the implant relative to the scapular plane (3°±14° and the off-set distance of the centre of the glenoid implant from the scapular plane (6±4 mm. An inferiorly inclined implant was found to be associated with higher levels of radiolucent lines while retroversion and non-neutral rotation were associated with a reduced range of motion. CONCLUSION: this study demonstrates that glenoid implants of anatomic TSA are poorly positioned and that this malposition has a direct effect on the clinical and radiological outcome. Thus, further developments in glenoid implantation techniques are required to enable the surgeon to achieve a desired implant position and outcome.

  15. Injury to the axillary and suprascapular nerves in rotator cuff arthropathy and after reverse shoulder arthroplasty: a prospective electromyographic analysis.

    Science.gov (United States)

    Lopiz, Yaiza; Rodriguez-González, Alberto; Martín-Albarrán, Susana; Marcelo, Hector; García-Fernández, Carlos; Marco, Fernando

    2018-02-20

    Neurologic pre- and postoperative injuries to the axillary and/or suprascapular nerve (SSN) have a higher incidence than expected and may lead to significantly decreased functional outcomes and increased risk of reverse shoulder arthroplasty (RSA) failure. Patients who underwent a RSA for rotator cuff tear arthropathy (RCTA) were included from December 2014 to December 2015. This study focused on the clinical (Constant score), radiographic, and pre- and postoperative electromyographic evaluations at 3 and 6 months. Twenty patients met the inclusion criteria. One was lost to follow-up. Preoperatively, 15 patients showed changes on electromyography (9 SSN and 15 axillary nerve lesions); all of them were chronic and disuse injuries. The mean preoperative relative Constant score (rCS) of all included patients was 39 ± 9 (range, 19-64). At 3 months postsurgery, the prevalence of acute injuries for both nerves was 31.5%. At 6 months postsurgery, 2 axillary nerve injuries and 6 SSN injuries remain unchanged, and the rest improved or normalized. The mean postsurgery rCS of the entire cohort at 6-month follow-up was 78 ± 6.5. Mean postoperative rCS for acute postoperative nerve injury was 71 ± 3 for the axillary nerve and 64 ± 5 for SSN. Axillary and SSN injuries in RCTA have a much higher incidence than expected. Most of these axillary lesions are transient, with an almost complete recovery seen on electromyography at 6 months and with scarce functional impact. However, SSN lesions appear to behave differently, with poor functional results and having a lower potential for a complete recovery. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. Composite reverse shoulder arthroplasty can provide good function and quality of life in cases of malignant tumour of the proximal humerus.

    Science.gov (United States)

    Lazerges, Cyril; Dagneaux, Louis; Degeorge, Benjamin; Tardy, Nicolas; Coulet, Bertrand; Chammas, Michel

    2017-12-01

    Management of proximal humeral tumours remains a surgical challenge. No study to date has assessed the quality of life scores following the composite reverse shoulder arthroplasty for this indication. We, therefore, evaluated function and quality of life following reconstruction with allograft for malignant tumour of the humerus. A series of six cases of humeral tumour treated by a single surgeon in a single centre was reviewed after a mean follow-up of 5.9 years. The tumours included two chondrosarcomas, one plasmocytoma and three metastases. Resection involved bone epiphysis, metaphysis and diaphysis in five cases (S3S4S5A) and epiphysis and metaphysis in one case (S3S4A). For reconstruction, an allograft composite reverse shoulder arthroplasty was used in all the cases. Outcomes were assessed with range of motion, the QuickDash score and the Short Form 12 (SF-12) Health Survey. Radiographs assessed osseointegration and complications. At the final follow-up, the mean shoulder range of motion were respectively 95°, 57° and 11° for forward flexion, abduction and external rotation. Mean QuickDASH score improved from 28 to 41 and VAS-pain scores improved from 5.1 to 2.3. The post-operative MSTS score was 73% and the Constant score was 46.1/100. The SF-12 PCS and MCS scores were also improved, respectively from 44.4 and 39.7 to 45.5 and 56.1. The mean satisfaction score was 8.1/10. Composite reverse shoulder arthroplasty is a viable alternative for reconstruction after resection of malignant humeral tumour. Although total tumour resection was the most important objective, the functional and quality of life scores were satisfactory.

  17. Total Hip Arthroplasty Dislocations Are More Complex Than They Appear: A Case Report of Intraprosthetic Dislocation of an Anatomic Dual-Mobility Implant After Closed Reduction

    Science.gov (United States)

    Waddell, Bradford S.; De Martino, Ivan; Sculco, Thomas; Sculco, Peter

    2016-01-01

    Background: Total hip arthroplasty is a successful operation for the treatment of hip pain. One of the common complications of hip arthroplasty is dislocation. While reduction of standard prosthetic dislocations is highly successful, new prostheses add the potential for new complications. Case Report: We present the case of a patient who experienced intraprosthetic dislocation of an anatomic dual-mobility total hip prosthesis after a closed hip reduction and include the prereduction and postreduction radiographic findings. Conclusion: Emergency department physicians should be aware of intraprosthetic dislocation. This complication can be easily missed because the metal/ceramic femoral head appears to be reduced in the acetabulum. PMID:27303232

  18. Miscellaneous conditions of the shoulder: Anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Farid, Nikdokht [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); Bruce, Dean [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States); University of Alberta, Edmonton, Alberta (Canada); Chung, Christine B. [University of California San Diego, Department of Radiology, 200 West Arbor Drive, San Diego, CA 92103 (United States); VA Healthcare System San Diego, Department of Radiology, 3350 La Jolla Village Drive, La Jolla, CA 92161 (United States)], E-mail: cbchung@ucsd.edu

    2008-10-15

    The purpose of this article is to review the key imaging findings in major categories of pathology affecting the shoulder joint including hydroxyapatite deposition disease, rotator cuff interval pathology, acromioclavicular joint pathology, glenohumeral osteoarthrosis, and synovial inflammatory processes, with specific emphasis on findings that have associated pitfalls in imaging diagnosis. The pathophysiology and clinical manifestations of the above mentioned categories of pathology will be reviewed, followed in each section by a detailed pictorial review of the key imaging findings in each category including plain film, computed tomography, and magnetic resonance imaging findings as applicable. Imaging challenges that relate to both diagnosis and characterization will be addressed with each type of pathology. The goal is that after reading this article, the reader will be able to recognize the key imaging findings in major categories of pathology affecting the shoulder joint and will become familiar with the potential pitfalls in their imaging diagnosis.

  19. Reverse shoulder arthroplasty for complex fractures of the proximal humerus in elderly patients: impact on the level of independency, early function, and pain medication.

    Science.gov (United States)

    Wolfensperger, Fabian; Grüninger, Patrick; Dietrich, Michael; Völlink, Mathias; Benninger, Emanuel; Schläppi, Michel; Meier, Christoph

    2017-08-01

    This study investigated early functional outcome, quality of life, and the level of independency in elderly patients after primary reverse shoulder arthroplasty (RSA) for complex fractures of the proximal humerus. This was a prospective case series that included 33 patients, aged ≥70 years, with a high level of independency who received RSA for complex fractures of the humerus (Orthopaedic Trauma Association B2/C) from January 2012 to April 2014. Level of independency, quality of life (Short Form 36 Health Survey score), early functional outcome (Constant-Murley score, Disabilities of the Arm, Shoulder and Hand Outcome Measure), and pain medication (World Health Organization grading) were obtained at the 6-month follow-up and 1 year after surgery. The Constant-Murley score was 64 ± 14 after 6 months and 71 ± 12 at 1 year (P < .001), reaching 87% compared with the contralateral shoulder. The Disabilities of the Arm, Shoulder and Hand score reached 29 ± 20 at 6 months and 30 ± 21 at 1 year. The Short Form 36 score was comparable to normative data. After 6 months, 84% of our study group were back at their previous level of independency. Within 1 year, this rate increased to 91%. At the 1-year follow-up, analgesia intake was back at the level before the injury in 97% of the patients. Primary RSA provides good early functional results, reliable pain control, and excellent restoration of an independent life style in elderly patients. Thus, RSA may be considered for active patients with a high demand on shoulder function. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  20. [EFFECTIVENESS OF ANATOMIC FEMORAL COMPONENT PROSTHESIS FOR SEVERE DEVELOPMENTAL DYSPLASIA OF THE HIP IN TOTAL HIP ARTHROPLASTY].

    Science.gov (United States)

    An, Xiao; Dong, Jiyuan; Gong, Ke; Zhang, Qi; Li, Xiang; Song, Wei

    2015-04-01

    To evaluate the effectiveness of anatomic femoral component prosthesis for severe development dysplasia of the hip (DDH) in total hip arthroplasty (THA). Between September 2009 and September 2013, 48 patients (51 hips) with severe DDH underwent THA with cementless anatomic femoral component prosthesis. There were 5 males (5 hips) and 43 females (46 hips) with an average age of 51 years (range, 28-67 years). The left hip was involved in 25 cases, the right hip in 20 cases, and bilateral hips in 3 cases. There were 39 cases (44 hips) of Crowe type III and 9 cases (7 hips) of Crowe type IV. The visual analogue scale (VAS) score was 5.72 +/- 1.84, and Harris score was 41.66 +/- 4.87 at preoperation. All patients had leg discrepancy with a length difference of (4.31 +/- 0.84) cm. The duration of surgery was 59-110 minutes (mean, 78.6 minutes), and the hospitalization days were 6-20 days (mean, 12.3 days). All patients obtained primary healing of incision without wound related complications of swelling, effusion, and infection. Two patients were found to have intramuscular venous thrombosis. All patients were followed up 10-54 months (mean, 29 months). Limp was observed at the early stage after operation in 9 patients and disappeared after 1 year, the other patients had normal gait. The VAS score 1.46?0.47, Harris score 88.66 +/- 3.48, and the leg length difference (1.15 +/- 0.33) cm at last follow-up all showed significant differences when compared with the preoperative values (Phip joint function and limb discrepancy. Short-term effectiveness was satisfactory, but the long-term effectiveness should still be observed in future.

  1. The active and passive kinematic difference between primary reverse and total shoulder prostheses

    NARCIS (Netherlands)

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

    2014-01-01

    Background: Reverse shoulder arthroplasty (RSA) and total shoulder arthroplasty (TSA) effectively decrease pain and improve clinical outcome. However, indications and biomechanical properties vary greatly. Our aim was to analyze both active and passive shoulder motion (thoracohumeral [TH],

  2. How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation

    International Nuclear Information System (INIS)

    Schnurr, C.; Nessler, J.; Koenig, D.P.; Meyer, C.; Schild, H.H.; Koebke, J.

    2009-01-01

    The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined. A total of 32 femoral hip resurfacing components were implanted on embalmed human femurs using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation. The difference between the measured and planned varus-valgus angle averaged 1 deg (mean±standard deviation (SD): group I, 1 deg±2 deg; group II, 1 deg±1 deg). The mean±SD difference between femoral neck anteversion and anteversion of the implant was 4 deg (group I, 4 deg±4 deg; group II, 4 deg±3 deg). The software-calculated implant position differed 7 deg±8 deg from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups. Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the

  3. Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty: A systematic review and meta-analysis.

    Science.gov (United States)

    Sun, Chuan-Xiu; Zhang, Lu; Mi, Li-Dong; Du, Guang-Yu; Sun, Xue-Gang; He, Sheng-Wei

    2017-06-01

    This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty. A systematic search was performed in Embase (1980-2017.04, embase.com), Medline (1966-2017.04, medline.com), PubMed (1966-2017.04, pubmed.com), ScienceDirect (1985-2017.04, sciencedirect.com), and Web of Science (1950-2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software. In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] -172.16, 95% confidence interval [CI] -35.46 to -308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI -0.12 to 0.22, P = .89, d = 0.19), length of stay (MD -0.06, 95% CI -0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53). Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required.

  4. Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up.

    Science.gov (United States)

    Merolla, Giovanni; Walch, Gilles; Ascione, Francesco; Paladini, Paolo; Fabbri, Elisabetta; Padolino, Antonio; Porcellini, Giuseppe

    2018-04-01

    There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs. Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component. Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P = .002) and lower rates of scapular notching (P = .0003), glenoid radiolucency (P = .016), and humeral bone remodeling (P = .004 and P = .030 for cortical thinning and spot weld, respectively). Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. A Cost-Effectiveness Analysis of Reverse Total Shoulder Arthroplasty versus Hemiarthroplasty for the Management of Complex Proximal Humeral Fractures in the Elderly.

    Science.gov (United States)

    Osterhoff, Georg; O'Hara, Nathan N; D'Cruz, Jennifer; Sprague, Sheila A; Bansback, Nick; Evaniew, Nathan; Slobogean, Gerard P

    2017-03-01

    There is ongoing debate regarding the optimal surgical treatment of complex proximal humeral fractures in elderly patients. To evaluate the cost-effectiveness of reverse total shoulder arthroplasty (RTSA) compared with hemiarthroplasty (HA) in the management of complex proximal humeral fractures, using a cost-utility analysis. On the basis of data from published literature, a cost-utility analysis was conducted using decision tree and Markov modeling. A single-payer perspective, with a willingness-to-pay (WTP) threshold of Can$50,000 (Canadian dollars), and a lifetime time horizon were used. The incremental cost-effectiveness ratio (ICER) was used as the study's primary outcome measure. In comparison with HA, the incremental cost per quality-adjusted life-year gained for RTSA was Can$13,679. One-way sensitivity analysis revealed the model to be sensitive to the RTSA implant cost and the RTSA procedural cost. The ICER of Can$13,679 is well below the WTP threshold of Can$50,000, and probabilistic sensitivity analysis demonstrated that 92.6% of model simulations favored RTSA. Our economic analysis found that RTSA for the treatment of complex proximal humeral fractures in the elderly is the preferred economic strategy when compared with HA. The ICER of RTSA is well below standard WTP thresholds, and its estimate of cost-effectiveness is similar to other highly successful orthopedic strategies such as total hip arthroplasty for the treatment of hip arthritis. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  6. Comparison of liposomal bupivacaine infiltration versus interscalene nerve block for pain control in total shoulder arthroplasty: A meta-analysis of randomized control trails.

    Science.gov (United States)

    Cao, Xiuling; Pan, Fang

    2017-09-01

    This meta-analysis aimed to compare the efficiency and safety of liposomal bupivacaine infiltration and interscalene nerve block for pain control after total shoulder arthroplasty. A systematic search was performed in Medline (1966 to May 2017), PubMed (1966 to May 2017), Embase (1980 to May 2017), ScienceDirect (1985 to May 2017) and the Cochrane Library. Only randomized controlled trials (RCTs) were included. Reported surgical outcomes, including visual analogue scale (VAS) scores, opioid consumption, length of stay, and postoperative adverse effects including the risk of nausea and vomiting. Meta-analysis was performed using Stata 11.0 software. Four RCTs including 510 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of VAS score at 12 hours (standard mean difference [SMD] = 0.272, 95% CI: -0.150 to 0.695, P = .207), 24 hours (SMD = -0.056, 95% CI: -0.458 to 0.346, P = 0.785), and 48 hours (SMD = 0.183, 95% CI: -0.148 to 0.513, P = .278). Liposomal bupivacaine infiltration groups required an equivalent amount of opioids at postoperative 12 hours (SMD = -0.039, 95% CI: -0.222 to 0.143, P = .672), 24 hours (SMD = 0.046, 95% CI: -0.136 to 0.228, P = .618) and 48 hours (SMD = -0.025, 95% CI: -0.207 to 0.157, P = .785). Liposomal bupivacaine infiltration provides equivalent postoperative pain control compared with interscalene nerve block following total shoulder arthroplasty. Both of them can reduce the consumption of opioids without severe adverse effects. More high-quality RCTs with long follow-up period are necessary for proper comparisons of the efficacy and safety of liposomal bupivacaine infiltration with interscalene nerve block.

  7. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient

    OpenAIRE

    Kane, Patrick M.; Stull, Justin D.; Culp, Randall W.

    2015-01-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty.

  8. Deltoid muscle volume affects clinical outcome of reverse total shoulder arthroplasty in patients with cuff tear arthropathy or irreparable cuff tears

    Science.gov (United States)

    Yoon, Jong Pil; Seo, Anna; Kim, Jeong Jun; Lee, Chang-Hwa; Baek, Seung-Hun; Kim, Shin Yoon; Jeong, Eun Taek; Oh, Kyung-Soo

    2017-01-01

    We aimed to estimate the interrelation between preoperative deltoid muscle status by measuring the 3-dimensional deltoid muscle volume and postoperative functional outcomes after reverse total shoulder arthroplasty(RTSA). Thirty-five patients who underwent RTSA participated in this study. All patients underwent preoperative magnetic resonance imaging(MRI) as well as pre- and postoperative radiography and various functional outcome evaluations at least 1 year. The primary outcome parameter was set as age- and sex-matched Constant scores. The 3-dimensional deltoid muscle model was generated using a medical image processing software and in-house code, and the deltoid muscle volume was calculated automatically. Various clinical and radiographic factors comprising the deltoid muscle volume adjusted for body mass index(BMI) were analyzed, and their interrelation with the outcome parameters was appraised using a multivariate analysis. As a result, all practical consequences considerably improved following surgery(all pdeltoid muscle volume adjusted for BMI(p = 0.009), absence of a subscapularis complete tear (p = 0.040), and greater change in acromion-deltoid tuberosity distance(p = 0.013) were associated with higher matched Constant scores. Multivariate analysis indicated that the deltoid muscle volume was the single independent prognostic factor for practical consequences(p = 0.011). In conclusion, the preoperative deltoid muscle volume significantly affected the functional outcome following RTSA in patients with cuff tear arthropathy or irreparable cuff tears. Therefore, more attention should be paid to patients with severe atrophied deltoid muscle who are at a high risk for poor practical consequences subsequent to RTSA. PMID:28355234

  9. Biomechanical strength and failure mechanism of different tubercula refixation methods within the framework of an arthroplasty for shoulder fracture.

    Science.gov (United States)

    Fleischer, J; Schleyer, A; Nassutt, R; Grittner, U; Ojodu, I; Hopp, S J

    2017-04-01

    Tuberosity repair in shoulder fracture prosthesis implantation still remains a challenge often leading to poor functional outcomes, despite a variety of materials and suggested suture patterns. We aimed to evaluate, which forces currently used suture and cerclage materials withstand and to assess whether they are useful with regard to stability of reconstruction of tuberosities and which failure modes they display. Using sheep infraspinatus tendons with attached tuberosities three different suture materials (suture 1: Ethibond size 2; suture 2: Orthocord size 2; suture 3: Fiberwire size 5) and a 0.8mm titanium cerclage wire were investigated. For each suture material as well as the cerclage wire 6 tests were carried out. A material testing machine was used to perform cyclic loading tests (20mm/min, F min =50N, F max =100N, respectively after 50 cycles: F max +50N until failure). Outcome measures and thus comparison criteria were the maximum holding force, number of cycles reached, total elongation of the system (tendon and suture) and qualitative appraisal and documentation of the mechanism of failure. Overall average maximum forces between the fixation materials differed significantly (P=0.003), especially suture 3 (braided polyethylene coating, non-resorbable polyfile UHMW core) displayed superior results in comparison to the cerclage wire (P=0.016). Although, primary elongation of the cerclage technique was significantly lower compared to the suture materials (P=0.002). All tests showed a high initial lengthening and caused incision-like defects in the bone or tendon and led to failure and huge displacement of the tuberosities. Currently used suture and cerclage materials have a limited usefulness for refixation of tuberosities due to an increased risk of obstruction for bony consolidation. Basic science, Biomechanics. Copyright © 2016. Published by Elsevier Masson SAS.

  10. The effect of glenoid component version and humeral polyethylene liner rotation on subluxation and impingement in reverse shoulder arthroplasty.

    Science.gov (United States)

    Permeswaran, Vijay N; Caceres, Andrea; Goetz, Jessica E; Anderson, Donald D; Hettrich, Carolyn M

    2017-10-01

    A previously validated finite element modeling approach was used to determine how changes in glenoid component version and polyethylene liner rotation within the humeral component affect the arm abduction angle at which impingement between the inferior glenoid and the polyethylene liner occurs as well as the amount of subluxation generated by that impingement. Five glenoid component versions (5° anteversion; neutral; 5°, 10°, and 20° retroversion) and 7 polyethylene liner rotations (20° and 10° anterior; neutral; 10°, 20°, 30°, and 40° posterior) were considered, resulting in 35 different clinically representative models. The humerus was internally and externally rotated and extended and flexed, and the resulting impingement and subluxation were measured. To further analyze more global trends and to identify implantations least prone to subluxation, polyethylene liner rotation was additionally varied in coarser 30° increments across the entire 360° range. All subluxation caused by impingement occurred during external rotation and extension, and external rotation produced nearly 10-fold more subluxation than extension. Neutral glenoid component version was associated with the least amount of subluxation for all polyethylene liner rotations. Posteriorly rotated polyethylene liners, which place the thick inferior region of the component away from the scapula, produced the least amount of subluxation. The 90° and 120° posterior liner rotations produced no subluxation, whereas the 30° and 60° anterior liner rotations produced the greatest amount of subluxation. These results indicate that rotating modern radially asymmetric humeral polyethylene liners posteriorly can reduce the risk of subluxation leading to dislocation and increase external rotation range of motion. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. [Muscle efficiency in total shoulder prosthesis implantation: dependence on position of the humeral head and rotator cuff function].

    Science.gov (United States)

    Klages, A; Hurschler, C; Wülker, N; Windhagen, H

    2001-09-01

    Modern shoulder prostheses permit an anatomic reconstruction of the joint, although the biomechanical advantages are not proven. The goal of this study was to investigate the relationship between position of the humeral head and function of the shoulder prosthesis (muscle efficiency). Shoulder elevation-motion and rotator cuff defects were simulated in vitro in a robot-assisted shoulder simulator. The EPOCA Custom Offset shoulder prosthesis (Argomedical AG, Cham, CH) was implanted in seven normal shoulders (77 +/- 20 kg, 55 +/- 14 years). Active elevation was simulated by hydraulic cylinders, and scapulothoratic motion by a specially programmed industrial robot. Muscle efficiency (elevation-angle/muscle-force of the deltoid muscle) was measured in anatomic (ANA), medialised (MED) and lateralised (LAT) positions of the humeral head, with or without rotator cuff muscle deficiency. Medialisation increased efficiency by 0.03 +/- 0.04 deg/N (p = 0.022), lateralisation decreased it by 0.04 +/- 0.06 deg/N (p = 0.009). Supraspinatus muscle deficiency increased the deltoid force required to elevate the arm, and thus decreased efficiency (ANA p = 0.091, MED p = 0.018, LAT p = 0.028). The data confirm that the position of the humeral head affects the mechanics of total shoulder arthroplasty. Medialisation increases efficiency of the deltoid muscle and may prove useful in compensating isolated supraspinatus muscle deficiency. Lateralisation, in contrast, leads to an unfavorable situation.

  12. Radiological aspects of Arthroplasties

    International Nuclear Information System (INIS)

    Garcia, Sara Eugenia; Barragan, John Henry; Narvaez, Jorge Andres

    2008-01-01

    The development of new surgical techniques, of new prosthetic materials, and the increase in life expectancy with greater coverage of health services has ugmented the performance of hip replacements in our country. The radiologist should be familiar with the different surgical techniques and prosthetic devices, the evaluation of its components and associated complications. The most frequently performed arthroplasties are: shoulder, elbow, hip and knee replacement. This article reviews the most frequent prosthetic devices used, the radiological aspects of arthroplasties and their most common complications.

  13. Separated Shoulder

    Science.gov (United States)

    ... ligaments that hold your collarbone (clavicle) to your shoulder blade. In a mild separated shoulder, the ligaments might ... the ligaments that hold your collarbone to your shoulder blade. Risk factors Participating in contact sports, such as ...

  14. Shoulder pain

    Science.gov (United States)

    ... This condition is called rotator cuff tendinitis or bursitis. Shoulder pain may also be caused by: Arthritis ... shoulder joint Bone spurs in the shoulder area Bursitis , which is inflammation of a fluid-filled sac ( ...

  15. Shoulder arthroscopy

    Science.gov (United States)

    ... Bankart lesion; Shoulder repair; Shoulder surgery; Rotator cuff repair ... tissues include the cartilage, bones, tendons, and ligaments. ... in a muscle, tendon, or cartilage is fixed. Any damaged tissue ...

  16. Normal shoulder: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Kieft, G.J.; Bloem, J.L.; Obermann, W.R.; Verbout, A.J.; Rozing, P.M.; Doornbos, J.

    1986-06-01

    Relatively poor spatial resolution has been obtained in magnetic resonance (MR) imaging of the shoulder because the shoulder can only be placed in the periphery of the magnetic field. The authors have devised an anatomically shaped surface coil that enables MR to demonstrate normal shoulder anatomy in different planes with high spatial resolution. In the axial plane anatomy analogous to that seen on computed tomographic (CT) scans can be demonstrated. Variations in scapular position (produced by patient positioning) may make reproducibility of sagittal and coronal plane images difficult by changing the relationship of the plane to the shoulder anatomy. Oblique planes, for which the angle is chosen from the axial image, have the advantage of easy reproducibility. Obliquely oriented structures and relationships are best seen in oblique plane images and can be evaluated in detail.

  17. Dislocated Shoulder

    Science.gov (United States)

    ... seek prompt medical attention. Most people regain full shoulder function within a few weeks. However, once you've ... in your neck or down your arm. The muscles in your shoulder may spasm from the disruption, often increasing the ...

  18. Total shoulder replacement in rheumatoid arthritis

    DEFF Research Database (Denmark)

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

    1996-01-01

    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 migra...

  19. Shoulder pain.

    Science.gov (United States)

    Ramponi, Denise R

    2011-01-01

    Shoulder pain is a frequent complaint encountered in the emergency setting. A brief review of shoulder anatomy and physical examination sets the foundation for evaluation of shoulder pain. Considerations of patient's age are helpful to predict injuries. Fractured clavicles are often seen in traumatic injuries in children and young adults, whereas fractures of the humeral head are more often seen in the elderly from traumatic injuries. Shoulder dislocations are more common in teens to fourth decade. This article reviews specific acute injuries, chronic conditions, and radiologic considerations of patients with shoulder complaints encountered in emergency settings.

  20. Results of the Total Evolutive Shoulder System (TESS): a single-centre study of 56 consecutive patients.

    Science.gov (United States)

    Kadum, Bakir; Mafi, Nader; Norberg, Sigge; Sayed-Noor, Arkan S

    2011-12-01

    Shoulder arthroplasty surgery has undergone remarkable progress. New concepts like reverse and stemless shoulder prostheses have been widely used. The Total Evolutive Shoulder System (TESS) is a new innovative system that provides the surgeon with different prosthetic versions. The purpose of the present study was to evaluate our short-term results and complications of the TESS. 56 consecutive patients were operated with one of the two versions of TESS (anatomical or reverse) between October 2007 and December 2009. Preoperative and postoperative evaluation of the function and life quality was achieved by the Quick Disability of the Arm, Shoulder and Hand (DASH) index and EQ-5D self-report questionnaire, respectively. Radiographic follow-up by anteroposterior, axillary and lateral views was done. The anterosuperior approach was used in all cases. We compared the outcome in fracture patients with other categories. 49 patients were available for 9-24 months (mean 14) clinical and radiographic postoperative follow-up. The mean of quick DASH improved from 56 preoperatively to 34 postoperatively (p TESS prosthesis showed promising short-term results with few complications. The reverse version could be implanted without stem if initial stability was adequate. Long-term follow-up is required to confirm the results of this innovative system in the long run.

  1. Humeral head size in shoulder arthroplasty

    DEFF Research Database (Denmark)

    Vaesel, M T; Olsen, Bo Sanderhoff; Søjbjerg, Jens Ole

    1998-01-01

    Changes in kinematics after hemiarthroplasty of the glenohumeral joint were investigated in nine cadaveric specimens. During experiments the influence of the humeral head size on glenohumeral kinematics was evaluated. A modular prosthesis with five different head sizes and press-fit stems was used....... Three-dimensional kinematic measurements during abduction and adduction from 0 degree to 70 degrees showed increased external rotation with increasing head size. Small prosthetic heads translated inferiorly and large prosthetic heads superiorly compared with the intact humeral head. During forced...... anterior and posterior translation the mobility is restricted with increasing head size. This study found that when a press-fit prosthesis is used, it takes 1.25 times the volume of the intact humeral head to reconstruct the kinematics of the glenohumeral joint....

  2. Shoulder reflexes

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  3. Painful shoulder

    Directory of Open Access Journals (Sweden)

    Benno Ejnismann

    2008-03-01

    Full Text Available Many factors can be involved in the painful shoulder. Beyond articularcauses other pathologies such as artrosis, periarticular diseases as rotadorcuff tears, long head of the biceps tendinitis, adhesive capsulitis, calcifyingtendinitis, degenerative arthritis of the acromioclavicular joint, cervicalradiculopathy and nervous injuries can cause pain in the shoulder.

  4. Shoulder Fractures

    Science.gov (United States)

    ... as shown on an x-ray. Selection of treatment depends upon the patient’s activity level, the location of the fracture and the severity of the fracture. Recovery Shoulder fractures may leave a patient with permanent shoulder stiffness, regardless of ...

  5. Shoulder surgery - discharge

    Science.gov (United States)

    ... repair Shoulder arthroscopy Shoulder CT scan Shoulder MRI scan Shoulder ... by: C. Benjamin Ma, MD, Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, San Francisco, CA. ...

  6. Shoulder dystocia.

    Science.gov (United States)

    Grobman, William

    2013-03-01

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

  7. Revision after shoulder replacement for acute fracture of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig; Salomonsson, Björn; Jensen, Steen L

    2017-01-01

    fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Patients and methods - This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported...... and clinically relevant higher risk of revision because of infection....

  8. Total hip arthroplasty survival in femoral head avascular necrosis versus primary hip osteoarthritis: Case-control study with a mean 10-year follow-up after anatomical cementless metal-on-metal 28-mm replacement.

    Science.gov (United States)

    Ancelin, D; Reina, N; Cavaignac, E; Delclaux, S; Chiron, P

    2016-12-01

    Total hip arthroplasty is the most widely used procedure to treat avascular necrosis (AVN) of the femoral head. Few studies have compared the outcomes of THA in femoral head AVN and primary hip osteoarthritis. Therefore we performed a case-control study to compare THA for femoral head AVN vs. primary hip osteoarthritis in terms of: (1) prosthesis survival, (2) complication rates, (3) functional outcomes and radiographic outcomes, (4) and to determine whether specific risk factors for THA failure exist in femoral head AVN. THA survival is similar in femoral head AVN and primary hip osteoarthritis. We compared two prospective cohorts of patients who underwent THA before 65 years of age, one composed of cases with femoral head AVN and the other of controls with primary hip osteoarthritis. In both cohorts, a cementless metal-on-metal prosthesis with a 28-mm cup and an anatomical stem was used. Exclusion criteria were THA with other types of prosthesis, posttraumatic AVN, and secondary osteoarthritis. With α set at 5%, to obtain 80% power, 246 patients were required in all. Prosthesis survival was assessed based on time to major revision (defined as replacement of at least one implant fixed to bone) and time to aseptic loosening. The other evaluation criteria were complications, Postel-Merle d'Aubigné (PMA) score, and the Engh and Agora Radiographic Assessment (ARA) scores for implant osseointegration. The study included 282 patients, 149 with AVN and 133 with osteoarthritis. Mean age was 47.8±10.2 years (range, 18.5-65) and mean follow-up was 11.4±2.8 years (range, 4.5-18.3 years). The 10-year survival rates were similar in the two groups: for major revision, AVN group, 92.5% (95% confidence interval [95% CI], 90.2-94.8) and osteoarthritis group, 95.3% (95% CI, 92.9-97.7); for aseptic loosening, AVN group, 98.6% (95% CI, 97.6-98.6) and osteoarthritis, 99.2% (95% CI, 98.4-100). The AVN group had higher numbers of revision for any reason (19 vs. 6, P=0.018) and

  9. Potential axillary nerve stretching during RSA implantation: an anatomical study.

    Science.gov (United States)

    Marion, Blandine; Leclère, Franck Marie; Casoli, Vincent; Paganini, Federico; Unglaub, Frank; Spies, Christian; Valenti, Philippe

    2014-09-01

    Clinical and subclinical neurological injury after reverse shoulder arthroplasty (RSA) may jeopardize functional outcomes due to the risk of irreversible damage to the axillary nerve. We proposed a simple anatomical study in order to assess the macroscopic effects on the axillary nerve when lowering the humerus as performed during RSA implantation. We also measured the effect on the axillary nerve of a lateralization of the humerus. Between 2011 and 2012, cadaveric dissections of 16 shoulder specimens from nine fresh human cadavers were performed in order to assess the effects on the axillary nerve after the lowering and lateralization of the humerus. We assessed the extent of stretching of the axillary nerve in four positions in the sagittal plane [lowering of the humerus: great tuberosity in contact with the acromion (position 1), in contact with the upper (position 2), middle (position 3) and lower rim of the glenoid (position 4)] and three positions in the frontal plane [lateralization of the humerus: humerus in contact with the glenoid (position 1), humerus lateralized 1 cm (position 2) and 2 cm (position 3)]. When the humerus was lowered, clear macroscopical changes appeared below the middle of the glenoid (the highest level of tension). As regards the lateralization of the humerus, macroscopic study and measurements confirm the absence of stretching of the nerve in those positions. Lowering of the humerus below the equator of the glenoid changes the course and tension of the axillary nerve and may lead to stretching and irreversible damage, compromising the function of the deltoid. Improvements in the design of the implants and modification of the positioning of the glenosphere to avoid notching and to increase mobility must take into account the anatomical changes induced by the prosthesis and its impact on the brachial plexus. Level of Evidence and study type Level IV.

  10. Joint Arthroplasties other than the Hip in Solid Organ Transplant Recipients

    Science.gov (United States)

    Sayed-Noor, Arkan S

    2009-01-01

    Transplantation Surgery has undergone a great development during the last thirty years and the survival of solid organ recipients has increased dramatically. Osteo-articular diseases such as osteoporosis, fractures, avascular bone necrosis and osteoarthritis are relatively common in these patients and joint arthroplasty may be required. The outcome of hip arthroplasty in patients with osteonecrosis of the femoral head after renal transplantation has been studied and documented by many researchers. However, the results of joint arthroplasties other than the hip in solid organs recipients were only infrequently reported in the literature. A systematic review of the English literature was conducted in order to investigate the outcome of joint arthroplasties other than the hip in kidney, liver or heart transplant recipients. Nine pertinent articles including 51 knee arthroplasties, 8 shoulder arthroplasties and 1 ankle arthroplasty were found. These articles reported well to excellent results with a complication rate and spectrum comparable with those reported in nontransplant patients. PMID:19572036

  11. Dislocated Shoulder

    Science.gov (United States)

    ... to pull the bones out of place. Extreme rotation of your shoulder joint can pop the ball ... have discussed for your injury. By Mayo Clinic Staff . Mayo Clinic Footer Legal Conditions and Terms Any ...

  12. Shoulder replacement

    Science.gov (United States)

    ... problem. Many people are able to return to sports such as golf, swimming, gardening, bowling, and others. Your new shoulder joint will last longer if less stress is placed on it. With normal use, a ...

  13. Shoulder Instability

    Science.gov (United States)

    ... Your doctor might want you to have a magnetic resonance image (MRI) scan. An MRI lets your ... doctor if you can do resistance and weight-lifting exercises to help your shoulder muscles grow stronger. ...

  14. Frozen shoulder

    Science.gov (United States)

    ... ed. Philadelphia, PA: Elsevier; 2016:chap 35. Harris JD, Griesser MJ, Jones GL. Stiff shoulder. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice . 4th ed. Philadelphia, PA: ...

  15. Avaliação dos resultados da artroplastia parcial de ombro para tratamento da artropatia por lesão do manguito rotador Evaluating the results of partial shoulder arthroplasty for the treatment of arthropathy due to rotator cuff lesion

    Directory of Open Access Journals (Sweden)

    Sérgio Luiz Checchia

    2008-06-01

    Full Text Available OBJETIVO: Avaliar os resultados obtidos com a artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador. MÉTODOS: No período de junho de 1989 a março de 2004, 11 ombros de 11 pacientes foram submetidos a artroplastia parcial de ombro para o tratamento de artropatia por LMR. O tempo de seguimento variou de 27 a 183 meses, com média de 69 meses. A idade média foi de 69,1 anos, variando de 44 a 78 anos. Houve predomínio do sexo feminino em 90,9% dos casos (10 pacientes. O membro dominante foi acometido em 10 pacientes. Os métodos escolhidos para avaliação dos pacientes, no seguimento pós-operatório, basearam-se nos critérios da UCLA; no índice de satisfação dos pacientes em relação ao alívio da dor; e no método de avaliação de objetivos limitados, proposto por Neer et al. RESULTADOS: O índice de satisfação dos pacientes em relação ao alívio da dor foi de 81,8%. Com o método de avaliação da UCLA, observamos média de 22,7 pontos. Por meio do método de avaliação de objetivos limitados, proposto por Neer et al, obtivemos seis pacientes com resultados satisfatórios e cinco insatisfatórios. CONCLUSÃO: A artroplastia parcial de ombro para o tratamento da artropatia por lesão do manguito rotador promove alívio do quadro doloroso e permite alguma melhora na função do membro para realização das atividades diárias; entretanto, é uma técnica que leva a altos índices de resultados insatisfatórios.OBJECTIVE: To evaluate the results achieved with partial arthroplasty of the shoulder to treat arthropathy due to rotator cuff lesion. METHODS: From June 1989 to March 2004, 11 shoulders of 11 patients were submitted to partial arthroplasty of the shoulder to treat an arthropathy due to rotator cuff lesion. Follow-up time varied from 27 to 182 months, with a mean of 69 months. Mean age was 69.1 years, ranging from 44 to 78 years. There was a predominance of the female gender, in 90.9% of

  16. Imaging shoulder impingement

    Energy Technology Data Exchange (ETDEWEB)

    Gold, R.H. (Dept. of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA (United States)); Seeger, L.L. (Dept. of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA (United States)); Yao, L. (Dept. of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA (United States))

    1993-11-01

    Appropriate imaging and clinical examinations may lead to early diagnosis and treatment of the shoulder impingement syndrome, thus preventing progression to a complete tear of the rotator cuff. In this article, we discuss the anatomic and pathophysiologic bases of the syndrome, and the rationale for certain imaging tests to evaluate it. Special radiographic projections to show the supraspinatus outlet and inferior surface of the anterior third of the acromion, combined with magnetic resonance images, usually provide the most useful information regarding the causes of impingement. (orig.)

  17. Imaging shoulder impingement

    International Nuclear Information System (INIS)

    Gold, R.H.; Seeger, L.L.; Yao, L.

    1993-01-01

    Appropriate imaging and clinical examinations may lead to early diagnosis and treatment of the shoulder impingement syndrome, thus preventing progression to a complete tear of the rotator cuff. In this article, we discuss the anatomic and pathophysiologic bases of the syndrome, and the rationale for certain imaging tests to evaluate it. Special radiographic projections to show the supraspinatus outlet and inferior surface of the anterior third of the acromion, combined with magnetic resonance images, usually provide the most useful information regarding the causes of impingement. (orig.)

  18. [Screw arthrodesis of the shoulder].

    Science.gov (United States)

    Lerch, S; Berndt, T; Lipka, W; Rühmann, O

    2011-07-01

    The aim of the procedure is arthrodesis of the shoulder by osteosynthesis of the glenohumeral and the acromiohumeral joint each with three screws, which results in preservation of scapulothoracic motion and pain relief. Traumatic brachial plexus lesions, palsy in infancy, poliomyelitis with preserved or restorable function of the elbow and the hand. Paralysis of the deltoid muscle and the rotator cuff. Nonrestorable vast defect of the rotator cuff with pseudoparalysis. Chronic infectious arthritis resistant to therapy. Unsuccessful attempts to treat glenohumeral instability. Alternative procedure to shoulder arthroplasty in young patients with omarthrosis, who perform hard physical work. Insufficient strength of the scapular muscles (Weaning from the splint after the end of the week 6 postoperatively, full range of motion allowed. In a prospective study from January 2007 to September 2008, 4 patients with a medium age of 35.7 years underwent screw arthrodesis of the shoulder with a follow-up of 1.0 (0.6-1.5) year. Primary fusion of all arthrodesis surfaces was achieved in all patients; no revision surgery was necessary. All patients improved in shoulder function with an average range of motion of 60° abduction and 40° anteversion.

