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Sample records for shoulder joint injection

  1. Shoulder pain: the role of diagnostic injections.

    Science.gov (United States)

    Larson, H M; O'Connor, F G; Nirschl, R P

    1996-04-01

    Many different shoulder disorders cause similar symptoms and pain patterns. An accurate diagnosis can generally be made by obtaining a detailed history, performing a comprehensive, directed physical examination and obtaining selected radiographs. Occasionally, shoulder injections can be of great assistance in establishing a clear diagnosis and providing relief of symptoms. Subacromial space injection, acromioclavicular joint injection, intra-articular injection and injection of the biceps tendon are helpful in identifying such disorders as subacromial bursitis, acromioclavicular arthritis, injury to the glenohumeral joint and bicipital tendinitis.

  2. Does Reducing the Concentration of Bupivacaine When Performing Therapeutic Shoulder Joint Injections Impact the Clinical Outcome?

    Science.gov (United States)

    Fox, Michael G; Patrie, James T

    2016-04-01

    Mixtures of local anesthetics and steroids are routinely injected intraarticularly to temporarily relieve joint pain, even though local anesthetics have been reported to cause chondrocyte death in a dose- and time-dependent manner. This study aimed to determine if intraarticular injections of bupivacaine 0.5% and bupivacaine 0.25% would provide similar pain relief. All fluoroscopically guided glenohumeral joint injections performed using 2.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone acetonide over a 42-month period were included if a pain score was recorded before, 5-10 minutes after, and 1 week after injection. Pain reduction of more than 2 points was considered much improved clinically with pain reduction of more than 1 point considered the minimum clinically important difference (MCID) threshold. Statistically significant and much improved pain reduction was achieved using both bupivacaine 0.5% and 0.25% 5-10 minutes (-3.7 points; 95% CI, -3.4 to -4.0 points; p ≤ 0.001; and -3.3 points; 95% CI, -3.0 to -3.5 points; p ≤ 0.001) and 1 week (-2.5 points; 95% CI, -2.2 to -2.9 points; p ≤ 0.001; and -2.1 points; 95% CI, -1.8 to -2.3 points; p ≤ 0.001) after injection, respectively. Adjusting for age, sex, pain score before injection, and indication, the mean decrease in pain was greater in the bupivacaine 0.5% group by 0.30 points 5-10 minutes after injection (95% CI, -0.03 to 0.63 points; p = 0.08) and 0.46 points 1 week after injection (95% CI, 0.13-0.77 points; p = 0.01). Both bupivacaine 0.5% and bupivacaine 0.25% provide statistically significant and much improved pain relief 5-10 minutes and 1 week after intraarticular glenohumeral injections. Bupivacaine 0.5% provided greater pain relief than bupivacaine 0.25%, but the difference was less than 0.5 points and therefore did not meet the MCID threshold.

  3. Evaluating the Effects of local Injections of Bupivacaine and Triamcinolone Acetate on Shoulder Joint Pain and Restricted Range of Motion Following Cerebrovascular Accidents

    Directory of Open Access Journals (Sweden)

    Asadollah Saadat Niaki M.D.

    2011-06-01

    Full Text Available Background: Shoulder pain is a common complication of cerebrovascular accidents. This study was conducted to assess the effects of local injections of bupivacaine and triamcinolone acetate on shoulder joint pain and on restricted range of motion following brain events. Methods: This single-blind clinical trial study included 35 patients with chronic shoulder pain (the controls and 35 patients with chronic shoulder pain due to brain events (the case group. The study was done at Imam Hossein Hospital & Gandhi Day Clinic during the year 2008-2010. The patients in the two groups received bupivacaine and triamcinolone acetate for subacromial bursa injection and suprascapular nerve block by following the protocol described by Dangoisse et al. The patients were followed up for 12 weeks and they were evaluated for pain and range of motion 1, 6, and 12 weeks after the injections.Results: The mean age of the patients was 60.9±9.07 years. Statistically significant improvements in pain score (P=0.001 and shoulder joint range of motion (P=0.001 were observed in patients with chronic shoulder pain versus patients with brain events 12 weeks after suprascapulare nerve block and subacromial bours injections by bupivacaine and triamcinolone acetate.Conclusion: Suprascapular nerve block and subacromial bursa injections of bupivacaine and triamcinolone acetate is a safe and efficacious treatment for the treatment of chronic shoulder pain and restricted range of motion but it is not efficacious or of significant value for the treatment of shoulder pain in patients with brain events.