  19. Shoulder biomechanics

    Energy Technology Data Exchange (ETDEWEB)

    Lugo, Roberto; Kung, Peter; Ma, C. Benjamin [Sports Medicine and Shoulder Service, University of California, San Francisco, 500 Parnassus Avenue, MU 320W-0728 San Francisco, CA 914143 (United States)], E-mail: maben@orthosurg.ucsf.edu

    2008-10-15

    The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic-stabilizing structures. Static stabilizers include the bony anatomy, negative intra-articular pressure, the glenoid labrum, and the glenohumeral ligaments along with the joint capsule. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. The combined effect of these stabilizers is to support the multiple degrees of motion within the glenohumeral joint. The goal of this article is to review how these structures interact to provide optimal stability and how failure of some of these mechanisms can lead to shoulder joint pathology.

  20. Shoulder proprioception - lessons we learned from idiopathic frozen shoulder.

    Science.gov (United States)

    Fabis, Jaroslaw; Rzepka, Remigiusz; Fabis, Anna; Zwierzchowski, Jacek; Kubiak, Grzegorz; Stanula, Arkadiusz; Polguj, Michal; Maciej, Radek

    2016-03-12

    Of all the most frequent soft tissue disorders of the shoulder, idiopathic frozen shoulder (IFS) offers the greatest potential for studying proprioception. Studies concerning the presence of proprioception dysfunctions have failed to determine the potential for spontaneous healing of passive shoulder stabilizers (anterior and posterior capsule, middle and inferior gleno-humeral ligaments), its relationship with passive (PJPS) and active (AJPS) shoulder proprioception for internal and external rotation (IR, ER), as well as the isokinetic muscle performance of the internal and external rotators. This study investigates these dependencies in the case of arthroscopic release of IFS. The study group comprised 23 patients (average aged 54.2) who underwent arthroscopic release due to IFS and 20 healthy volunteers. The average follow-up time was 29.2 months. The Biodex system was used for proprioception measurement in a modified neutral arm position and isokinetic evaluation. The results were analysed using the T-test, Wilcoxon and interclass correlation coefficient. P-values lower than 0.05 were considered significant. Statistically significant differences were found between involved (I) and uninvolved (U) shoulders only in the cases of PJPS and AJPS, peak torque, time to peak torque and acceleration time for ER (p  0.05) for the U shoulders. The anatomical structure of anterior (capsule, middle and anterior band of inferior gleno-humeral ligament) and posterior (capsule and posterior band of inferior gleno-humeral ligament) passive shoulder restraints has no impact on the difference in PJPS values between ER and IR in a modified neutral shoulder position. The potential for spontaneous healing of the anterior and posterior passive shoulder restraints influences PJPS recovery after arthroscopic release of IFS. ER peak torque deficits negatively affect AJPS values. PJPS and AJPS of ER and IR can be measured with a high level of reproducibility using an isokinetic

  1. CT diagnosis with shoulder joint injuries

    International Nuclear Information System (INIS)

    Gay, B.; Hoerl, M.; Schindler, G.

    1986-01-01

    With recidivistic shoulder luxation the CT examination makes possible the objective comprehension of predisposable anatomical evidence as well as the proof of posttraumatic changes. Changes in the acetabular margin (Bankart lesion) as well as in the humerus head (Hills-Sachs lesion) are depicted with recidivistic shoulder luxation as the morphological substrate of the posttraumatic damage. Individual examinations of 83 patients with recidivistic shoulder luxations showed that the mentioned changes often appear in combinations. With the CT examination the Hills-Sachs lesion can be comprehended and its location, extension and depth can be judged as well. (orig./MG) [de

  2. Diagnosis and Management of Periprosthetic Shoulder Infections.

    Science.gov (United States)

    Mook, William R; Garrigues, Grant E

    2014-06-04

    ➤ The unique bacterial flora of the shoulder present diagnostic and treatment challenges that are distinct from those seen with failed hip and knee arthroplasties.➤ The presentation, diagnosis, and management of suppurative periprosthetic joint infections of the shoulder are similar to those of the hip and the knee.➤ Failed arthroplasties with positive cultures (FAPCs) are poorly performing shoulder reconstructions associated with low-virulence microorganisms that do not evoke a suppurative inflammatory response. Propionibacterium acnes is the predominant bacterium isolated from these cases.➤ With improved surgeon awareness and the addition of longer tissue-culture incubation times, detection of FAPCs has become more common. However, management is hampered by the lack of reliable, timely tests that can determine the presence of less virulent organisms in the preoperative or intraoperative settings.➤ The implications of positive culture results in FAPCs are unclear. Key test characteristics such as the false-positive rate and the prevalence of positive cultures in well-performing shoulders are unknown as there is no useful confirmatory test to validate the culture data and no reliable way to detect the presence of less virulent microorganisms without reoperation.➤ Soft-tissue and osseous deficits are frequently encountered when revising previously infected shoulders. The rate of complications in these scenarios is high, and the outcomes are the least favorable compared with revisions for any other indication.➤ The development of a consensus definition of a periprosthetic shoulder infection is critical to future investigations of these devastating complications. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

  3. The experience of the RIPO, a shoulder prosthesis registry with 6-year follow-up.

    Science.gov (United States)

    Porcellini, G; Combi, A; Merolla, G; Bordini, B; Stea, S; Zanoli, G; Paladini, P

    2017-12-04

    Implant registries have proved valuable in assessing the outcomes of arthroplasty procedures. Moreover, by identifying lesser quality implants they have indirectly improved the quality of care. The registry of prosthetic shoulder implants was established in 2008. It records information on all types of primary and revision arthroplasty procedures involving the glenohumeral joint, including reverse and total arthroplasty, hemiarthroplasty, resurfacing, removal, and any other surgical procedures that are required to manage these patients. The collected data include patient demographics, weight, height, operated side, cuff status, and diagnosis/reason for revision surgery, information on previous surgical procedures involving either shoulder, comorbidities, antibiotic and thromboembolic prophylaxis, blood transfusions, surgical approach, cuff repair procedures performed during arthroplasty, bone grafts, drains, and perioperative complications, and data about the prosthetic components implanted, including the fixation method. Procedures were performed on 3754 shoulders. They included 2226 RSA, 320 TSA, 730 HA, 233 resurfacing procedures, 245 revisions, and 77 "other" procedures. The survival curves of the implants are greater than 90%, and no differences were found among prosthesis from different manufacturers. The diagnosis that prompted to arthroplasty was: osteoarthritis in 60.9% of cases and fractures, bone necrosis, sequelae of fracture and rotator cuff tear arthropathy for the rest of implants. This study describes the epidemiological data and mid-term implant outcomes of the shoulder arthroplasty procedures performed in our region, from 2008 to 2014, and compares them with published data from national registries of similar size. III.

  4. Revision after shoulder replacement for acute fracture of the proximal humerus.

    Science.gov (United States)

    Brorson, Stig; Salomonsson, Björn; Jensen, Steen L; Fenstad, Anne Marie; Demir, Yilmaz; Rasmussen, Jeppe V

    2017-08-01

    Background and purpose - For more than half a century, stemmed hemiarthroplasty (SHA) has been used in the treatment of comminuted and displaced fractures of the proximal humerus. Reverse shoulder arthroplasty (RSA) has been increasingly popular in cases where it is difficult to obtain satisfactory fixation of the tuberosities. We report revision rates and reasons for revision after shoulder arthroplasty for acute fractures of the proximal humerus. Patients and methods - This study was based on a common dataset from the Nordic Arthroplasty Register Association (NARA), which includes data reported to the national shoulder arthroplasty registries in Denmark, Sweden, and Norway. We included 6,756 shoulder arthroplasties performed for acute fractures between 2004 and 2013. Results - There were 6,112 SHAs (90%) and 565 RSAs (8.4%). The cumulative arthroplasty survival rate after 5 years was 0.96 for both SHA and RSA. The relative risk of revision of RSA was 1.4 (95% CI: 0.9-2.2) with SHA as reference. For both types of arthroplasty, the most common reason for revision was infection (SHA 0.8%, RSA 2.1%). The relative risk of revision due to infection was 3.1 (95% CI: 1.6-5.9) for RSA with SHA as reference. The relative risk of revision for patients who were less than 75 years of age was 2.8 (95% CI: 2.0-3.8) compared to older patients. Interpretation - Revision after shoulder arthroplasty for acute fractures was rare. Survival rates were similar between SHA and RSA, but RSA had a statistically significant and clinically relevant higher risk of revision because of infection.

  5. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient.

    Science.gov (United States)

    Kane, Patrick M; Stull, Justin D; Culp, Randall W

    2016-05-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis. Concomitant total wrist and total elbow arthroplasty was performed with satisfactory results at both joints. She tolerated the procedure well and had an uneventful clinical course postoperatively. Literature Review Currently, no literature exists that describes one-stage total wrist and total elbow arthroplasty. Individually, total wrist and total elbow arthroplasty have both been reported to result in good outcomes and patient satisfaction. Previous studies have reported the utility of concomitant ipsilateral upper extremity procedures with a one-stage total elbow and total shoulder arthroplasty having been identified as a cost-saving procedure with expedited return to functionality versus a two-stage procedure. Clinical Relevance Patients with ipsilateral degenerative changes in the wrist and elbow should be considered on an individual case basis for concomitant total wrist and total elbow arthroplasty.

  6. Concomitant Total Wrist and Total Elbow Arthroplasty in a Rheumatoid Patient

    Science.gov (United States)

    Kane, Patrick M.; Stull, Justin D.; Culp, Randall W.

    2015-01-01

    Background Concomitant arthroplasty has been described to have several benefits over multistage procedures. Ipsilateral total elbow and total shoulder arthroplasty has been reported with good outcomes in upper extremity concomitant arthroplasty. Case Description A 65-year-old woman presented with ipsilateral left-sided wrist and elbow joint degeneration as a result of longstanding rheumatoid arthritis. Concomitant total wrist and total elbow arthroplasty was performed with satisfactory results at both joints. She tolerated the procedure well and had an uneventful clinical course postoperatively. Literature Review Currently, no literature exists that describes one-stage total wrist and total elbow arthroplasty. Individually, total wrist and total elbow arthroplasty have both been reported to result in good outcomes and patient satisfaction. Previous studies have reported the utility of concomitant ipsilateral upper extremity procedures with a one-stage total elbow and total shoulder arthroplasty having been identified as a cost-saving procedure with expedited return to functionality versus a two-stage procedure. Clinical Relevance Patients with ipsilateral degenerative changes in the wrist and elbow should be considered on an individual case basis for concomitant total wrist and total elbow arthroplasty. PMID:27104080

  7. MRI of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.

    2000-02-01

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

  8. MRI of the shoulder

    International Nuclear Information System (INIS)

    Vahlensieck, M.

    2000-01-01

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

  9. Ultrasonographic evaluation of the canine shoulder.

    Science.gov (United States)

    Long, C D; Nyland, T G

    1999-01-01

    The aim of this study was to determine the normal ultrasonographic anatomy of the canine shoulder. Fourteen shoulders from 7 clinically normal mid-sized dogs were radiographed and imaged using high frequency ultrasound. Each shoulder was isolated postmortem, and the ultrasonographic and gross anatomy was studied during dissection. The ultrasonographic appearance of the shoulder specimens was similar to that found in the live dogs. Twenty-four shoulders isolated postmortem from 12 variably sized dogs were also used to characterize the normal ultrasound anatomy over a range of sizes. Important anatomic structures that could be consistently evaluated were the biceps tendon and bursa, the bicipital groove surface, the supraspinatous tendon, the infraspinatous tendon, the teres minor tendon, and the caudal aspect of the humeral head. Results of ultrasonographic examination of 4 dogs with shoulder lameness are described to illustrate some applications of canine shoulder ultrasonography in the evaluation of the canine shoulder. In these dogs, ultrasound was a valuable tool to evaluate effusion and synovial proliferation within the bicipital bursa, supraspinatous and biceps tendinitis, biceps tendon strain, and dystrophic calcification.

  10. Shoulder separation - aftercare

    Science.gov (United States)

    ... the collarbone (clavicle) meets the top of the shoulder blade (acromion of the scapula). It is not the same as a shoulder ... that connects the collarbone and top of the shoulder blade. These tears can also come from car accidents ...

  11. Pregnancy Complications: Shoulder Dystocia

    Science.gov (United States)

    ... X Home > Complications & Loss > Pregnancy complications > Shoulder dystocia Shoulder dystocia Now playing: E-mail to a friend Please ... some women more likely than others to have shoulder dystocia? A pregnant woman may be at risk for ...

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

    Directory of Open Access Journals (Sweden)

    S. K. Mustafa

    2006-01-01

    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.

  13. Hyperphosphatemic Tumoral Calcinosis after Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Takeshi Mochizuki

    2017-01-01

    Full Text Available We report a case of hyperphosphatemic tumoral calcinosis (TC that occurred after total knee arthroplasty. A 64-year-old Japanese man presented with painful swellings in both shoulders, the left elbow, and the right hip that developed after he underwent total knee arthroplasty (TKA. The pathology of the patient’s bone at the time of TKA included a thick osteoid seam with calcareous deposition at the margin of the trabecular bone, which is not generally seen in osteoarthritis. Computed tomography scans of the swollen joints demonstrated leaflet and amorphous calcification masses around the joints. We diagnosed the patient with TC. The present case highlights that TC lesions are rare but should be considered in the differential diagnosis of subcutaneous soft and hard masses around the joint.

  14. [Modern imaging in radioanatomic study of the shoulder].

    Science.gov (United States)

    Lucas, C; De Korvin, B; al Ghossein, I; Kadouch, R; Duvauferrier, R

    1989-01-01

    The authors describe the most appropriate imaging technique or techniques for assessment of each anatomical structure in the shoulder: the head of the humerus, socket, acromion, joint space, labrum, musculotendinous structures of the supraspinatus, subscapularis and long biceps muscles. The techniques used are the most useful view of standard X-rays, as well as arthropathy, CT scan, arthroscan, ultrasonography and MRI. This is a preliminary study to assessment of shoulder lesions. In the shoulder, radiologists are frequently required to identify the anatomical disorder as exactly as possible without falling into the traps associated with all forms of imaging even the most sophisticated.

  15. Soft tissue disorders of the shoulder. Frozen shoulder, calcific tendintis, and bicipital tendinitis.

    Science.gov (United States)

    Simon, W H

    1975-04-01

    The painful periarticular conditions about the shoulder joint-calcific tendinitis, bicipital tendinitis, and frozen shoulder syndrome-are seen commonly in the general practice of medicine or in the practice of orthopedic surgery. Their etiologies are unknown. Their treatment is relatively simple and depends upon a knowledge of the anatomic structures involved and the proper use of rest and exercise. Operative intervention is rarely necessary in any of these conditions. The frozen shoulder syndrome, however, in our experience is best treated in the subacute or chronic stages by infiltration brisement under general anesthesia.

  16. Hemiplegic Shoulder Pain.

    Science.gov (United States)

    Wilson, Richard D; Chae, John

    2015-11-01

    Hemiplegic shoulder pain is a common complaint for stroke survivors. Many pathologies are included in the diagnosis of hemiplegic shoulder pain, and many with shoulder pain have a multifactorial cause. This article provides rehabilitation specialists with an approach to evaluation and management of those with hemiplegic shoulder pain. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. The influence of computer-assisted surgery on rotational, coronal and sagittal alignment in revision total knee arthroplasty

    NARCIS (Netherlands)

    Meijer, Marrigje F; Stevens, Martin; Boerboom, Alexander L; Bulstra, Sjoerd K; Reininga, Inge Hf

    2014-01-01

    Background: Despite good results of primary total knee arthroplasty (TKA), the number of revision total knee arthroplasties (rTKAs) is rising. Proper implant position is essential, since malposition leads to worse clinical outcome. In rTKA most anatomical landmarks have disappeared because of

  18. Conversion of a surgical elbow arthrodesis to total elbow arthroplasty.

    Science.gov (United States)

    Rog, Dominik; Zuckerman, Lee M; Riedel, Barth

    2015-01-01

    Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior.

  19. Conversion of a Surgical Elbow Arthrodesis to Total Elbow Arthroplasty

    Directory of Open Access Journals (Sweden)

    Dominik Rog

    2015-01-01

    Full Text Available Arthrodesis of the elbow joint addresses pain due to intra-articular pathology, but with significant functional limitations. Loss of motion at the elbow is not completely compensated by the wrist and shoulder joints and elbow fusion is thus purely a salvage procedure. Advances in joint arthroplasty have allowed surgeons to address the functional limitations of arthrodesis, but despite these advances the elbow is still one of the joint replacements with higher complication rate. Conversion of a joint fusion to arthroplasty has been reported for the hip, knee, shoulder, and ankle. The takedown of a surgically fused elbow was reported in German literature in 2013. We present the first such case report in the English literature with a 49-year-old male whose status is elbow fusion performed for trauma 31 years prior.

  20. Web Page Content and Quality Assessed for Shoulder Replacement.

    Science.gov (United States)

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

    2016-01-01

    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.

  1. [Classification of periprosthetic shoulder fractures].

    Science.gov (United States)

    Kirchhoff, C; Kirchhoff, S; Biberthaler, P

    2016-04-01

    The key targets in the treatment of periprosthetic humeral fractures (PHF) are the preservation of bone, successful bony consolidation and provision of a stable anchoring of the prosthesis with the major goal of restoring the shoulder-arm function. A substantial problem of periprosthetic shoulder fractures is the fact that treatment is determined not only by the fracture itself but also by the implanted prosthesis and its function. Consequently, the exact preoperative shoulder function and, in the case of an implanted anatomical prosthesis, the status and function of the rotator cuff need to be assessed in order to clarify the possibility of a secondarily occurring malfunction. Of equal importance in this context is the type of implanted prosthesis. The existing classification systems of Wright and Cofield, Campbell et al., Groh et al. and Worland et al. have several drawbacks from a shoulder surgeon's point of view, such as a missing reference to the great variability of the available prostheses and the lack of an evaluation of rotator cuff function. The presented 6‑stage classification for the evaluation of periprosthetic fractures of the shoulder can be considered just as simple or complex to understand as the classification of the working group for osteosynthesis problems (AO, Arbeitsgemeinschaft für Osteosynthesefragen), depending on the viewpoint. From our point of view the classification presented here encompasses the essential points of the existing classification systems and also covers the otherwise missing points, which should be considered in the assessment of such periprosthetic fractures. The classification presented here should provide helpful assistance in the daily routine to find the most convenient form of therapy.

  2. Magnetic Resonance Imaging of the Rotator Cuff in Destroyed Rheumatoid Shoulder: Comparison with Findings during Shoulder Replacement

    International Nuclear Information System (INIS)

    Soini, I.; Belt, E.A.; Niemitukia, L.; Maeenpaeae, H.M.; Kautiainen, H.J.

    2004-01-01

    Purpose: To evaluate the predictive value of preoperative magnetic resonance imaging (MRI) with respect to rotator cuff ruptures. Material and Methods: Thirty-one patients with rheumatic disease underwent preoperative MRI before shoulder arthroplasty. The scans were reviewed independently by two experienced radiologists. Three surgeons performed all the replacements (hemiarthroplasties), and the condition of the rotator cuff was assessed. Complete and massive tears of the rotator cuff were recorded and compared at surgery and on MRI. Results: With MRI, 21 shoulders (68%) were classified as having complete or massive tears of the rotator cuff and at surgery 14 shoulders (45%). Cohen's kappa coefficient was 0.44 (95% CI: 0.16 to 0.72) and accuracy 0.71 (95% CI: 0.52 to 0.86). Conclusion: In severely destroyed rheumatoid shoulder, the findings of soft tissues were incoherent both with MRI and at surgery. The integrity of tendons could not readily be elucidated with MRI because of an inflammatory process and scarred tissues; in surgery, too, changes were frequently difficult to categorize. Preoperative MRI of severely destroyed rheumatoid shoulder before arthroplasty turned out to be of only minor importance

  3. CT scan evaluation of glenoid bone and pectoralis major tendon: interest in shoulder prosthesis

    Science.gov (United States)

    Obert, Laurent; Peyron, Christelle; Boyer, Etienne; Menu, Gauthier; Loisel, François; Aubry, Sébastien

    2016-01-01

    Introduction: The shoulder arthroplasty brings satisfaction to patients in terms of quality of life and indolence. However whether anatomic implant or reverse, it does not escape from the loosening of the glenoid component. Moreover, optimal implantation is required to ensure the functional outcome without shortening of the arm. The purpose of this study is obtain CT scan evaluation of the glenoid bone stock in order to optimize glenoid component implantation and obtain a reference to determine optimal humeral component placement in case of humeral proximal fracture. Materials and methods: Between 2010 and 2011 we have analyzed 200 intact shoulder’s CT. We measured maximal and minimal width in the transverse plane of the glenoid, the distance from the pectoralis major (PM) tendon to the humeral head, the greater tubercle, change of curvature and the anatomical neck. Results: Mean maximum width was 27.4 ± 3.4 mm and mean minimum width was 15.5 ± 2.8 mm. Distances between upper edge of PM tendon to: humeral head, greater tubercle, change of curvature and anatomical neck were respectively: 67.6 ± 9.98 mm, 57.8 ± 10.3 mm, 28.7 ± 9 mm, and 34.2 ± 9.7 mm. Conclusion: Our study has produced an assessment of glenoid bone stock for optimal positioning of the glenoid implant but also to obtain a reference to determine the ideal location of the humeral component in the case of proximal humerus fracture. PMID:27716461

  4. CT scan evaluation of glenoid bone and pectoralis major tendon: interest in shoulder prosthesis

    Directory of Open Access Journals (Sweden)

    Obert Laurent

    2016-01-01

    Full Text Available Introduction: The shoulder arthroplasty brings satisfaction to patients in terms of quality of life and indolence. However whether anatomic implant or reverse, it does not escape from the loosening of the glenoid component. Moreover, optimal implantation is required to ensure the functional outcome without shortening of the arm. The purpose of this study is obtain CT scan evaluation of the glenoid bone stock in order to optimize glenoid component implantation and obtain a reference to determine optimal humeral component placement in case of humeral proximal fracture. Materials and methods: Between 2010 and 2011 we have analyzed 200 intact shoulder’s CT. We measured maximal and minimal width in the transverse plane of the glenoid, the distance from the pectoralis major (PM tendon to the humeral head, the greater tubercle, change of curvature and the anatomical neck. Results: Mean maximum width was 27.4 ± 3.4 mm and mean minimum width was 15.5 ± 2.8 mm. Distances between upper edge of PM tendon to: humeral head, greater tubercle, change of curvature and anatomical neck were respectively: 67.6 ± 9.98 mm, 57.8 ± 10.3 mm, 28.7 ± 9 mm, and 34.2 ± 9.7 mm. Conclusion: Our study has produced an assessment of glenoid bone stock for optimal positioning of the glenoid implant but also to obtain a reference to determine the ideal location of the humeral component in the case of proximal humerus fracture.

  5. Diagnostic shoulder arthroscopy: incidence of physiologic variants of joint structures

    Directory of Open Access Journals (Sweden)

    Martin Mikek

    2005-04-01

    Full Text Available Background: Shoulder arthroscopy first described by Burman already in 1930, has evolved only in last 15 years to become a common accepted diagnostic and therapeutic procedure in treatment of different shoulder conditions. Parallely to the advances in arthroscopic operative techniques also our knowledge about arthroscopic shoulder anatomy expanded and many physiologic variants in anatomical structures have been identified in glenohumeral joint. It is very important to be familiar with those when performing shoulder arthroscopy, since in some cases they can easily be mistaken for pathologic lesions which can lead to unnecessary and potentially harmful operative procedures.Methods: We prospectively evaluated arthroscopic shoulder anatomy in 54 consecutive shoulder arthroscopies performed for different shoulder conditions in our practice. In all patients diagnostic arthroscopy was performed following the SCOI protocol described by Snyder. With regard to the anatomy variants described in literature and its importance in shoulder arthroscopy, special attention was focused on three regions of glenohumeral joint: long head of biceps tendon with its anchor and adjacent superior labrum, anterior joint capsule with glenohumeral ligaments and subscapularis tendon and on anterior labrum. The incidence of the observed anatomical variants was calculated. The most common combinations of anatomy variants were described and schematically presented.Results: The most significant anatomical variant observed in the region of long head of biceps tendon, biceps anchor and superior labrum was sublabral sulcus that was observed in 17% of shoulders. The region of anterior capsule with glenohumeral ligaments and subscapularis tendon showed greatest anatomical variability, especially the MGHL and the IGHL were very variably expressed and in some cases also absent. In the region of anterior labrum two significant anatomical variants were observed, one of them sublabral hole

  6. 9. Painful shoulder complaints.

    Science.gov (United States)

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

    2010-01-01

    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.

  7. Shoulder pain in primary care: frozen shoulder.

    Science.gov (United States)

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound.

  8. Shoulder Problems in Athletes.

    Science.gov (United States)

    Clancy, William G., Jr.

    A description is given of typical sport-related injuries to the shoulder area. These include: (1) brachial plexus injuries; (2) peripheral nerve injuries about the shoulder; (3) acromioclavicular injuries; (4) sternoclavicular injuries; (5) shoulder dislocations; (6) recurrent traumatic subluxation/dislocations; and (7) overuse injuries.…

  9. Treatment and follow-up of a locked posterior shoulder dislocation

    DEFF Research Database (Denmark)

    Schmal, Hagen; Klemt, Christof; Südkamp, Norbert P.

    2004-01-01

    Posterior shoulder dislocation appears to be a rare event and is a frequently overlooked problem in traumatology. Once the diagnosis is made, usually by clinical examination and use of conventional radiography, head damage should be evaluated by an arthro-CT of the shoulder. In case of severe...... humeral head damage and advanced age, arthroplasty of the shoulder seems to provide a reliable treatment method. Implantation of a new-generation prosthesis in a female patient and follow-up by assessment using the Constant-Murley score are described. © Urban & Vogel....

  10. ESTUDO ANATÔMICO DAS ARTÉRIAS DO OMBRO DE Cebus libidinosus (RYLANDS, 2000; PRIMATES – CEBIDAE ANATOMIC STUDY OF ARTERIES OF SHOULDER Cebus libidinosus (RYLANDS, 2000; PRIMATES - CEBIDAE

    Directory of Open Access Journals (Sweden)

    Yandra Cássia Lobato do Prado

    2007-07-01

    Full Text Available As pesquisas nos Cebus libidinosus têm sido incremAs pesquisas nos Cebus libidinosus têm sido in¬crementadas, em razão do pouco conhecimento de sua morfofisiologia e por terem expressivo desenvolvimento psicomotor comparável ao dos primatas do Velho Mundo. A região do ombro merece especial atenção, em virtude dos hábitos arborícolas e as constantes manipulações de objetos. Neste trabalho utilizaram-se 24 exemplares de Cebus libidinosus doados pelo Instituto Brasileiro do Meio Ambiente (IBAMA de Sete Lagoas, MG, Brasil, sacrificados de acordo com as recomendações do Comitê Brasileiro de Experimentação Animal (COBEA e inclu¬ídos nas coleções anatômicas da Universidade Federal de Uberlândia (UFU e Universidade Federal de Goiás (UFG. O sistema arterial destes indivíduos foi injetado com látex corado e posteriormente dissecaram-se as artérias sob lupa estereoscópica. Na maioria dos casos, as artérias encontra¬da, apresentaram relativa correspondência de distribuição e número comparável ao modelo humano e de outros primatas, com variações quanto à frequência e origem dos vasos. De modo geral as artérias do ombro deste Cebídeo se originaram de vasos derivados indiretamente da artéria axilar, uma vez que surgiram como pequenos troncos arte¬riais que se subdividiram, e não como ramos individuais, como descrito nos outros animais estudados, e de modo específico ocorreram variações de todas as estruturas em relação aos outros primatas estudados. PALAVRAS-CHAVES: Anatomia, artérias, Cebus libidinosus, primatas. The researches in Cebus libidinosus has been reali¬zed because less known about your morphophisiology and its expressive psychomotor development comparative with Old World primates. The shoulder regions deserve special attention because behavior paste and objects manipulations. Twenty four Cebus specimens were donated by the “Bra¬zilian Institute for Environment and Recyclable Natural Resources

  11. The volleyball athlete's shoulder: biomechanical adaptations and injury associations.

    Science.gov (United States)

    Challoumas, Dimitrios; Stavrou, Antonio; Dimitrakakis, Georgios

    2017-06-01

    In volleyball, the dominant shoulder of the athlete undergoes biomechanical and morphological adaptations; however, definitive conclusions about their exact nature, aetiology, purpose and associations with shoulder injury have not been reached. We present a systematic review of the existing literature describing biomechanical adaptations in the dominant shoulders of volleyball players and factors that may predispose to shoulder pain/injury. A thorough literature search via Medline, EMBASE and SCOPUS was conducted for original studies of volleyball players and 15 eligible articles were identified. Assessment of study quality was performed using the STROBE statement. The reviewed literature supports the existence of a glenohumeral internal rotation deficit (GIRD) and a possible (and less pronounced) external rotation gain in the dominant vs. the non-dominant shoulder of volleyball athletes. Unlike other overhead sports, the GIRD in volleyball athletes appears to be anatomical as a response to the repetitive overhead movements and not to be associated with shoulder pain/injury. Additionally, the dominant shoulder exhibits muscular imbalance, which appears to be a significant risk factor for shoulder pain. Strengthening of the external rotators should be used alongside shoulder stretching and joint mobilisations, core strengthening and optimisation of spike technique as part of injury management and prevention programmes.

  12. Clinical forms of shoulder instability in pediatric patients

    Directory of Open Access Journals (Sweden)

    Yaroslav N. Proshchenko

    2016-12-01

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

  13. The painful shoulder

    International Nuclear Information System (INIS)

    Hartl, P.W.

    1987-01-01

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

  14. Magnetic resonance imaging of the shoulder: Rationale and current applications

    International Nuclear Information System (INIS)

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

    1990-01-01

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

  15. Os acromiale causing shoulder impingement syndrome: a case report

    International Nuclear Information System (INIS)

    Romero, I.; Rodriguez, A.; Roca, M.; Garcia, Y.

    2001-01-01

    Shoulder impingement syndrome is caused by repeated mechanical trauma to the rotator cuff due to encroachment of the coracoacromial ligament; in most cases, it is a primary lesion. Os acromiale, an anatomic variant of the shoulder structures, is one of the predisposing factors for the development of this entity. We present a case of os acromiale complicated by complete rupture of the tendon of the supraspinatus muscle and luxation of the long head of the biceps tendon. We stress the importance of magnetic resonance in the study of this anatomic variant and in the detection of complications or associated lesions. (Author) 10 refs

  16. Outpatient Total Joint Arthroplasty.

    Science.gov (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam

    2017-12-01

    Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

  17. Imaging of hip arthroplasty

    International Nuclear Information System (INIS)

    Breitenseher, M.J.; Mayerhoefer, M.; Gottsauner-Wolf, F.; Krestan, C.; Imhof, H.; Toma, C.D.

    2002-01-01

    Hip arthroplasty has become a common and still increasing procedure for the treatment of osteoarthritis, advanced head necrosis, post-inflammatory arthritis or rheumatoid arthritis.Radiography is the most important imaging modality for monitoring the normal, asymptomatic hip arthroplasty. Radiographs are obtained at the end of a surgical treatment, to exclude complications like fracture or component misplacement. In the follow-up radiographs are used for the diagnosis of loosening and infection of the hip arthroplasty as well as soft tissue ossification. Together with the history and clinical information, the analysis of morphological findings allows to find the grade of loosening. MRI has been advocated in the diagnosis of infection, in particular in the localisation of soft tissue involvement.Imaging, especially by radiographs, is used for the evaluation of the normal and complicated follow-up of hip arthroplasty. (orig.) [de

  18. Outcome, revision rate and indication for revision following resurfacing hemiarthroplasty for osteoarthritis of the shoulder

    DEFF Research Database (Denmark)

    Rasmussen, J V; Polk, A; Sorensen, A K

    2014-01-01

    In this study, we evaluated patient-reported outcomes, the rate of revision and the indications for revision following resurfacing hemiarthroplasty of the shoulder in patients with osteoarthritis. All patients with osteoarthritis who underwent primary resurfacing hemiarthroplasty and reported...... to the Danish Shoulder Arthroplasty Registry (DSR), between January 2006 and December 2010 were included. There were 772 patients (837 arthroplasties) in the study. The Western Ontario Osteoarthritis of the Shoulder (WOOS) index was used to evaluate patient-reported outcome 12 months (10 to 14) post......-operatively. The rates of revision were calculated from the revisions reported to the DSR up to December 2011 and by checking deaths with the Danish National Register of Persons. A complete questionnaire was returned by 688 patients (82.2%). The mean WOOS was 67 (0 to 100). A total of 63 hemiarthroplasties (7...

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Shi-Uk; Lang, Philipp E-mail: phil.lang@stanford.edu

    2000-08-01

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

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

    International Nuclear Information System (INIS)

    Lee, Shi-Uk; Lang, Philipp

    2000-01-01

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

  1. The Shoulder Gradient in Patients with Unilateral Shoulder Impingement Syndrome

    Science.gov (United States)

    Kim, Hee-Sang; Lee, Jong Ha; Yun, Dong Hwan; Yun, Jee-Sang; Shin, Yong Won; Chon, Jinmann

    2011-01-01

    Objective To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome. Method Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula. Results In patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03±1.28 mm, compared with 10.46±1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31±3.73 degrees, compared with 3.85±4.42 degrees for the higher shoulder. Conclusion The frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder. PMID:22506196

  2. The shoulder gradient in patients with unilateral shoulder impingement syndrome.

    Science.gov (United States)

    Kim, Hee-Sang; Lee, Jong Ha; Yun, Dong Hwan; Yun, Jee-Sang; Shin, Yong Won; Chon, Jinmann; Hwang, Dae Gyu

    2011-10-01

    To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome. Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapula. In patients with unilateral shoulder impingement syndrome, the frequency of shoulder impingement syndrome was 76.2% (16 of 21) on the side of the relatively lower shoulder. The mean acromiohumeral interval on the side of the lower shoulder was 10.03±1.28 mm, compared with 10.46±1.50 mm for the higher shoulder. The angle between a vertical line and a line connecting a superior angle with an inferior angle of the scapular of the side of the lower shoulder was -0.31±3.73 degrees, compared with 3.85±4.42 degrees for the higher shoulder. The frequency of shoulder impingement syndrome was significantly higher on the side of the relatively lower shoulder, and there is no significant difference in the acromiohumeral interval between the side of the lower shoulder and that of the higher shoulder. In patients with unilateral shoulder impingement syndrome, the scapular on the side of lower shoulder was more rotated downward than on the side of the higher shoulder.

  3. Complications of shoulder dystocia.

    Science.gov (United States)

    Dajani, Nafisa K; Magann, Everett F

    2014-06-01

    Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. SHOULDER DYSTOCIA : OBSTETRICIAN'S NIGHTMARE

    OpenAIRE

    KUMAR, SUSHIL; ANTHONY, ZK

    2002-01-01

    Shoulder dystocia is an uncommon complication of delivery. 12 cases of shoulder dystocia are presented. The study suggests that prediction of shoulder dystocia on the basis of clinical profile is difficult A high index of suspicion is to be maintained in the presence of certain risk factors such as multigravida with large baby having prolonged 1st (decelarative phase) and 2nd stage of labour necessitating instrumental delivery. High neonatal morbidity (brachial palsy 44% and low Apgar score 4...

  5. Shoulder Impingement Treatment

    Science.gov (United States)

    ... Find a Pediatrician Health Issues Conditions Injuries & Emergencies Sports Injuries Vaccine Preventable Diseases Healthy Children > Health Issues > Injuries & Emergencies > Sports Injuries > Shoulder Impingement ...

  6. Painful shoulder post fall.

    Science.gov (United States)

    Mayne, Alistair Iw; Jariwala, Arpit

    2018-03-03

    CLINICAL INTRODUCTION: A 32-year-old man presented to the ED after a heavy fall on his left shoulder. He presented the following day with pain and gross limitation of movement in the left shoulder. There was no history of previous injury to the left shoulder. This was his non-dominant limb and he worked in a manual occupation. He was neurovascularly intact. His initial radiographs are shown in figures 1 and 2.emermed;emermed-2017-207003v1/F1F1F1Figure 1Anteroposterior radiograph (AP) radiograph of left shoulder.emermed;emermed-2017-207003v1/F2F2F2Figure 2Lateral radiograph of left shoulder.  QUESTION: Management options:Anterior shoulder dislocation - closed reductionAnterior shoulder dislocation - CT scanPosterior shoulder dislocation - closed reductionPosterior shoulder dislocation - CT scan. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. Shoulder Blade Squeeze (Posture Exercise)

    Science.gov (United States)

    ... Exercise & Weight Exercise at Home Shoulder Blade Squeeze Shoulder Blade Squeeze Make an Appointment Ask a Question Find ... do it: Stand straight and tall. Pull your shoulder blades back and slightly downward to bring your elbows ...

  8. Arthroplasty register for Germany

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2009-10-01

    Full Text Available Scientific background: The annual number of joint replacement operations in Germany is high. The introduction of an arthroplasty register promises an important contribution to the improvement of the quality of patient’s care. Research questions: The presented report addresses the questions on organization and functioning, benefits and cost-benefits as well as on legal, ethical and social aspects of the arthroplasty registers. Methods: A systematic literature search was conducted in September 2008 in the medical databases MEDLINE, EMBASE etc. and was complemented with a hand search. Documents describing arthroplasty registers and/or their relevance as well as papers on legal, ethical and social aspects of such registers were included in the evaluation. The most important information was extracted and analysed. Results: Data concerning 30 arthroplasty registers in 19 countries as well as one international arthroplasty register were identified. Most of the arthroplasty registers are maintained by national orthopedic societies, others by health authorities or by their cooperation. Mostly, registries are financially supported by governments and rarely by other sources.The participation of the orthopedists in the data collection process of the arthroplasty registry is voluntary in most countries. The consent of the patients is usually required. The unique patient identification is ensured in nearly all registers.Each data set consists of patient and clinic identification numbers, data on diagnosis, the performed intervention, the operation date and implanted prostheses. The use of clinical scores, patient-reported questionnaires and radiological documentation is rare. Methods for data documentation and transfer are paper form, electronic entry as well as scanning of the data using bar codes. The data are mostly being checked for their completeness and validity. Most registers offer results of the data evaluation to the treating orthopedists and

  9. Can pelvic tilting be ignored in total hip arthroplasty?

    Directory of Open Access Journals (Sweden)

    Won Yong Shon

    2014-01-01

    CONCLUSION: The sagittal position of pelvis is a key factor in impingement and dislocation after total hip arthroplasty. Pelvic tilting affects the position of acetabular component in the sagittal plane of the body as compared with its anatomic position in the pelvis. We suggest a preoperative lateral view of spine-pelvis, in upright and supine position for evaluation of a corrective adaptation of the acetabular cup accordingly with pelvic balance.

  10. Ultrasound of the rotator cuff with MRI and anatomic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Rutten, Matthieu J.C.M. [Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL ' s-Hertogenbosch (Netherlands)]. E-mail: M.Rutten@JBZ.nl; Maresch, Bas J. [Department of Radiology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6710 HN Ede (Netherlands)]. E-mail: MareschB@zgv.nl; Jager, Gerrit J. [Department of Radiology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL ' s-Hertogenbosch (Netherlands)]. E-mail: G.Jager@JBZ.nl; Blickman, Johan G. [Department of Radiology, University Medical Center Nijmegen, Geert Grooteplein Zuid 18, 6500 HB Nijmegen (Netherlands)]. E-mail: J.Blickman@rad.umcn.nl; Holsbeeck, Marnix T. van [Department of Radiology, Henry Ford Hospital, 2799 W Grand Boulevard, Detroit, MI 48202 (United States)]. E-mail: vanholsbeeck@comcast.net

    2007-06-15

    Magnetic resonance imaging and high-resolution ultrasound (US) are frequently used for the detection of rotator cuff tears. The diagnostic yield of US is influenced by several factors as technique, knowledge of the imaging characteristics of anatomic and pathologic findings and of pitfalls. The purpose of this article is to illustrates that the standardized high-resolution US examination of the shoulder covers the entire rotator cuff and correlates with MR imaging and anatomic sections.

  11. [History of hip arthroplasty].

    Science.gov (United States)

    Płomiński, Janusz; Kwiatkowski, Krzysztof

    2007-02-01

    The authors present the history of hip prosthesis in treatment of coxarthrosis. Despite eighty years of experience the problem of gaining good and long-term results still exist and is difficult to solve. Even changing the way on cementless stabilization of prosthesis doesn't has result in solving the problem of aseptic loosening of hip arthroplasty. Problems of wear derbies made the producers find new to reduce particulate debris. The future of hip arthroplasty is connected with hip resurfacing. Moreover, the higher number of primary hip plasty the more prosthesis are loosening. The treatment is far more difficult and more expensive.

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

    International Nuclear Information System (INIS)

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

    2002-01-01

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

  13. Multidetector spiral CT arthrography of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

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

  14. Multidetector spiral CT arthrography of the shoulder

    International Nuclear Information System (INIS)

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

    2008-01-01

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

  15. The Shoulder Gradient in Patients with Unilateral Shoulder Impingement Syndrome

    OpenAIRE

    Kim, Hee-Sang; Lee, Jong Ha; Yun, Dong Hwan; Yun, Jee-Sang; Shin, Yong Won; Chon, Jinmann; Hwang, Dae Gyu

    2011-01-01

    Objective To investigate the relationship between the shoulder gradient and acromiohumeral interval of both shoulders in patients with unilateral shoulder impingement syndrome. Method Using the angulometer, we measured the shoulder gradient in patients with unilateral shoulder impingement syndrome in a standing position. Using the radiography, we measured the acromiohumeral interval and the angle between a vertical line and a line connecting a superior angle with an inferior angle of the scap...

  16. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...

  17. Elbow arthroplasty in perspective

    NARCIS (Netherlands)

    Heijink, A.

    2017-01-01

    This thesis focuses on the effect of biomechanical aspects of prosthesis design and outcome after radial head and total elbow arthroplasty. First, we examine the available evidence regarding the role of several unfavorable biomechanical conditions about the elbow in the development of

  18. Painful/unstable shoulder

    International Nuclear Information System (INIS)

    Saez, F.; Negueruela, J.; Martin, J.C.; Elizagaray, E.; Pena, J.M.; Merino, A.

    1991-01-01

    This paper reports on the diagnostic performance of CT-arthrography of the painful/unstable shoulder that was evaluated in more than 300 patients. We have encountered a great variety of painful shoulder pathology, including impingement syndrome, cuff tear arthropathy, lesions of the long head of the biceps tendon, calcifying tendinitis, adhesive capsulitis, dead arm syndrome, and degenerative joint disease. Lesions related to instability include cases of capsular avulsions, disruption of the glenohumeral ligaments, labral pathology, glenoid fractures, Hill-Sachs lesions, and changes in glenoid angulation. CT-arthrography is an accurate exploration for both unstable and painful shoulders

  19. Simulation and Shoulder Dystocia.

    Science.gov (United States)

    Shaddeau, Angela K; Deering, Shad

    2016-12-01

    Shoulder dystocia is an unpredictable obstetric emergency that requires prompt interventions to ensure optimal outcomes. Proper technique is important but difficult to train given the urgent and critical clinical situation. Simulation training for shoulder dystocia allows providers at all levels to practice technical and teamwork skills in a no-risk environment. Programs utilizing simulation training for this emergency have consistently demonstrated improved performance both during practice drills and in actual patients with significantly decreased risks of fetal injury. Given the evidence, simulation training for shoulder dystocia should be conducted at all institutions that provide delivery services.

  20. Frozen shoulder - aftercare

    Science.gov (United States)

    Harris JD, Griesser MJ, Jones GL. Stiff shoulder. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 55. Kelley MJ, Shaffer MA, ...

  1. Radiotherapy for shoulder impingement

    International Nuclear Information System (INIS)

    Adamietz, B.; Sauer, R.; Keilholz, L.

    2008-01-01

    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.)

  2. Primary total elbow arthroplasty

    Directory of Open Access Journals (Sweden)

    Suresh Kumar

    2013-01-01

    Full Text Available Background: Primary total elbow arthroplasty (TEA is a challenging procedure for orthopedic surgeons. It is not performed as frequently as compared to hip or knee arthroplasty. The elbow is a nonweight-bearing joint; however, static loading can create forces up to three times the body weight and dynamic loading up to six times. For elderly patients with deformity and ankylosis of the elbow due to posttraumatic arthritis or rheumatoid arthritis or comminuted fracture distal humerus, arthroplasty is one of the option. The aim of this study is to analyze the role of primary total elbow arthroplasty in cases of crippling deformity of elbow. Materials and Methods: We analyzed 11 cases of TEA, between December 2002 and September 2012. There were 8 females and 3 males. The average age was 40 years (range 30-69 years. The indications for TEA were rheumatoid arthritis, comminuted fracture distal humerus with intraarticular extension, and posttraumatic bony ankylosis of elbow joint. The Baksi sloppy (semi constrained hinge elbow prosthesis was used. Clinico-radiological followup was done at 1 month, 3 months, 6 months, 1 year, and then yearly basis. Results: In the present study, average supination was 70° (range 60-80° and average pronation was 70° (range 60-80°. Average flexion was 135° (range 130-135°. However, in 5 cases, there was loss of 15 to 35° (average 25° of extension (45° out of 11 cases. The mean Mayo elbow performance score was 95.4 points (range 70-100. Arm length discrepancy was only in four patients which was 36% out of 11 cases. Clinico-radiologically all the elbows were stable except in one case and no immediate postoperative complication was noted. Radiolucency or loosening of ulnar stem was seen in 2 cases (18% out of 11 cases, in 1 case it was noted after 5 years and in another after 10 years. In second case, revision arthroplasty was done, in which only ulnar hinge section, hinge screw and lock screw with hexagonal head

  3. The Maastricht Ultrasound Shoulder pain trial (MUST): Ultrasound imaging as a diagnostic triage tool to improve management of patients with non-chronic shoulder pain in primary care

    OpenAIRE

    Ottenheijm, Ramon PG; Joore, Manuela A; Walenkamp, Geert HIM; Weijers, René E; Winkens, Bjorn; Cals, Jochen WL; de Bie, Rob A; Dinant, Geert-Jan

    2011-01-01

    Abstract Background Subacromial disorders are considered to be one of the most common pathologies affecting the shoulder. Optimal therapy for shoulder pain (SP) in primary care is yet unknown, since clinical history and physical examination do not provide decisive evidence as to the patho-anatomical origin of the symptoms. Optimal decision strategies can be furthered by applying ultrasound imaging (US), an accurate method in diagnosing SP, demonstrating a clear relationship between diagnosis ...

  4. Cervical Total Disc Arthroplasty

    OpenAIRE

    Basho, Rahul; Hood, Kenneth A.

    2012-01-01

    Symptomatic adjacent segment degeneration of the cervical spine remains problematic for patients and surgeons alike. Despite advances in surgical techniques and instrumentation, the solution remains elusive. Spurred by the success of total joint arthroplasty in hips and knees, surgeons and industry have turned to motion preservation devices in the cervical spine. By preserving motion at the diseased level, the hope is that adjacent segment degeneration can be prevented. Multiple cervical disc...

  5. Total hip arthroplasty in Denmark

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2005-01-01

    The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs.......The annual number of total hip arthroplasties (THA) has increased in Denmark over the past 15 years. There is, however, limited detailed data available on the incidence of THAs....

  6. Shoulder impingement syndrome in relation to shoulder intensive work

    OpenAIRE

    Frost, P.; Andersen, J. H.

    1999-01-01

    OBJECTIVES: To analyse the risk of shoulder impingement syndrome relative to shoulder intensive work. METHODS: A cross sectional study of a historical cohort of 1591 workers employed between 1986 and 1993 at a slaughterhouse or a chemical factory. Workers not doing tasks in slaughtering or meat processing constituted the reference group. Intensity of shoulder work in meat processing tasks was assessed by video based observations. Information on shoulder disorders was collected by quest...

  7. Activities of daily living with reverse prostheses: importance of scapular compensation for functional mobility of the shoulder.

    Science.gov (United States)

    Terrier, Alexandre; Scheuber, Patricia; Pioletti, Dominique P; Farron, Alain

    2013-07-01

    The nonanatomical design of reverse shoulder prostheses induce medial displacement of the center of rotation, impingements and may reduce the mobility of the shoulder. The aim of this study is to test the hypothesis that during activities of daily living functional mobility of the shoulder can be restored by scapular compensation. A numerical 3-dimensional model was developed to reproduce the movement of the scapula and humerus, during 4 activities of daily living measured experimentally. This hypothesis was tested in 4 configurations of the aequalis reverse prosthesis (standard 36-mm glenosphere, 42-mm glenosphere, lateralized 36-mm glenosphere, lateralized Bony Increased-Offset Reverse Shoulder Arthroplasty [BIO-RSA]), which were implanted in the virtual model. All impingement positions were evaluated, as the required scapular compensation to avoid impingements. With the 36-mm glenosphere, impingements occurred only for rest of hand to back-pocket positions. The 42-mm partly improved the mobility. The 2 lateralized glenospheres were free of impingement. When impingements occurred, the scapular compensation was less than 10°. Most reverse prostheses impingements reported in clinical and biomechanical studies can be avoided, either by scapular compensation or by a glenosphere lateralization. After reverse shoulder arthroplasty, a fraction of the mobility of the gleno-humeral is transferred to the scapulo-thoracic joint. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  8. Shoulder impingement syndrome in relation to shoulder intensive work.

    Science.gov (United States)

    Frost, P; Andersen, J H

    1999-07-01

    To analyse the risk of shoulder impingement syndrome relative to shoulder intensive work. A cross sectional study of a historical cohort of 1591 workers employed between 1986 and 1993 at a slaughterhouse or a chemical factory. Workers not doing tasks in slaughtering or meat processing constituted the reference group. Intensity of shoulder work in meat processing tasks was assessed by video based observations. Information on shoulder disorders was collected by questionnaire and by physical examinations. Impingement syndrome was diagnosed when shoulder symptoms had been present for at least 3 months during the past year and there were signs of subacromial impingement in the corresponding shoulder at physical examination. Shoulder function was assessed at the same occasion with the Constant scoring technique. Prevalence of shoulder impingement syndrome was analysed according to job title and cumulative exposure. Prevalence ratio for shoulder impingement syndrome was 5.27 (95% confidence interval (95% CI), 2.09 to 12.26) among currently working and 7.90 (95% CI, 2.94 to 21.18) among former slaughterhouse workers. Transformed model based prevalence ratios according to years in slaughterhouse work showed an overall association between cumulative exposure and risk for shoulder impingement syndrome. This study supports the hypothesis that shoulder intensive work is a risk factor for impingement syndrome of the shoulder. Despite the historical cohort design healthy worker selection may have influenced the exposure-response relation found.

  9. [Management of shoulder dystocia].

    Science.gov (United States)

    Le Ray, C; Oury, J-F

    2015-12-01

    The objective of this review is to propose recommendations on the management of shoulder dystocia. The PubMed database, the Cochrane Library and the recommendations from the foreign obstetrical societies or colleges have been consulted. In case of shoulder dystocia, if the obstetrician is not present at delivery, he should be systematically informed as quickly as possible (professional consensus). A third person should also be called for help in order to realize McRoberts maneuver (professional consensus). The patient has to be properly installed in gynecological position (professional consensus). It is recommended not to pull excessively on the fetal head (grade C), do not perform uterine expression (grade C) and do not realize inverse rotation of the fetal head (professional consensus). McRoberts maneuver, with or without a suprapubic pressure, is simple to perform, effective and associated with low morbidity, thus, it is recommended in the first line (grade C). Regarding the maneuvers of the second line, the available data do not suggest the superiority of one maneuver in relation to another (grade C). We proposed an algorithm; however, management should be adapted to the experience of the operator. If the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, delivery of the posterior arm should be performed preferentially (professional consensus). Routine episiotomy is not recommended in shoulder dystocia (professional consensus). Other second intention maneuvers are described. It seems necessary to know at least two maneuvers to perform in case of shoulder dystocia unresolved by the maneuver McRoberts (professional consensus). All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation. Copyright © 2015. Published by Elsevier Masson SAS.

  10. MRI of the shoulder joint with surface coils at 1. 5 Tesla. Normal anatomy and possible clinical application

    Energy Technology Data Exchange (ETDEWEB)

    Beyer, D.; Steinbrich, W.; Krestin, G.; Koebke, J.; Kummer, B.; Bunke, J.

    1987-03-01

    High spatial resolution magnetic resonance images of the shoulder were obtained in axial, sagittal and coronal orientations using a 1.5 T imaging system and anatomically shaped, wrap-around surface coils. Variations in scapular position induced by patient positioning change the relationship of the planes to the shoulder anatomy and make reproducibility of sagittal and coronal planes difficult. We, therefore, use - after axial orientation - image-oblique planes perpendicular and parallel to the glenoid fossa. In this manner MRI can visualise the anatomic structures of the shoulder including rotator cuff, long biceps tendon, articular capsule, articular cartilage, muscles and bones due to the high soft tissue contrast of MRI.

  11. Robotics in shoulder rehabilitation

    Science.gov (United States)

    Sicuri, Chiara; Porcellini, Giuseppe; Merolla, Giovanni

    2014-01-01

    Summary In the last few decades, several researches have been conducted in the field of robotic rehabilitation to meet the intensive, repetitive and task-oriented training, with the goal to recover the motor function. Up to now, robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors leaving less explored the field of orthopaedic shoulder rehabilitation. In this review we analyse the present status of robotic technologies, in order to understand which are the current indications and which may be the future perspective for their application in both neurological and orthopaedic shoulder rehabilitation. PMID:25332937

  12. Paraplegia and the shoulder.

    Science.gov (United States)

    Hastings, Jennifer; Goldstein, Barry

    2004-08-01

    Among consumers, families, therapists, physicians, and other rehabilitation professionals, there has been an increasing interest in shoulder pain associated with spinal cord injury. These disorders primarily affect the soft tissues, including the tendons (eg, rotator cuff tendonitis and bicipital tendinitis), muscles (eg, myalgias and myofascial pain syndromes), and bursae. Disorders of bone and joints also have been of interest (eg, osteoporosis and osteoarthritis of the acromioclavicular and glenohumeral joints). This article addresses the historical context, epidemiology, pathophysiology,diagnosis, prevention, and treatment of shoulder pain as it relates to patients with spinal cord injury.

  13. Sleep position and shoulder pain.

    Science.gov (United States)

    Zenian, John

    2010-04-01

    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. (c) 2009 Elsevier Ltd. All rights reserved.

  14. Total knee arthroplasty

    DEFF Research Database (Denmark)

    Schrøder, Henrik M.; Petersen, Michael M.

    2016-01-01

    Total knee arthroplasty (TKA) is a successful treatment of the osteoarthritic knee, which has increased dramatically over the last 30 years. The indication is a painful osteoarthritic knee with relevant radiographic findings and failure of conservative measures like painkillers and exercise...... surgeon seems to positively influence the rate of surgical complications and implant survival. The painful TKA knee should be thoroughly evaluated, but not revised except if a relevant indication can be established. The most frequent indications for revision are: aseptic loosening, instability, infection...

  15. [A boy with a cough and shoulder pain].

    Science.gov (United States)

    Kompier, Charlotte J A; Roelants, Roosje; van de Griendt, Erik-Jonas

    2013-01-01

    A 15-year-old boy reported to the Accident and Emergency Department with excessive coughing, shortness of breath and pain in the area of his left shoulder blade. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from his sputum. The boy was otherwise healthy, and had no immune deficiency or underlying anatomic abnormality. He probably contracted the MRSA infection at the international school he attends.

  16. Artifacts and pitfalls in shoulder magnetic resonance imaging

    OpenAIRE

    Marcon, Gustavo Felix; Macedo, Tulio Augusto Alves

    2015-01-01

    AbstractMagnetic 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 ...

  17. The three-dimensional glenohumeral subluxation index in primary osteoarthritis of the shoulder.

    Science.gov (United States)

    Jacxsens, Matthijs; Van Tongel, Alexander; Henninger, Heath B; Tashjian, Robert Z; De Wilde, Lieven

    2017-05-01

    Assessment of glenohumeral subluxation is essential in preoperative planning of total shoulder arthroplasty. The purpose of this study was to evaluate a 3-dimensional (3D) glenohumeral subluxation index (GHSI) in shoulders with primary osteoarthritis (OA) and its relationship with morbid glenoid retroversion. The 3D computed tomography reconstructions of 120 healthy shoulders and 110 shoulders with primary glenohumeral arthritis (OA group), classified according to Walch's glenoid morphology, were analyzed. The 3D GHSI was assessed by measuring posterior decentering of the humeral head in relation to the native glenoid in each subject, and its correlation to morbid glenoid version was calculated. The reproducible 3D GHSI (intraclass correlation coefficients ≥ 0.842) showed a posterior decentering of the humeral head in the OA population and in each type of glenoid morphology (P ≤ .005). A moderate correlation was observed in the OA group (r = -0.542; P < .001), but weak linear relationships were found for different glenoid morphology types (r between 0.041 and -0.307). Type A shoulders (r = -0.375; P = .006) correlated better than type B shoulders (r =  -0.217; P = .104). After shoulders were subcategorized according to a threshold for 3D subluxation, the posteriorly subluxated group increased its correlation (r = -0.438; P < .001), whereas the centered shoulders still exhibited no relationship (r = -0.192; P = .329). Posterior humeral head decentering in relation to the native glenoid is present in each glenoid morphology type. Grouping measures according to morphology type and 3D subluxation showed at best moderate correlations between morbid version and 3D GHSI. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  18. Clinical evaluation of a new custom offset shoulder prosthesis for treatment of complex fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Mehlhorn, Alexander T; Schmal, Hagen; Sudkamp, Norbert P

    2006-01-01

    A and only 33% in Group B. The least satisfying partial function was shoulder mobility in both groups. Radiographic evaluation did not correlate with the Constant Score. Patients secondarily treated with arthroplasty seem to have less chance to achieve a satisfying functional outcome compared to those......Primary hemiarthroplasty of the shoulder is an accepted procedure to treat complex proximal humeral fractures. The goal of this study was to assess the functional outcome in patients treated with hemiarthroplasty using a custom offset shoulder prosthesis, either for an acute four-part fracture...... of the proximal humerus or following failed primary treatment of a complex humeral fracture. Thirty seven patients were followed up for a mean of 17 months after shoulder replacement (Group A: four-part-fractures; n = 26, Group B: posttraumatic necrosis/non-union after failed primary treatment; n = 11...

  19. Deformations in the Shoulder Tissues During Load Carriage: A Computational Model.

    Science.gov (United States)

    Hadid, Amir; Belzer, Noa; Shabshin, Nogah; Epstein, Yoram; Gefen, Amit

    2015-11-01

    Shoulder soft tissue deformations seem to be one of the limiting factors of load carriage among soldiers and recreational backpackers that are required to carry heavy loads. Yet, there are no loading limits related to the forces borne by the shoulders, and the backpacks designs are not consistent with providing pressure relief from this sensitive anatomical region. The aim of this study was to develop a model that will enable to study the biomechanical loads that develop in the shoulder under heavy loads and to help in optimizing load carriage systems design. A 3-dimensional, anatomically accurate finite element model of a human shoulder was constructed based on MRI scans. The model was developed to calculate the effective stresses on the skin below the shoulder strap (superficial loads) and the effective strain in the brachial plexus region (inner tissue deformation) for loads of up to 35 kg. The model successfully predicted deformations in the soft tissue surrounding the brachial plexus when compared with deformations measured from load-bearing MRI scans. The model yielded a skin pressure mapping, which showed pressure hotspots in the clavicle region. Inner tissue deformations mapping, as assessed by brachial plexus envelop strains, were found to peak at 30% effective strain at the lateral aspect below the pectoralis muscle. The newly developed model successfully predicted soft tissue deformations in the shoulder related to backpacks. This model can be used to optimize load carriage systems for better distribution of pressure over the shoulders and lower inner tissue deformations.

  20. Do large heads enhance stability and restore native anatomy in primary total hip arthroplasty?

    Science.gov (United States)

    Lombardi, Adolph V; Skeels, Michael D; Berend, Keith R; Adams, Joanne B; Franchi, Orlando J

    2011-06-01

    Dislocation remains a serious complication in hip arthroplasty. Resurfacing proponents tout anatomic femoral head restoration as an advantage over total hip arthroplasty. However, advances in bearings have expanded prosthetic head options from traditional sizes of 22, 26, 28, and 32 mm to diameters as large as 60 mm. Large heads reportedly enhance stability owing to increased range of motion before impingement and increased jump distance to subluxation. Available larger diameter material combinations include metal- or ceramic-on-highly crosslinked polyethylene and metal-on-metal, each with distinct advantages and disadvantages. We sought to determine (1) if using larger diameter heads has lowered our dislocation rate; and (2) how closely an anatomic metal-on-metal bearing with diameters to 60 mm replicates native femoral head size. We retrospectively reviewed 2020 primary arthroplasties performed with large heads (≥ 36 mm) in 1748 patients and noted dislocation incidence. In a prospective subset of 89 cases using anatomic heads, native femoral head diameter was measured intraoperatively with calipers by an independent observer and later compared with implanted size. One dislocation has occurred in 2020 hips for an incidence of 0.05%. The prosthetic head averaged 0.7 mm larger than the native head with 68 of 89 (76%) reconstructed to within ± 2 mm of native size. Larger diameter heads have contributed to lower dislocation rates and large-diameter metal-on-metal articulation can provide close anatomic restoration in primary THA.

  1. Swimmer's Shoulder: Painful Shoulder in the Competitive Swimmer.

    Science.gov (United States)

    Matzkin, Elizabeth; Suslavich, Kaytelin; Wes, David

    2016-08-01

    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.

  2. Patient-reported outcome and risk of revision after shoulder replacement for osteoarthritis

    Science.gov (United States)

    2014-01-01

    Purpose We used patient-reported outcome and risk of revision to compare hemiarthroplasty (HA) with total shoulder arthroplasty (TSA) and stemmed hemiarthroplasty (SHA) with resurfacing hemiarthroplasty (RHA) in patients with glenohumeral osteoarthritis. Patients and methods We included all patients reported to the Danish Shoulder Arthroplasty Registry (DSR) between January 2006 and December 2010. 1,209 arthroplasties in 1,109 patients were eligible. Western Ontario Osteoarthritis of the Shoulder index (WOOS) was used to evaluate patient-reported outcome 1 year postoperatively. For simplicity of presentation, the raw scores were converted to a percentage of the maximum score. Revision rates were calculated by checking reported revisions to the DSR until December 2011. WOOS and risk of revision were adjusted for age, sex, previous surgery, and type of osteoarthritis. Results There were 113 TSAs and 1096 HAs (837 RHAs and 259 SHAs). Patients treated with TSA generally had a better WOOS, exceeding the predefined minimal clinically important difference, at 1 year (mean difference 10, p < 0.001). RHA had a better WOOS than SHA (mean difference 5, p = 0.02), but the difference did not exceed the minimal clinically important difference. There were no statistically significant differences in revision rate or in adjusted risk of revision between any of the groups. Interpretation Our results are in accordance with the results from other national shoulder registries and the results published in systematic reviews favoring TSA in the treatment of glenohumeral osteoarthritis. Nonetheless, this registry study had certain limitations and the results should be interpreted carefully. PMID:24650020

  3. Finite element models of the human shoulder complex: a review of their clinical implications and modelling techniques.

    Science.gov (United States)

    Zheng, Manxu; Zou, Zhenmin; Bartolo, Paulo Jorge Da Silva; Peach, Chris; Ren, Lei

    2017-02-01

    The human shoulder is a complicated musculoskeletal structure and is a perfect compromise between mobility and stability. The objective of this paper is to provide a thorough review of previous finite element (FE) studies in biomechanics of the human shoulder complex. Those FE studies to investigate shoulder biomechanics have been reviewed according to the physiological and clinical problems addressed: glenohumeral joint stability, rotator cuff tears, joint capsular and labral defects and shoulder arthroplasty. The major findings, limitations, potential clinical applications and modelling techniques of those FE studies are critically discussed. The main challenges faced in order to accurately represent the realistic physiological functions of the shoulder mechanism in FE simulations involve (1) subject-specific representation of the anisotropic nonhomogeneous material properties of the shoulder tissues in both healthy and pathological conditions; (2) definition of boundary and loading conditions based on individualised physiological data; (3) more comprehensive modelling describing the whole shoulder complex including appropriate three-dimensional (3D) representation of all major shoulder hard tissues and soft tissues and their delicate interactions; (4) rigorous in vivo experimental validation of FE simulation results. Fully validated shoulder FE models would greatly enhance our understanding of the aetiology of shoulder disorders, and hence facilitate the development of more efficient clinical diagnoses, non-surgical and surgical treatments, as well as shoulder orthotics and prosthetics. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.

  4. The shoulder in competitive swimming.

    Science.gov (United States)

    Richardson, A B; Jobe, F W; Collins, H R

    1980-01-01

    Shoulder pain is the most common orthopaedic problem in competitive swimming. In a group of 137 of this country's best swimmers, 58 had had symptoms of "swimmer's shoulder." Population characteristics of this group indicated that symptoms increased with the caliber of the athlete, were slightly more common in men, and were related to sprint rather than distance swimming. The use of hand-paddle training exacerbated symptoms, which were more common during the early and middle season. Consideration of shoulder mechanics in swimming reveals that freestyle, butterfly, and backstroke require similar motions; a swimmer using any of these strokes is susceptible to developing shoulder pain. Swimmer's shoulder represents chronic irritation of the humeral head and rotator cuff on the coracoacromial arch during abduction of the shoulder, the so-called impingement syndrome. Treatment included stretching, rest, ice therapy, oral antiinflammatory agents, judicious use of injectable steroids, and surgery as a last resort.

  5. Shoulder Dystocia: Prediction and Management

    OpenAIRE

    Hill, Meghan G; Cohen, Wayne R

    2016-01-01

    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.

  6. Shoulder dystocia: prediction and management.

    Science.gov (United States)

    Hill, Meghan G; Cohen, Wayne R

    2016-01-01

    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.

  7. Direct Repair of the Superior Band of Bigelow's Ligament After Hip Arthroplasty: a Surgical Technique.

    Science.gov (United States)

    Liu, Joseph; McLawhorn, Alexander S; Christ, Alexander B; Dzenis, Peteris; Healey, John H

    2016-07-01

    The posterolateral approach is one of the most common approaches used during hip arthroplasty. A posterior soft tissue repair is necessary to limit the risk of postoperative dislocation. For a trapezoidal capsulotomy, the proximal limb divides the superior band of the iliofemoral ligament (Bigelow's ligament). A transosseous repair frequently leaves a defect in this region, which may elevate the risk for dislocation. The purpose of this article is to describe a simple, rational technique for reinforcing the posterior capsular repair. A meticulous exposure of the hip capsule is performed during the posterolateral surgical approach. A trapezoidal capsulotomy is performed. After implantation of the arthroplasty implants, retractors are placed to expose the superior capsule. Prior to transosseous repair of the capsule and short external rotator tendons, the proximal limb of the capsulotomy is reapproximated anatomically and repaired with non-absorbable sutures. If anatomical repair is not possible, leg length and femoral offset should be reassessed carefully. The described modification may further minimize the risk of dislocation following hip arthroplasty, as the superior band of Bigelow's ligament is an additional checkrein to internal and external rotation. This repair provides a secondary intraoperative assessment of leg length and femoral offset to ensure proper biomechanical reconstruction of the hip joint. It is the authors' preferred technique of all hip hemiarthroplasties and total hip arthroplasties, whenever possible.

  8. Shoulder dystocia: management and documentation.

    Science.gov (United States)

    Stitely, Michael L; Gherman, Robert B

    2014-06-01

    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. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Structural Analysis and Design of PCC Shoulders

    Science.gov (United States)

    1982-04-01

    A structural evaluation of PCC highway shoulders has been conducted and a comprehensive design procedure for plain jointed concrete shoulders developed. The procedure can be used to provide PCC shoulders either for rehabilitation of existing pavement...

  10. Accuracy of the glenohumeral subluxation index in nonpathologic shoulders.

    Science.gov (United States)

    Jacxsens, Matthijs; Van Tongel, Alexander; Willemot, Laurent B; Mueller, Andreas M; Valderrabano, Victor; De Wilde, Lieven

    2015-04-01

    Correction of posterior humeral subluxation, measured by the humeral subluxation index (HSI) according to Walch, is necessary in total shoulder arthroplasty to prevent early loosening. The 3-dimensional (3D) measurement of the shoulder is becoming well accepted and common practice as it overcomes positional errors to which 2-dimensional (2D) glenohumeral measurements are prone. The first objective was to describe the HSI in a nonpathologic population with the 2D HSI according to Walch and a newly described 3D HSI method. The second objective was to compare both measuring methods with each other. In 151 nonpathologic shoulders, the 2D HSI was measured on the midaxial computed tomography scan cut of the scapula. The 3D HSI, based on the native glenoid plane, was defined as [formula in text], in which X is the projection of the center of the humeral head to the anteroposterior axis of the glenoid fossa and R is the radius of the humeral head. Both measuring methods were compared with each other. Correlation was determined. Interobserver and intraobserver reliability of the 3D HSI was measured. The mean 3D HSI (51.5% ± 2.7%) was significantly (P < .001) more posterior than the mean 2D HSI (48.7% ± 5.2%), with a mean difference of 2.9% ± 5.6%. No correlation was found between the 2D and 3D HSI. The interobserver and intraobserver reliability was excellent. The 2D HSI seems to underestimate the humeral subluxation compared with a 3D reliable equivalent. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. [Epidemiology of shoulder dystocia].

    Science.gov (United States)

    Deneux-Tharaux, C; Delorme, P

    2015-12-01

    To synthetize the available evidence regarding the incidence and risk factors of shoulder dystocia (SD). Consultation of the Medline database, and of national guidelines. Shoulder dystocia is defined as a vaginal delivery that requires additional obstetric manoeuvres to deliver the foetus after the head has delivered and gentle traction has failed. With this definition, the incidence of SD in population-based studies is about 0.5-1% of vaginal deliveries. Many risk factors have been described but most associations are not independent, or have not been constantly found. The 2 characteristics consistently found as independent risk factors for SD in the literature are previous SD (incidence of SD of about 10% in parturients with previous SD) and foetal macrosomia. Maternal diabetes and obesity also are associated with a higher risk of SD (2 to 4 folds) but these associations may be completely explained by foetal macrosomia. However, even factors independently and constantly associated with SD do not allow a valid prediction of SD because they are not discriminant; 50 to 70% of SD cases occur in their absence, and the great majority of deliveries when they are present is not associated with SD. Shoulder dystocia is defined by the need for additional obstetric manoeuvres to deliver the foetus after the head has delivered and gentle traction has failed, and complicates 0.5-1% of vaginal deliveries. Its main risk factors are previous SD and macrosomia, but they are poorly predictive. SD remains a non-predictable obstetrics emergency. Knowledge of SD risk factors should increase the vigilance of clinicians in at-risk contexts. Copyright © 2015. Published by Elsevier Masson SAS.

  12. Can we predict shoulder dystocia?

    Science.gov (United States)

    Revicky, Vladimir; Mukhopadhyay, Sambit; Morris, Edward P; Nieto, Jose J

    2012-02-01

    To analyse the significance of risk factors and the possibility of prediction of shoulder dystocia. This was a retrospective cohort study. There were 9,767 vaginal deliveries at 37 and more weeks of gestation analysed during 2005-2007. Studied population included 234 deliveries complicated by shoulder dystocia. Shoulder dystocia was defined as a delivery that required additional obstetric manoeuvres to release the shoulders after gentle downward traction has failed. First, a univariate analysis was done to identify the factors that had a significant association with shoulder dystocia. Parity, age, gestation, induction of labour, epidural analgesia, birth weight, duration of second stage of labour and mode of delivery were studied factors. All factors were then combined in a multivariate logistic regression analysis. Adjusted odds ratios (Adj. OR) with 95% confidence intervals (CI) were calculated. The incidence of shoulder dystocia was 2.4% (234/9,767). Only mode of delivery and birth weight were independent risk factors for shoulder dystocia. Parity, age, gestation, induction of labour, epidural analgesia and duration of second stage of labour were not independent risk factors. Ventouse delivery increases the risk of shoulder dystocia almost 3 times, forceps delivery comparing to the ventouse delivery increases risk almost 3.4 times. Risk of shoulder dystocia is minimal with the birth weight of 3,000 g or less. It is difficult to foretell the exact birth weight and the mode of delivery, therefore occurrence of shoulder dystocia is highly unpredictable. Regular drills for shoulder dystocia and awareness of increased incidence with instrumental deliveries are important to reduce fetal and maternal morbidity and mortality.

  13. Recurrent shoulder dystocia: a review.

    Science.gov (United States)

    Bingham, Jemel; Chauhan, Suneet P; Hayes, Edward; Gherman, Robert; Lewis, David

    2010-03-01

    The goals of this review were to determine the incidence of recurrent shoulder dystocia and the incidence of brachial plexus injury in such cases. A search of PubMed was conducted between 1980 and March 2009. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The search yielded 191 publications, of which 9 provided complete data; these were used to calculate the incidence of recurrent shoulder dystocia. The rate of shoulder dystocia in the prior pregnancies was 1.64% (31,311/1,911,014). Among 10,591 known subsequent vaginal births, the rate of recurrent shoulder dystocia was 12% (OR, 8.25; 95% CI, 7.77, 8.76). Brachial plexus injury occurred significantly more often during recurrent shoulder dystocia than during the first shoulder dystocia (4% vs. 1%; OR, 3.59; 95% CI, 2.44, 5.29; or 45/1000 vs. 13/1000 births). About 12% of parturients with a history of shoulder dystocia have a recurrent dystocia in the subsequent pregnancy, a risk of about 1 in 8. Brachial plexus injury occurs in 19/1000 vaginal births during the first episode of shoulder dystocia, and in 45/1000 vaginal births after recurrent dystocia. Obstetricians & Gynecologist, Family Physicians. After completion of this educational activity, the reader will be able to compare the risk of primary versus recurrent shoulder dystocia. Formulate counseling and treatment strategies for pregnant women who have had a prior pregnancy complicated by shoulder dystocia. Assess the strength of the evidence suggesting the risk of recurrent shoulder dystocia.

  14. MRI of shoulder instability

    Energy Technology Data Exchange (ETDEWEB)

    Steinbach, Lynne S. [University of California San Francisco, 505 Parnassus, Suite M392, San Francisco, CA 94143-0628 (United States)], E-mail: lynne.steinbach@radiology.ucsf.edu

    2008-10-15

    The most unstable joint in the body, the glenohumeral joint is subject to many insults including microinstability, subluxation and dislocation. During the last two decades, MRI has allowed for direct visualization of many of the lesions related to instability, aiding in diagnosis as well as therapeutic planning and follow-up. This article reviews the use of MRI for shoulder instability and describes the different types of lesions associated with this disorder. Topics include technical considerations, the use of MR arthrography, normal anatomy and variants, labral and glenohumeral ligament pathology, and osseous lesions related to instability.

  15. Reverse total shoulder glenoid baseplate stability with superior glenoid bone loss.

    Science.gov (United States)

    Martin, Elise J; Duquin, Thomas R; Ehrensberger, Mark T

    2017-10-01

    Superior wear of the glenoid bone is common in patients with rotator cuff arthropathy. This can become a treatment challenge for patients who require shoulder arthroplasty. In reverse shoulder arthroplasty (RSA), glenoid bone loss may affect the stability of baseplate fixation. The primary purpose of this biomechanical laboratory study was to assess the initial fixation stability of RSA glenosphere baseplates in the presence of variable amounts of superior glenoid bone loss. High-density solid rigid polyurethane foam (30 pounds/cubic foot) was machined to model the glenoid with variable superior defects that provided different levels of support (100%, 90%, 75%, and 50%) for the glenosphere baseplate. The samples were cyclically loaded (0-750 N at 1 Hz for 5000 cycles) at a 60° glenohumeral angle. The micromotion and migration of the baseplate were calculated from displacement data captured during the loading tests with an array of 3 linear variable differential transformers mounted around the baseplate. Micromotion was significantly greater in samples with 50% defects compared with those with smaller defects. Migration was significantly greater after testing for all defect sizes. Initial fixation of RSA glenosphere baseplates was significantly reduced in models with 50% bone loss on the superior edge compared with models with less bone loss in this high-density bone foam model. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. [Symphysiotomy to relieve shoulder dystocia

    NARCIS (Netherlands)

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

    2014-01-01

    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.

  17. Proximal Interphalangeal Joint Silicone Arthroplasty for Osteoarthritis: Midterm Outcomes.

    Science.gov (United States)

    Naghshineh, Nima; Goyal, Kanu; Giugale, Juan M; Neral, Mithun K; Ferreira, Joel V; Buterbaugh, Glenn A; Imbriglia, Joseph E

    2018-04-01

    Osteoarthritis of the proximal interphalangeal (PIP) joint affects a large percentage of the population and can lead to significant functional disability. The purpose of this study is to evaluate the midterm clinical effectiveness of PIP joint arthroplasty for nonrheumatic arthritis. A single-center retrospective cohort study evaluating preoperative and postoperative objective and subjective measures was conducted. Range of motion (ROM), Disabilities of the Arm, Shoulder and Hand scores, key pinch strength, grip strength, and satisfaction with respect to pain, deformity, function, and strength were measured. Forty-five fingers in 25 patients were followed up for a mean period of 42 months. Preoperative and postoperative mean ROM was equivalent at 59.1° and 59.2°, respectively. Postoperative grip and key pinch strength showed significant improvement and near normalization compared with contralateral extremity. Complication rate was 37% with 20% requiring revision surgery. Patients with diabetes mellitus had higher odds of requiring revision surgery. Pain scores improved from 7.4 to 1.9 on a visual analog scale. Overall satisfaction was high at 84%, and 91% of patients would have the surgery performed again. Silicone arthroplasty for osteoarthritis of the PIP remains a good option for pain relief. Our study presents midterm follow-up data that support significant pain relief, increased grip and key pinch strength, and high satisfaction associated with this implant.

  18. Psychometric properties of two questionnaires in the context of total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Merser, Søren

    2014-01-01

    Disabilites of Arm Shoulder and Hand (QuickDASH) and Patient-rated Wrist Evaluation questionnaires in patients with total wrist arthroplasty. METHODS: In a prospective cohort of 102 cases, we evaluated the QuickDASH. Furthermore, in a cross-sectional study and a test-retest on a subgroup of the patients, we...... evaluated the Patient-rated Wrist Evaluation. RESULTS: Internal consistency and reproducibility were very high (Cronbach's alpha 0.96/0.97; Spearman's rho 0.90/ 0.91; intraclass coefficient 0.91/0.92), and there were no floor or ceiling effects. The responsiveness of the QuickDASH was high (standardised...... patients scored significantly higher on the QuickDASH than other patients did. The scores of both questionnaires were very closely related. CONCLUSION: Both questionnaires are valid and equivalent for use in patients with total wrist arthroplasty. FUNDING: This research received no specific grant from any...

  19. [The total shoulder prosthesis].

    Science.gov (United States)

    Mazas, F; Gagey, O

    1990-04-11

    Prosthetic shoulder replacement is impeded by two main obstacles: the articular cavity is very shallow, and the small glenoid surface rests on a narrow neck to which prosthetic pieces are difficult to attach. The principal, currently used prostheses are non-retentive models which reproduce the anatomy of the joint. They differ from each other mainly in the glenoid piece pattern which may be sealed only to the glenoid cavity or also fixed onto the acromion. On the whole, the clinical results reported are encouraging, particularly as regards the absence of pain, but the radiological course of the glenoidal sealing is a source of concern. Obvious unsealing is rare, but cracks between bone and cement are very frequent and some of them become wider as time goes by. In addition, there is still no satisfactory solution to the problem of big rotator cuff tears. This type of prosthesis must be envisaged with caution and should be reserved to very painful shoulders, but it would be wise not to wait until the rotator cuff is destroyed. The best indications are glenohumeral osteoarthritis, rheumatoid arthritis and necrosis of the tumoral head.

  20. The Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995...... complications. Completeness of primary and revision surgery is evaluated annually and validation of a number of variables has been carried out. DESCRIPTIVE DATA: A total of 139,525 primary THAs and 22,118 revisions have been registered in the DHR between January 1, 1995 and December 31, 2014. Since 1995....... All Danish orthopedic departments - both public and private - report to the register, and registration is compulsory. MAIN VARIABLES: The main variables in the register include civil registration number, indication for primary and revision surgery, operation date and side, and postoperative...

  1. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

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

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark....... 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...

  2. The Weight-Bearing Shoulder.

    Science.gov (United States)

    Patel, Ronak M; Gelber, Jonathan D; Schickendantz, Mark S

    2018-01-01

    The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder also serves as the primary weight-bearing joint. Because the weight-bearing shoulder is subject to considerable joint reaction forces and overuse, a broad spectrum of pathology can affect the joint. The combination of muscle imbalance and repetitive trauma presents most commonly as subacromial impingement syndrome but can progress to other pathology. Patients with high-level spinal cord injury, leading to quadriplegia and motor deficits, have an increased incidence of shoulder pain. Understanding the needs of patients who use manual wheelchairs or walking aids can help the physician to better comprehend the pathology of and better manage the weight-bearing shoulder.