  4. 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

  5. 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.

  6. Treatment of frozen shoulder with subcutaneous TNF-alpha blockade compared with local glucocorticoid injection

    DEFF Research Database (Denmark)

    Schydlowsky, Pierre; Szkudlarek, Marcin; Madsen, Ole Rintek

    2012-01-01

    We compared the effect of subcutaneous adalimumab injections with intraarticular glucocorticoid injections on frozen shoulder of 18 patients with unilateral joint involvement. Ten patients were randomised to subcutaneous injections with adalimumab and eight to intraarticular glucocorticoid inject...

  7. 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.

  8. Athletes’ Shoulder Joints Traumas Manual Therapy Rehabilitation

    OpenAIRE

    A.N. Sykhorychko; Т.G. Kovalenko; М.А. Sykhorychko

    2012-01-01

    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.

  9. Hip joint injection

    Science.gov (United States)

    ... medicine into the joint. The provider uses a real-time x-ray (fluoroscopy) to see where to place ... Wakefield RJ. Arthrocentesis and injection of joints and soft tissue. In: Firestein GS, Budd RC, Gabriel SE, ...

  10. Diagnosing patients with longstanding shoulder joint pain

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  11. 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.

  12. 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.)

  13. ultrasound-guided shoulder arthrogram injection

    African Journals Online (AJOL)

    2008-10-15

    Oct 15, 2008 ... Using an aseptic technique and without moving the ultrasound transducer from the desired transverse plane, the needle is advanced into the joint space through the rotator cuff interval, using real-time ultrasound guidance (Fig.2). The needle is inserted into the shoulder approximately midway between the ...

  14. Glenohumeral Joint Injections

    Science.gov (United States)

    Gross, Christopher; Dhawan, Aman; Harwood, Daniel; Gochanour, Eric; Romeo, Anthony

    2013-01-01

    Context: Intra-articular injections into the glenohumeral joint are commonly performed by musculoskeletal providers, including orthopaedic surgeons, family medicine physicians, rheumatologists, and physician assistants. Despite their frequent use, there is little guidance for injectable treatments to the glenohumeral joint for conditions such as osteoarthritis, adhesive capsulitis, and rheumatoid arthritis. Evidence Acquisition: We performed a comprehensive review of the available literature on glenohumeral injections to help clarify the current evidence-based practice and identify deficits in our understanding. We searched MEDLINE (1948 to December 2011 [week 1]) and EMBASE (1980 to 2011 [week 49]) using various permutations of intra-articular injections AND (corticosteroid OR hyaluronic acid) and (adhesive capsulitis OR arthritis). Results: We identified 1 and 7 studies that investigated intra-articular corticosteroid injections for the treatment of osteoarthritis and adhesive capsulitis, respectively. Two and 3 studies investigated the use of hyaluronic acid in osteoarthritis and adhesive capsulitis, respectively. One study compared corticosteroids and hyaluronic acid injections in the treatment of osteoarthritis, and another discussed adhesive capsulitis. Conclusion: Based on existing studies and their level of evidence, there is only expert opinion to guide corticosteroid injection for osteoarthritis as well as hyaluronic acid injection for osteoarthritis and adhesive capsulitis. PMID:24427384

  15. The imaging of the shoulder joint

    International Nuclear Information System (INIS)

    Hayamizu, Kyoko; Ito, Katsuhide; Naito, Akira

    1988-01-01

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

  16. Can shoulder joint reaction forces be estimated by neural networks?

    NARCIS (Netherlands)

    de Vries, W.H.K.; Veeger, H.E.J.; Baten, C.T.M.; van der Helm, F.C.T.