  3. Contemporary management of shoulder dystocia.

    Science.gov (United States)

    Gittens-Williams, Lisa

    2010-11-01

    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.

  4. Shoulder dystocia: definitions and incidence.

    Science.gov (United States)

    Hansen, Alexandra; Chauhan, Suneet P

    2014-06-01

    Though subjective in nature, both the American College of Obstetricians and Gynecologists practice bulletin and the Royal College of Obstetricians and Gynaecologists green guideline are in agreement on the descriptor of shoulder dystocia: requirement of additional obstetric maneuvers when gentle downward traction has failed to affect the delivery of the shoulders. The rate of shoulder dystocia is about 1.4% of all deliveries and 0.7% for vaginal births. Compared to non-diabetics (0.6%), among diabetics, the rate of impacted shoulders is 201% higher (1.9%); newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously (2.0% vs. 0.6%, respectively). When the birthweight is categorized as 4500 g, the likelihood of shoulder dystocia in the US vs. other countries varies significantly. Future studies should focus on lowering the rate of shoulder dystocia and its associated morbidities, without concomitantly increasing the rate of cesarean delivery. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Shoulder arthrodesis in 14 dogs.

    Science.gov (United States)

    Fitzpatrick, Noel; Yeadon, Russell; Smith, Thomas J; Johnson, Jacqueline; Baltzer, Wendy I; Amils, Raquel; Farrell, Michael; Frost, Alasdair O; Frost, Alastair; Holsworth, Ian G

    2012-08-01

    To report surgical technique and clinical outcome of shoulder arthrodesis in dogs. Multicenter clinical case series. Dogs (n = 14). Shoulder arthrodesis featured craniolateral plate and screw application, with application of a 2nd plate and screws craniolaterally or caudolaterally in 5 shoulders. Implants included the locking string of pearls (SOP)™ plate in 7 shoulders. Subjective preoperative, 5-8 weeks postoperative, and 11-16 weeks postoperative clinical and radiographic findings were documented. Owner questionnaire evaluation of outcome was performed 6-20 months postoperatively. Mean angle of arthrodesis was 114° (range 102°-122°). Progression of arthrodesis was noted in 13/14 cases at both the 5-8 and 11-16 weeks postoperative radiographic assessments. Nine complications occurred in 7/14 dogs, graded as catastrophic in 2/9, major in 2/9, and minor in 5/9. Where morbidity was successfully managed, 11-16-week and 6-10-month postoperative limb function was positive on both veterinary and owner evaluations in almost all cases, and in several, functional lameness was considered sufficiently mild as to be imperceptible on subjective veterinary evaluation. Where present, limb circumduction was noted as the major feature of persistent lameness. Shoulder arthrodesis in dogs results in acceptable limb function and should be considered for the management of debilitating shoulder pathology despite a high incidence of complications. Application of the SOP plate to aid shoulder arthrodesis warrants further study. © Copyright 2012 by The American College of Veterinary Surgeons.

  6. Psychometric properties of two questionnaires in the context of total wrist arthroplasty

    DEFF Research Database (Denmark)

    Boeckstyns, Michel E H; Merser, Søren

    2014-01-01

    Disabilites of Arm Shoulder and Hand (QuickDASH) and Patient-rated Wrist Evaluation questionnaires in patients with total wrist arthroplasty. METHODS: In a prospective cohort of 102 cases, we evaluated the QuickDASH. Furthermore, in a cross-sectional study and a test-retest on a subgroup of the patients, we...... response mean 1.06 and effect size 1.07). The construct validity of both scales was confirmed by three a priori formulated hypotheses: a moderate, negative correlation of scores with grip-strength; a moderate, positive correlation with pain and a very weak or no correlation with mobility. Rheumatoid...

  7. Conversion of failed modern unicompartmental arthroplasty to total knee arthroplasty.

    Science.gov (United States)

    Levine, W N; Ozuna, R M; Scott, R D; Thornhill, T S

    1996-10-01

    Between January 1983 and January 1991, 29 patients (31 knees) with a failed Robert Brigham metal-backed knee arthroplasty (Johnson & Johnson, Raynham, MA) underwent revision to a total knee arthroplasty (TKA). Twenty-five patients had osteoarthritis, three avascular necrosis, and one rheumatoid arthritis. The average patient age was 72.3 years (range, 49-88 years), and the average weight was 179 lb. (range, 112-242 lb.). The interval between the primary and secondary index procedures averaged 62 months (range, 7-106 months), and mean postrevision follow-up period was 45 months (range, 24-104 months). The primary mechanism of failure of the UKA was tibial polyethylene wear in 21 knees and opposite compartment progression of arthritis in 10 knees. Sixteen knees had particulate synovitis with dense metallic staining of the synovium. At revision, the posterior cruciate ligament was spared in 30 knees and substituted in 1 knee. Restoration of bony deficiency at revision required cancellous bone-graft for contained defects in seven knees, tibial wedges in four knees, and femoral wedges in two knees. No defects received structural allografts. The data suggest that failed, modern unicompartmental knee arthroplasty can successfully be converted to TKA. In most cases, the posterior cruciate ligament can be spared and bone defects corrected with simple wedges or cancellous grafts. Moreover, the results of revision of failed unicompartmental knee arthroplasty are superior to those of failed TKA and failed high tibial osteotomy and comparable to the authors' results of primary TKA with similar-length follow-up periods. Although these results are encouraging, longer-term follow-up evaluation is required to determine survivorship of these revision arthroplasties.

  8. 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

  9. Shoulder injuries in soccer players

    OpenAIRE

    Longo, Umile Giuseppe; Loppini, Mattia; Berton, Alessandra; Martinelli, Nicolò; Maffulli, Nicola; Denaro, Vincenzo

    2012-01-01

    Even though soccer is the most popular sport of the world, no review is available at present to resume the available data on shoulder injuries in soccer. The aim of this review is to report the available epidemiological data on shoulder specific injuries in soccer players and to describe the common mechanisms of shoulder injuries in soccer. Studies published through September 15, 2011, were identified by using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Pub-Med, Web of Science, and the full Cochr...

  10. Ultrasonography of the painful shoulder

    International Nuclear Information System (INIS)

    Terriza, M.D.; Manzanares, R.

    1995-01-01

    A thorough knowledge of the normal anatomy was applied in the study of 132 patients with painful shoulder to establish the ultrasonographic findings that indicate the diagnosis of lesions of the rotator cuff of the shoulder (tendentious, tendons degeneration and the different types of fracture) as well as bursitis, lesions of the tendon of the long head of the biceps, joint effusions, lesions of the humeral head, etc. As an initial method of studying painful shoulder using standard plain radiography, this techniques is considered a reliable diagnostic procedure. (Author)

  11. Vaccination-related shoulder dysfunction.

    Science.gov (United States)

    Bodor, Marko; Montalvo, Enoch

    2007-01-08

    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. Patient-reported outcome and risk of revision after shoulder replacement for osteoarthritis

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe V; Polk, Anne; Brorson, Stig

    2014-01-01

    PURPOSE: We used patient-reported outcome and risk of revision to compare hemiarthroplasty (HA) with total shoulder arthroplasty (TSA) and stemmed hemiarthroplasty (SHA) with resurfacing hemiarthroplasty (RHA) in patients with glenohumeral osteoarthritis. PATIENTS AND METHODS: We included all...... and 1096 HAs (837 RHAs and 259 SHAs). Patients treated with TSA generally had a better WOOS, exceeding the predefined minimal clinically important difference, at 1 year (mean difference 10, p SHA (mean difference 5, p = 0.02), but the difference did not exceed...

  13. Anatomical terminology in Ophthalmology

    OpenAIRE

    Abib, Fernando César; Oréfice, Fernando

    2005-01-01

    O objetivo deste artigo é informar à classe oftalmológica a existência da edição em língua portuguesa da Terminologia Anatômica Internacional, editada pela Federation Committee on Anatomical Terminology (FCAT). No Brasil a Terminologia Anatômica Internacional é traduzida pela Comissão de Terminologia Anatômica (CTA) da Sociedade Brasileira de Anatomia (SBA).The purpose of this article is inform ophthalmologists of the International Anatomical Terminology in the Portuguese language edited by t...

  14. Using your shoulder after surgery

    Science.gov (United States)

    ... home. Use the information below as a reminder. Self-care Wear the sling or immobilizer at all times, ... Your surgeon will refer you to a physical therapist to learn exercises for your shoulder. You will ...

  15. Shoulder injuries in overhead sports

    International Nuclear Information System (INIS)

    Woertler, K.

    2010-01-01

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

  16. [Shoulder injuries in overhead sports].

    Science.gov (United States)

    Wörtler, K

    2010-05-01

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

  17. [Impingement syndromes of the shoulder].

    Science.gov (United States)

    Beirer, M; Imhoff, A B; Braun, S

    2017-04-01

    In addition to tears of the rotator cuff, isolated impingement syndrome of the shoulder is the most common diagnosis in shoulder disorders. This is of high relevance in orthopedic sports medicine. In fact, impingement of the shoulder is not the diagnosis but rather a symptom of a functional or even a structural pathology. Detailed knowledge about the different types of impingement and the underlying causes is essential to provide adequate treatment. Primarily, impingement of the shoulder should be treated nonoperatively. However, if there is no clinical improve despite adequate conservative treatment, there is usually a structural pathology which cannot be adequately compensated for and surgical treatment may be necessary. In the case of severe structural pathologies, such as a full-thickness tear of the rotator cuff, a subsequent surgical treatment may be indicated.

  18. [Symphysiotomy to relieve shoulder dystocia].

    Science.gov (United States)

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

    2014-01-01

    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.

  19. Irreducible Traumatic Posterior Shoulder Dislocation

    Directory of Open Access Journals (Sweden)

    Blake Collier

    2017-01-01

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

  20. DIABETES AND SHOULDER ADHESIVE CAPSULITIS

    OpenAIRE

    J. Mohanakrishnan; Bhanumathy Mohanakrishnan

    2016-01-01

    Background: Adhesive capsulitis (AC) of shoulder is a common condition encountered by physical therapists in their routine outpatient care services; AC of shoulder is as by itself being a self limiting disorder lasts from months to years causing pain and discomfort to the patients. The condition is commonly associated with Diabetes mellitus or other co morbidities. The incidence of AC is high among diabetic individuals and it becomes mandatory on the part of physical therapists and other heal...

  1. Calcific tendinopathy of the shoulder.

    Science.gov (United States)

    Bureau, Nathalie J

    2013-02-01

    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. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  2. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient.

    Science.gov (United States)

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

    2014-02-01

    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. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Knee Arthrodesis After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Morville Schrøder, Henrik; Odgaard, Anders

    2016-01-01

    BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty in a nati......BACKGROUND: Arthrodesis is considered a salvage procedure after failure of a knee arthroplasty. Data on the use of this procedure are limited. The purpose of this study was to identify the incidence, causes, surgical techniques, and outcomes of arthrodesis after failed knee arthroplasty...

  4. Rigid Patient Positioning is Unreliable in Total Hip Arthroplasty.

    Science.gov (United States)

    Milone, Michael T; Schwarzkopf, Ran; Meere, Patrick A; Carroll, Kaitlin M; Jerabek, Seth A; Vigdorchik, Jonathan

    2017-06-01

    To our knowledge, no study has assessed the ability of rigid patient positioning devices to afford arthroplasty surgeons with ideal acetabular orientation throughout surgery. The purpose of this study is to use robotic arm-assisted computer navigation to assess the reliability of pelvic position in total hip arthroplasty performed on patients positioned with rigid positioning devices. A prospective cohort of 100 hips (94 patients) underwent robotic-guided total hip arthroplasty in the lateral decubitus position from the posterior approach, 77 stabilized by universal lateral positioner, and 23 by peg board. Before reaming, computed tomography-templated computer software generated true values of pelvic anteversion and inclination based on the position of the robot arm registered to the patient's preoperative pelvic computed tomography. Mean alteration in anteversion and inclination values was 1.7° (absolute value, 5.3°; range, -20° to 20°) and 1.6° (absolute value, 2.6°; range, -8° to 10°), respectively. And 22% of anteversion values were altered by >10° and 41% by >5°. There was no difference between hip positioners used (P = .36). Anteversion variability was correlated with body mass index (P = .02). Despite the use of rigid patient positioning devices-a lateral hip positioner or peg board-this study reveals clinically important malposition of the pelvis in many cases, especially with regard to anteversion. These results show a clear need to pay particular attention to anatomic landmarks or computer-assisted techniques to assure accurate acetabular cup positioning. Patient positioning should not be solely trusted. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. CURBSIDE CONSULTATION IN HIP ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    Scott M. Sporer

    2009-03-01

    Full Text Available DESCRIPTION A user friendly reference for decision making in hip arthroplasty designed in a question formed clinical problem scenarios and answers format .The articles composed of the answers, containing current concepts and preferences of experts in primary and revision hip surgery are enhanced by several images, diagrams and references and written in the form of a curbside consultation by Scott M. Sporer, MD. and his collaborators. PURPOSE By this practical reference of hip arthroplasty, Scott M. Sporer, MD. and the contributors have aimed providing the reader practical and clinically relevant information, evidence-based advices, their preferences and opinions containing current concepts for difficult and controversial clinical situations in total hip replacement surgery which are often not addressed clearly in traditional references. FEATURES The book is composed of 9 sections and 49 articles each written by a different expert designed in a question and answers format including several images and diagrams and also essential references at the end of each article. In the first section preoperative questions is subjected. Second section is about preoperative acetabulum questions. Third section is about preoperative femur questions. Fourth section is about intraoperative questions. Intraoperative acetabulum question is subjected in the fifth section and the intraoperative femur questions in the sixth section. The seventh section is about postoperative questions. Eighth and ninth sections are about general questions about failure and failure of acetabulum in turn. AUDIENCE Mainly practicing orthopedic surgeons, fellows and residents who are interested in hip arthroplasty have been targeted but several carefully designed scenarios of controversial and difficult situations surrounding total hip replacement surgery and the current information will also be welcomed by experienced clinicians practicing in hip arthroplasty. ASSESSMENT Scott M. Sporer

  6. Anterior shoulder dislocations in sports.

    Science.gov (United States)

    Aronen, J G

    1986-01-01

    Anterior shoulder dislocations, primary and recurrent, are among the most disabling injuries to the shoulder that can plague the athlete. The diagnosis is easily made by the following: the physical appearance of the shoulder; loss of capability by the athlete to internally and externally rotate the shoulder with the elbow at his side; by evaluating the mechanism of injury; and x-rays. Anterior shoulder dislocations should be reduced as soon as possible after diagnosis, to minimise the stretching effect on the neurovascular structures while the humeral head is dislocated. The reduction is not done to allow the athlete to return immediately to sport. Use of a simple traction method in the first 10 to 15 minutes following the injury will result in a successful reduction in the vast majority of dislocations. Reduction of the humeral head can be confirmed by the athlete regaining the capability to internally and externally rotate his shoulder with his elbow at his side. Following reduction, the athlete should begin a treatment regimen which includes a restrengthening programme emphasising the muscles of internal rotation and adduction plus rigid restrictions of activities until the goals of the rehabilitation programme are satisfied. The author's experience with this treatment regimen with athletes at the United States Naval Academy, has shown a decrease of the recurrence rate of primary anterior shoulder dislocations to 25% versus the 80% recurrence rate we have become familiar with from studies done which did not stress specific rehabilitation programmes. The athlete should also be instructed in a self-performed traction method for reduction should a redislocation occur, to minimise the stretching effect on the neurovascular structures and allow relief from discomfort. Surgery for primary and recurrent anterior dislocations should only be considered when the athlete fails to achieve the desired goals after participating in a specific, progressive, adequate

  7. The unstable painful shoulder (UPS) as a cause of pain from unrecognized anteroinferior instability in the young athlete.

    Science.gov (United States)

    Boileau, Pascal; Zumstein, Matthias; Balg, Frederic; Penington, Scott; Bicknell, Ryan T

    2011-01-01

    The etiology of shoulder pain in the overhead athlete is often difficult to determine. This study hypothesized that (1) instability can present in a purely painful form, without any apparent history of instability, but with anatomic lesions indicative of instability, termed unstable painful shoulder (UPS), and that (2) arthroscopic shoulder stabilization is effective. The study evaluated 20 patients (mean age, 22 ± 8 years) at a mean of 38 months postoperatively (range, 24-69 months). Inclusion criteria were painful shoulder with lesions indicative of instability on imaging or at surgery, minimum 2-year follow-up. Exclusion criteria were recognized instability, other associated pathologies, and previous shoulder surgery. Patients were young, hyperlax athletes who complained of deep, anterior shoulder pain and denied any instability. Pain was reproduced with the arm in an anterior apprehension position and relieved by a relocation test; however, no actual apprehension was experienced. Patients often had glenohumeral laxity and hyperlaxity. Lesions indicative of instability confirmed that at least 1 unapparent shoulder subluxation occurred. The Rowe, Walch-Duplay, and University of California, Los Angeles scores improved significantly (P Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  8. Early fetal anatomical sonography.

    LENUS (Irish Health Repository)

    Donnelly, Jennifer C

    2012-10-01

    Over the past decade, prenatal screening and diagnosis has moved from the second into the first trimester, with aneuploidy screening becoming both feasible and effective. With vast improvements in ultrasound technology, sonologists can now image the fetus in greater detail at all gestational ages. In the hands of experienced sonographers, anatomic surveys between 11 and 14 weeks can be carried out with good visualisation rates of many structures. It is important to be familiar with the normal development of the embryo and fetus, and to be aware of the major anatomical landmarks whose absence or presence may be deemed normal or abnormal depending on the gestational age. Some structural abnormalities will nearly always be detected, some will never be and some are potentially detectable depending on a number of factors.

  9. Imaging of hip joint arthroplasty

    International Nuclear Information System (INIS)

    Mayerhoefer, M.E.; Fruehwald-Pallamar, J.; Czerny, C.

    2009-01-01

    The hip joint is the largest joint in the human body and consequently, its evaluation by diagnostic imaging is highly important. This includes imaging of hip joint arthroplasty, which is used to avoid joint immobility following a wide spectrum of diseases, such as end-stage degenerative disease, avascular necrosis of the femoral head or post-traumatic fractures. Conventional radiography is still the standard imaging modality for the evaluation of hip arthroplasty both directly following surgery and for periodical follow-up. In the majority of cases conventional radiography enables adequate assessment of early and late complications that can arise following hip arthroplasty, such as loosening, prosthetic or periprosthetic fracture, luxation, infection and soft tissue calcification. If the diagnosis cannot be established by means of radiography, advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), with or without injection of contrast media, may provide additional information. This is particularly true for the depiction of inflammatory processes. Regardless of the imaging modality used patients' clinical symptoms must also be taken into account in order to establish the correct diagnosis. (orig.) [de

  10. Reference Man anatomical model

    Energy Technology Data Exchange (ETDEWEB)

    Cristy, M.

    1994-10-01

    The 70-kg Standard Man or Reference Man has been used in physiological models since at least the 1920s to represent adult males. It came into use in radiation protection in the late 1940s and was developed extensively during the 1950s and used by the International Commission on Radiological Protection (ICRP) in its Publication 2 in 1959. The current Reference Man for Purposes of Radiation Protection is a monumental book published in 1975 by the ICRP as ICRP Publication 23. It has a wealth of information useful for radiation dosimetry, including anatomical and physiological data, gross and elemental composition of the body and organs and tissues of the body. The anatomical data includes specified reference values for an adult male and an adult female. Other reference values are primarily for the adult male. The anatomical data include much data on fetuses and children, although reference values are not established. There is an ICRP task group currently working on revising selected parts of the Reference Man document.

  11. Comparison of Three-Dimentional Scapular Position and Orientation Between Subjects with and without Shoulder Impingement

    Directory of Open Access Journals (Sweden)

    Afsoun Nodehi-Moghaddam

    2006-04-01

    Full Text Available Objective: Epidemiologic Investigations have revealed a high prevalence (16% - 44% of shoulder complaints consistent with "impingement" in certain occupations. Multiple theories exist in respect to the primary etiology of shoulder "impingement" such as anatomic abnormalities of the coracoacrominal arch or humeral head weakness or degeneration of the rotator cuff tendons shoulder kinematic postural abnormalities and improper scapular muscles control. comparison of kinematic parameters of shoulder complex in healthy and impingement persons. Materials & Methods: 17 patients with shoulder Impingement syndrome that were selected conveniently (age = 43.82 and 17 healthy persons that were matched with patients (age=44.5 participated in this case – control study. A three - dimentional electromechanical digitizer was used to measure scapular position and orientation. Measurments were taken while the arm placed at the side of the body and elevated 45˚, 90˚, 120˚ along with full range of motien in the scapular plane. Orientation was described by upward rotation angle, posterior tilting angle and internal rotation angle. Position was described by medio – lateral position and superio – inferior position.  Results: Comparing to non impaired subjects, those with impingement, demonstrated a significantly lower upward rotation angle (90˚ , 120˚ and posterior tilt angle of the scapla in respective scapular plane. (P<0/05 Conclusion: These results suggest that altered scapular kinematic maybe an Important aspect of the "impingement syndrome". Scapular upward Rotation and posterior tipping are important to consider in the rehabilitation of pateints with symptoms of shoulder Impingement.

  12. CT and MRI of hip arthroplasty

    International Nuclear Information System (INIS)

    Cahir, J.G.; Toms, A.P.; Marshall, T.J.; Wimhurst, J.; Nolan, J.

    2007-01-01

    Plain films are the initial imaging method of choice for evaluation of hip arthroplasty. Recent advances in technology and imaging techniques have largely overcome the problems of beam hardening in computed tomography (CT) and magnetic susceptibility artefact in magnetic resonance imaging (MRI). CT and MRI have now become useful imaging techniques in the assessment of hip arthroplasty

  13. Humeral windows in revision total elbow arthroplasty.

    Science.gov (United States)

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery.

  14. Fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    thromboembolic complications in particular (V); feasibility studies showing excellent outcomes following fast-track bilateral simultaneous total knee arthroplasty (VI) and non-septic revision knee arthroplasty (VII); how acute pain relief in total hip arthroplasty is not enhanced by the use of local infiltration......Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from...... on clinical and organizational aspects of fast-track hip and knee arthroplasty (I–IX). A detailed description of the fast-track set-up and its components is provided. Major results include identification of patient characteristics to predict length of stay and satisfaction with different aspects...

  15. Hip resurfacing arthroplasty and perioperative blood testing.

    Science.gov (United States)

    Cook, Andrew; Cook, Steven; Smith, Ian; Weinrauch, Patrick

    2014-01-01

    It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  16. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    Directory of Open Access Journals (Sweden)

    Andrew Cook

    2014-01-01

    Full Text Available It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testing about the time of hip resurfacing arthroplasty. We present analysis of perioperative blood tests and transfusion rates in 107 patients undertaking unilateral hybrid hip resurfacing arthroplasty by the senior author at a single institution over a three-year period. We conclude that routine perioperative testing of haemoglobin levels for hip resurfacing arthroplasty procedures does not assist in clinical management. We recommend that postoperative blood testing only be considered should the patient demonstrate clinical signs of symptomatic anaemia or if particular clinical circumstances necessitate.

  17. Adhesive capsulitis of the shoulder.

    Science.gov (United States)

    Neviaser, Andrew S; Neviaser, Robert J

    2011-09-01

    Adhesive capsulitis is characterized by painful, gradual loss of active and passive shoulder motion resulting from fibrosis and contracture of the joint capsule. Other shoulder pathology can produce a similar clinical picture, however, and must be considered. Management is based on the underlying cause of pain and stiffness, and determination of the etiology is essential. Subtle clues in the history and physical examination can help differentiate adhesive capsulitis from other conditions that cause a stiff, painful shoulder. The natural history of adhesive capsulitis is a matter of controversy. Management of true capsular restriction of motion (ie, true adhesive capsulitis) begins with gentle, progressive stretching exercises. Most patients improve with nonsurgical treatment. Indications for surgery should be individualized. Failure to obtain symptomatic improvement and continued functional disability following ≥6 months of physical therapy is a general guideline for surgical intervention. Diligent postoperative therapy to maintain motion is required to minimize recurrence of adhesive capsulitis.

  18. MR imaging of the shoulder

    International Nuclear Information System (INIS)

    Fritts, H.M.; Craig, E.; Kyle, R.; Strefling, M.; Miller, D.; Heithoff, K.; Schellhas, K.

    1988-01-01

    Magnetic resonance (MR) imaging (1.5-T unit) was performed in over 600 shoulders to evaluate shoulder pain. Ultrasound (US) and arthrography were performed in over 100 patients. Surgery was performed in over 75 patients. MR imaging offers information not well evaluated with other modalities, including bony impingement, tendinitis, bursitis, and osseous abnormalities, such as primary arthritis, avascular necrosis, occult fractures, and tumors. US and MR findings correlate well with surgical findings for medium to large rotator cuff tears. MR imaging with T2 weighting is superior for differentiating small tears from associated tendinitis. An algorithm for cost-effective shoulder imaging integrating US, MR imaging, arthrography, and computed tomographic arthrography are presented

  19. Shoulder Injuries and Disorders - Multiple Languages

    Science.gov (United States)

    ... Elbows, Forearms, and Shoulders - 简体中文 (Chinese, Simplified (Mandarin dialect)) Bilingual PDF Health Information Translations Exercises to Strengthen Your Shoulder - 简体中文 (Chinese, Simplified ( ...

  20. Painful Shoulder in Swimmers: A Diagnostic Challenge.

    Science.gov (United States)

    McMaster, William C.

    1986-01-01

    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)

  1. Shoulder Dystocia: Incidence and Risk Factors.

    Science.gov (United States)

    Ouzounian, Joseph G

    2016-12-01

    Shoulder dystocia complicates ∼1% of vaginal births. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part its occurrence remains largely unpredictable and unpreventable.

  2. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 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 cobalt-chromium...

  3. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 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) component...

  4. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    NARCIS (Netherlands)

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after

  5. Shoulder Taping and Neuromuscular Control.

    Science.gov (United States)

    Snodgrass, Suzanne J; Farrell, Scott F; Tsao, Henry; Osmotherly, Peter G; Rivett, Darren A; Chipchase, Lucy S; Schabrun, Siobhan M

    2018-03-23

      Scapular taping can offer clinical benefit to some patients with shoulder pain; however, the underlying mechanisms are unclear. Understanding these mechanisms may guide the development of treatment strategies for managing neuromusculoskeletal shoulder conditions.   To examine the mechanisms underpinning the benefits of scapular taping.   Descriptive laboratory study.   University laboratory.   A total of 15 individuals (8 men, 7 women; age = 31.0 ± 12.4 years, height = 170.9 ± 7.6 cm, mass = 73.8 ± 14.4 kg) with no history of shoulder pain.   Scapular taping.   Surface electromyography (EMG) was used to assess the (1) magnitude and onset of contraction of the upper trapezius (UT), lower trapezius (LT), and serratus anterior relative to the contraction of the middle deltoid during active shoulder flexion and abduction and (2) corticomotor excitability (amplitude of motor-evoked potentials from transcranial magnetic stimulation) of these muscles at rest and during isometric abduction. Active shoulder-flexion and shoulder-abduction range of motion were also evaluated. All outcomes were measured before taping, immediately after taping, 24 hours after taping with the original tape on, and 24 hours after taping with the tape removed.   Onset of contractions occurred earlier immediately after taping than before taping during abduction for the UT (34.18 ± 118.91 milliseconds and 93.95 ± 106.33 milliseconds, respectively, after middle deltoid contraction; P = .02) and during flexion for the LT (110.02 ± 109.83 milliseconds and 5.94 ± 92.35 milliseconds, respectively, before middle deltoid contraction; P = .06). These changes were not maintained 24 hours after taping. Mean motor-evoked potential onset of the middle deltoid was earlier at 24 hours after taping (tape on = 7.20 ± 4.33 milliseconds) than before taping (8.71 ± 5.24 milliseconds, P = .008). We observed no differences in peak root mean square EMG activity or corticomotor excitability of

  6. MR imaging of the shoulder

    International Nuclear Information System (INIS)

    Holt, R.G.; Neumann, C.H.; Petersen, S.; Steinbach, L.S.; Jahnke, A.H.; Morgan, F.W.; Heuck, A.

    1990-01-01

    This paper defines the MR appearance of the supraspinatus tendon and associated structures in asymptomatic individuals in order to assist in the differentiation of normal aging from rotator cuff pathology as seen in shoulder impingement syndrome. Proton-density and T2-weighted oblique coronal spin-echo images were obtained at 1.5 T. Images of 48 shoulders from asymptomatic volunteers, aged 22-25 years, were evaluated for signal intensity and distribution in the supraspinatus tendon (SST) and for the appearance of the subacromial-subdeltoid (peribursal) fat plane and acromial outlet

  7. Diagnostic Injections About the Shoulder.

    Science.gov (United States)

    McFarland, Edward; Bernard, Johnathan; Dein, Eric; Johnson, Alex

    2017-12-01

    Injections about the shoulder serve diagnostic as well as therapeutic purposes. Diagnosis of shoulder conditions, such as rotator cuff tears, acromioclavicular joint pathology, subacromial impingement or anterolateral pain syndrome, glenohumeral joint pathology, suprascapular nerve entrapment, and biceps tendon pathologies, is often complicated by concomitant conditions with overlapping symptoms and by inconclusive physical examination and imaging results. Injections of anesthetic agents can often help clinicians locate the source of pain. However, technique and accuracy of needle placement can vary by route. Accuracy is often improved with the use of ultrasonography guidance, although studies differ on the benefits of guided versus unguided injection.

  8. Shoulder arthography in rheumatoid arthritis

    International Nuclear Information System (INIS)

    Reinbold, W.D.; Hehne, H.J.; Rau, W.S.; Freiburg Univ.

    1983-01-01

    Shoulder arthrography in a patient with rheumatoid arthritis is performed to differentiate between a rheumatoid flare and limitation of motion secondary to tear in the rotator cuff. Accurate diagnosis is important because of the therapeutic implications. The arthrographic findings characteristic of rheumatoid involvement of the shoulder joint are nodular filling defects of the joint, the subacromial and subdeltoideal bursa in case of rotator cuff tear, irregular capsular attachment, contracted joint space and visualized lymphatic drainage. A dilatation of the biceps tendon sheath has not been shown. (orig.) [de

  9. Anatomical imaging for radiotherapy

    International Nuclear Information System (INIS)

    Evans, Philip M

    2008-01-01

    The goal of radiation therapy is to achieve maximal therapeutic benefit expressed in terms of a high probability of local control of disease with minimal side effects. Physically this often equates to the delivery of a high dose of radiation to the tumour or target region whilst maintaining an acceptably low dose to other tissues, particularly those adjacent to the target. Techniques such as intensity modulated radiotherapy (IMRT), stereotactic radiosurgery and computer planned brachytherapy provide the means to calculate the radiation dose delivery to achieve the desired dose distribution. Imaging is an essential tool in all state of the art planning and delivery techniques: (i) to enable planning of the desired treatment, (ii) to verify the treatment is delivered as planned and (iii) to follow-up treatment outcome to monitor that the treatment has had the desired effect. Clinical imaging techniques can be loosely classified into anatomic methods which measure the basic physical characteristics of tissue such as their density and biological imaging techniques which measure functional characteristics such as metabolism. In this review we consider anatomical imaging techniques. Biological imaging is considered in another article. Anatomical imaging is generally used for goals (i) and (ii) above. Computed tomography (CT) has been the mainstay of anatomical treatment planning for many years, enabling some delineation of soft tissue as well as radiation attenuation estimation for dose prediction. Magnetic resonance imaging is fast becoming widespread alongside CT, enabling superior soft-tissue visualization. Traditionally scanning for treatment planning has relied on the use of a single snapshot scan. Recent years have seen the development of techniques such as 4D CT and adaptive radiotherapy (ART). In 4D CT raw data are encoded with phase information and reconstructed to yield a set of scans detailing motion through the breathing, or cardiac, cycle. In ART a set of

  10. Gimbaled-shoulder friction stir welding tool

    Science.gov (United States)

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

    2010-01-01

    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.

  11. Periarthritis of the shoulder-MRI findings

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-09-01

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

  12. Frozen shoulder and risk of cancer

    DEFF Research Database (Denmark)

    Pedersen, Alma B; Horváth-Puhó, Erzsébet; Ehrenstein, Vera

    2017-01-01

    BACKGROUND: Frozen shoulder might be a complication or a presenting symptom of cancer. We examined the risk of a cancer diagnosis after an incident diagnosis of frozen shoulder. METHODS: We used prospectively collected data from Danish registries to identify patients with frozen shoulder during 1...

  13. Periarthritis of the shoulder-MRI findings

    International Nuclear Information System (INIS)

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

    1997-01-01

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

  14. Shoulder complaints after nerve sparing neck dissections

    NARCIS (Netherlands)

    van Wilgen, CP; Dijkstra, PU; van der Laan, BFAM; Plukker, JTM; Roodenburg, JLN

    The purpose of the study was to analyse the prevalence of shoulder complaints after nerve sparing neck dissection at least I year after surgery, and to analyse the influence of radiation therapy on shoulder complaints. Patients were interviewed for shoulder complaints, and patients filled out the

  15. DIABETES AND SHOULDER ADHESIVE CAPSULITIS

    Directory of Open Access Journals (Sweden)

    J. Mohanakrishnan

    2016-08-01

    Full Text Available Background: Adhesive capsulitis (AC of shoulder is a common condition encountered by physical therapists in their routine outpatient care services; AC of shoulder is as by itself being a self limiting disorder lasts from months to years causing pain and discomfort to the patients. The condition is commonly associated with Diabetes mellitus or other co morbidities. The incidence of AC is high among diabetic individuals and it becomes mandatory on the part of physical therapists and other health professionals to approach this issue on a holistic manner. This paper deals with the importance of a physiotherapist role in prevention and dealing with the causative factors of AC and not merely its symptom. Methods: Extensive literature review was done from the electronic data bases, Systematic reviews and critical reviews from Pub med indexed journals and other peer reviewed publications across the globe. Results: It was not the type of diabetes but the duration of the disease and the glycemic index, marking the causative factor for adhesive capsulitis of shoulder. Conclusion: It may be concluded that physiotherapist play a vital role in identifying the pre-diabetic or a diabetic state of an individual reporting in a multi disciplinary set up with a AC of shoulder, and also has a role in the prevention of AC by helping the individual to maintain a good glycemic control with a holistic approach which includes aerobic exercises, General Flexibility exercises, Weight management and Yoga therapy.

  16. Throwing Injuries of the Shoulder.

    Science.gov (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…

  17. MRI of Little Leaguer's shoulder

    International Nuclear Information System (INIS)

    Hatem, Stephen F.; Recht, Michael P.; Profitt, Brad

    2006-01-01

    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.)

  18. History of shoulder instability surgery.

    Science.gov (United States)

    Randelli, Pietro; Cucchi, Davide; Butt, Usman

    2016-02-01

    The surgical management of shoulder instability is an expanding and increasingly complex area of study within orthopaedics. This article describes the history and evolution of shoulder instability surgery, examining the development of its key principles, the currently accepted concepts and available surgical interventions. A comprehensive review of the available literature was performed using PubMed. The reference lists of reviewed articles were also scrutinised to ensure relevant information was included. The various types of shoulder instability including anterior, posterior and multidirectional instability are discussed, focussing on the history of surgical management of these topics, the current concepts and the results of available surgical interventions. The last century has seen important advancements in the understanding and treatment of shoulder instability. The transition from open to arthroscopic surgery has allowed the discovery of previously unrecognised pathologic entities and facilitated techniques to treat these. Nevertheless, open surgery still produces comparable results in the treatment of many instability-related conditions and is often required in complex or revision cases, particularly in the presence of bone loss. More high-quality research is required to better understand and characterise this spectrum of conditions so that successful evidence-based management algorithms can be developed. IV.

  19. [Shoulder dystocia: an obstetrical emergency].

    Science.gov (United States)

    Marques, Joana Borges; Reynolds, Ana

    2011-01-01

    Shoulder dystocia is one of the most feared obstetric emergencies due to related maternal and neonatal complications and therefore, the growing of medico-legal litigation that it entails. Although associated with risk factors such as fetal macrossomia, gestacional diabetes and instrumented delivery, the majority of cases are unpredictable. The lack of a consensus on shoulder dystocia diagnosis causes variations on its incidence and hampers a more comprehensive analysis. Management guidelines described for its resolution include several manoeuvres but the ideal sequence of procedures is not clearly defined in more severe cases. Hands-on and team training, through simulation-based techniques applied to medicine, seems to be a promising method to learn how to deal with shoulder dystocia having in mind a reduction in related maternal or neonatal morbidity and mortality. The main goal of this paper is to provide a comprehensive revision of shoulder dystocia highlighting its relevance as an obstetric emergency. A reflection on the management is presented emphasising the importance of simulation-based training.

  20. Interscalene block for shoulder surgery

    African Journals Online (AJOL)

    2011-06-15

    Jun 15, 2011 ... Fracture dislocation of the shoulder is a common musculoskeletal injury following road traffic accident. Peripheral ... Fracture luxation de l'épaule est une commune blessures musculo-squelettiques suite route trafic accident. Périphériques nerf .... vertebral artery injection, pneumothorax, Horner's syndrome ...

  1. Understanding anatomical terms.

    Science.gov (United States)

    Mehta, L A; Natrajan, M; Kothari, M L

    1996-01-01

    Words are our masters and words are our slaves, all depending on how we use them. The whole of medical science owes its origin to Greco-Roman culture and is replete with terms whose high sound is not necessarily accompanied by sound meaning. This is even more the case in the initial, pre-clinical years. Anatomical terminology seems bewildering to the initiate; and maybe that is a reason why love of anatomy as a subject does not always spill over through later years. Employing certain classifications of the origin of the anatomical terms, we have prepared an anthology that we hope will ease the student's task and also heighten the student's appreciation of the new terms. This centers on revealing the Kiplingian "how, why, when, where, what, and who" of a given term. This presentation should empower students to independently formulate a wide network of correlations once they understand a particular term. The article thus hopes to stimulate students' analytic and synthetic faculties as well. A small effort can reap large rewards in terms of enjoyment of the study of anatomy and the related subjects of histology, embryology, and genetics. It is helpful to teachers and students alike. This exercise in semantics and etymology does not demand of the student or his teacher any background in linguistics, grammar, Greek, Latin, Sanskrit, anatomy, or medicine.

  2. Failure of aseptic revision total knee arthroplasties.

    Science.gov (United States)

    Leta, Tesfaye H; Lygre, Stein Håkon L; Skredderstuen, Arne; Hallan, Geir; Furnes, Ove

    2015-02-01

    In Norway, the proportion of revision knee arthroplasties increased from 6.9% in 1994 to 8.5% in 2011. However, there is limited information on the epidemiology and causes of subsequent failure of revision knee arthroplasty. We therefore studied survival rate and determined the modes of failure of aseptic revision total knee arthroplasties. This study was based on 1,016 aseptic revision total knee arthroplasties reported to the Norwegian Arthroplasty Register between 1994 and 2011. Revisions done for infections were not included. Kaplan-Meier and Cox regression analyses were used to assess the survival rate and the relative risk of re-revision with all causes of re-revision as endpoint. 145 knees failed after revision total knee arthroplasty. Deep infection was the most frequent cause of re-revision (28%), followed by instability (26%), loose tibial component (17%), and pain (10%). The cumulative survival rate for revision total knee arthroplasties was 85% at 5 years, 78% at 10 years, and 71% at 15 years. Revision total knee arthroplasties with exchange of the femoral or tibial component exclusively had a higher risk of re-revision (RR = 1.7) than those with exchange of the whole prosthesis. The risk of re-revision was higher for men (RR = 2.0) and for patients aged less than 60 years (RR = 1.6). In terms of implant survival, revision of the whole implant was better than revision of 1 component only. Young age and male sex were risk factors for re-revision. Deep infection was the most frequent cause of failure of revision of aseptic total knee arthroplasties.

  3. Complications of labor and delivery: shoulder dystocia.

    Science.gov (United States)

    Anderson, Jane E

    2012-03-01

    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. Published by Elsevier Inc.

  4. Recurrent Shoulder Dystocia: Risk Factors and Counseling.

    Science.gov (United States)

    Gurewitsch Allen, Edith D

    2016-12-01

    A prior history of delivery complicated by shoulder dystocia confers a 6-fold to nearly 30-fold increased risk of shoulder dystocia recurrence in a subsequent vaginal delivery, with most reported rates between 12% and 17%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, directing intervention efforts at the particular subgroup of women with a prior history of shoulder dystocia has merit. Potentially modifiable risk factors and individualized management strategies that may reduce shoulder dystocia recurrence and its associated significant morbidities are reviewed.