    2016-01-01

    To facilitate the development of future shoulder endoprostheses, a long term load profile of the shoulder joint is desired. A musculoskeletal model using 3D kinematics and external forces as input can estimate the mechanical load on the glenohumeral joint, in terms of joint reaction forces. For long

  17. Shoulder joint loading and posture during medicine cart pushing task.

    Science.gov (United States)

    Xu, Xu; Lin, Jia-Hua; Boyer, Jon

    2013-01-01

    Excessive physical loads and awkward shoulder postures during pushing and pulling are risk factors for shoulder pain. Pushing a medicine cart is a major component of a work shift for nurses and medical assistants in hospitals and other health care facilities. A laboratory experiment was conducted to examine the effects of common factors (e.g., lane congestion, cart load stability, floor surface friction) on shoulder joint moment and shoulder elevation angle of participants during cart pushing. Participants pushed a medicine cart on straight tracks and turning around right-angle corners. Peak shoulder joint moments reached 25.1 Nm, 20.3 Nm, and 26.8 Nm for initial, transition, and turning phases of the pushing tasks, indicating that shoulder joint loading while pushing a medical cart is comparable to levels previously reported from heavy manual activities encountered in industry (e.g., garbage collection). Also, except for user experience, all other main study factors, including congestion level, cart load stability, location of transition strip, shoulder tendency, surface friction, and handedness, significantly influenced shoulder joint moment and shoulder elevation angle. The findings provide a better understanding of shoulder exposures associated with medicine cart operations and may be helpful in designing and optimizing the physical environment where medicine carts are used.

  18. Cadaveric Study of the Articular Branches of the Shoulder Joint.

    Science.gov (United States)

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

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

  19. Primary joint disease in the shoulder of the beagle dog

    International Nuclear Information System (INIS)

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

    1985-01-01

    Shoulder joints of 149 beagle dogs, whose ages were over 8 years at the time of death, were examined to document primary joint disease. Clinical histories of the dogs suggested no underlying causes, i.e. no evidence of osteochondrosis, trauma or joint infection. Radiographic examinations revealed normally developing shoulders in the first years of their lives. Radiographic changes were progressive with age. Bilateral involvement was common. The changes consisted of osteophyte formation on the caudal aspect of the humeral head and glenoid. Postmortem findings included: subchondral bone sclerosis (thin-section radiographs), cartilage wearing, joint capsule thickening, and pannus formation. The authors believe that the changes occurring in the shoulder joints are those of primary joint disease. 12 references

  20. Intra-articular elastofibroma of the shoulder joint

    International Nuclear Information System (INIS)

    Bae, Sang-Jin; Shin, Myung Jin; Kim, Sung Moon; Cho, Kyung-Ja

    2002-01-01

    A 19-year-old man presented with an elastofibroma in his left shoulder joint. The patient had had limitation of motion in his left arm for 3 years, especially when rotating internally. Radiography of his left shoulder showed bone erosion in the neck of the humerus. On MR imaging, a soft tissue mass was noted in the shoulder joint eroding bone. The mass showed similar signal intensity to that of surrounding muscles on T1- and T2-weighted images. At surgery, a soft, encapsulated mass was found attached to the subscapularis muscle. It was pathologically confirmed as an elastofibroma. This unusual manifestation of an elastofibroma is discussed. (orig.)

  1. Extravasation of joint fluid into the mediastinum and the deep neck during atthoscopic shoulder surgery

    Energy Technology Data Exchange (ETDEWEB)

    Han, Ji Yeon; Lee, Ki Nam [Dept. of Radiology, Dong-A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of)

    2014-01-15

    Extravasation of shoulder joint fluid into the surrounding muscles during shoulder arthroscopic surgery is common and inevitable. Here, we report a case of massive extravasation of shoulder joint fluid leading to mediastinal and retrotracheal effusion after arthroscopic shoulder surgery. We will discuss the anatomical basis of fluid leakage from the shoulder to the mediastinum and to the deep neck on CT.