  5. Infection after primary hip arthroplasty

    Science.gov (United States)

    2011-01-01

    Background and purpose The aim of the present study was to assess incidence of and risk factors for infection after hip arthroplasty in data from 3 national health registries. We investigated differences in risk patterns between surgical site infection (SSI) and revision due to infection after primary total hip arthroplasty (THA) and hemiarthroplasty (HA). Materials and methods This observational study was based on prospective data from 2005–2009 on primary THAs and HAs from the Norwegian Arthroplasty Register (NAR), the Norwegian Hip Fracture Register (NHFR), and the Norwegian Surveillance System for Healthcare–Associated Infections (NOIS). The Norwegian Patient Register (NPR) was used for evaluation of case reporting. Cox regression analyses were performed with revision due to infection as endpoint for data from the NAR and the NHFR, and with SSI as the endpoint for data from the NOIS. Results The 1–year incidence of SSI in the NOIS was 3.0% after THA (167/5,540) and 7.3% after HA (103/1,416). The 1–year incidence of revision due to infection was 0.7% for THAs in the NAR (182/24,512) and 1.5% for HAs in the NHFR (128/8,262). Risk factors for SSI after THA were advanced age, ASA class higher than 2, and short duration of surgery. For THA, the risk factors for revision due to infection were male sex, advanced age, ASA class higher than 1, emergency surgery, uncemented fixation, and a National Nosocomial Infection Surveillance (NNIS) risk index of 2 or more. For HAs inserted after fracture, age less than 60 and short duration of surgery were risk factors of revision due to infection. Interpretation The incidences of SSI and revision due to infection after primary hip replacements in Norway are similar to those in other countries. There may be differences in risk pattern between SSI and revision due to infection after arthroplasty. The risk patterns for revision due to infection appear to be different for HA and THA. PMID:22066562

  6. Management of the frozen shoulder

    Directory of Open Access Journals (Sweden)

    van de Laar SM

    2014-10-01

    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

  7. Conversion total hip arthroplasty: Primary or revision total hip arthroplasty.

    Science.gov (United States)

    Schwarzkopf, Ran; Baghoolizadeh, Mahta

    2015-11-18

    Total hip arthroplasty (THA) is an increasingly common procedure among elderly individuals. Although conversion THA is currently bundled in a diagnosis related group (DRG) with primary THA, there is a lack of literature supporting this classification and it has yet to be identified whether conversion THA better resembles primary or revision THA. This editorial analyzed the intraoperative and postoperative factors and functional outcomes following conversion THA, primary THA, and revision THA to understand whether the characteristics of conversion THA resemble one procedure or the other, or are possibly somewhere in between. The analysis revealed that conversion THA requires more resources both intraoperatively and postoperatively than primary THA. Furthermore, patients undergoing conversion THA present with poorer functional outcomes in the long run. Patients undergoing conversion THA better resemble revision THA patients than primary THA patients. As such, patients undergoing conversion THA should not be likened to patients undergoing primary THA when determining risk stratification and reimbursement rates. Conversion THA procedures should be planned accordingly with proper anticipation of the greater needs both in the operating room, and for in-patient and follow-up care. We suggest that conversion THA be reclassified in the same DRG with revision THA as opposed to primary THA as a step towards better allocation of healthcare resources for conversion hip arthroplasties.

  8. Postoperative radiologic imaging of joint arthroplasty

    International Nuclear Information System (INIS)

    Aldinger, P.R.; Ludwig, K.

    2006-01-01

    With increased life expectancy in industrialised countries, improvement of implant design and operative technique, arthroplasty has become a routine procedure. The hip and knee joints are treated by arthroplasty most frequently. Nowadays joint replacement can be performed in many other joints. Radiologic imaging is an important tool for evaluation of the operative results and for detection of early and late complications. In the following article we describe the relevance of different imaging modalities as well as their systematic application in patients with joint arthroplasty. (orig.)

  9. Total ankle arthroplasty: An imaging overview

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Da Rae; Choi, Yun Sun; Chun, Ka Young; Jung, Yoon Young; Kim, Jin Su; Young, Ki Won [Eulji Hospital, Eulji University, Seoul (Korea, Republic of); Potter, Hollis G.; Li, Angela E. [Dept. of Radiology and Imaging, Hospital for Special Surgery, New York (United States)

    2016-06-15

    With advances in implant technology, total ankle arthroplasty (TAA) has become an increasingly popular alternative to arthrodesis for the management of end-stage ankle arthritis. However, reports in the literature do not focus on the imaging features of TAA. Through a literature review, we demonstrate basic design features of the current ankle arthroplasty system, and the normal and abnormal postoperative imaging features associated with such devices. Pre- and postoperative evaluations of ankle arthroplasty mainly include radiography; in addition, computed tomography and magnetic resonance imaging provide further characterization of imaging abnormalities. Familiarization with multimodal imaging features of frequent procedural complications at various postoperative intervals is important in radiological practice.

  10. Recurrent shoulder dystocia: is it predictable?

    Science.gov (United States)

    Kleitman, Vered; Feldman, Roi; Walfisch, Asnat; Toledano, Ronen; Sheiner, Eyal

    2016-11-01

    To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors were assessed. A retrospective cohort analysis comparing all singleton deliveries with and without shoulder dystocia in their preceding delivery was conducted. Independent predictors of recurrent shoulder dystocia were investigated using a multiple logistic regression model. Of the 201,422 deliveries included in the analysis, 307 occurred in women with a previous shoulder dystocia (0.015 %). Women with a history of shoulder dystocia were more likely to be older, experienced higher rates of gestational diabetes mellitus, polyhydramnios, prolonged second stage, operative delivery and macrosomia (>4000 g) in the following delivery. Previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia (OR = 6.1, 95 % CI 3.2-11.8, p value Shoulder dystocia is an independent risk factor for recurrent shoulder dystocia. Deliveries in women with a history of shoulder dystocia are characterized by higher rates of operative delivery, prolonged second stage of labor and macrosomia.

  11. Molecular biology of frozen shoulder-induced limitation of shoulder joint movements.

    Science.gov (United States)

    Cui, Jiaming; Lu, Wei; He, Yong; Jiang, Luoyong; Li, Kuokuo; Zhu, Weimin; Wang, Daping

    2017-01-01

    Frozen shoulder is a chronic condition characterized by pain in the shoulder and restriction of movements in all directions. Some patients are left with long-term limitation of shoulder joint activity with various severities, which results in reduced quality of life. Currently, there is a paucity of literature on the molecular biology of frozen shoulder, and the molecular biological mechanism for periarthritis-induced limitation of shoulder joint movements remains unclear. Research in this field is focused on inflammation and cytokines associated with fibrosis. Repeated investigations confirmed alterations of specified inflammatory mediators and fibrosis-associated cytokines, which might be involved in the pathogenesis of frozen shoulder by causing structural changes of the shoulder joint and eventually the limitation of shoulder movements. The aim of this article is to review studies on molecular biology of frozen shoulder and provide a reference for subsequent research, treatment, and development of new drugs.

  12. Os acromiale causing shoulder impingement syndrome: a case report; Os acromiale como causa de impingement del hombro: a proposito de un caso

    Energy Technology Data Exchange (ETDEWEB)

    Romero, I.; Rodriguez, A.; Roca, M.; Garcia, Y. [Hospital Universitario Miguel Servet. Zaragoza (Spain)

    2001-07-01

    Shoulder impingement syndrome is caused by repeated mechanical trauma to the rotator cuff due to encroachment of the coracoacromial ligement; in most cases, it is a primary lesion. Os acromiale, an anatomic variant of the shoulder structures, is one of the predisposing factors for the development of this entity. We present a case of os acromiale complicated by complete rupture of the tendon of the supraspinatus muscle and luxation of the long head of the biceps tendon. We stress the importance of magnetic resonance in the study of this anatomic variant and in the detection of complications or associated lesions. (Author) 10 refs.

  13. Cervical disc arthroplasty: Pros and cons.

    Science.gov (United States)

    Moatz, Bradley; Tortolani, P Justin

    2012-01-01

    Cervical disc arthroplasty has emerged as a promising potential alternative to anterior cervical discectomy and fusion (ACDF) in appropriately selected patients. Despite a history of excellent outcomes after ACDF, the question as to whether a fusion leads to adjacent segment degeneration remains unanswered. Numerous US investigational device exemption trials comparing cervical arthroplasty to fusion have been conducted to answer this question. This study reviews the current research regarding cervical athroplasty, and emphasizes both the pros and cons of arthroplasty as compared with ACDF. Early clinical outcomes show that cervical arthroplasty is as effective as the standard ACDF. However, this new technology is also associated with an expanding list of novel complications. Although there is no definitive evidence that cervical disc replacement reduces the incidence of adjacent segment degeneration, it does show other advantages; for example, faster return to work, and reduced need for postoperative bracing.

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

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  15. Transcutaneous Electrical Nerve Stimulation Reduces Post-Thoractomy Ipsilateral Shoulder Pain. A Prospective Randomized Study.

    Science.gov (United States)

    Esteban González, Pedro; Novoa, Nuria M; Varela, Gonzalo

    2015-12-01

    The patient's position during an axillary thoracotomy can cause postoperative pain and decrease mobility of the ipsilateral shoulder. In this study, we assessed whether the implementation of a standardized analgesia program using transcutaneous electrical nerve stimulation (TENS) decreases local pain and improves ipsilateral shoulder mobility. Randomized, single-blind, single-center clinical trial of 50 patients who had undergone anatomical lung resection via axillary muscle-sparing thoracotomy. Patients were treated with TENS devices for 30 minutes every 8 hours, beginning on postoperative day 1. Pain and mobility of the affected limb were recorded at the same time on postoperative days 1 through 3. A visual analogue scale was used for pain assessment and shoulder mobility was assessed with a goniometer. Results were compared using a non-parametric test. Twenty-five patients were randomized to each group. Mean age of the control group was 62.7±9.3 years and 63.4±10.2 years in the experimental group. Shoulder mobility parameters were similar in both groups on all postoperative days. However, pain during flexion significantly decreased on day 2 (P=.03) and day 3 (P=.04) in the experimental group. The use of TENS decreases pain from shoulder flexion in patients undergoing axillary thoracotomy for pulmonary resection. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  16. The reverse shoulder prosthesis: a review of imaging features and complications

    International Nuclear Information System (INIS)

    McFarland, Edward G.; Sanguanjit, Prakasit; Tasaki, Atsushi; Keyurapan, Ekavit; Fishman, Elliot K.; Fayad, Laura M.

    2006-01-01

    The reverse shoulder prosthesis is a prosthesis that has been in clinical use in Europe since 1985 and was approved for use in the United States in 2004. This unique prosthesis has a baseplate attached to the glenoid, which holds a spherical component, while the humeral component includes a polyethylene insert that is flat. This design is the ''reverse'' configuration of that seen with a conventional arthroplasty, in which the spherical component is part of the humeral component. The indications for the reverse prosthesis are: (1) painful arthritis associated with irreparable rotator cuff tears (cuff tear arthropathy), (2) failed hemiarthroplasty with irreparable rotator cuff tears, (3) pseudoparalysis due to massive, irreparable rotator cuff tears, (4) some reconstructions after tumor resection, and (5) some fractures of the shoulder not repairable or reconstructable with other techniques. This prosthesis can produce a significant reduction in pain and some improvement in function for most of the indications mentioned. However, the unique configuration and the challenge of its insertion can result in a high incidence of a wide variety of unusual complications. Some of these complications, such as dislocation of the components, are similar to conventional shoulder replacement. Other complications, such as notching of the scapula and acromial stress fractures, are unique to this prosthesis. (orig.)

  17. The reverse shoulder prosthesis: a review of imaging features and complications

    Energy Technology Data Exchange (ETDEWEB)

    McFarland, Edward G.; Sanguanjit, Prakasit; Tasaki, Atsushi [Johns Hopkins University, Department of Orthopedic Surgery, Lutherville, MD (United States); Keyurapan, Ekavit [Mahidol University, Department of Orthopaedic Surgery, Bangkok (Thailand); Fishman, Elliot K.; Fayad, Laura M. [Johns Hopkins Medical Institutions, Johns Hopkins University, Department of Radiology and Radiological Sciences, Baltimore, MD (United States)

    2006-07-15

    The reverse shoulder prosthesis is a prosthesis that has been in clinical use in Europe since 1985 and was approved for use in the United States in 2004. This unique prosthesis has a baseplate attached to the glenoid, which holds a spherical component, while the humeral component includes a polyethylene insert that is flat. This design is the ''reverse'' configuration of that seen with a conventional arthroplasty, in which the spherical component is part of the humeral component. The indications for the reverse prosthesis are: (1) painful arthritis associated with irreparable rotator cuff tears (cuff tear arthropathy), (2) failed hemiarthroplasty with irreparable rotator cuff tears, (3) pseudoparalysis due to massive, irreparable rotator cuff tears, (4) some reconstructions after tumor resection, and (5) some fractures of the shoulder not repairable or reconstructable with other techniques. This prosthesis can produce a significant reduction in pain and some improvement in function for most of the indications mentioned. However, the unique configuration and the challenge of its insertion can result in a high incidence of a wide variety of unusual complications. Some of these complications, such as dislocation of the components, are similar to conventional shoulder replacement. Other complications, such as notching of the scapula and acromial stress fractures, are unique to this prosthesis. (orig.)

  18. Gemella haemolysans Infection in Total Hip Arthroplasty.

    Science.gov (United States)

    Rose, Barry; Jeer, Parminder J S; Spriggins, Anthony J

    2012-01-01

    Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  19. Hip Resurfacing Arthroplasty and Perioperative Blood Testing

    OpenAIRE

    Cook, Andrew; Cook, Steven; Smith, Ian; Weinrauch, Patrick

    2014-01-01

    It is standard practice in many institutions to routinely perform preoperative and postoperative haemoglobin level testing in association with hip joint arthroplasty procedures. It is our observation, however, that blood transfusion after uncomplicated primary hip arthroplasty in healthy patients is uncommon and that the decision to proceed with blood transfusion is typically made on clinical grounds. We therefore question the necessity and clinical value of routine perioperative blood testin...

  20. Calcitonin effects on shoulder adhesive capsulitis.

    Science.gov (United States)

    Rouhani, Alireza; Mardani-Kivi, Mohsen; Bazavar, Mohammadreza; Barzgar, Mahmood; Tabrizi, Ali; Hashemi-Motlagh, Keyvan; Saheb-Ekhtiari, Khashayar

    2016-08-01

    Adhesive capsulitis (frozen shoulder) is a relatively prevalent disease of shoulder and affects soft tissue of glenohumeral joint. Signs include painful restricted motion and disability of the patient in daily activities. Calcitonin is a thyroid hormone, and its effectiveness has been demonstrated in painful conditions. The presents study aims to evaluate the effect of calcitonin in treating shoulder adhesive capsulitis. This double-blinded randomized clinical trial was conducted on 64 patients suffering from shoulder adhesive capsulitis. The intervention and control groups were given intranasal calcitonin and placebo for 6 weeks, respectively. For both groups, physiotherapy and non-steroidal anti-inflammatory drugs were administered correspondingly. The patients were evaluated pre- and post-treatment for shoulder pain and shoulder range of motion (ROM). Shoulder functional outcome (secondary outcome) was evaluated using Disability of Arm, Shoulder, and Hand, Shoulder Pain and Disability Index, and Health Assessment Questionnaire disability criteria. The mean age of patients in calcitonin and control group was 52.4 ± 4.6 and 53.2 ± 4.9, respectively. Demographic characteristics and pre-treatment scores were similar in both groups (all P > 0.05). In post-treatment follow-up, shoulder pain, ROM, and the patients' functional scores were significantly improved in both groups (P adhesive capsulitis with regard to the efficiency in alleviating pain and improving functional outcome. II.

  1. The nerves around the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Blum, Alain, E-mail: alain.blum@gmail.com [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)

    2013-01-15

    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.

  2. Impingement syndrome of the shoulder

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  3. Robotics in Arthroplasty: A Comprehensive Review.

    Science.gov (United States)

    Jacofsky, David J; Allen, Mark

    2016-10-01

    Robotic-assisted orthopedic surgery has been available clinically in some form for over 2 decades, claiming to improve total joint arthroplasty by enhancing the surgeon's ability to reproduce alignment and therefore better restore normal kinematics. Various current systems include a robotic arm, robotic-guided cutting jigs, and robotic milling systems with a diversity of different navigation strategies using active, semiactive, or passive control systems. Semiactive systems have become dominant, providing a haptic window through which the surgeon is able to consistently prepare an arthroplasty based on preoperative planning. A review of previous designs and clinical studies demonstrate that these robotic systems decrease variability and increase precision, primarily focusing on component positioning and alignment. Some early clinical results indicate decreased revision rates and improved patient satisfaction with robotic-assisted arthroplasty. The future design objectives include precise planning and even further improved consistent intraoperative execution. Despite this cautious optimism, many still wonder whether robotics will ultimately increase cost and operative time without objectively improving outcomes. Over the long term, every industry that has seen robotic technology be introduced, ultimately has shown an increase in production capacity, improved accuracy and precision, and lower cost. A new generation of robotic systems is now being introduced into the arthroplasty arena, and early results with unicompartmental knee arthroplasty and total hip arthroplasty have demonstrated improved accuracy of placement, improved satisfaction, and reduced complications. Further studies are needed to confirm the cost effectiveness of these technologies. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Diagnosis of shoulder impingement syndrome

    International Nuclear Information System (INIS)

    Hodler, J.

    1996-01-01

    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.) [de

  5. Serum Metal Ion Concentrations in Paediatric Patients following Total Knee Arthroplasty Using Megaprostheses

    Directory of Open Access Journals (Sweden)

    Jörg Friesenbichler

    2014-01-01

    Full Text Available The purpose of this study was to determine the concentrations of cobalt, chromium, and molybdenum in the serum of paediatric tumour patients after fixed hinge total knee arthroplasty. Further, these metal ion levels were compared with serum metal ion levels of patients with other orthopaedic devices such as hip and knee prostheses with metal-on-metal or metal-on-polyethylene articulation to find differences between anatomical locations, abrasion characteristics, and bearing surfaces. After an average follow-up of 108 months (range: 67 to 163 of 11 paediatric patients with fixed hinge total knee arthroplasty, the mean concentrations for Co and Cr were significantly increased while Mo was within the limits compared to the upper values from the reference laboratory. Furthermore, these serum concentrations were significantly higher compared to patients with a standard rotating hinge device (P=0.002 and P<0.001 and preoperative controls (P<0.001. On the other hand, the serum levels of patients following MoM THA or rotating hinge arthroplasty using megaprostheses were higher. Therefore, periodic long-term follow-ups are recommended due to the rising concerns about systemic metal ion exposure in the literature. Upon the occurrence of adverse reactions to metal debris the revision of the fixed hinge implant should be considered.

  6. Medium-term evaluation of total knee arthroplasty without patellar replacement

    Directory of Open Access Journals (Sweden)

    José Wanderley Vasconcelos

    2013-06-01

    Full Text Available OBJECTIVE: To mid-term evaluate patients who were submitted to total knee arthroplasty without patellar resurfacing. METHODS: It was realized a retrospective cross-sectional study of patients who were submitted to total knee arthroplasty without patellar resurfacing. In all patients clinical examination was done based on the protocol of the Knee Society Scoring System, which assessed pain, range of motion, stability, contraction, knee alignment and function, and radiological evaluation. RESULTS: A total of 36 patients were evaluated. Of these, 07 were operated only on left knee, 12 only on right knee and 17 were operated bilaterally, totaling 53 knees. Ages ranged from 26 to 84 years. Of the 53 knees evaluated, 33 (62.26% had no pain. The maximum flexion range of motion averaged 104.7°. No knee had difficulty in active extension. As to the alignment for anatomical axis twelve knees (22.64% showed deviation between 0° and 4° varus. Thirty-nine (75.49% knees showed pace without restriction and the femorotibial angle ranged between 3° varus and 13° valgus with an average of 5° valgus. The patellar index ranged from 0.2 to 1.1. CONCLUSION: Total knee arthroplasty whitout patellar resurfacing provides good results in mid-term evaluation.

  7. Results of total hip arthroplasty using a bionic hip stem.

    Science.gov (United States)

    Fokter, Samo K; Sarler, Taras; Strahovnik, Andrej; Repše-Fokter, Alenka

    2015-06-01

    The trabecular-orientated bionic hip stem was designed to mimic the natural force transmission through the femur in total hip arthroplasty, resulting in supposedly longer prosthesis survivability. The aim of this study was to compare the second-generation bionic hip stem to a standard uncemented hip stem. A group of 18 patients (21 hips) who underwent total hip arthroplasty with a bionic stem (bionic group) was compared with a historic group of 12 patients (12 hips) treated with standard anatomic hip stem (control group). During the first year after the procedure, the densitometric measurements of the bone around the prosthesis were taken. Radiographic and clinical assessments were additionally performed preoperatively and at the three month, six month, one year and three year follow-ups in the bionic group. In the bionic group, one patient was revised for aseptic loosening and 16 patients (19 hips) were available to the final follow-up. A significant decrease of bone mineral density was found in Gruen zones 3, 4 and 5 in the bionic group, and in zone 7 in both groups. The bionic group had a significantly higher bone mineral density in Gruen zone 1 at the one year follow-up. At the final follow-up, all prostheses were radiologically stable in both groups. Provided that a good implant position is achieved, comparable short-term results can be obtained using a bionic stem. Still, a decrease of bone mineral density in Gruen zone 7 occurred in both groups. Further studies are required to determine survivability of the bionic stem.

  8. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy.

    Science.gov (United States)

    Atilla, Bülent

    2016-03-01

    Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65-71. DOI: 10.1302/2058-5241.1.000026.

  9. Risk of shoulder dystocia in second delivery: does a history of shoulder dystocia matter?

    Science.gov (United States)

    Overland, Eva A; Spydslaug, Anny; Nielsen, Christopher S; Eskild, Anne

    2009-05-01

    Our aim was to estimate the relative and absolute risk of shoulder dystocia in the second delivery according to history of shoulder dystocia and offspring birthweight. A retrospective cohort study including all women in Norway with 2 consecutive singleton vaginal deliveries with fetus in cephalic presentation, during the period 1967-2005 (n = 537,316). In the second delivery shoulder dystocia occurred in 0.8% of all women. In women with a prior shoulder dystocia the recurrence risk was 7.3%. Most cases of shoulder dystocia in second delivery were in women without such history (96.2%). Offspring birthweight was the most important risk factor for shoulder dystocia in second delivery: crude odds ratio, 292.9 (95% confidence interval, 237.8-360.7) comparing birthweight > 5000 g with 3000-3499 g. Prior shoulder dystocia increased the risk of shoulder dystocia in the second delivery. However, offspring birthweight was by far the most important risk factor.

  10. Evaluation of shoulder integrity in space: first report of musculoskeletal US on the International Space Station

    Science.gov (United States)

    Fincke, E. Michael; Padalka, Gennady; Lee, Doohi; van Holsbeeck, Marnix; Sargsyan, Ashot E.; Hamilton, Douglas R.; Martin, David; Melton, Shannon L.; McFarlin, Kellie; Dulchavsky, Scott A.

    2005-01-01

    Investigative procedures were approved by Henry Ford Human Investigation Committee and NASA Johnson Space Center Committee for Protection of Human Subjects. Informed consent was obtained. Authors evaluated ability of nonphysician crewmember to obtain diagnostic-quality musculoskeletal ultrasonographic (US) data of the shoulder by following a just-in-time training algorithm and using real-time remote guidance aboard the International Space Station (ISS). ISS Expedition-9 crewmembers attended a 2.5-hour didactic and hands-on US training session 4 months before launch. Aboard the ISS, they completed a 1-hour computer-based Onboard Proficiency Enhancement program 7 days before examination. Crewmembers did not receive specific training in shoulder anatomy or shoulder US techniques. Evaluation of astronaut shoulder integrity was done by using a Human Research Facility US system. Crew used special positioning techniques for subject and operator to facilitate US in microgravity environment. Common anatomic reference points aided initial probe placement. Real-time US video of shoulder was transmitted to remote experienced sonologists in Telescience Center at Johnson Space Center. Probe manipulation and equipment adjustments were guided with verbal commands from remote sonologists to astronaut operators to complete rotator cuff evaluation. Comprehensive US of crewmember's shoulder included transverse and longitudinal images of biceps and supraspinatus tendons and articular cartilage surface. Total examination time required to guide astronaut operator to acquire necessary images was approximately 15 minutes. Multiple arm and probe positions were used to acquire dynamic video images that were of excellent quality to allow evaluation of shoulder integrity. Postsession download and analysis of high-fidelity US images collected onboard demonstrated additional anatomic detail that could be used to exclude subtle injury. Musculoskeletal US can be performed in space by minimally

  11. Gimballed Shoulders for Friction Stir Welding

    Science.gov (United States)

    Carter, Robert; Lawless, Kirby

    2008-01-01

    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.

  12. Rugby and Shoulder Trauma: A Systematic Review

    OpenAIRE

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

    2014-01-01

    Rugby is a popular contact sport worldwide. Collisions and tackles during matches and practices often lead to traumatic injuries of the shoulder. This review reports on the epidemiology of injuries, type of lesions and treatment of shoulder injuries, risk factors, such as player position, and return to sport activities. Electronic searches through PubMed (Medline), EMBASE, and Cochrane Library retrieved studies concerning shoulder injuries in rugby players. Data regarding incidence, type and ...

  13. Studies in shoulder disorders and tendinopathy

    OpenAIRE

    Ostor, Andrew James Knowles

    2017-01-01

    The human shoulder is the most complex of any peripheral synovial joint. Despite the high incidence and prevalence of symptomatic shoulder disorders, particularly of the rotator cuff, a paucity of robust research exists into this area. Lack of consensus on the most appropriate clinical method of assessing the shoulder and lack of adequate diagnostic criteria has inhibited the development of effective management strategies. This has substantial implications for individuals, heal...

  14. Athletes’ Shoulder Joints Traumas Manual Therapy Rehabilitation

    Directory of Open Access Journals (Sweden)

    A.N. Sykhorychko

    2012-06-01

    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.

  15. Problem of painful shoulder in hemiparetics patients

    OpenAIRE

    Daumann, Pavla

    2013-01-01

    This bachelor thesis is focused on a painful hemiparetic shoulder as a frequently observed complication in patients suffering from stroke. Basic information about stroke, anatomy and kinematics of shoulder joint is included in a theoretical part of the thesis. The largest portion describes a pathogenesis of painful hemiparetic shoulder, its prevention and commonly used physiotherapeutic approaches. The practical part of the thesis consists of two case reports of patients with stroke suffering...

  16. Shoulder dystocia: impacts, prevention, prognosis, troubleshooting

    OpenAIRE

    G. Kontopoulos; S. Kouvelas

    2017-01-01

    Shoulder dystocia is one of the most dramatic complications encountered in obstetrics. When this complication occurs, it can result in increased maternal morbidity rate and increased incidence of neonatal morbidity and mortality. Although several risk factors are clearly associated with dystocia shoulder. The recognition of individual cases of shoulder dystocia has proven impossible in practice, before they occur during labor. Several guidelines have been published concerning the treatment...

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

    Science.gov (United States)

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

    2011-11-01

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

  18. Kinematics of the contralateral and ipsilateral shoulder: A possible relationship with post-stroke shoulder pain

    OpenAIRE

    Niessen, M.H.M.; Janssen, T.W.J.; Meskers, C.G.M.; Koppe, P.; Konijnenbelt, M.; Veeger, H.E.J.

    2008-01-01

    Objective: Post-stroke shoulder pain is a common phenomenon in hemiplegia and impedes rehabilitation. The aim of this study was to identify a possible relationship between post-stroke shoulder pain, scapula resting position and shoulder motion. Methods: Shoulder kinematics of 27 patients after stroke (17 men) were compared with 10 healthy age-matched control subjects. Using an electromagnetic tracking device, the kinematics of both the contralateral and ipsilateral (i.e. paretic and non-paret...

  19. Shoulder muscle activity and function in common shoulder rehabilitation exercises.

    Science.gov (United States)

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

    2009-01-01

    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

  20. Infraglenoidal scapular notching in reverse total shoulder replacement: a prospective series of 60 cases and systematic review of the literature

    Directory of Open Access Journals (Sweden)

    Hochreiter Josef

    2011-05-01

    Full Text Available Abstract Background The impact of infraglenoidal scapular notching in reversed total shoulder arthroplasty (RTSA is still controversially discussed. Our goal was to evaluate its potential influence on subjective shoulder stability and clinical outcome. We hypothesized that subjective instability and clinical outcome after implantation of RTSA correlates with objective scapular notching. Methods Sixty shoulders were assessed preoperatively and at minimum 2-year follow-up for active range of motion and by use of the Oxford instability score, Rowe score for instability, Constant score for pain, Constant shoulder score, DASH score. All shoulders were evaluated on anterior-posterior and axillary lateral radiographic views. These X-ray scans were classified twice by two orthopaedic surgeons with respect to infraglenoidal scapular notching according to the classification of Nerot. Notching was tested for correlation with clinical outcome scores to the evaluated notching. Results We found no significant correlation between infraglenoidal scapular notching and clinical outcomes after a mid-term follow-up from 24 to 60 months, but at the final follow-up of 60 months and more, we did see statistically significant, positive correlations between infraglenoidal scapular notching and the Constant pain score as well as active range of motion. At mean follow-up of 42 months (range from 24 to 96 months we found no significant correlation between subjective instability and infraglenoidal scapular notching. Conclusions We conclude that patients' subjective impression on their shoulders' stability is not correlating with radiological signs of infraglenoidal scapular notching. Nevertheless clinical parameters are affected by infraglenoidal scapular notching, at least in the long term

  1. Rehabilitation of the shoulder in tennis players.

    Science.gov (United States)

    Plancher, K D; Litchfield, R; Hawkins, R J

    1995-01-01

    The tennis player places unique demands on the shoulder by creating a high risk for overuse and overloading of the soft tissues. Tennis requires concentric work to position and move the arm, eccentric work to stabilize the shoulder, effective depression of the humeral head to avoid impingement in the overhead position, and normal stability to prevent secondary impingement. The tennis serve produces enormous angular velocities about the shoulder joint. A comprehensive rehabilitation program has been described in which the therapist, trainer, player, and physician alike need to have an understanding of the basic biomechanics of this sport. This program can be used to treat the painful shoulder, prevent injury, and enhance performance.

  2. Magnetic resonance imaging of the shoulder

    International Nuclear Information System (INIS)

    Ziemianski, A.; Romanowski, L.

    1994-01-01

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

  3. Shoulder dystocia: impacts, prevention, prognosis, troubleshooting

    Directory of Open Access Journals (Sweden)

    G. Kontopoulos

    2017-03-01

    Full Text Available Shoulder dystocia is one of the most dramatic complications encountered in obstetrics. When this complication occurs, it can result in increased maternal morbidity rate and increased incidence of neonatal morbidity and mortality. Although several risk factors are clearly associated with dystocia shoulder. The recognition of individual cases of shoulder dystocia has proven impossible in practice, before they occur during labor. Several guidelines have been published concerning the treatment of shoulder dystocia, aiming to instruct obstetricians to a maneuver sequence to reduce maternal and neonatal morbidity and mortality.

  4. Shoulder dystocia: risk factors, predictability, and preventability.

    Science.gov (United States)

    Mehta, Shobha H; Sokol, Robert J

    2014-06-01

    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. Copyright © 2014 Elsevier Inc. All rights reserved.

  5. Emergency department management of shoulder dystocia.

    Science.gov (United States)

    Del Portal, Daniel A; Horn, Amanda E; Vilke, Gary M; Chan, Theodore C; Ufberg, Jacob W

    2014-03-01

    Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome. To review multiple techniques for managing a shoulder dystocia in the ED. We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort. Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

  6. Can shoulder dystocia be reliably predicted?

    Science.gov (United States)

    Dodd, Jodie M; Catcheside, Britt; Scheil, Wendy

    2012-06-01

    To evaluate factors reported to increase the risk of shoulder dystocia, and to evaluate their predictive value at a population level. The South Australian Pregnancy Outcome Unit's population database from 2005 to 2010 was accessed to determine the occurrence of shoulder dystocia in addition to reported risk factors, including age, parity, self-reported ethnicity, presence of diabetes and infant birth weight. Odds ratios (and 95% confidence interval) of shoulder dystocia was calculated for each risk factor, which were then incorporated into a logistic regression model. Test characteristics for each variable in predicting shoulder dystocia were calculated. As a proportion of all births, the reported rate of shoulder dystocia increased significantly from 0.95% in 2005 to 1.38% in 2010 (P = 0.0002). Using a logistic regression model, induction of labour and infant birth weight greater than both 4000 and 4500 g were identified as significant independent predictors of shoulder dystocia. The value of risk factors alone and when incorporated into the logistic regression model was poorly predictive of the occurrence of shoulder dystocia. While there are a number of factors associated with an increased risk of shoulder dystocia, none are of sufficient sensitivity or positive predictive value to allow their use clinically to reliably and accurately identify the occurrence of shoulder dystocia. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  7. Obstetric Emergencies: Shoulder Dystocia and Postpartum Hemorrhage.

    Science.gov (United States)

    Dahlke, Joshua D; Bhalwal, Asha; Chauhan, Suneet P

    2017-06-01

    Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and management to avoid significant morbidity or mortality. Shoulder dystocia is an uncommon, unpredictable, and unpreventable obstetric emergency and can be managed with appropriate intervention. Postpartum hemorrhage occurs more commonly and carries significant risk of maternal morbidity. Institutional protocols and algorithms for the prevention and management of shoulder dystocia and postpartum hemorrhage have become mainstays for clinicians. The goal of this review is to summarize the diagnosis, incidence, risk factors, and management of shoulder dystocia and postpartum hemorrhage. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. 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.

    Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder

  9. Critical shoulder angle combined with age predict five shoulder pathologies: a retrospective analysis of 1000 cases.

    Science.gov (United States)

    Heuberer, Philipp R; Plachel, Fabian; Willinger, Lukas; Moroder, Philipp; Laky, Brenda; Pauzenberger, Leo; Lomoschitz, Fritz; Anderl, Werner

    2017-06-15

    Acromial morphology has previously been defined as a risk factor for some shoulder pathologies. Yet, study results are inconclusive and not all major shoulder diseases have been sufficiently investigated. Thus, the aim of the present study was to analyze predictive value of three radiological parameters including the critical shoulder angle, acromion index, and lateral acromion angle in relationship to symptomatic patients with either cuff tear arthropathy, glenohumeral osteoarthritis, rotator cuff tear, impingement, and tendinitis calcarea. A total of 1000 patients' standardized true-anteroposterior radiographs were retrospectively assessed. Receiver-operating curve analyses and multinomial logistic regression were used to examine the association between shoulder pathologies and acromion morphology. The prediction model was derived from a development cohort and applied to a validation cohort. Prediction model's performance was statistically evaluated. The majority of radiological measurements were significantly different between shoulder pathologies, but the critical shoulder angle was an overall better parameter to predict and distinguish between the different pathologies than the acromion index or lateral acromion angle. Typical critical shoulder angle-age patterns for the different shoulder pathologies could be detected. Patients diagnosed with rotator cuff tears had the highest, whereas patients with osteoarthritis had the lowest critical shoulder angle. The youngest patients were in the tendinitis calcarea and the oldest in the cuff tear arthropathy group. The present study showed that critical shoulder angle and age, two easily assessable variables, adequately predict different shoulder pathologies in patients with shoulder complaints.

  10. Anatomical adaptations of aquatic mammals.

    Science.gov (United States)

    Reidenberg, Joy S

    2007-06-01

    This special issue of the Anatomical Record explores many of the anatomical adaptations exhibited by aquatic mammals that enable life in the water. Anatomical observations on a range of fossil and living marine and freshwater mammals are presented, including sirenians (manatees and dugongs), cetaceans (both baleen whales and toothed whales, including dolphins and porpoises), pinnipeds (seals, sea lions, and walruses), the sea otter, and the pygmy hippopotamus. A range of anatomical systems are covered in this issue, including the external form (integument, tail shape), nervous system (eye, ear, brain), musculoskeletal systems (cranium, mandible, hyoid, vertebral column, flipper/forelimb), digestive tract (teeth/tusks/baleen, tongue, stomach), and respiratory tract (larynx). Emphasis is placed on exploring anatomical function in the context of aquatic life. The following topics are addressed: evolution, sound production, sound reception, feeding, locomotion, buoyancy control, thermoregulation, cognition, and behavior. A variety of approaches and techniques are used to examine and characterize these adaptations, ranging from dissection, to histology, to electron microscopy, to two-dimensional (2D) and 3D computerized tomography, to experimental field tests of function. The articles in this issue are a blend of literature review and new, hypothesis-driven anatomical research, which highlight the special nature of anatomical form and function in aquatic mammals that enables their exquisite adaptation for life in such a challenging environment. 2007 Wiley-Liss, Inc.

  11. Cryotherapy on postoperative rehabilitation of joint arthroplasty.

    Science.gov (United States)

    Ni, Sheng-Hui; Jiang, Wen-Tong; Guo, Lei; Jin, Yu-Heng; Jiang, Tian-Long; Zhao, Yuyan; Zhao, Jie

    2015-11-01

    The effectiveness of cryotherapy on joint arthroplasty recovery remains controversial. This systematic review was conducted to assess the effectiveness of cryotherapy in patients after joint arthroplasty. Comprehensive literature searches of several databases including Cochrane Library (2013), MEDLINE (1950-2013), and Embase (1980-2013) were performed. We sought randomised controlled trials that compared the experimental group received any form of cryotherapy with any control group after joint arthroplasty. The main outcomes were postoperative blood loss, adverse events, and pain. Analyses were performed with Revman 5.0. Results were shown as mean differences (MD) and standard deviations or as risk difference and 95 % confidence intervals (CIs). Ten trials comprised 660 total knee arthroplastys and three trials comprised 122 total hip arthroplastys (THAs) met the inclusion criteria. Blood loss was significantly decreased by cryotherapy (MD = -109.68; 95 % CI -210.92 to -8.44; P = 0.03). Cryotherapy did not increase the risk of adverse effect (n.s.). Cryotherapy decreased pain at the second day of postoperative (MD = -1.32; 95 % CI -2.37 to -0.27; P = 0.0003), but did not decreased pain at the first and third day of postoperative (n.s.). Cryotherapy appears effective in these selected patients after joint arthroplasty. The benefits of cryotherapy on blood loss after joint arthroplasty were obvious. However, the subgroup analysis indicated that cryotherapy did not decreased blood loss after THA. Cryotherapy did not increase the risk of adverse effect. Cryotherapy decreased pain at the second day of postoperative, but did not decreased pain at the first and third day of postoperative. II.

  12. Relationship among shoulder proprioception, kinematics, and pain after stroke

    NARCIS (Netherlands)

    Niessen, M.H.M.; Veeger, H.E.J.; Meskers, C.G.M.; Koppe, P.A.; Konijnenbelt, M.H.; Janssen, T.W.J.

    2009-01-01

    Niessen MH, Veeger DH, Meskers CG, Koppe PA, Konijnenbelt MH, Janssen TW. Relationship among shoulder proprioception, kinematics, and pain after stroke. Objective: To identify a possible relationship among chronic poststroke shoulder pain (PSSP), scapular resting pose, and shoulder proprioception.

  13. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Zhuang, Hongming; Chacko, Thomas K.; Hickeson, Marc; Stevenson, Karen; Feng, Qi; Ponzo, Fabio; Alavi, Abass [Division of Nuclear Medicine, Department of Radiology, The Hospital of University of Pennsylvania, 110 Donner Building, 3400 Spruce Street, Philadelphia, PA 19104 (United States); Garino, Jonathan P. [Department of Orthopedic Surgery, The Hospital of University of Pennsylvania, Philadelphia, PA 19802 (United States)

    2002-10-01

    Hip arthroplasty is a common surgical procedure, but the diagnosis of infection associated with hip arthroplasty remains challenging. Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been shown to be a promising imaging modality in settings where infection is suspected. However, inflammatory reaction to surgery can result in increased FDG uptake at various anatomic locations, which may erroneously be interpreted as sites of infection. The purpose of this study was to assess the patterns and time course of FDG accumulation following total hip replacement over an extended period of time. Firstly, in a prospective study nine patients with total hip replacement were investigated to determine the patterns of FDG uptake over time. Three FDG-PET scans were performed in each patient at about 3, 6 and 12 months post arthroplasty. Secondly, in a retrospective analysis, the medical and surgical history and FDG-PET imaging results of 710 patients who had undergone whole-body scans for the evaluation of possible malignant disorders were reviewed. The history of arthroplasty and FDG-PET findings in the hip region were reviewed for this study. Patients with symptomatic arthroplasties or related complaints during FDG-PET scanning were excluded from the analysis. During the entire study period, all nine patients enrolled in the prospective study were demonstrated to have increased FDG uptake around the femoral head or neck portion of the prosthesis that extended to the soft tissues surrounding the femur. Among the patients reviewed in the retrospective study, 18 patients with a history of 21 hip arthroplasties who were asymptomatic at the time of FDG-PET scan met the criteria for inclusion. The time interval between the hip arthroplasty and the FDG-PET study ranged from 3 months to 288 months (mean{+-}SD: 80.4{+-}86.2 months). In 81% (17 of 21) of these prostheses, increased FDG uptake could be noted around the femoral head or neck portion of the

  14. Persistent non-specific FDG uptake on PET imaging following hip arthroplasty

    International Nuclear Information System (INIS)

    Zhuang, Hongming; Chacko, Thomas K.; Hickeson, Marc; Stevenson, Karen; Feng, Qi; Ponzo, Fabio; Alavi, Abass; Garino, Jonathan P.

    2002-01-01

    Hip arthroplasty is a common surgical procedure, but the diagnosis of infection associated with hip arthroplasty remains challenging. Fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) has been shown to be a promising imaging modality in settings where infection is suspected. However, inflammatory reaction to surgery can result in increased FDG uptake at various anatomic locations, which may erroneously be interpreted as sites of infection. The purpose of this study was to assess the patterns and time course of FDG accumulation following total hip replacement over an extended period of time. Firstly, in a prospective study nine patients with total hip replacement were investigated to determine the patterns of FDG uptake over time. Three FDG-PET scans were performed in each patient at about 3, 6 and 12 months post arthroplasty. Secondly, in a retrospective analysis, the medical and surgical history and FDG-PET imaging results of 710 patients who had undergone whole-body scans for the evaluation of possible malignant disorders were reviewed. The history of arthroplasty and FDG-PET findings in the hip region were reviewed for this study. Patients with symptomatic arthroplasties or related complaints during FDG-PET scanning were excluded from the analysis. During the entire study period, all nine patients enrolled in the prospective study were demonstrated to have increased FDG uptake around the femoral head or neck portion of the prosthesis that extended to the soft tissues surrounding the femur. Among the patients reviewed in the retrospective study, 18 patients with a history of 21 hip arthroplasties who were asymptomatic at the time of FDG-PET scan met the criteria for inclusion. The time interval between the hip arthroplasty and the FDG-PET study ranged from 3 months to 288 months (mean±SD: 80.4±86.2 months). In 81% (17 of 21) of these prostheses, increased FDG uptake could be noted around the femoral head or neck portion of the

  15. The Fibromyalgia Survey Score Correlates With Preoperative Pain Phenotypes But Does Not Predict Pain Outcomes After Shoulder Arthroscopy.

    Science.gov (United States)

    Cheng, Jennifer; Kahn, Richard L; YaDeau, Jacques T; Tsodikov, Alexander; Goytizolo, Enrique A; Guheen, Carrie R; Haskins, Stephen C; Oxendine, Joseph A; Allen, Answorth A; Gulotta, Lawrence V; Dines, David M; Brummett, Chad M

    2016-08-01

    Fibromyalgia (FM) characteristics can be evaluated using a simple, self-reported measure that correlates with postoperative opioid consumption after lower-extremity joint arthroplasty. The purpose of this study was to determine whether preoperative pain history and the FM survey score can predict postoperative outcomes after shoulder arthroscopy, which may cause moderate to severe pain. In this prospective study, 100 shoulder arthroscopy patients completed preoperative validated self-report measures to assess baseline quality of recovery score, physical functioning, depression, anxiety, and neuropathic pain. FM characteristics were evaluated using a validated measure of widespread pain and comorbid symptoms on a 0 to 31 scale. Outcomes were assessed on postoperative day 2 (opioid consumption [primary], pain, physical functioning, quality of recovery score), and day 14 (opioid consumption, pain). FM survey scores ranged from 0 to 13. The cohort was divided into tertiles for univariate analyses. Preoperative depression and anxiety (Ppain (P=0.008) were higher, and physical functioning was lower (Ppain or opioid consumption; however, it was independently associated with poorer quality of recovery scores (P=0.001). The only independent predictor of postoperative opioid use was preoperative opioid use (P=0.038). FM survey scores were lower than those in a previous study of joint arthroplasty. Although they distinguished a negative preoperative pain phenotype, FM scores were not independently associated with postoperative opioid consumption. Further research is needed to elucidate the impact of a FM-like phenotype on postoperative analgesic outcomes.

  16. Acromioclavicular joint acceleration-deceleration injury as a cause of persistent shoulder pain: Outcome after arthroscopic resection

    Directory of Open Access Journals (Sweden)

    Ehud Atoun

    2014-01-01

    Full Text Available Background: Shoulder pain in general and acromioclavicular joint (ACJ pain specifically is common after acceleration-deceleration injury following road traffic accident (RTA. The outcome of surgical treatment in this condition is not described in the literature. The aim of the present study was to report the outcome of arthroscopic resection of the ACJ in these cases. Materials and Methods: Nine patients with localized ACJ pain, resistant to nonoperative treatment were referred on an average 18 months after the injury. There were 3 male and 6 females. The right shoulder was involved in seven patients and the left in two. The average age was 38.9 years (range 29-46 years. All presented with normal X-rays but with torn acromioclavicular joint disc and effusion on magnetic resonance imaging (MRI. Arthroscopic ACJ excision arthroplasty was performed in all patients. Results: At a mean followup of 18 month, all patients had marked improvement. The Constant score improved from 36 to 81, the pain score from 3/15 to 10/15 and the patient satisfaction improved from 3.5/10 to 9.3/10. Conclusion: Arthroscopic ACJ excision arthroplasty, gives good outcomes in patients not responding to conservative management in ACJ acceleration-deceleration injury.

  17. Ultrasonography of the equine shoulder

    International Nuclear Information System (INIS)

    Dik, K.J.

    1996-01-01

    Six horses with shoulder injuries were presented in this report with emphasis on the use of ultrasonography vs. radiography in diagnosis. The two imaging modalities represented valuable and complementary diagnostic procedures. Two horses had fracture fragments of the lateral humeral tuberosity, the accurate ultrasonographic findings encouraging clearer radiographic identification by oblique projections. In one horseultrasonography enabled more accurate localization of calcification within the supraspinatus muscle. In the remaining three cases ultrasonography visualized distension of the bicipital bursa due to aseptic bursitis, bursal hemorrhage, or associated with injury of the biceps brachii muscle and the underlying intermediate humeral tubercle, the bony involvement more clearly demonstrated radiographically

  18. Shoulder arthropathy in primary hyperparathyroidism

    International Nuclear Information System (INIS)

    Nussbaum, A.J.; Doppman, J.L.

    1982-01-01

    An erosive arthropathy of the hands and wrists has been recognized in patients with primary and secondary hyperparathyroidism. Recently, intra-articular erosions of the humeral head were described in six patients who had been on chronic long-term hemodialysis with secondary hyperparathyroidism. We would like to present the finding of shoulder erosions in four patients with primary hyperparathyroidism and one patient with renal osteodystrophy and suggest that the humeral erosion can occur in both an intra-articular and peri-articular location. (orig.)

  19. Revision rate of Birmingham Hip Resurfacing arthroplasty: comparison of published literature and arthroplasty register data.

    Science.gov (United States)

    Schuh, Reinhard; Neumann, Daniel; Rauf, Rauend; Hofstaetter, Jochen; Boehler, Nikolaus; Labek, Gerold

    2012-07-01

    Hip resurfacing arthroplasty has gained popularity for treating young and active patients who have arthritis. There are two major data sources for assessing outcome and revision rate after total joint arthroplasty: sample-based clinical trials and national arthroplasty registers. The purpose of this study was to evaluate the outcome of the Birmingham Hip Resurfacing (BHR) arthroplasty in terms of revision rate as reported in clinical studies and recorded by national arthroplasty registers. A comprehensive literature research was performed from English-language, peer-reviewed journals and annual reports from national joint arthroplasty registers worldwide. Only publications from MEDLINE-listed journals were included. The revision rate was used as the primary outcome parameter. In order to allow for direct comparison of different data sets, calculation was based on revisions per 100 observed component years. For statistical analysis, confidence intervals (CI) were calculated. A total of 18,708 implants, equivalent to 106,565 observed component years, were analysed in the follow-up studies. The register reports contained 9,806 primary cases corresponding to 44,294 observed component years. Statistical analysis revealed a significant difference in revisions per 100 observed component years between the development team (0.27; CI: 0.14-0.40) and register data (0.74; CI: 0.72-0.76). The BHR arthroplasty device shows good results in terms of revision rate in register data as well as in clinical studies. However, the excellent results reported by the development team are not reproducible by other surgeons. Based on the results of our study, we believe that comprehensive national arthroplasty registers are the most suitable tool for assessing hip arthroplasty revision rate.

  20. Early death following revision total hip arthroplasty.

    Science.gov (United States)

    Jones, Mark D; Parry, Michael; Whitehouse, Michael R; Blom, Ashley W

    2017-12-04

    The frequency of primary total hip arthroplasty procedures is increasing, with a subsequent rise in revision procedures. This study aims to describe timing and surgical mortality associated with revision total hip arthroplasty (THA) compared to those on the waiting list. All patients from a single institution who underwent revision total hip arthroplasty or were added to the waiting list for the same procedure between 2003 and 2013 were recorded. Mortality rates were calculated at 30 and 90 days following surgery or addition to the waiting list. 561 patients were available for the survivorship analysis in the surgical group. Following exclusion, 901 and 484 patients were available for the 30 and the 90-day analysis in the revision THA waiting list group.30- and 90-day mortality rates were significantly greater for the revision THA group compared to the waiting list group (excess surgical mortality at 30 days = 0.357%, p = 0.037; odds ratio of 5.22, excess surgical mortality at 90 days = 0.863%, p = 0.045). Revision total hip arthroplasty is associated with a significant excess surgical mortality rate until 90 days post-operation when compared to the waiting list population. We would encourage other authors with access to larger samples to use our method to quantify excess mortality after both primary and revision arthroplasty procedures.

  1. [Sport activity after hip and knee arthroplasty].

    Science.gov (United States)

    Keren, Amit; Berkovich, Yaron; Berkovitch, Yaron; Soudry, Michael

    2013-11-01

    Joint arthroplasty is one of the commonest surgical procedures in orthopedic surgery. In recent years there was an increase in the number of procedures, patient satisfaction and implant survival. Originally, these operations were designed for old patients in order to relieve pain and to enable ambulation. Over the past few years, these operations have become common in younger patients which desire to return to activity, including sports activities. The importance of physical activity is a well known fact. In recent years it became clear that with the proper physical activity the outcomes of the operations are better. There are several types of arthroplasty. Many factors influence the outcome of the operation apart from the post-surgery physical activity. These factors include patient factors, surgical technique and type of arthroplasty. This review summarizes the recommendations for sports activities after hip and knee arthroplasties. These activities are evaluated according to surgeons' recommendations, stress applied on the implant and long term outcomes. The recommended sports activities after joint arthroplasties are walking, swimming and cycling. Soccer, basketball and jogging are not advised. Tennis, downhill skiing and horse riding are recommended with previous experience. There are many more sports activities that patients can participate in, and it is important that the patient discuss the different options prior to the operation. Since these operations are so common, many non-orthopedic physicians encounter these patients in their practice. They should be acquainted with the recommendations for sports activities and encourage them.

  2. Technology in Arthroplasty: Are We Improving Value?

    Science.gov (United States)

    Waddell, Bradford S; Carroll, Kaitlin; Jerabek, Seth

    2017-09-01

    Total joint arthroplasty is regarded as a highly successful procedure. Patient outcomes and implant longevity, however, are related to proper alignment and position of the prostehses. In an attempt to reduce outliers and improve accuracy and precision of component position, navigation and robotics have been introduced. These technologies, however, come at a price. The goals of this review are to evaluate these technologies in total joint arthroplasty and determine if they add value. Recent studies have demonstrated that navigation and robotics in total joint arthroplasty can decrease outliers while improving accuracy in component positioning. While some studies have demonstrated improved patient reported outcomes, not all studies have shown this to be true. Most studies cite increased cost of equipment and longer operating room times as the major downsides of the technologies at present. Long-term studies are just becoming available and are promising, as some studies have shown decreased revision rates when navigation is used. Finally, there are relatively few studies evaluating the direct cost and value of these technologies. Navigation and robotics have been shown to improve component position in total joint arthroplasty, which can improve patient outcomes and implant longevity. These technologies offer a promising future for total joint arthroplasty.

  3. On the new anatomical nomenclature.

    Science.gov (United States)

    Marecková, E; Simon, F; Cervený, L

    2001-05-01

    The present paper is concerned with the linguistic aspect of the new anatomical nomenclature (Terminologia Anatomica 1998). Orthographic, morphological, syntactic, lexical, and terminological comments are presented. In the authors' opinion, shortcomings might have been effectively avoided by cooperation with linguists.

  4. EFFECT OF GONG'S MOBILIZATION VERSUS MULLIGAN'S MOBILIZATION ON SHOULDER PAIN AND SHOULDER MEDIAL ROTATION MOBILITY IN FROZEN SHOULDER

    Directory of Open Access Journals (Sweden)

    Jyoti Rinku Dilip

    2016-02-01

    Full Text Available Background: Frozen shoulder is a painful condition with gradual restriction of all planes of movement in the shoulder joint. The purpose of the present study is to evaluate the effect of Gong’s Mobilization versus Mulligan’s Mobilization on Shoulder pain and Shoulder Medial Rotation mobility in subjects with Frozen shoulder. Methods: An Experimental study design, 40 subjects with unilateral frozen shoulder were selected and randomized 20 subjects into each of two groups- Gong’s mobilization and Mulligan’s mobilization respectively. Gong’s group received the Gong’s mobilization technique with conventional therapy while Mulligan’s group received Mulligan’s mobilization along with conventional therapy. The duration of intervention was 5 treatment sessions per week for two weeks. Outcome measures such as shoulder medial rotation was measured using a Goniometer and pain was measured using a VAS scale before and after two weeks of intervention. Results: Analysis using Independent ‘t’ test and Mann Whitney U test found that there is statistically significant difference p<0.000 when pre to post interventions means were compared within the groups. When post intervention means were compared between the Gong’s and Mulligan’s groups there was no statistically significant difference in Active and Passive Range of Shoulder Medial Rotation but there was statistically significant difference in VAS when compared between the groups. Conclusion: It is concluded that both Gong’s mobilization with conventional therapy and Mulligan’s mobilization with conventional therapy are effective in improving Shoulder Medial Rotation Mobility in Frozen Shoulder. However Gong’s mobilization shown greater percentage of effect in reducing pain and Mulligan’s Mobilization shown greater percentage in improving ROM.

  5. Anatomic Preformed Post: Case Report

    OpenAIRE

    Lamas Lara, César; Cirujano Dentista, Docente del Área de Operatoria Dental y Endodoncia de la Facultad de OdontoIogía de la UNMSM.; Alvarado Menacho, Sergio; Cirujano Dentista, Especialista en Rehabilitación Oral, Profesor Asociado del Área de Prótesis y Oclusión de la Facultad de Odontología de la UNMSM.; Pari Espinoza, Rosa; Alumna del 5to año de Odontología de la UNMSM.

    2014-01-01

    Nowadays, preformed posts are being used frequently, but they do not follow root canal anatomy. Obtaining a more anatomical form of the root canal and reducing the space of the cement, it would help to reduce the possibility of its eviction. This article details the process of making of an anatomical preformed post and the advantages that would represent its clinical use. En la actualidad los postes preformados se utilizan con mucha frecuencia, pero tienenla dificultad de no seguir la anat...

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

    Directory of Open Access Journals (Sweden)

    Lacy, Kyle

    2015-01-01

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

  7. Consensus for physiotherapy for shoulder pain.

    Science.gov (United States)

    Klintberg, Ingrid Hultenheim; Cools, Ann M J; Holmgren, Theresa M; Holzhausen, Ann-Christine Gunnarsson; Johansson, Kajsa; Maenhout, Annelies G; Moser, Jane S; Spunton, Valentina; Ginn, Karen

    2015-04-01

    Shoulder pain is a common disorder. Despite growing evidence of the importance of physiotherapy, in particular active exercise therapy, little data is available to guide treatment. The aim of this project was to contribute to the development of an internationally accepted assessment and treatment algorithm for patients with shoulder pain. Nine physiotherapists with expertise in the treatment of shoulder dysfunction met in Sweden 2012 to begin the process of developing a treatment algorithm. A questionnaire was completed prior to the meeting to guide discussions. Virtual conferences were thereafter the platform to reach consensus. Consensus was achieved on a clinical reasoning algorithm to guide the assessment and treatment for patients presenting with local shoulder pain, without significant passive range of motion deficits and no symptoms or signs of instability. The algorithm emphasises that physiotherapy treatment decisions should be based on physical assessment findings and not structural pathology, that active exercises should be the primary treatment approach, and that regular re-assessment is performed to ensure that all clinical features contributing to the presenting shoulder pain are addressed. Consensus was also achieved on a set of guiding principles for implementing exercise therapy for shoulder pain, namely, a limited number of exercises, performed with appropriate scapulo-humeral coordination and humeral head alignment, in a graduated manner without provoking the presenting shoulder pain. The assessment and treatment algorithm presented could contribute to a more formal, extensive process aimed at achieving international agreement on an algorithm to guide physiotherapy treatment for shoulder pain.

  8. MRI findings in the painful poststroke shoulder.

    Science.gov (United States)

    Shah, Rajiv R; Haghpanah, Sepideh; Elovic, Elie P; Flanagan, Steven R; Behnegar, Anousheh; Nguyen, Vu; Page, Stephen J; Fang, Zi-Ping; Chae, John

    2008-06-01

    We describe the structural abnormalities in the painful shoulder of stroke survivors and their relationships to clinical characteristics. Method- Eighty-nine chronic stroke survivors with poststroke shoulder pain underwent T1- and T2-weighted multiplanar, multisequence MRI of the painful paretic shoulder. All scans were reviewed by one radiologist for the following abnormalities: rotator cuff, biceps and deltoid tears, tendinopathies and atrophy, subacromial bursa fluid, labral ligamentous complex abnormalities, and acromioclavicular capsular hypertrophy. Clinical variables included subject demographics, stroke characteristics, and the Brief Pain Inventory Questions 12. The relationship between MRI findings and clinical characteristics was assessed through logistic regression. Thirty-five percent of subjects exhibited a tear of at least one rotator cuff, biceps or deltoid muscle. Fifty-three percent of subjects exhibited tendinopathy of at least one rotator cuff, bicep or deltoid muscle. The prevalence of rotator cuff tears increased with age. However, rotator cuff tears and rotator cuff and deltoid tendinopathies were not related to severity of poststroke shoulder pain. In approximately 20% of cases, rotator cuff and deltoid muscles exhibited evidence of atrophy. Atrophy was associated with reduced motor strength and reduced severity of shoulder pain. Rotator cuff tears and rotator cuff and deltoid tendinopathies are highly prevalent in poststroke shoulder pain. However, their relationship to shoulder pain is uncertain. Atrophy is less common but is associated with less severe shoulder pain.

  9. Eponymous terms in anterior shoulder stabilization surgery

    NARCIS (Netherlands)

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

    2017-01-01

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

  10. MRI of impingement syndromes of the shoulder

    International Nuclear Information System (INIS)

    Mulyadi, E.; Harish, S.; O'Neill, J.; Rebello, R.

    2009-01-01

    The diagnosis of shoulder impingement is primarily a clinical one. Imaging has a role in assisting clinicians in developing a treatment strategy by identifying and characterizing the cause of shoulder impingement. In this review, the relevant anatomy, cause/pathomechanics, clinical features, and magnetic resonance imaging (MRI) findings of the different types of impingement syndromes are presented

  11. Proprioception of the shoulder after stroke

    NARCIS (Netherlands)

    Niessen, M.H.M.; Veeger, H.E.J.; Koppe, P.A.; Konijnenbelt, M.; van Dieen, J.H.

    2008-01-01

    Niessen MH, Veeger DH, Koppe PA, Konijnenbelt MH, van Dieën J, Janssen TW. Proprioception of the shoulder after stroke. Objective: To investigate position sense and kinesthesia of the shoulders of stroke patients. Design: Case-control study. Setting: A rehabilitation center. Participants: A total of

  12. Avoiding Shoulder Injury from Resistance Training.

    Science.gov (United States)

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

    2001-01-01

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

  13. [Prediction, prevention and management of shoulder dystocia].

    Science.gov (United States)

    Csorba, Roland

    2012-05-20

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-02-15

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

  15. Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder

    Directory of Open Access Journals (Sweden)

    Gi-Young Park

    2017-04-01

    Full Text Available Purpose The purpose of this study was to measure the axillary recess (AR thickness in an asymptomatic shoulder by using ultrasonography (US and to analyze the factors affecting it. Methods We recruited 141 patients (52 males; 89 females; age, 57.7±9.9 years with unilateral shoulder pain and performed US on the unaffected shoulder. Two physiatrists measured the AR thickness of the unaffected shoulder independently. All patients were examined in an upright sitting position with 90° shoulder abduction. The ultrasonographic transducer was placed longitudinally on the mid-axillary line and along the long axis of the humeral shaft. The factors affecting the AR thickness values were analyzed, and intra-class correlation coefficients were used for assessing the reproducibility of each measurement. Results The intrarater reliability values for the two physiatrists were 0.98 and 0.96, respectively. The inter-rater reliability of the mean AR thickness measurements was 0.91. The mean AR thickness in all subjects, males, and females was 2.8±0.6 mm, 3.1±0.6 mm, and 2.6±0.5 mm (P<0.01, respectively. No difference between the left and the right sides (males, P=0.086; females, P=0.535 or between the dominant and the non-dominant sides (males, P=0.173; female, P=0.244 was found. The AR thickness correlated positively with the height (r=0.313, P<0.01 and the weight (r=0.319, P<0.01. However, it did not correlate with the body mass index (r=0.152, P=0.077 or the age (r=-0.056, P=0.515. Conclusion US measurements of the AR thickness in asymptomatic shoulders demonstrated excellent intrarater and inter-rater reliabilities. The AR thickness showed anatomical variation with sex, height, and weight.

  16. Ultrasonographic measurement of the axillary recess thickness in an asymptomatic shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Park, Gi Young; Lee, Jin Hoon; Kwon, Dae Gil [Dept. of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of)

    2017-04-15

    The purpose of this study was to measure the axillary recess (AR) thickness in an asymptomatic shoulder by using ultrasonography (US) and to analyze the factors affecting it. We recruited 141 patients (52 males; 89 females; age, 57.7±9.9 years) with unilateral shoulder pain and performed US on the unaffected shoulder. Two physiatrists measured the AR thickness of the unaffected shoulder independently. All patients were examined in an upright sitting position with 90° shoulder abduction. The ultrasonographic transducer was placed longitudinally on the mid-axillary line and along the long axis of the humeral shaft. The factors affecting the AR thickness values were analyzed, and intra-class correlation coefficients were used for assessing the reproducibility of each measurement. The intrarater reliability values for the two physiatrists were 0.98 and 0.96, respectively. The inter-rater reliability of the mean AR thickness measurements was 0.91. The mean AR thickness in all subjects, males, and females was 2.8±0.6 mm, 3.1±0.6 mm, and 2.6±0.5 mm (P<0.01), respectively. No difference between the left and the right sides (males, P=0.086; females, P=0.535) or between the dominant and the non-dominant sides (males, P=0.173; female, P=0.244) was found. The AR thickness correlated positively with the height (r=0.313, P<0.01) and the weight (r=0.319, P<0.01). However, it did not correlate with the body mass index (r=0.152, P=0.077) or the age (r=-0.056, P=0.515). US measurements of the AR thickness in asymptomatic shoulders demonstrated excellent intrarater and inter-rater reliabilities. The AR thickness showed anatomical variation with sex, height, and weight.

  17. Primary total knee arthroplasty in the management of epiphyseal fracture around the knee.

    Science.gov (United States)

    Parratte, S; Bonnevialle, P; Pietu, G; Saragaglia, D; Cherrier, B; Lafosse, J M

    2011-10-01

    Over the past few years the use of arthroplasty was broadened to treating complex epiphyseal fractures at the shoulder and elbow joints. Similar trends to treat this type of fractures at the knee are less documented. Based on a multicenter retrospective series study, the aims of this work is to evaluate the short term clinical results of total knee prostheses in the management of comminuted epiphyseal fractures around the knee, to identify the technical issues and fine tune the indications. Following the initiative of the French Hip and Knee Society (SFHG) and the Traumatology Study Group (GETRAUM), 26 charts from eight different centers in France were included in this multicenter retrospective series. Inclusion criteria were: primary total knee arthroplasty (TKA) in the management of complex articular fractures involving the proximal end of the tibia or distal end of the femur. Surgical features were identified and complications were analyzed. The assessment protocol at last follow-up was standardized and included patient demographic data, analysis of the Parker and IKS scores. During the immediate postoperative period, six patients (23%) reported a general complication and four patients (15%) a local arthroplasty-related complication. At last follow-up (mean 16.2 months), the overall final Parker score was 6.3 (a mean decrease of 1.7) and the mean IKS knee score was 82 points for a mean function score of 54 points. Primary TKA is a suitable management option for complex fractures in autonomous elderly patients suffering from knee osteoarthritis. The key technical details of this procedure should be respected and meticulously planned to achieve optimal results and limit the risk of complications. This risk in these acute complex fractures remains higher than after conventional TKA but comparable to that observed after TKA for post-traumatic arthritis. IV; retrospective cohort study. Copyright © 2011. Published by Elsevier Masson SAS.

  18. Cervicothoracic junction arthroplasty after previous fusion surgery for adjacent segment degeneration: case report.

    Science.gov (United States)

    Sekhon, Lali

    2005-01-01

    This is the first reported case of cervical arthroplasty using the Bryan Cervical Disc Prosthesis System (Medtronic Sofamor Danek, Inc., Memphis, TN) in the management of adjacent segment degeneration associated with previous fusion surgery and surgery at the cervicothoracic junction. This case report describes a 25-year-old woman who initially underwent a two-level anterior cervical fusion in 1998, 2 years after being involved in a motor vehicle accident. She was well until 18 months before presentation, when she developed bilateral shoulder pain, mechanical neck pain worse on flexion, and bilateral C8 distribution arm pain and paresthesia. On clinical examination, no focal deficits were found, although the range of motion was reduced. Preoperative cervical spine x-rays and magnetic resonance scanning confirmed accelerated degeneration of the C4-C5 and C7-T1 disc spaces, with evidence of neural compression at those levels. After careful consideration of various treatment options and failure of all conservative measures, the patient underwent an anterior C4-C5 and C7-T1 decompression with removal of the anterior cervical plate and placement of two artificial disc prostheses. After surgery, her course was uncomplicated and she was discharged from hospital well. There was complete resolution of the arm symptoms and reduction of the neck pain, with a reduction in the amount of analgesia she was taking. Seven months after surgery, she remains well with repeat x-rays confirming motion at the operated levels. This case demonstrates that cervical arthroplasty is a reasonable treatment option for patients who have had previous surgery in which interbody fusion has been performed and who have developed degeneration of adjacent levels. Despite the altered biomechanics at the cervicothoracic junction, no adverse features were noted with arthroplasty at this level.

  19. Diagnostic imaging of shoulder impingement

    International Nuclear Information System (INIS)

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

    1996-01-01

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

  20. Impingement Syndrome of the Shoulder.

    Science.gov (United States)

    Garving, Christina; Jakob, Sascha; Bauer, Isabel; Nadjar, Rudolph; Brunner, Ulrich H

    2017-11-10

    Shoulder pain is the third most common musculoskeletal complaint in orthopedic practice. It is usually due to a defect of the rotator cuff and/or an impingement syndrome. This review is based on pertinent literature retrieved by a selective search of the Medline database. Patients with shoulder impingement syndrome suffer from painful entrapment of soft tissue whenever they elevate the arm. The pathological mechanism is a structural narrowing in the subacromial space. A multiplicity of potential etiologies makes the diagnosis more difficult; it is established by the history and physical examination and can be confirmed with x-ray, ultra - sonography, and magnetic resonance imaging. The initial treatment is conservative, e.g., with nonsteroidal antiinflammatory drugs, infiltrations, and patient exercises. Conservative treatment yields satisfactory results within 2 years in 60% of cases. If symptoms persist, decompressive surgery is performed as long as the continuity of the rotator cuff is preserved and there is a pathological abnormality of the bursa. The correct etiologic diagnosis and choice of treatment are essential for a good outcome. The formal evidence level regarding the best treatment strategy is low, and it has not yet been determined whether surgical or conservative treatment is better. Randomized controlled therapeutic trials are needed so that a standardized treatment regimen can be established.

  1. Jogging after total hip arthroplasty.

    Science.gov (United States)

    Abe, Hirohito; Sakai, Takashi; Nishii, Takashi; Takao, Masaki; Nakamura, Nobuo; Sugano, Nobuhiko

    2014-01-01

    Jogging has been classified as a high-impact sport, and jogging after total hip arthroplasty (THA) has not been well documented. To investigate the participation rate for postoperative jogging as well as jogging parameters and the influence of jogging on implant stability and bearing wear. Case-control study; Level of evidence, 3. Included in this study were 804 hips in 608 patients (85 men, 523 women) who underwent THA between 2005 and 2011 with follow-up longer than 1 year. The mean patient age was 62 years (range, 26-98 years), and mean follow-up duration was 4.8 years (range, 2.3-7.8 years). Hip resurfacing arthroplasty (HRA) was performed in 81 patients and conventional THA in 527 patients. During routine postsurgical visits, patients were given a questionnaire concerning preoperative and postoperative jogging routines. For joggers, frequency, distance, duration, and velocity of jogging were recorded. Patients who did not jog postoperatively were asked to provide reasons for not jogging. Radiographs concerning implant migration and polyethylene wear were evaluated with specialized software, and serum cobalt and chromium ion concentrations were investigated for patients with metal-on-metal articulation. A total of 33 patients (5.4%) performed jogging preoperatively, and 23 patients (3.8%) performed jogging postoperatively. Of the 23 who jogged postoperatively, conventional THA was performed in 13 patients and HRA in 10 patients. Postoperatively, joggers trained a mean of 4 times (range, 1-7 times) per week, covering a mean distance of 3.6 km (range, 0.5-15 km) in a mean time of 29 minutes (range, 5-90 minutes) per session and at a mean speed of 7.7 km/h (range, 3-18 km/h). No patient complained of pain or showed serum cobalt and chromium ion elevation greater than 7 ppb. No hip showed loosening, abnormal component migration, or excessive wear at a mean 5-year follow-up. There were 74 postoperative non-joggers with an interest in jogging. The reasons given for

  2. Reverse hybrid total hip arthroplasty

    Science.gov (United States)

    Wangen, Helge; Havelin, Leif I; Fenstad, Anne M; Hallan, Geir; Furnes, Ove; Pedersen, Alma B; Overgaard, Søren; Kärrholm, Johan; Garellick, Göran; Mäkelä, Keijo; Eskelinen, Antti; Nordsletten, Lars

    2017-01-01

    Background and purpose The use of a cemented cup together with an uncemented stem in total hip arthroplasty (THA) has become popular in Norway and Sweden during the last decade. The results of this prosthetic concept, reverse hybrid THA, have been sparsely described. The Nordic Arthroplasty Register Association (NARA) has already published 2 papers describing results of reverse hybrid THAs in different age groups. Based on data collected over 2 additional years, we wanted to perform in depth analyses of not only the reverse hybrid concept but also of the different cup/stem combinations used. Patients and methods From the NARA, we extracted data on reverse hybrid THAs from January 1, 2000 until December 31, 2013. 38,415 such hips were studied and compared with cemented THAs. The Kaplan-Meier method and Cox regression analyses were used to estimate the prosthesis survival and the relative risk of revision. The main endpoint was revision for any reason. We also performed specific analyses regarding the different reasons for revision and analyses regarding the cup/stem combinations used in more than 500 cases. Results We found a higher rate of revision for reverse hybrids than for cemented THAs, with an adjusted relative risk of revision (RR) of 1.4 (95% CI: 1.3–1.5). At 10 years, the survival rate was 94% (CI: 94–95) for cemented THAs and 92% (95% CI: 92–93) for reverse hybrids. The results for the reverse hybrid THAs were inferior to those for cemented THAs in patients aged 55 years or more (RR =1.1, CI: 1.0–1.3; p revision due to periprosthetic femoral fracture for reverse hybrids than for cemented THAs in patients aged 55 years or more (RR =3.1, CI: 2.2–4.5; p revision than cemented THAs in patients aged 55 or more. The difference in survival was mainly caused by a higher incidence of early revision due to periprosthetic femoral fracture in the reversed hybrid THAs. PMID:28095724

  3. Shoulder Ultrasonography: Performance and Common Findings

    Directory of Open Access Journals (Sweden)

    Diana Gaitini

    2012-01-01

    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. Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: Do we sacrifice ankle to the knee?

    Science.gov (United States)

    Gursu, Sarper; Sofu, Hakan; Verdonk, Peter; Sahin, Vedat

    2016-08-01

    Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10° underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. Pre-operatively, the mean HKA was 16.6° and the mean AA was 10.41°, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6° and the mean AA to -2.1. The mean LDTA was 87.3°. Before the operation, the mean AJOA was -7.6°, opening to the medial aspect of the ankle, and it was 0.04° after the operation and opening to the lateral aspect (p < 0.05). Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle. IV.

  5. Transfemoral Amputation After Failure of Knee Arthroplasty

    DEFF Research Database (Denmark)

    Gottfriedsen, Tinne B; Schrøder, Henrik M; Odgaard, Anders

    2016-01-01

    complications in 9 (8%). In 92 (80%) of the cases, there were ≥2 indications for amputation. CONCLUSIONS: The cumulative incidence of amputation within 15 years after primary knee arthroplasty was 0.32%, with a tendency toward a decreasing incidence in the last part of the study period. LEVEL OF EVIDENCE......BACKGROUND: Transfemoral amputation is considered the last treatment option for failed knee arthroplasty. The extent to which this procedure is performed is not well known. The purpose of this study was to identify the incidence and causes of amputation following failure of knee arthroplasty...... were followed by amputation. Hospital records of all identified cases were reviewed. A competing-risk model was used to estimate the cumulative incidence of amputation. Differences in cumulative incidences were analyzed with use of the Gray test. RESULTS: A total of 115 amputations were performed...

  6. Imaging patellar complications after knee arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Melloni, Pietro [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)], E-mail: pmelloni@cspt.es; Valls, Rafael; Veintemillas, Maite [Unitat de Imatge d' Alta Tecnologia, Centre Diagnostic, Corporacio Parc Tauli, Universitat Autonoma de Barcelona, Sabadell (Barcelona) (Spain)

    2008-03-15

    The purpose of this study is to describe complications affecting the patella in patients with total or partial knee arthroplasty. We respectively analysed plain-film radiographs, as well as ultrasound images when acquired, in a consecutive series of 1272 patients. The mean interval from knee replacement to patellar complications was 5 years and 7 months (range, 5 months to 14 years). The complications described include fracture, instability, dislocation or luxation, necrosis of the patella, infection of the patella, erosion of the patella, patellar impingement on the prosthesis and patellar or quadricipital tendon tear. We discuss the pathological imaging findings in the patella and their differential diagnosis after knee arthroplasty. Patellar complications after knee arthroplasty are uncommon but often potentially serious.

  7. Patient selection criteria for outpatient joint arthroplasty.

    Science.gov (United States)

    Kort, Nanne P; Bemelmans, Yoeri F L; van der Kuy, P Hugo M; Jansen, Jacqueline; Schotanus, Martijn G M

    2017-09-01

    General consensus of patient selection criteria for outpatient joint arthroplasty is lacking, which is paramount to prevent prolonged hospital stay, adverse events and/or readmissions. This review highlights patient selection criteria for OJA based on the current literature and expert opinion. A search of the English and International electronic healthcare databases including MEDLINE/PubMed, EMBASE, AMED and the Cochrane library was performed in November 2015 to include studies published during the last 10 years. Furthermore, a survey of physicians from different specialties was performed. Fourteen studies described results regarding outpatient joint arthroplasty. Studies on outpatient hip and/or knee arthroplasty resulted in similar outcome in preselected patients. Patients who are able and willing to participate, with a low ASA classification (II), bleeding disorders, poorly controlled and/or severe cardiac (e.g. heart failure, arrhythmia) or pulmonary (e.g. embolism, respiratory failure) comorbidities, uncontrolled DM (type I or II), a high BMI (>30 m 2 /kg), chronic opioid consumption, functional neurological impairments, dependent functional status, chronic/end-stage renal disease and/or reduced preoperative cognitive capacity should be excluded from outpatient joint arthroplasty. The expert opinion-based selection criteria were comparable to literature with a further extension of exclusion for patients with practical issue's, urologic medical history and/or severe mobility disorders. Based on the current literature, the presented patient selection criteria provide a basis for outpatient joint arthroplasty and can be useful when selecting patients. Together with a change in mindset, a multidisciplinary approach and literature-based protocols, outpatient joint arthroplasty can be applied in daily orthopaedic practice while ensuring patients' safety. Clinical review, Level III.

  8. Epilepsia partialis continua present with shoulder joint-trunk-hip joint rhythmic clonic seizure: a case report

    Directory of Open Access Journals (Sweden)

    Lv YD

    2016-09-01

    Full Text Available Yudan Lv, Zan Wang, Fengna Chu, Chang Liu, Hongmei Meng Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, ChangChun, People’s Republic of China Abstract: Epilepsia partialis continua (EPC is a particular type of epilepsy which is distinguished from “common epilepsy” by its characteristic semiological features. However, unusual manifestations should be described in order to give awareness at clinical diagnosis. In this case report we describe a rare EPC case not previously reported, in which left shoulder joint-trunk-hip joint jerk was present for 1 week. Abnormal electroencephalogram and cerebrospinal fluid results supported a diagnosis of viral encephalitis. Antiepileptic treatment seemed effective. Our report emphasizes that a detailed functional anatomical analysis and synchronized electroencephalogram discharge should be done to avoid misdiagnosis in patients with synchronic shoulder-trunk-hip jerk symptoms. Keywords: EPC, shoulder-trunk-hip, EEG, clonic seizure, virus encephalitis

  9. Gemella haemolysans Infection in Total Hip Arthroplasty

    Directory of Open Access Journals (Sweden)

    Barry Rose

    2012-01-01

    Full Text Available Gemella haemolysans is a Gram-positive coccus and commensal of the upper respiratory tract and oral mucosa that rarely causes clinically important infections. There is only one previous report of this organism causing periprosthetic infection, in a total knee arthroplasty. We present a case of septic loosening of an uncemented total hip arthroplasty due to G. haemolysans, in an asplenic patient with insulin dependent diabetes mellitus. Treatment with two-stage revision has been successful at 7 years of follow-up.

  10. Proprioception and Knee Arthroplasty: A Literature Review.

    Science.gov (United States)

    Wodowski, Andrew J; Swigler, Colin W; Liu, Hongchao; Nord, Keith M; Toy, Patrick C; Mihalko, William M

    2016-04-01

    Proprioceptive mechanoreceptors provide neural feedback for position in space and are critical for three-dimensional interaction. Proprioception is decreased with osteoarthritis of the knees, which leads to increased risk of falling. As the prevalence of osteoarthritis increases so does the need for total knee arthroplasty (TKA), and knowing the effect of TKA on proprioception is essential. This article reviews the literature regarding proprioception and its relationship to balance, aging, osteoarthritis, and the effect of TKA on proprioception. Knee arthroplasty involving retention of the cruciate ligaments is also reviewed, as well the evidence of proprioception in the posterior cruciate ligament after TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Dynamic high-resolution ultrasound of the shoulder: how we do it.

    Science.gov (United States)

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

    2015-02-01

    Ultrasonography (US) is an established and well-accepted modality that can be used to evaluate articular and peri-articular structures around the shoulder. US has been proven to be useful in a wide range of rotator cuff diseases (tendon tears, tendinosis, and bursitis) as well as non-rotator cuff abnormalities (instability problems, synovial joint diseases, and nerve entrapment syndromes). Diagnostic accuracy of shoulder US when evaluating rotator cuff tears can reach 91-100% for partial and full thickness tears detection, respectively, having been reported to be as accurate as magnetic resonance imaging in experienced hands. US is cheap, readily available, capable to provide high-resolution images, and does not use ionizing radiations. In addition, US is the only imaging modality that allows performing dynamic evaluation of musculoskeletal structures, that may help to further increase diagnostic performance. In this setting, a standardized imaging protocol is essential for an exhaustive and efficient examination, also helping reducing the intrinsic dependence from operators of US. Furthermore, knowledge of pitfalls that can be encountered when examining the shoulder may help to avoid erroneous images interpretation. In this article we use detailed anatomic schemes and high-resolution US images to describe the normal US anatomy of soft tissues, articular, and para-articular structures located in and around the shoulder. Short video clips emphasizing the crucial role of dynamic maneuvers and dynamic real-time US examination of these structures are included as supplementary material. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  12. Quantitative assessment of morphology, T1ρ, and T2 of shoulder cartilage using MRI

    International Nuclear Information System (INIS)

    Nardo, Lorenzo; Carballido-Gamio, Julio; Tang, Solomon; Lai, Andrew; Krug, Roland

    2016-01-01

    The aim of this study was to assess the feasibility of quantifying shoulder cartilage morphology and relaxometry in a clinically feasible scan time comparing different pulse sequences and assessing their reproducibility at 3 Tesla. Three pulse sequences were compared for morphological assessments of shoulder cartilage thickness and volume (SPGR, MERGE, FIESTA), while a combined T1ρ-T2 sequence was optimized for relaxometry measurements. The shoulders of six healthy subjects were scanned twice with repositioning, and the cartilage was segmented and quantified. The degree of agreement between the three morphological sequences was assessed using Bland-Altman plots, while the morphological and relaxometry reproducibility were assessed with root-mean-square coefficients of variation (RMS-CVs) Bland-Altman plots indicated good levels of agreement between the morphological assessments of the three sequences. The reproducibility of morphological assessments yielded RMS-CVs between 4.0 and 17.7 %. All sequences correlated highly (R > 0.9) for morphologic assessments with no statistically significant differences. For relaxometry assessments of humeral cartilage, RMS-CVs of 6.4 and 10.6 % were found for T1ρ and T2, respectively. The assessment of both cartilage morphology and relaxometry is feasible in the shoulder with SPGR, humeral head, and T1ρ being the more reproducible morphological sequence, anatomic region, and quantitative sequence, respectively. (orig.)

  13. MRI of the posttraumatic shoulder

    International Nuclear Information System (INIS)

    Dimitrov, N.

    2013-01-01

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

  14. Anatomical pathology is dead? Long live anatomical pathology.

    Science.gov (United States)

    Nicholls, John M; Francis, Glenn D

    2011-10-01

    The standard diagnostic instrument used for over 150 years by anatomical pathologists has been the optical microscope and glass slide. The advent of immunohistochemistry in the routine laboratory in the 1980s, followed by in situ hybridisation in the 1990s, has increased the armamentaria available to the diagnostic pathologist, and this technology has led to changed patient management in a limited number of neoplastic diseases. The first decade of the 21 century has seen an increasing number of publications using proteomic technologies that promise to change disease diagnosis and management, the traditional role of an anatomical pathologist. Despite the plethora of publications on proteomics and pathology, to date there are actually limited data where proteomic technologies do appear to be of greater diagnostic value than the standard histological slide. Though proteomic techniques will become more prevalent in the future, it will need the expertise of an anatomical pathologist to dissect out and validate this added information.

  15. Data Quality in Institutional Arthroplasty Registries: Description of a Model of Validation and Report of Preliminary Results.

    Science.gov (United States)

    Bautista, Maria P; Bonilla, Guillermo A; Mieth, Klaus W; Llinás, Adolfo M; Rodríguez, Fernanda; Cárdenas, Laura L

    2017-07-01

    Arthroplasty registries are a relevant source of information for research and quality improvement in patient care and its value depends on the quality of the recorded data. The purpose of this study is to describe a model of validation and present the findings of validation of an Institutional Arthroplasty Registry (IAR). Information from 209 primary arthroplasties and revision surgeries of the hip, knee, and shoulder recorded in the IAR between March and September 2015 were analyzed in the following domains. Adherence is defined as the proportion of patients included in the registry, completeness is defined as the proportion of data effectively recorded, and accuracy is defined as the proportion of data consistent with medical records. A random sample of 53 patients (25.4%) was selected to assess the latest 2 domains. A direct comparison between the registry's database and medical records was performed. In total, 324 variables containing information on demographic data, surgical procedure, clinical outcomes, and key performance indicators were analyzed. Two hundred nine of 212 patients who underwent surgery during the study period were included in the registry, accounting for an adherence of 98.6%. Completeness was 91.7% and accuracy was 85.8%. Most errors were found in the preoperative range of motion and timely administration of prophylactic antibiotics and thromboprophylaxis. This model provides useful information regarding the quality of the recorded data since it identified deficient areas within the IAR. We recommend that institutional arthroplasty registries be constantly monitored for data quality before using their information for research or quality improvement purposes. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Freddy B. Marcondes

    2013-04-01

    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.

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

    Science.gov (United States)

    Marcondes, Freddy B; de Jesus, Julio F; Bryk, Flavio F; de Vasconcelos, Rodrigo A; Fukuda, Thiago Y

    2013-01-01

    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. 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. 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. The ANOVA results indicated significant differences between the groups in the dominant shoulder ROM, posterior capsule tightness, external rotation strength and strength ratio (pPainful Group displayed a significant difference for ROM, posterior capsule tightness and external rotation strength (ppain 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.

  18. The relationships between shoulder pain, range of motion, and disability in patients with shoulder dysfunction.

    Science.gov (United States)

    Anwer, Shahnawaz; Alghadir, Ahmad H; Al-Eisa, Einas S; Iqbal, Zaheen Ahmad

    2018-02-06

    Shoulder dysfunction is a major cause of musculoskeletal pain in general population. A variety of shoulder disorders can cause a reduction in shoulder range of motion and subsequent disability. To investigate the relationship between the shoulder pain, range of motion, and disability in patients with shoulder dysfunction. Sixty-four patients (49 men and 15 women) with shoulder disorders with a varying diagnosis including, adhesive capsulitis, rotator cuff injury, impingement syndrome, acromio-clavicular pain, and instability, participated in this cross-sectional study. Participants were asked to report the shoulder pain intensity and level of disability on a numerical rating scale (NRS) and the shoulder pain and disability index (SPADI), respectively. In addition, the active shoulder range of motion was evaluated. The Spearman rank correlation coefficient was used to investigate the association between the shoulder pain, range of motion, and disability. A good negative correlation found between the shoulder abduction, flexion, and rotation range of motion with the NRS score (rho =-0.710 to -0.747). A moderate negative correlation found between the extension and the NRS score (rho =-0.643). A good negative correlation found between abduction and the SPADI total score (rho =-0.714). A moderate negative correlation found between the shoulder flexion and rotation range of motion with the SPADI total score (rho =-0.547 to -0.694). A fair negative correlation found between the extension and the SPADI total score (rho =-0.495). A moderated positive correlation found between the NRS and the SPADI total score (rho = 0.667). The flexion, abduction, and rotation ROMs were most significantly associated with severity of pain and the physical disability in patients with shoulder dysfunction. Further, longitudinal studies are required to confirm these results.

  19. An entropy-assisted musculoskeletal shoulder model.

    Science.gov (United States)

    Xu, Xu; Lin, Jia-Hua; McGorry, Raymond W

    2017-04-01

    Optimization combined with a musculoskeletal shoulder model has been used to estimate mechanical loading of musculoskeletal elements around the shoulder. Traditionally, the objective function is to minimize the summation of the total activities of the muscles with forces, moments, and stability constraints. Such an objective function, however, tends to neglect the antagonist muscle co-contraction. In this study, an objective function including an entropy term is proposed to address muscle co-contractions. A musculoskeletal shoulder model is developed to apply the proposed objective function. To find the optimal weight for the entropy term, an experiment was conducted. In the experiment, participants generated various 3-D shoulder moments in six shoulder postures. The surface EMG of 8 shoulder muscles was measured and compared with the predicted muscle activities based on the proposed objective function using Bhattacharyya distance and concordance ratio under different weight of the entropy term. The results show that a small weight of the entropy term can improve the predictability of the model in terms of muscle activities. Such a result suggests that the concept of entropy could be helpful for further understanding the mechanism of muscle co-contractions as well as developing a shoulder biomechanical model with greater validity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Antenatal and intrapartum prediction of shoulder dystocia.

    Science.gov (United States)

    Gupta, Manish; Hockley, Christine; Quigley, Maria A; Yeh, Peter; Impey, Lawrence

    2010-08-01

    To (1) develop algorithms to calculate the risk of shoulder dystocia at individual deliveries; (2) evaluate screening for shoulder dystocia. Retrospective analysis of 40284 consecutive term cephalic singleton pregnancies using a 'train and test' method. Four models were derived using logistic regression and tested (birthweight alone; birthweight and other independent antenatal variables; birthweight and all independent antenatal and intrapartum variables; and all independent variables excluding birthweight). Shoulder dystocia occurred in 240 deliveries (0.6%). Birthweight was the most important risk factor although 98 cases (41%) occurred in babies weighing shoulder dystocia of >10%. Although the antenatal model had high predictability (area under curve 0.89), it was no better than birthweight alone and had a sensitivity of 52.4%. Where birthweight was excluded, prediction of shoulder dystocia was poor. Antepartum and labour calculation of the risk of shoulder dystocia is possible. Whilst greatly hindered by the inaccuracy of estimating weight, it allows due weight to be given to factors which may already be influencing clinical practice. However, shoulder dystocia cannot be predicted with sufficient accuracy to allow universal screening. Copyright 2010. Published by Elsevier Ireland Ltd.

  1. Evaluation of vibrant muscles over the shoulder region among workers of the hand screen printing industry.

    Science.gov (United States)

    Subramaniam, Shankar; Raju, Naveenkumar; Jeganathan, Karthick; Periyasamy, Mohankumar

    2018-06-01

    This study focuses on evaluation of the muscle activities associated with shoulder pain among workers of the hand screen printing (HSP) industry. Activities of three major muscles which showed higher muscle activity for a HSP job were observed for fatigue using surface electromyography (SEMG). The anatomical sites were chosen on the basis of a statistical survey and a visual inspection conducted before the experiment. Activities of the deltoid, teres major and infraspinatus were recorded using SEMG and the nature of muscle activities was studied for about 50 m of cloth printing. Data collected were processed using LabVIEW 2014 and the activities were analyzed using statistical tests and regression analyses. The results showed an increased risk of shoulder disorders with an increase in working time. Some of the risks which might cause disorders were predicted from the results; inspection and possible mitigations were suggested.

  2. Registration in the danish hip arthroplasty registry: completeness of total hip arthroplasties and positive predictive value of registered diagnosis and postoperative complications

    DEFF Research Database (Denmark)

    Pedersen, Alma Becic; Johnsen, Søren Paaske; Overgaard, Søren

    2004-01-01

    There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark.......There are few publications regarding the validity of data in hip arthroplasty registers. The Danish Hip Arthroplasty Registry (DHR) is a nationwide clinical database of THAs and revisions in Denmark....

  3. Imaging of bursae around the shoulder joint

    International Nuclear Information System (INIS)

    Bureau, N.J.; Dussault, R.G.; Keats, T.E.

    1996-01-01

    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

  4. 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)

    1996-08-01

    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.

  5. Total Hip Arthroplasty Using the S-ROM-A Prosthesis for Anatomically Difficult Asian Patients

    Directory of Open Access Journals (Sweden)

    Akira Hozumi

    2015-01-01

    Full Text Available Background. The S-ROM-A prosthesis has been designed for the Asian proximal femur with a small deformed shape and narrow canal. In this study, the clinical and radiological results using the S-ROM-A prosthesis for Japanese patients with severe deformity due to dysplasia and excessive posterior pelvic tilt were examined. Methods. 94 hips were followed up for a mean of 55 months, with a mean age at surgery of 61 years. The primary diagnoses were 94 coxarthritis cases, including 51 dysplasia and 37 primary OA, 1 avascular necrosis, 2 traumatic arthritis, and 3 Perthes disease. Thirty-one hips had been treated with osteotomy of the hip joints. Preoperative intramedullary canal shapes were stovepipe in 23 hips, normal in 51 hips, and champagne-flute in 5 hips. The maximum pelvic inclination angle was 56°. Results. The mean JOA score improved from 46 points preoperatively to 80 points at final follow-up. On radiological evaluation of the fixation of the implants according to the Engh classification, 92 (97% hips were classified as “bone ingrown fixation.” Conclusion. In primary THA, using the S-ROM-A prosthesis for Asian patients with proximal femoral deformity, even after osteotomy and with posterior pelvic tilt, provided good short- to midterm results.

  6. Method for determining the spatial position of the shoulder with ultrasound-based motion analyzer.

    Science.gov (United States)

    Illyés, Arpád; Kiss, Rita M

    2006-02-01

    Several methods have been developed recently for the analysis of the spatial motion of the scapula and the arm, whereby the spatial position of shoulder bones is determined in static conditions by interrupting motion. The authors have developed a 3D motion analysis method recording scapular motion in progress with appropriate accuracy in the course of arm movements of various degrees. The objective of this study is to explore the applicability of the method developed, as well as to compare it with and verify it by other methods developed earlier. The position and displacements of shoulder bones were determined on 30 shoulders of 15 healthy people. The newly developed measurement method is based on the mechanical basic principle stating that the position and motion of a rigid body -- in this case, the bones (segments) forming the shoulder joint -- can be calculated at any moment from the spatial coordinates of three points of a segment and any changes thereof in the course of motion. Ultrasound-based triplets providing the three points (fundamental points) by a segment as required for measurement were fixed on the sternum (modeling the trunk), the clavicle, the acromion (modeling the scapula), the upper arm, and the lower arm. The position of the sixteen anatomical points involved in the study were determined by an ultrasound-based pointer in the local coordinate system specified by the fundamental points before starting measurements. The ZEBRIS ultrasound-based motion analysis system was used for measuring the spatial coordinates of triplets in the course of continuous motion. The spatial coordinates of the designated anatomical points can be calculated by the method of triangulation. The method was calibrated by a ZEBRIS mapping (3DCAD) software commercially available, and the measurement error rate of the method was determined by statistical calculations. On the basis of calibration and error calculations it could be established that the accuracy and the

  7. Role of suprascapular nerve block in chronic shoulder pain: A comparative study of 60 cases

    Directory of Open Access Journals (Sweden)

    Anil Salgia

    2014-01-01

    Full Text Available Background: Suprascapular nerve block using anatomical landmark has been shown to be a safe and effective treatment for chronic shoulder pain from rheumatoid and degenerative arthritis. This can be performed as an outpatient procedure that reduces pain and disability. Aims and Objectives: To access efficacy of suprascapular nerve block in chronic shoulder pain. To compare results between placebo and use of methyl prednisolone with bupivacaine for nerve block . Materials and Methods: 60 patients with chronic shoulder pain were taken up for the trial. In the study group, all patients received the block through the anatomical landmark approach, with a single sitting suprascapular nerve block. On randomized basis, 30 patients were given 10 ml of 0.5% bupivacaine and 40 mg of methyl prednisolone acetate (depo medrol to block the suprascapular nerve. Another 30 patients were injected with 11 ml of 0.9% saline. Patients were followed up on 2 nd day, 7 th day, and 21 st day and 3 months for the status of relief of pain and improvement of movement of joint. Results: Evaluation of the efficacy of the block was achieved by comparing verbal pain scores and improvement in range of movements at 2, 7, 21 days and 3 months after the injection. Significant pain relief is defined as improvement of more than 70% on verbal and visual analog pain scale scores. Results were consistent with VAS score of pain. Maximum improvement was noted in the bupivacaine+methyl prednisolone mixed group. Conclusion: The result of this study shows a clear benefit of methyl prednisolone + bupivacaine for suprascapular nerve block in cases of chronic shoulder pain. There was statistically and clinically significant reduction in pain and improvement in range of movements.

  8. Postoperative pain treatment after total knee arthroplasty

    DEFF Research Database (Denmark)

    Karlsen, Anders Peder Højer; Wetterslev, Mik; Hansen, Signe Elisa

    2017-01-01

    INTRODUCTION: The aim of this systematic review was to document efficacy, safety and quality of evidence of analgesic interventions after total knee arthroplasty (TKA). METHODS: This PRISMA-compliant and PROSPERO-registered review includes all-language randomized controlled trials of medication-b...... of an optimal procedure-specific analgesic regimen after TKA....

  9. Total hip arthroplasty: an editiorial comment.

    Science.gov (United States)

    Peterson, L F

    1977-09-01

    Total hip arthroplasty has become an accepted method of management of severe painful problems of the hip. It has undergone some dramatic changes, the major thrust now being to more nearly match the mechanical characteristics of the implant to the bone and cartilage they replace.

  10. Design improvements in Total Knee Arthroplasty

    NARCIS (Netherlands)

    Barink, M.

    2007-01-01

    The thesis deals with three questions concerning the knee joint and total knee arthroplasty. 1. Are there parameters which can be changed to reduce bone resorption, caused by TKA, without affecting other relevant parameters? A debonded anterior flange of the femoral TKA component reduces bone

  11. Total hip arthroplasty for giant cell tumour.

    Directory of Open Access Journals (Sweden)

    Kulkarni S

    1996-07-01

    Full Text Available A 32 month follow up of an uncommon case of a Giant Cell Tumour affecting the proximal end of femur is presented. Following a wide excision, the hip was reconstructed using Charnley type of low friction total hip arthroplasty. At a 32 month review, there was no recurrence and the function was good.

  12. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  13. Technical pearls in total hip arthroplasty

    NARCIS (Netherlands)

    Mulier, M.; Raaijmaakers, M.; van den Bekerom, M.

    2010-01-01

    Total hip arthroplasty (THA) has had a big impact on the quality of life of millions of patients. Primary THA has a very high success rate and implant survival time of more than 30 years have been reported. However, because of the high number of procedures performed, the small percentage of patients

  14. Knee Arthroplasty: With or Without Patellar Component?

    Directory of Open Access Journals (Sweden)

    Árpád Sólyom

    2015-09-01

    Full Text Available Arthroplasty is used when there is irreversible damage to the articular cartilage of the knee. It involves implanting a bicompartimental (femoral and tibial components or a tricompartimental (femoral, tibial and patellar components prosthesis. It is a very invasive and costly operation, so our objective was to evaluate the necessity of the patellar component.

  15. Innovations in revision total knee arthroplasty

    NARCIS (Netherlands)

    Meijer, Marrigje

    2015-01-01

    Osteoarthritis (OA) is the most common joint disorder in the world and total knee arthroplasty (TKA) is thought to be the gold standard for the surgical treatment of end-stage OA. Despite good results, a significant proportion of patients need to have their knee prosthesis replaced, and an increase

  16. POSTERIOR APPROACH FOR HIP ARTHROPLASTY: A SINGLE ...

    African Journals Online (AJOL)

    The most common indication was osteoarthritis. Two complications were encountered; surgical site infection and post-operative cerebrovascular accident. There were no dislocations. Conclusions: The posterior approach is a viable approach for hip arthroplasty for use in Kenya with low complication rates. INTRODUCTION.

  17. Prevention of infection after knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Hagen, Anja

    2010-01-01

    Full Text Available Scientific background: Man-made joints (joint endoprostheses, including knee endoprostheses, are used in some irreversible diseases of the human joints. The implantation of joint endoprostheses (arthroplasty is associated with an increased risk for infection. To prevent infections, different interventions without and with the use of antibiotics (hygiene procedures and antibiotic prophylaxis are used. The benefits of these interventions are not clear yet. Research questions: The presented report addresses the questions regarding the medical effectiveness, the cost-effectiveness as well as the ethical, social and legal aspects related to the use of interventions to prevent infections after knee arthroplasty. Methods: A systematic literature search is conducted in the medical electronic databases MEDLINE, EMBASE, SciSearch etc. in June 2009 and has been completed by a hand search. The analysis includes publications which describe and/or evaluate clinical data from randomized controlled trials (RCT, systematic reviews of RCT, registers of endoprostheses or databases concerning interventions to prevent infections after knee arthroplasty. The conducted literature search also aims to identify health-economic studies and publications dealing explicitly with ethical, social or legal aspects in the use of interventions to prevent infections after knee arthroplasty. The synthesis of information from different publications has been performed qualitatively. Results: The systematic literature search yields 1,030 hits. Based on the predefined inclusion and exclusion criteria a total of ten publications is included in the analysis. The presented report does not find evidence of the effectiveness of different hygiene interventions with a high evidence level. Most of the unspecific interventions are recommended on the basis of results from non-RCT, from studies for other clinical indications and/or for clinically not relevant endpoints, as well as on the basis of

  18. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders.

    Science.gov (United States)

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

    2015-02-01

    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.

  19. Comparison of anatomic vs. straight femoral stem design in total hip replacement - femoral canal fill in vivo.

    Science.gov (United States)

    de Boer, Friso A; Sariali, Elhadi

    2017-05-12

    The femoral canal fill between an anatomic and a straight prosthesis design in cementless total hip arthroplasty (THA) was compared. We hypothesised that the anatomic SPS stem has higher proximal fill and lesser distal fill than the straight stem. The femoral canal fill was measured on 3 months routine postoperative x-rays at 5 levels of the stem in 50 consecutive patients, aged 35-83 years, who underwent 56 THA procedures by a single surgeon in this hospital. 22 patients received a straight design Ceramconcept Global stem, 34 patients received an anatomic design Symbios SPS stem. Both anteroposterior (AP) and lateral x-rays were combined to suggest a 3-D measurement. On the AP x-rays, the canal fill was significantly higher using the anatomic design stem at the proximal measurement levels, and was significantly higher at the distal levels using the straight stem. With the AP and lateral x-rays combined, the canal fill at the proximal levels was also significantly higher in the anatomic groups, nonsignificantly lower at the central level and significantly lower at the distal levels. In THA surgery, achieving high fill at the metaphysis of the femur and less fill at the diaphysis has been suggested to result in satisfactory outcome and high stability of the prosthesis. This study demonstrated that, compared to straight stem design, an anatomically designed stem has a significantly higher metaphyseal femoral canal fill.

  20. Rare Inferior Shoulder Dislocation (Luxatio Erecta)

    Science.gov (United States)

    Cift, Hakan; Soylemez, Salih; Demiroglu, Murat; Ozkan, Korhan; Ozden, Vahit Emre; Ozkut, Afsar T.

    2015-01-01

    Although shoulder dislocations have been seen very frequently, inferior dislocation of shoulder constitutes only 0.5% of all shoulder dislocations. We share our 4 patients with luxatio erecta and present their last clinical control. 2 male and 2 female Caucasian patients were diagnosed as luxatio erecta. Patients' ages were 78, 62, 65, and 76. All patients' reduction was done by traction-abduction and contour traction maneuver in the operating room. The patients had no symptoms and no limitation of range of motion of their shoulder at their last control. Luxatio erecta is seen rarely, and these patients may have neurovascular injury. These patients should be carefully examined and treated by the orthopaedic and traumatology surgeons. PMID:25883820

  1. Rare Inferior Shoulder Dislocation (Luxatio Erecta

    Directory of Open Access Journals (Sweden)

    Hakan Cift

    2015-01-01

    Full Text Available Although shoulder dislocations have been seen very frequently, inferior dislocation of shoulder constitutes only 0.5% of all shoulder dislocations. We share our 4 patients with luxatio erecta and present their last clinical control. 2 male and 2 female Caucasian patients were diagnosed as luxatio erecta. Patients’ ages were 78, 62, 65, and 76. All patients’ reduction was done by traction-abduction and contour traction maneuver in the operating room. The patients had no symptoms and no limitation of range of motion of their shoulder at their last control. Luxatio erecta is seen rarely, and these patients may have neurovascular injury. These patients should be carefully examined and treated by the orthopaedic and traumatology surgeons.

  2. Candida infection of a prosthetic shoulder joint

    International Nuclear Information System (INIS)

    Lichtman, E.A.; Veterans Administration Medical Center, New York

    1983-01-01

    A heroin addict developed a Candida parapsilosis infection in a prosthetic shoulder joint. Radiographs showed loose fragments of cement with prosthetic loosening. The patient was treated with removal of the prosthesis and intravenous amphotericin B followed by oral ketoconazole. (orig.)

  3. Questions and Answers About Shoulder Problems

    Science.gov (United States)

    ... Diseases Muscle and Bone Diseases Joint Replacement Surgery Bursitis Fibromyalgia Fibrous Dysplasia Growth Plate Injuries Marfan Syndrome ... tear. Rotator cuff disease, such as tendinitis and bursitis, happens when tendons in the shoulder inflame or ...

  4. Handball load and shoulder injury rate

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...... was performed at baseline and midseason. Results An increase in handball load by >60% was associated with greater shoulder injury rate (HR 1.91; 95% CI 1.00 to 3.70, p=0.05) compared with the reference group. The effect of an increase in handball load between 20% and 60% was exacerbated among players...

  5. MRI findings in the painful hemiplegic shoulder.

    Science.gov (United States)

    Távora, D G F; Gama, R L; Bomfim, R C; Nakayama, M; Silva, C E P

    2010-10-01

    To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. 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. Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Adhesive capsulitis was found to be a possible cause of PHS. Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  6. 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)

    2010-10-15

    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.

  7. Candida infection of a prosthetic shoulder joint

    Energy Technology Data Exchange (ETDEWEB)

    Lichtman, E.A.

    1983-09-01

    A heroin addict developed a Candida parapsilosis infection in a prosthetic shoulder joint. Radiographs showed loose fragments of cement with prosthetic loosening. The patient was treated with removal of the prosthesis and intravenous amphotericin B followed by oral ketoconazole.

  8. Subacromial shoulder disorders among baggage handlers

    DEFF Research Database (Denmark)

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

    2016-01-01

    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...... 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....... 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...

  9. 'Drooping shoulder' - nontraumatic causes of glenohumeral subluxation

    International Nuclear Information System (INIS)

    Lev-Toaff, A.S.; Karasick, D.; Rao, V.M.

    1984-01-01

    Nontraumatic glenohumeral subluxation can occur in patients with hemiplegia or brachial plexus involvement by tumor. Two cases of inferior subluxation of the humeral head are presented and nontraumatic etiologies of the ''drooping shoulder'' are discussed. (orig.)

  10. [Neonatal complications related to shoulder dystocia].

    Science.gov (United States)

    Lopez, E; de Courtivron, B; Saliba, E

    2015-12-01

    To describe neonatal complications related to shoulder dystocia. This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  11. Do patients return to sports and work after total shoulder replacement surgery?

    Science.gov (United States)

    Bülhoff, Matthias; Sattler, Peter; Bruckner, Thomas; Loew, Markus; Zeifang, Felix; Raiss, Patric

    2015-02-01

    Studies evaluating the return to sports and work after shoulder arthroplasty are rare, and there are no studies evaluating return to work after total shoulder arthroplasty (TSA). Patients undergoing TSA will be able to return to their preoperative sports levels and occupations. Case series; Level of evidence, 4. A total of 154 patients with 170 TSAs for primary glenohumeral arthritis were included. Two subgroups were formed: patients who had participated in sports during the 5 years before surgery (group 1; n = 105 [68%]) and patients who had never participated in sports (group 2; n = 49 [32%]). The return-to-work rate in patients who had not retired after surgery were also analyzed, as were responses to a survey. The mean age at the time of surgery was 71 years (range, 33-88 years) in group 1 and 76 years (range, 54-88 years) in group 2. Mean follow-up time was 6.2 years (range, 2.5-12.6 years). Fifty-seven patients (54%) in group 1 participated in sports right up to the time of surgery. All 57 (100%) returned to sports after surgery. A further 3 patients (3%) from group 1 resumed sporting activity after surgery; swimming was the most popular sport. No patient in group 2 started sports activity after shoulder replacement surgery. Many of the patients, 14% of the entire group, had retired by final follow-up because of TSA. Fourteen percent of patients in group 1 and group 2 were pursuing their work at the time of most recent follow-up. Thirty patients of the entire cohort (19.5%) had to change their occupations because of surgery. Patients who participated in sports before TSA were successfully able to return to sports activities after surgery. Patients who did not participate in sports just before surgery were unlikely to start sports after surgery. Fourteen percent of the entire cohort was able to return to work after surgery. © 2014 The Author(s).

  12. Concept of healing of recurrent shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Donato D'Angelo

    2014-08-01

    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.

  13. High Fidelity In Situ Shoulder Dystocia Simulation

    Directory of Open Access Journals (Sweden)

    Andrew Pelikan, MD

    2018-04-01

    Full Text Available Audience: Resident physicians, emergency department (ED staff Introduction: Precipitous deliveries are high acuity, low occurrence in most emergency departments. Shoulder dystocia is a rare but potentially fatal complication of labor that can be relieved by specific maneuvers that must be implemented in a timely manner. This simulation is designed to educate resident learners on the critical management steps in a shoulder dystocia presenting to the emergency department. A special aspect of this simulation is the unique utilization of the “Noelle” model with an instructing physician at bedside maneuvering the fetus through the stations of labor and providing subtle adjustments to fetal positioning not possible though a mechanized model. A literature search of “shoulder dystocia simulation” consists primarily of obstetrics and mid-wife journals, many of which utilize various mannequin models. None of the reviewed articles utilized a bedside provider maneuvering the fetus with the Noelle model, making this method unique. While the Noelle model is equipped with a remote-controlled motor that automatically rotates and delivers the baby either to the head or to the shoulders and can produce a turtle sign and which will prevent delivery of the baby until signaled to do so by the instructor, using the bedside instructor method allows this simulation to be reproduced with less mechanistically advanced and lower cost models.1-5 Objectives: At the end of this simulation, learners will: 1 Recognize impending delivery and mobilize appropriate resources (ie, both obstetrics [OB] and NICU/pediatrics; 2 Identify risk factors for shoulder dystocia based on history and physical; 3 Recognize shoulder dystocia during delivery; 4 Demonstrate maneuvers to relieve shoulder dystocia; 5 Communicate with team members and nursing staff during resuscitation of a critically ill patient. Method: High-fidelity simulation. Topics: High fidelity, in situ, Noelle model

  14. Resuscitating the Baby after Shoulder Dystocia

    OpenAIRE

    Menticoglou, Savas; Schneider, Carol

    2016-01-01

    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 m...

  15. Coloarticular fistula: A rare complication of revision total hip arthroplasty

    OpenAIRE

    Long, Suzanne S.; Tawa, Nicholas E.; Ayres, Douglas K.; Abdeen, Ayesha; Wu, Jim S.

    2011-01-01

    Fistula formation between bowel and total hip arthroplasty or revision arthroplasty hardware is rare. We present a case of a 78-year-old woman with protrusio of left hip arthroplasty and acetabular reconstruction hardware that caused direct perforation of the sigmoid colon and fistula formation between the sigmoid colon and the left hip joint. The patient underwent several joint debridements, sigmoid colectomy, and removal of all orthopedic hardware; she ultimately died after two prolonged ho...

  16. Conservative treatment and rehabilitation of shoulder problems

    International Nuclear Information System (INIS)

    Paternostro-Sluga, T.; Zoech, C.

    2004-01-01

    The shoulder joint has an important influence on arm- and handfunction. Therefore, activities of daily living, working and leisure time can be negatively influenced by diseases of the shoulder joint. Problems of the shoulder joint can be induced by muscular dysbalance and poor body posture. There is a strong relationship between shoulder function and body posture. Conservative treatment and rehabilitation of the shoulder joint aims at improving the local dysfunction of the shoulder joint as well as at improving function and social participation. Antiinflammatory and pain medication, exercise, occupational, electro-, ultrasound and shock wave therapy, massage, thermotherapy and pulsed electromagnetic fields are used as conservative treatments. Exercise therapy aims at improving muscular performance, joint mobility and body posture. Occupational therapy aims at improving functional movements for daily living and work. Electrotherapy is primarily used to relieve pain. Shock wave and ultrasound therapy proved to be an effective treatment for patients with calcific tendinitis. The subacromial impingement syndrome can be effectively treated by conservative therapy. (orig.) [de

  17. Anterior Shoulder Instability in the Military Athlete

    Science.gov (United States)

    Waterman, Brian; Owens, Brett D.; Tokish, John M.

    2016-01-01

    Context: Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability. Evidence Acquisition: A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability. Study Design: Clinical review. Level of Evidence: Level 4. Results: The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or “off-track” engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered. Conclusion: Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population. PMID:27694151

  18. Rugby and Shoulder Trauma: A Systematic Review.

    Science.gov (United States)

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

    2015-01-01

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

  19. Neonatal morbidity associated with shoulder dystocia maneuvers.

    Science.gov (United States)

    Spain, Janine E; Frey, Heather A; Tuuli, Methodius G; Colvin, Ryan; Macones, George A; Cahill, Alison G

    2015-03-01

    We sought to examine neonatal morbidity associated with different maneuvers used among term patients who experience a shoulder dystocia. We conducted a retrospective cohort study of all women who experienced a clinically diagnosed shoulder dystocia at term requiring obstetric maneuvers at a single tertiary care hospital from 2005 through 2008. We excluded women with major fetal anomaly, intrauterine death, multiple gestation, and preterm. Women exposed to Rubin maneuver, Wood's screw maneuver, or delivery of the posterior arm were compared to women delivered by McRoberts/suprapubic pressure only, which served as the reference group. The primary outcome was a composite morbidity of neonatal injury (defined as clavicular or humeral fracture or brachial plexus injury) and neonatal depression (defined as Apgar shoulder dystocia, defined as time from delivery of fetal head to delivery of shoulders. Among the 231 women who met inclusion criteria, 135 were delivered by McRoberts/suprapubic pressure alone (57.9%), 83 women were exposed to Rubin maneuver, 53 women were exposed to Wood's screw, and 36 women were exposed to delivery of posterior arm. Individual maneuvers were not associated with composite morbidity, neonatal injury, or neonatal depression after adjusting for nulliparity and duration of shoulder dystocia. We found no association between shoulder dystocia maneuvers and neonatal morbidity after adjusting for duration, a surrogate for severity. Our results demonstrate that clinicians should utilize the maneuver most likely to result in successful delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. The "bench-presser's shoulder": an overuse insertional tendinopathy of the pectoralis minor muscle.

    Science.gov (United States)

    Bhatia, Deepak N; de Beer, Joe F; van Rooyen, Karin S; Lam, Francis; du Toit, Donald F

    2007-08-01

    Tendinopathies of the rotator cuff muscles, biceps tendon and pectoralis major muscle are common causes of shoulder pain in athletes. Overuse insertional tendinopathy of pectoralis minor is a previously undescribed cause of shoulder pain in weightlifters/sportsmen. To describe the clinical features, diagnostic tests and results of an overuse insertional tendinopathy of the pectoralis minor muscle. To also present a new technique of ultrasonographic evaluation and injection of the pectoralis minor muscle/tendon based on use of standard anatomical landmarks (subscapularis, coracoid process and axillary artery) as stepwise reference points for ultrasonographic orientation. Between 2005 and 2006, seven sportsmen presenting with this condition were diagnosed and treated at the Cape Shoulder Institute, Cape Town, South Africa. In five patients, the initiating and aggravating factor was performance of the bench-press exercise (hence the term "bench-presser's shoulder"). Medial juxta-coracoid tenderness, a painful active-contraction test and bench-press manoeuvre, and decrease in pain after ultrasound-guided injection of a local anaesthetic agent into the enthesis, in the absence of any other clinically/radiologically apparent pathology, were diagnostic of pectoralis minor insertional tendinopathy. All seven patients were successfully treated with a single ultrasound-guided injection of a corticosteroid into the enthesis of pectoralis minor followed by a period of rest and stretching exercises. This study describes the clinical features and management of pectoralis minor insertional tendinopathy, secondary to the bench-press type of weightlifting. A new pain site-based classification of shoulder pathology in weightlifters is suggested.

  1. Comfort and acceptability of various immobilization positions using a shoulder external rotation and abduction brace.

    Science.gov (United States)

    Hatta, Taku; Yamamoto, Nobuyuki; Sano, Hirotaka; Itoi, Eiji

    2017-03-01

    Immobilization with shoulder braces is used for conservative treatment of an initial shoulder dislocation. Various arm positions have been investigated to determine optimal position in terms of the anatomical reduction of the Bankart lesion. Recently, the effect of immobilization in shoulder abduction as well as in external rotation has been reported. However, there are few studies assessing subjects' acceptability of the brace in various arm positions. We hypothesized that a certain arm position regarding abduction or external rotation for immobilization would induce significant discomfort during activities of daily living. A dominant arm of 20 healthy participants was immobilized with a shoulder brace in 4 different positions; adduction and internal rotation (Add-IR), adduction and external rotation (Add-ER), 30° of abduction and 30° of external rotation (Abd-30ER), and 30° of abduction and 60° of external rotation (Abd-60ER). After completing immobilization for 24 h, subjects were asked to assess the discomfort of bracing for overall and individual activities, using a visual analogue scale. Data were compared among the four positions. For overall activities and several activities (eating, reading books, and removing and putting on pants), Abd-60ER was significantly more uncomfortable than adducted arm positions. Abd-30ER did not show any differences compared to the other arm positions. Immobilization in abduction and external rotation seems to be acceptable although the arm position in 30° of abduction and 60° of external rotation is less comfortable than the others. Our results might be useful in determining and developing the ideal shoulder brace which could keep patients' compliance and improve their outcomes. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  2. Importance of a three-dimensional measure of humeral head subluxation in osteoarthritic shoulders.

    Science.gov (United States)

    Terrier, Alexandre; Ston, Julien; Farron, Alain

    2015-02-01

    During total shoulder arthroplasty (TSA), humeral head subluxation may be difficult to manage. Furthermore, there is a risk for postoperative recurrence of subluxation, affecting the outcome of TSA. An accurate evaluation of the subluxation is necessary to evaluate this risk. Currently, subluxation is measured in 2 dimensions (2D), usually relative to the glenoid face. The goal of this study was to extend this measure to 3 dimensions (3D) to compare glenohumeral and scapulohumeral subluxation and to evaluate the association of subluxation with the glenoid version. The study analyzed 112 computed tomography scans of osteoarthritic shoulders. We extended the usual 2D definition of glenohumeral subluxation, scapulohumeral subluxation, and glenoid version by measuring their orientation in 3D relative to the scapular plane and the scapular axis. We evaluated statistical associations between subluxation and version in 2D and 3D. Orientation of subluxation and version covered all sectors of the glenoid surface. Scapulohumeral subluxation and glenoid version were highly correlated in amplitude (R(2) = 0.71; P < .01) and in orientation (R(2) = 0.86; P < .01). Approximately every degree of glenoid version induced 1% of scapulohumeral subluxation in the same orientation of the version. Conversely, glenohumeral subluxation was not correlated to glenoid version in 2D or in 3D. Orientation of the humeral subluxation is rarely within the arbitrary computed tomography plane and should therefore be measured in 3D to detect out-of-plane subluxation. Scapulohumeral subluxation and glenoid version measured in 3D could bring valuable information for decision making during TSA. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  3. Adverse Outcomes in Hip Arthroplasty: Long-Term Trends

    Science.gov (United States)

    Wolf, Brian R.; Lu, Xin; Li, Yue; Callaghan, John J.; Cram, Peter

    2012-01-01

    Background: Total hip arthroplasty is a common surgical procedure, but little is known about longitudinal trends in associated adverse outcomes. Our objective was to describe long-term trends in demographics, comorbidities, and adverse outcomes for older patients who underwent primary and revision total hip arthroplasty. Methods: We identified a retrospective, observational cohort of 1,405,379 Medicare beneficiaries who underwent primary total hip arthroplasty and 337,874 who underwent revision total hip arthroplasty between 1991 and 2008. The primary outcome was a composite representing the occurrence of one or more of the following adverse outcomes during the index admission or during readmission within ninety days after discharge: death, hemorrhage, infection, pulmonary embolism, sepsis, deep venous thrombosis, and myocardial infarction. Secondary outcomes included each of these outcomes assessed individually. Results: Between 1991 and 2008, the mean age and the mean comorbidity burden increased for all total hip arthroplasty patients. The length of hospital stay after primary and revision total hip arthroplasty declined by approximately 50% over the study period. However, the rate of readmission for any cause has recently increased and has surpassed 10% for primary total hip arthroplasty and 20% for revision total hip arthroplasty. The composite rate of adverse outcomes after primary total hip arthroplasty declined from 4% to 3.4% over the study period, whereas the composite adverse outcome rate after revision total hip arthroplasty slowly increased from 7% to 10.9%. We observed a steady decline in the rates of most individual adverse outcomes after primary total hip arthroplasty over the majority of the study period. Many of these rates stabilized or began to increase slightly near the end of the study period. In contrast, an increase in the rates of many adverse outcomes was observed in the revision total hip arthroplasty population even after accounting for

  4. Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

    Science.gov (United States)

    Sheehan, Scott E.; Orwin, John F.; Lee, Kenneth S.

    2016-01-01

    Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial soft-tissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases—with select MR imaging and arthroscopic correlation. Online supplemental material is available for this article. ©RSNA, 2016 PMID:27726738

  5. Cementless arthroplasty with a distal femoral shortening for the treatment of Crowe type IV developmental hip dysplasia.

    Science.gov (United States)

    Guo, Chang-Yong; Liang, Bo-Wei; Sha, Mo; Kang, Liang-Qi; Wang, Jiang-Ze; Ding, Zhen-Qi

    2015-01-01

    Severe developmental dysplasia of the hip is a surgical challenge. The purpose of this study is to describe the cementless arthroplasty with a distal femoral shortening osteotomy for Crowe type IV developmental hip dysplasia and to report the results of this technique. 12 patients (2 male and 10 female) of Crowe type IV developmental hip dysplasia operated between January 2005 and December 2010 were included in the study. All had undergone cementless arthroplasty with a distal femoral shortening osteotomy. Acetabular cup was placed at the level of the anatomical position in all the hips. The clinical outcomes were assessed and radiographs were reviewed to evaluate treatment effects. The mean followup for the 12 hips was 52 months (range 36-82 months). The mean Harris hip score improved from 41 points (range 28-54) preoperatively to 85 points (range 79-92) at the final followup. The mean length of bone removed was 30 mm (range 25-40 mm). All the osteotomies healed in a mean time of 13 weeks (range 10-16 weeks). There were no neurovascular injuries, pulmonary embolism or no infections. Our study suggests that cementless arthroplasty with a distal femoral shortening is a safe and effective procedure for severe developmental dysplasia of the hip.

  6. The Nordic Arthroplasty Register Association

    Science.gov (United States)

    Fenstad, Anne M; Salomonsson, Roger; Mehnert, Frank; Furnes, Ove; Overgaard, Søren; Pedersen, Alma B; Herberts, Peter; Kärrholm, Johan; Garellick, Göran

    2009-01-01

    Background and purpose The possibility of comparing results and of pooling the data has been limited for the Nordic arthroplasty registries, because of different registration systems and questionnaires. We have established a common Nordic database, in order to compare demographics and the results of total hip replacement surgery between countries. In addition, we plan to study results in patient groups in which the numbers are too small to be studied in the individual countries. Material and methods Primary total hip replacements (THRs) from 1995–2006 were selected for the study. Denmark, Sweden, and Norway contributed data. A common code set was made and Cox multiple regression, with adjustment for age, sex, and diagnosis was used to calculate prosthesis survival with any revision as endpoint. Results 280,201 operations were included (69,242 from Denmark, 140,821 from Sweden, and 70,138 from Norway). Females accounted for 60% of the patients in Denmark and Sweden, and 70% in Norway. Childhood disease was the cause of 3.1%, 1.8%, and 8.7% of the operations in Denmark, Sweden, and Norway, respectively. Resurfacing of hips accounted for 0.5% or less in all countries. The posterior approach was used in 91% of cases in Denmark, 60% in Sweden, and 24% in Norway. Cemented THRs were used in 46% of patients in Denmark, in 89% of patients in Sweden, and in 79% of patients in Norway. Of the 280,201 primary THRs, 9,596 (3.4%) had been revised. 10-year survival was 92% (95% CI: 91.6–92.4) in Denmark, 94% (95% CI: 93.6–94.1) in Sweden, and 93% (95% CI: 92.3–93.0) in Norway. In Denmark, 34% of the revisions were due to dislocation, as compared to 23% in Sweden and Norway. Replacement of only cup or liner constituted 44% of the revisions in Denmark, 29% in Sweden, and 33% in Norway. Interpretation This unique common Nordic collaboration has shown differences between the countries concerning demographics, prosthesis fixation, and survival. The large number of patients in

  7. Two-year follow-up of low-level laser therapy for elderly with painful adhesive capsulitis of the shoulder

    Directory of Open Access Journals (Sweden)

    Ip D

    2015-05-01

    Full Text Available David Ip, Nga-Yue Fu Asia Medical Pain Centre, Mong Kok, Hong Kong, People's Republic of China Introduction: This paper reports on the medium-term mean 2-year prospective follow-up of a patient cohort of 35 unselected elderly patients with mean age of 65 years who visited our tertiary referral pain center for painful adhesive capsulitis of the shoulder managed with low-level laser therapy (LLLT. Materials and methods: All patients in this prospective cohort study had documentation of the diagnosis by contrast-enhanced magnetic resonance imaging before study entry and all had failed to respond to a combination of conventional physical therapy and nonsteroidal anti-inflammatory medications for not fewer than 4 weeks. LLLT, at a wavelength of 810 nm emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm2, was employed to irradiate six predetermined anatomic points and two acupuncture points. The treatment regimen consisted of three sessions of treatment per week for 8 consecutive weeks. Each treatment session lasted 180 seconds. Serial clinical assessment was undertaken using the Constant–Murley shoulder score. Results: A total of 50 painful shoulder joints were treated, as a number of elderly presented with bilateral symptoms. All but four painful shoulders showed significant improvement in Constant–Murley shoulder score at the end of 8-weeks’ LLLT treatment and, surprisingly, the improvement was found maintained at follow-up assessments at 1 year and 2 years. Conclusion: We conclude that LLLT is a viable option in the conservative treatment of shoulder pain arising from adhesive capsulitis of the shoulder in the elderly, with a positive clinical result of more than 90% and with clinical efficacy both in the short-term and the medium-term. Keywords: Constant–Murley shoulder score, LLLT, shoulder pain, acupuncture point

  8. How to Treat the Complex Unstable Intertrochanteric Fractures in Elderly Patients? DHS or Arthroplasty

    Directory of Open Access Journals (Sweden)

    Ebrahim Hasankhani

    2014-09-01

    Full Text Available Background:  Due to difficulty in obtaining anatomical reduction, management of the unstable intertrochanteric fractures in elderly osteoporotic patients is challenging. The purpose of this study is to compare the results of hip arthroplasty (total, hemi, or bipolar with DHS in the elderly patients with unstable intertrochanteric fractures.   Methods:  We prospectively studied and followed-up 80 old patients with complex unstable intertrochanteric fracture from January 2007 to December 2010. Depending on the time of the patients’ admission, we alternatively treated them by DHS and arthroplasty, and placed them in Groups A and B, respectively. We followed them up radiologically and also clinically by Harris Hip Score for more than 24 months. Statistical analysis was performed using SPSS version 11.5 for Windows.  Results: The mean length of follow-up and age were 34.3±4.1 months (ranged; 24-59 and the 75.2±5.2 years (ranged; 58-96, respectively. Comparing Group A with B, demographic data, mean blood loss, duration of operation, time to walking and duration of hospital stay had no significant difference but overall device related complications were significantly higher in Group A. Functional scores were also higher in Group B, but this difference was not significant statistically. In both groups, the patients with Type A3 compared with Type A2, had more duration of surgery and blood loss.  Conclusions:  Arthroplasty is an alternative treatment in elderly patients with unstable intertrochanteric fractures and can provide good and satisfactory clinical outcomes associated with low complication and mortality rates.

  9. The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears

    DEFF Research Database (Denmark)

    Bjarnison, Arnar O; Sørensen, Thomas J; Kallemose, Thomas

    2017-01-01

    BACKGROUND: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of rotator cuff tear (RCT) and osteoarthritis (OA) of the shoulder. This study assessed whether the CSA was associated with RCT and OA...

  10. Muscular imbalance and shoulder pain in volleyball attackers.

    Science.gov (United States)

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

    1996-09-01

    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. 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 sports activities. Volleyball attackers have a different muscular and capsular pattern at the playing shoulder compared to the opposite shoulder. Their playing shoulder is depressed, the scapula lateralised, and the dorsal muscles and the posterior and inferior part of the shoulder capsule shortened. These differences were of more significance in volleyball attackers with shoulder pain than in volleyball players without shoulder pain. In contrast to recreational athletes without any overhead sports activity, there were no significant difference in the comparison of the two shoulders. The histories, clinical and sonographic findings did not reveal further typical features for volleyball attackers with shoulder pain. Muscular balance of the shoulder girdle is very important in this sport. It is therefore imperative to include adequate stretching and muscular training programme for the prevention, as well as for therapy, of shoulder pain in volleyball attackers.

  11. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS.

    Science.gov (United States)

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2011-01-01

    To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Misericórdia, São Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. 14 of the 55 players evaluated were pitchers, and 20 reported pain during the pitching motion. The mean values for lateral and medial rotation and range of motion (ROM) in the dominant shoulder were, respectively, 110 °, 61 ° and 171 °, with a statistically significant difference in relation to the non-dominant limb. Pitchers had greater gains in lateral rotation and deficits in medial rotation than did non-pitchers. Pain presented a statistically significant correlation with diminished ROM, greater length of time playing the sport and situations of "shoulder at risk". Statistically significant differences in dominant shoulder mobility were found, with increased lateral rotation, diminished medial rotation and smaller ROM, in relation to the contralateral limb. There was a statistically significant relationship between the pitcher's position and greater gain in lateral rotation and diminished medial rotation. There were statistically significant correlations between pain and diminished ROM, greater length of time playing the sport and situations of "shoulder at risk". There was a statistical tendency suggesting that players with diminished medial rotation of the dominant shoulder presented a relationship with pain.

  12. Aesthetic Shoulder Augmentation with Silicone Implants.

    Science.gov (United States)

    Chung, Yoon Jae; Jang, Hyun

    2014-02-01

    Men with narrower shoulders may appear less muscular than other men. Deltoid muscle underdevelopment or atrophy, a condition commonly linked to narrow shoulder issues, may be associated with congenital deformity, trauma, or neoplasm. For some people, regular exercise does not effectively develop the deltoid muscle region. Some people naturally have a smaller build than others. Even with developed deltoid muscles, these people still appear to be small. The authors have performed lateral shoulder augmentation with silicone implants for 4 years. Based on their experience, this procedure stands as a reliable solution for men with narrow shoulders. Lateral shoulder augmentation with silicone implants was developed and used for 81 patients between April 2009 and April 2013. None of the patients had shoulder deformities except for two patients (one patient with Poland's syndrome and one patient with Sprengel's deformity). The implants were placed through a horizontal axillary crease incision in a plane dissected between the deltoid fascia and muscle. All augmentation or correction procedures have been met with complete patient approval. Five patients had minor complications such as hematoma and implement displacement. However, all these complications were resolved to the satisfaction of the patients. When silicone implants are used to achieve purely aesthetic improvements, successful shoulder augmentation procedures are observed. This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .

  13. Anatomical structure of Polystichum Roth ferns rachises

    Directory of Open Access Journals (Sweden)

    Oksana V. Tyshchenko

    2012-03-01

    Full Text Available The morpho-anatomical characteristics of rachis cross sections of five Polystichum species is presented. The main and auxiliary anatomical features which help to distinguish investigated species are revealed.

  14. Long-term outcome of segmental reconstruction of the humeral head for the treatment of locked posterior dislocation of the shoulder.

    Science.gov (United States)

    Gerber, Christian; Catanzaro, Sabrina; Jundt-Ecker, Michele; Farshad, Mazda

    2014-11-01

    Locked posterior glenohumeral dislocations with impaction fractures involving less than 30% to 35% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 35% to 40% are treated with humeral head arthroplasty. As an alternative, reconstruction of the defect with segmental femoral or humeral head allograft has been proposed, but the long-term outcome of this joint-preserving procedure is unknown. Twenty-two shoulders in 21 patients with a locked posterior shoulder dislocation and an impaction of at least 30% (mean, 43%) of the humeral head were treated with segmental reconstruction of the humeral head defect. They were reviewed clinically and radiographically at a minimum follow-up of 5 years. Of the 22 shoulders, 19 could be followed up at 128 months (range, 60-294 months) postoperatively. Only 2 of the 19 patients needed a prosthesis more than 180 months after the index operation. Of the other 17, 4 had radiographically advanced osteoarthritis (OA), 4 had mild OA, and 9 had no or minimal OA. Eighteen shoulders were rated as subjectively excellent, none were rated as good, and one was rated as fair. The final Constant-Murley score averaged 77 points (range, 52-98 points), the Subjective Shoulder Value averaged 88% (range, 75%-100%), and only 2 patients had mild to moderate pain. Mean active anterior elevation was 145°, and mean external rotation with the arm at the side was 42°. Segmental reconstruction of humeral head defects for large anteromedial impaction fractures caused by locked posterior dislocations durably restores stability and freedom from pain with an excellent subjective long-term outcome. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Utilization rates of knee-arthroplasty in OECD countries.

    Science.gov (United States)

    Pabinger, C; Lothaller, H; Geissler, A

    2015-10-01

    The number of knee arthroplasties and the prevalence of obesity are increasing exponentially. To date there have been no published reviews on utilization rates of knee arthroplasty in OECD countries. We analysed economic, medical and population data relating to knee arthroplasty surgeries performed in OECD countries. Gross domestic product (GDP), health expenditures, obesity prevalence, knee arthroplasty utilization rates and growth in knee arthroplasty rates per 100,000 population were assessed for total population, for patients aged 65 years and over, and patients aged 64 years and younger. Obesity prevalence and utilization of knee arthroplasty have increased significantly in the past. The mean utilization rate of knee arthroplasty was 150 (22-235) cases per 100,000 total population in 2011. The strongest annual increase (7%) occurred in patients 64 years and under. Differences between individual countries can be explained by economic and medical patterns, with countries with higher medical expenditures and obesity prevalence having significantly higher utilization rates. Countries with lower utilization rates have significantly higher growth in utilization rates. The future demand for knee prostheses will increase x-fold by 2030, with exact rates dependant upon economic, social and medical factors. We observed a 10-fold variation in the utilization of knee arthroplasty among OECD countries. A significant and strong correlation of GDP, health expenditures and obesity prevalence with utilization of knee arthroplasty was found. Patients aged 64 years and younger show a two-fold higher growth rate in knee arthroplasty compared to the older population. This trend could result in a four-fold demand for knee arthroplasty in OECD countries by 2030. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  16. Unification of Sinonasal Anatomical Terminology

    Directory of Open Access Journals (Sweden)

    Voegels, Richard Louis

    2015-07-01

    Full Text Available The advent of endoscopy and computed tomography at the beginning of the 1980s brought to rhinology a revival of anatomy and physiology study. In 1994, the International Conference of Sinus Disease was conceived because the official “Terminologia Anatomica”[1] had little information on the detailed sinonasal anatomy. In addition, there was a lack of uniformity of terminology and definitions. After 20 years, a new conference has been held. The need to use the same terminology led to the publication by the European Society of Rhinology of the “European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses,” that can be accessed freely at www.rhinologyjournal.com. Professor Valerie Lund et al[2] wrote this document reviewing the anatomical terms, comparing to the “Terminology Anatomica” official order to define the structures without eponyms, while respecting the embryological development and especially universalizing and simplifying the terms. A must-read! The text's purpose lies beyond the review of anatomical terminology to universalize the language used to refer to structures of the nasal and paranasal cavities. Information about the anatomy, based on extensive review of the current literature, is arranged in just over 50 pages, which are direct and to the point. The publication may be pleasant reading for learners and teachers of rhinology. This text can be a starting point and enables searching the universal terminology used in Brazil, seeking to converge with this new European proposal for a nomenclature to help us communicate with our peers in Brazil and the rest of the world. The original text of the European Society of Rhinology provides English terms that avoided the use of Latin, and thus fall beyond several national personal translations. It would be admirable if we created our own cross-cultural adaptation of this new suggested anatomical terminology.

  17. [Cellular subcutaneous tissue. Anatomic observations].

    Science.gov (United States)

    Marquart-Elbaz, C; Varnaison, E; Sick, H; Grosshans, E; Cribier, B

    2001-11-01

    We showed in a companion paper that the definition of the French "subcutaneous cellular tissue" considerably varied from the 18th to the end of the 20th centuries and has not yet reached a consensus. To address the anatomic reality of this "subcutaneous cellular tissue", we investigated the anatomic structures underlying the fat tissue in normal human skin. Sixty specimens were excised from the surface to the deep structures (bone, muscle, cartilage) on different body sites of 3 cadavers from the Institut d'Anatomie Normale de Strasbourg. Samples were paraffin-embedded, stained and analysed with a binocular microscope taking x 1 photographs. Specimens were also excised and fixed after subcutaneous injection of Indian ink, after mechanic tissue splitting and after performing artificial skin folds. The aspects of the deep parts of the skin greatly varied according to their anatomic localisation. Below the adipose tissue, we often found a lamellar fibrous layer which extended from the interlobular septa and contained horizontally distributed fat cells. No specific tissue below the hypodermis was observed. Artificial skin folds concerned either exclusively the dermis, when they were superficial or included the hypodermis, but no specific structure was apparent in the center of the fold. India ink diffused to the adipose tissue, mainly along the septa, but did not localise in a specific subcutaneous compartment. This study shows that the histologic aspects of the deep part of the skin depend mainly on the anatomic localisation. Skin is composed of epidermis, dermis and hypodermis and thus the hypodermis can not be considered as being "subcutaneous". A difficult to individualise, fibrous lamellar structure in continuity with the interlobular septa is often found under the fat lobules. This structure is a cleavage line, as is always the case with loose connective tissues, but belongs to the hypodermis (i.e. fat tissue). No specific tissue nor any virtual space was

  18. Anatomical glenohumeral internal rotation deficit and symmetric rotational strength in male and female young beach volleyball players.

    Science.gov (United States)

    Saccol, Michele Forgiarini; Almeida, Gabriel Peixoto Leão; de Souza, Vivian Lima

    2016-08-01

    Beach volleyball is a sport with a high demand of shoulder structures that may lead to adaptations in range of motion (ROM) and strength like in other overhead sports. Despite of these possible alterations, no study evaluated the shoulder adaptations in young beach volleyball athletes. The aim of this study was to compare the bilateral ROM and rotation strength in the shoulders of young beach volleyball players. Goniometric passive shoulder ROM of motion and isometric rotational strength were evaluated in 19 male and 14 female asymptomatic athletes. External and internal ROM, total rotation motion, glenohumeral internal rotation deficit (GIRD), external rotation and internal rotation strength, bilateral deficits and external rotation to internal rotation ratio were measured. The statistical analysis included paired Student's t-test and analysis of variance with repeated measures. Significantly lower dominant GIRD was found in both groups (pvolleyball athletes present symmetric rotational strength and shoulder ROM rotational adaptations that can be considered as anatomical. These results indicate that young practitioners of beach volleyball are subject to moderate adaptations compared to those reported for other overhead sports. Copyright © 2015 Elsevier Ltd. All rights reserved.

  19. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  20. Total hip arthroplasty: a still evolving technique

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Galia

    Full Text Available ABSTRACT It has been advocated that total hip arthroplasty (THA is probably the most successful surgical intervention performed in Medicine. In the 1960s, Sir John Charnley not only introduced, but also modified and improved the technique of cemented arthroplasties. The concepts on biological , fixation established by Pillar and Galante served as the foundation for the development of uncemented implants that are now used worldwide. Currently, THA is a worldwide widespread surgery performed on millions of people. However, keeping abreast of the large number of information available on these procedures, especially on implant fixation, designs, different tribological pairings, and the long-term results can be challenging at times. This article is a brief update on the main aspects of THA.

  1. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery....... Methods 29 patients were operated with 30 revision arthroplasties. Median age was 67 (34-84) years. All patients followed a standardized fast-track set-up designed for primary TKA. We determined the outcome regarding LOS, morbidity, mortality, and satisfaction. Results Median LOS was 2 (1-4) days...... undergoing revision TKA for non-septic reasons may be included in fast-track protocols. Outcome appears to be similar to that of primary TKA regarding LOS, morbidity, and satisfaction. Our findings call for larger confirmatory studies and studies involving other indications (revision THA, 1-stage septic...

  2. Anteversion of the acetabular component aligned with the transverse acetabular ligament in total hip arthroplasty.

    Science.gov (United States)

    Miyoshi, Hideaki; Mikami, Hiroshi; Oba, Koichi; Amari, Rui

    2012-06-01

    In total hip arthroplasty (THA), accurately positioning the cup is crucial for achieving an adequate postoperative range of motion and stability. For 47 THA cases in which the inferomedial rim of the cup had been positioned parallel to the transverse acetabular ligament, we retrospectively performed the measurements of the radiographic cup anteversion angle relative to the anterior pelvic plane using 3-dimensional reconstruction computed tomography. The mean anteversion angle was 21.2°, with no significant difference detected in mean cup anteversion between the dysplastic hip group (15 hips) and the control group (15 hips). We suggest that the transverse acetabular ligament is a practical anatomical landmark for determining cup anteversion in THA for both dysplastic and nondysplastic hip cases. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. Endotoxins in surgical instruments of hip arthroplasty

    OpenAIRE

    Goveia, Vania Regina; Mendoza, Isabel Yovana Quispe; Guimarães, Gilberto Lima; Ercole, Flavia Falci; Couto, Bráulio Roberto Gonçalves Marinho; Leite, Edna Marilea Meireles; Stoianoff, Maria Aparecida Resende; Ferreira, José Antonio Guimarães

    2016-01-01

    Abstract OBJECTIVE To investigate endotoxins in sterilized surgical instruments used in hip arthroplasties. METHOD A descriptive exploratory study conducted in a public teaching hospital. Six types of surgical instruments were selected, namely: acetabulum rasp, femoral rasp, femoral head remover, chisel box, flexible bone reamer and femoral head test. The selection was based on the analysis of the difficulty in removing bone and blood residues during cleaning. The sample was made up of 60...

  4. Proprioception after bicruciate-retaining total knee arthroplasty is comparable to unicompartmental knee arthroplasty.

    Science.gov (United States)

    Baumann, Florian; Bahadin, Özkan; Krutsch, Werner; Zellner, Johannes; Nerlich, Michael; Angele, Peter; Tibesku, Carsten Oliver

    2017-06-01

    Rising expectations in functional performance of total knee joints are inciting further improvement of knee arthroplasty implants. From a patient-centred view, bicruciate-retaining models provide a more natural feeling knee. However, there is no evidence of functional advantage for these implants. The aim of this study was to evaluate balance ability as a measure of proprioception in patients with a bicruciate-retaining total knee arthroplasty. A prospective, controlled trial was conducted to compare balance ability in 60 patients after arthroplasty of the knee for osteoarthritis. We compared patients with a bicruciate-retaining knee arthroplasty (BCR group) to a control group of patients with a medial unicompartmental knee arthroplasty (UKA group) and another control group of patients with a posterior stabilized total knee arthroplasty (PS group). The patient population comprised 30 women (50.0 %) and 30 men in three cohorts of 20 each. The mean age was 62.1 ± 8.0 years (range 43-78). Patients were evaluated preoperatively and 9 months post-operatively. The evaluation included clinical, radiological, and balance testing-a single-leg stance with eyes closed compared to eyes open. The difference in area of sway between eyes closed and eyes open represents static balance ability after knee arthroplasty. Perioperative data showed that there was no intra-operative fracture of the intercondylar eminence. There was a decreased post-operative knee extension 9 months post-operative in the BCR group, which was not clinically relevant in any case. We recorded a lower difference in the area of sway between eyes closed and eyes open (ΔA (ec-eo) ) for the BCR group (p = 0.01) and the UKA group (p = 0.04) compared to the PS group. This study found superior static balance ability after preservation of both cruciate ligaments in arthroplasty of the knee, indicating superior proprioceptive function. Hence, BCR implants could provide improved functional properties

  5. Anatomical distribution of human bite marks in a series of 67 cases.

    Science.gov (United States)

    Vale, G L; Noguchi, T T

    1983-01-01

    A study was made of the anatomical distribution of human bite marks, as well as their distribution by age of victim and type of crime involved. Bite marks in this study occurred primarily in sex-related crimes, child abuse cases, and cases involving other types of physical altercations. Bite marks were found on virtually all areas of the body, with more than one bite mark on 40% of the victims. Female victims were most commonly bitten on the breasts, arms, and legs, while male victims were most commonly bitten on the arms and shoulders.

  6. Revision of the Failed Thumb Carpometacarpal Arthroplasty.

    Science.gov (United States)

    Papatheodorou, Loukia K; Winston, Jonathan D; Bielicka, Deidre L; Rogozinski, Benjamin J; Lourie, Gary M; Sotereanos, Dean G

    2017-12-01

    To evaluate the outcome of revision surgery for failed thumb carpometacarpal (CMC) arthroplasty. We retrospectively analyzed 32 patients with failed thumb CMC arthroplasty. The primary reason for revision was pain caused by metacarpal subsidence. Revision surgery included soft tissue interposition and distraction pinning to address the metacarpal subsidence. Additional ligament reconstruction was performed in patients with thumb instability. Eight patients required additional metacarpophalangeal joint fusion for concomitant joint hyperextension. Eleven required additional partial excision of the trapezoid for concomitant scaphotrapezoidal joint arthritis. All patients were evaluated clinically and radiographically. Mean follow-up was 57 months (range, 24-121 months). Pain levels evaluated by visual analog scale were significantly reduced in all patients after revision surgery. Mean grip strength and key pinch strength significantly increased. Twenty-seven patients achieved good functional results; those for 5 patients were fair. This study showed that revision surgery with distraction pinning and soft tissue interposition with or without ligament reconstruction was an effective treatment for failed CMC arthroplasty of the thumb. Therapeutic IV. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. The evidenced-based shoulder evaluation.

    Science.gov (United States)

    O'Kane, John W; Toresdahl, Brett G

    2014-01-01

    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.

  8. Effect of isokinetic training on shoulder impingement.

    Science.gov (United States)

    Wang, T L; Fu, B M; Ngai, G; Yung, P

    2014-01-31

    The aim of this study was to review the literature evaluating the effect of isokinetic training in patients suffering from shoulder impingement syndrome (SIS). Studies published up to March 2011 were located from the Pubmed, Scopus, Lilacs, Physiotherapy Evidence Database, and Cochrane Library databases using "isokinetic", "shoulder", and "impingement" as key words. Referenced studies were also checked. Studies were included if isokinetic training was employed as at least one of the treatments in the therapeutic program to treat shoulder impingement or other shoulder pathologies leading to impingement-related pain. All eligible studies described the level of evidence, patient characteristics, interventions, outcome evaluation, results, complications, and return to work. There were 2 randomized control trials (RCTs) and 4 studies with level 4 evidence that met the inclusion criteria. All of the studies included showed a statistically or clinically significant outcome after isokinetic training. However, most of the studies could not identify the isolated effect of isokinetic training. There was not enough evidence to support or refute the effectiveness of isokinetic training for SIS. This result does not reflect a true lack of effect, but rather a lack of RCTs. A consensus definition of the different types and stages of SIS is urgently needed. More RCTs are also essential to clarify the value of this technique. The homogeneity of treatment interventions, study populations, and outcome measures should be prioritized. Further studies are also needed to clarify the differences in isokinetic data across different types and stages of shoulder impingement.

  9. Gait analysis methodology for the measurement of biomechanical parameters in total knee arthroplasties. A literature review.

    Science.gov (United States)

    Papagiannis, Georgios I; Triantafyllou, Athanasios I; Roumpelakis, Ilias M; Papagelopoulos, Panayiotis J; Babis, George C

    2018-03-01

    Gait analysis using external skin markers provides scope for the study of kinematic and kinetic parameters shown on different total knee arthroplasties (TKA). Thus an appropriate methodology is of great importance for the collection and correlation of valid data. Calibration of equipment is of great importance before measurements, to assure accuracy. Force plates should be calibrated to 1080 Hz and optoelectronic cameras should use 120 Hz frequency, because of the nature of gait activity. Davis model which accurately defines the position of the markers is widely accepted and cited, for the gait analysis of TKA's. To ensure the reproducibility of the measurement, a static trial at the anatomical position must be captured. Following, all acquisitions of dynamic data must be checked for consistency in walking speed, and abnormal gait style because of fatigue or distraction. To establish the repeatability of the measurement, this procedure must be repeated at a pre-defined number of 3-5 gait cycles. Anthropometric measurements should be combined with three-dimensional marker data from the static trial to provide positions of the joint's center and define anatomical axes of total knee arthroplasty. Kinetic data should be normalized to bodyweight (BW) and percentage of BW and height depending on the study. External moments should also be calculated by using inverse dynamics and amplitude-normalized to body mass (Nm/kg). Gait analysis using external skin markers provides scope for the study of biomechanical parameters shown on different TKAs. Thus a standard gait analysis methodology when measuring TKA biomechanical parameters is necessary for the collection and correlation of accurate, adequate, valid and reproducible data. Further research should be done to clarify if the development of a specific kinematic model is appropriate for a more accurate definition of total knee implant joint center in measurements concerning 3D gait analysis.

  10. Prospective Comparison of a Metal-Free Ceramic Total Knee Arthroplasty with an Identical Metal System.

    Science.gov (United States)

    Trieb, Klemens; Ullmann, David; Metzinger, Katharina; Kramar, Reinhard; Mauerer, Andreas; Hofstätter, Stefan; Fiala, Rainer

    2018-02-01

    The aim of this open-label, prospective, short-term study was to carry out an initial comparison of a completely metal-free ceramic with a geometrically identical metallic arthroplasty over a 1-year follow-up period. This study investigates a completely metal-free system using a composite matrix material containing aluminum oxide (Al 2 O 3 , BPK-S Integration, Peter Brehm GmbH, Weisendorf, Germany) or zirconium oxide (ZrO 2 , BPK-S Integration Ceramic, Biolox Delta-CeramTec GmbH, Plochingen, Germany). Eighty patients (40 in each group) received either a completely metal-free ceramic system (matrix of aluminum and zirconium oxide) or an anatomically identical metallic knee system made of a cobalt-chromium alloy. Clinical assessment was performed preoperatively, and during follow-up at 3 and 12 months, using the Knee Society Score, Oxford Knee Score, and EQ-5D-VAS. For radiological evaluation, standard preoperative and postoperative standardized radiographs were taken at the given follow-up visits. The postoperative clinical scores improved significantly at the 3- and 12-month follow-ups, but did not differ statistically between the two groups. The radiologically evaluated mean postoperative mechanical and anatomical axes showed proper alignment within both groups at all times. No revision surgery had to be performed, and no complications or loosening were recorded whatsoever. To our knowledge, this is the first study comparing a total ceramic metal-free knee system with a geometrically identical metallic TKA (total knee arthroplasty). Longer follow-ups will be required to demonstrate the overall efficiency of this TKR and perhaps to expand its medical indication. Georg Thieme Verlag KG Stuttgart · New York.

  11. Design and application of combined 8-channel transmit and 10-channel receive arrays and radiofrequency shimming for 7-T shoulder magnetic resonance imaging.

    Science.gov (United States)

    Brown, Ryan; Deniz, Cem Murat; Zhang, Bei; Chang, Gregory; Sodickson, Daniel K; Wiggins, Graham C

    2014-01-01

    The objective of the study was to investigate the feasibility of 7-T shoulder magnetic resonance imaging by developing transmit and receive radiofrequency (RF) coil arrays and exploring RF shim methods. A mechanically flexible 8-channel transmit array and an anatomically conformable 10-channel receive array were designed and implemented. The transmit performance of various RF shim methods was assessed through local flip angle measurements in the right and left shoulders of 6 subjects. The receive performance was assessed through signal-to-noise ratio measurements using the developed 7-T coil and a baseline commercial 3-T coil. The 7-T transmit array driven with phase-coherent RF shim weights provided adequate B₁⁺ efficiency and uniformity for turbo spin echo shoulder imaging. B₁⁺ twisting that is characteristic of high-field loop coils necessitates distinct RF shim weights in the right and left shoulders. The 7-T receive array provided a 2-fold signal-to-noise ratio improvement over the 3-T array in the deep articular shoulder cartilage. Shoulder imaging at 7-T is feasible with a custom transmit/receive array either in a single-channel transmit mode with a fixed RF shim or in a parallel transmit mode with a subject-specific RF shim.

  12. Distraction Arthroplasty of the Trapeziometacarpal Joint Without Trapeziectomy

    Directory of Open Access Journals (Sweden)

    Kin Weng Wong

    2011-01-01

    Conclusion: Our technique (distraction arthroplasty without trapeziectomy preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.

  13. Perioperative blood saving measures in total hip and knee arthroplasty

    NARCIS (Netherlands)

    Horstmann, W.G.

    2011-01-01

    This dissertation explores and discusses different aspects of blood loss and blood-saving measures in total hip and knee arthroplasty. Background: Worldwide, approximately 1 million total hip and 1 million total knee prostheses are implanted each year. Total hip arthroplasty and total

  14. Low implant migration of the SIGMA® medial unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Koppens, Daan; Stilling, Maiken; Munk, Stig

    2017-01-01

    The purpose of this study was to evaluate implant migration of the fixed-bearing Sigma® medial unicompartmental knee arthroplasty (UKA). UKA is a regularly used treatment for patients with medial osteoarthritis (OA) of the knee. UKA has a higher revision rate than total knee arthroplasty. Implant...... migration can be used as a predictor of implant loosening....

  15. Painful posterior shoulder instability: Anticipating and preventing failure. A study in 25 patients.

    Science.gov (United States)

    Garret, J; Nourissat, G; Hardy, M B; Antonucci, D; Clavert, P; Mansat, P; Godenèche, A

    2017-12-01

    Painful posterior shoulder instability (PPSI) is the least common of the three clinical patterns of posterior shoulder instability. PPSI is defined as pain combined with anatomical evidence of posterior instability but no instability events. We studied a multicentre cohort of 25 patients with PPSI; 23 were identified retrospectively and had a follow-up of at least 2 years and 2 patients were included prospectively. Most patients engaged in sports. All 25 patients underwent surgery, which usually consisted in arthroscopic capsulo-labral reconstruction. The outcome was excellent in 43% of patients; another 43% had improvements but reported persistent pain. The pain remained unchanged or worsened in the remaining 14% of patients. Causes of failure consisted of a missed diagnosis of shoulder osteoarthritis with posterior subluxation, technical errors, and postoperative complications. The main cause of incomplete improvement with persistent pain was presence of cartilage damage. Outcomes were excellent in patients who were free of cartilage damage, bony abnormalities associated with posterior instability (reverse Hill-Sachs lesion, erosion or fracture of the posterior glenoid), technical errors, and postoperative complications. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Case reports: unusual cause of shoulder pain in a collegiate baseball player.

    Science.gov (United States)

    Ligh, Cassandra A; Schulman, Brian L; Safran, Marc R

    2009-10-01

    The objective of reporting this case was to introduce a unique cause of shoulder pain in a high-level Division I NCAA collegiate baseball player. Various neurovascular causes of shoulder pain have been described in the overhead athlete, including quadrilateral space syndrome, thoracic outlet syndrome, effort thrombosis, and suprascapular nerve entrapment. All of these syndromes are uncommon and frequently are missed as a result of their rarity and the need for specialized tests to confirm the diagnosis. This pitcher presented with nonspecific posterior shoulder pain that was so severe he could not throw more than 50 feet. Eventually, intermittent axillary artery compression with the arm in abduction resulting from hypertrophy of the pectoralis minor and scalene muscles was documented by performing arteriography with the arm in 120 degrees abduction. MRI-MR angiographic evaluation revealed no anatomic abnormalities. The patient was treated successfully with a nonoperative rehabilitation program and after 6 months was able to successfully compete at the same level without pain.

  17. Resting position variables at the shoulder: evidence to support a posture-impairment association.

    Science.gov (United States)

    Borstad, John D

    2006-04-01

    A relationship between posture and impairment at the shoulder is theorized, but not supported by evidence. It is proposed that posture and impairment are not directly related, but linked by movement dysfunction. The purpose of this analysis was to explore the relationships among posture, pectoralis minor muscle length, and movement alterations at the shoulder. Subjects who were asymptomatic for shoulder pathology were divided into 2 groups of 25 subjects each based on normalized pectoralis minor muscle resting length. Scapula orientation, thoracic kyphosis, and pectoralis minor muscle lengths were measured, and ratios and indexes of postural variables were calculated. All variables were analyzed for correlations and group differences. Significant group differences were demonstrated for several posture variables, including thoracic spine kyphosis and scapular internal rotation. The distance from the sternal notch to the coracoid process demonstrated the highest correlation with pectoralis minor muscle length. The findings indicate a relationship between posture and pectoralis minor muscle length and support a proposed model linking posture, an anatomical variable, movement dysfunction, and impairment.

  18. Two-Stage Progressive Femoral Lowering Followed by Cementless Total Hip Arthroplasty for Treating Crowe IV-Hartofilakidis Type 3 Developmental Dysplasia of the Hip.

    Science.gov (United States)

    Binazzi, Roberto

    2015-05-01

    High developmental dysplasia of the hip is commonly treated with total hip arthroplasty and shortening osteotomy. We present a two stage technique, consisting of progressive femoral lowering followed by total hip arthroplasty. The clinico-radiographic results of eleven patients (twelve hips) who were operated on with the two-stage technique were evaluated at a mean follow-up of 11 ± 5 years. At the final follow-up, ten patients (eleven hips) had a mean Harris hip score of 85 ± 5 points with no implant loosening. One patient (one hip) was revised at 5 years due to infection. No neurovascular complications were observed in any patients. With this technique, we could place the cup in the anatomical position and obtain complete limb symmetry with excellent clinical results at long-term. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. Salvage of infected total knee arthroplasty with Ilizarov external fixator

    Directory of Open Access Journals (Sweden)

    Venkata Gurava Reddy

    2011-01-01

    Full Text Available Background: Knee arthrodesis may be the only option of treatment in cases of chronic infected total knee arthroplasty (TKA with concomitant irreparable extensor mechanism disruption, extensive bone loss or severe systemic morbidities. Circular external fixation offers possible progressive adjustment to stimulate the bony fusion and to make corrections in alignment. We evaluated the results of knee arthrodesis with one or two stage circular external fixator for infected TKA. Materials and Methods: 16 cases of femoro-tibial fusion were retrospectively evaluated. Male-to-female ratio was 10:6. Mean age of the patients was 62.2 years. Cierney-Mader classification was used for anatomical and physiological evaluation while the bone stock deficiency was classified into mild, moderate and severe. Surgical technique involved either single or two stage arthrodesis using circular external fixator. Results: Union was achieved in 15 patients (93.75%. The mean duration for union (frame application time in these patients was 28.33 weeks (range 22 to 36 weeks. Analysis showed that in the group with frame application time of less than 28 weeks, the incidence of mild to moderate bone deficiency was 83.33%, while in the frame application time more than 28 weeks group the incidence was 20% (P-value 0.034. Similarly the incidence of Cierney-Mader 4B (Bl, Bs, Bls was found to be 33.33% in the group of frame application time of less than 28 weeks, while it was 90% in the group with frame application time more than 28 weeks (P-value 0.035. Conclusion: Circular external fixator is a safe and reliable method to achieve knee arthrodesis in cases of deep infection following TKA. Severe bone stock deficiency and Cierney- Mader type B host are likely risk factors for prolonged frame application time. We recommend a two-stage procedure especially when there is compromised host or severe bone loss.

  20. Overuse in volleyball training/practice: A review on shoulder and spine-related injuries.

    Science.gov (United States)

    Seminati, Elena; Minetti, Alberto Enrico

    2013-01-01

    Overuse injuries are predominant in sports involving the repetition of similar movements patterns, such as in volleyball or beach volleyball, and they may represent as much a problem as do acute injuries. This review discusses the prevalence of two of the most common overuse-related injuries in volleyball: shoulder and back/spine injuries. Risk factors and the aetiology of these injuries are illustrated in order to make possible to initiate preventive programme or post-injuries solutions. Data collected from literature showed a moderately higher injury rate for overuse shoulder injuries compared to the back/spine (19.0 ± 11.2% and 16.8 ± 9.7%, respectively). These data could be underestimated, and future epidemiological studies should consider overuse injuries separately from the others, with new methodological approaches. In addition to age, biomechanical and anatomical features of a volleyball technique utilised in game and the amount of hours played are considered as the main risk factors for overuse upper limb injuries, both for professional and recreational athletes. Together with post-injuries solutions, great importance has to be placed on preventive programmes, such as preventive rehabilitation, stretching, adequate warm up, strength-power exercises, etc. Furthermore, it is particularly suggested that coaches and players work together in order to develop new game/training techniques that minimise stresses and range of motion of the principal anatomical structures involved, while maintaining athletes performance.