  2. Extravasation of joint fluid into the mediastinum and the deep neck during atthoscopic shoulder surgery

    International Nuclear Information System (INIS)

    Han, Ji Yeon; Lee, Ki Nam

    2014-01-01

    Extravasation of shoulder joint fluid into the surrounding muscles during shoulder arthroscopic surgery is common and inevitable. Here, we report a case of massive extravasation of shoulder joint fluid leading to mediastinal and retrotracheal effusion after arthroscopic shoulder surgery. We will discuss the anatomical basis of fluid leakage from the shoulder to the mediastinum and to the deep neck on CT.

  3. 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

  4. Cryotherapy does not impair shoulder joint position sense.

    Science.gov (United States)

    Dover, Geoffrey; Powers, Michael E

    2004-08-01

    To determine the effects of a cryotherapy treatment on shoulder proprioception. Crossover design with repeated measures. University athletic training and sports medicine research laboratory. Thirty healthy subjects (15 women, 15 men). A 30-minute cryotherapy treatment. Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception. Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application. Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

  5. Arthrography of the equine shoulder joint

    International Nuclear Information System (INIS)

    Nixon, A.J.; Spencer, C.P.

    1990-01-01

    Techniques and normal radiographic anatomy for positive and double contrast shoulder arthrography in horses were evaluated. General anaesthesia was used for most radiographic projections of the shoulder. The mediolateral projection provided the most information during arthrography, although the supinated mediolateral view occasionally allowed better definition of the cartilage surfaces on the medial aspects of the humeral head. The craniocaudal mediolateral oblique and caudocranial projections provided limited additional information. Water soluble non-ionic contrast agents, such as metrizamide and iohexol, were suitable for shoulder arthrography; iohexol resulted in less synovitis and lameness. Arthrography in cases of osteochondrosis and osteochondritis dissecans allowed better evaluation of cartilage attachment to subchondral bone, better evaluation of the length and depth of cartilage lesions and more accurately defined the site and shape of osteocartilaginous free bodies. Cartilage thickening without detachment from the subchondral bone could only be determined by arthrography. Although these thick cartilage regions may later dissect from the subchondral bone, most cases where the cartilage was firmly adherent were not candidates for surgical debridement and carried a favourable prognosis. The determination of a free flap by arthrography indicated the need for surgery. Extensive humeral and glenoid cavity lesions were better defined by arthrography, allowing a rational decision between surgical debridement or euthanasia. Using arthrography, evaluation of the size and patency of the communicating canal to a subchondral cystic defect better separated cases with long, narrow and poorly patent canals for conservative rather than surgical therapy

  6. Postoperative MR arthography of the shoulder joint

    International Nuclear Information System (INIS)

    Rand, T.; Trattnig, S.; Breitenseher, M.; Freilinger, W.; Cochole, M.; Imhof, H.

    1996-01-01

    Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff. (orig.) [de

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

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  8. Ultrasound-guided intraarticular injection for MR arthrography of the shoulder

    International Nuclear Information System (INIS)

    Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K.

    2010-01-01

    Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

  9. Determination of a safe INR for joint injections in patients taking warfarin.

    Science.gov (United States)

    Bashir, M A; Ray, R; Sarda, P; Li, S; Corbett, S

    2015-11-01

    With an increase in life expectancy in 'developed' countries, the number of elderly patients receiving joint injections for arthritis is increasing. There are legitimate concerns about an increased risk of thromboembolism if anticoagulation is stopped or reversed for such an injection. Despite being a common dilemma, the literature on this issue is scarce. We undertook 2,084 joint injections of the knee and shoulder in 1,714 patients between August 2008 and December 2013. Within this cohort, we noted 41 patients who were taking warfarin and followed them immediately after joint injection in the clinic or radiology department, looking carefully for complications. Then, we sought clinical follow-up, correspondence, and imaging evidence for 4 weeks, looking for complications from these joint injections. We recorded International Normalised Ratio (INR) values before injection. No complications were associated with the procedure after any joint injection. The radiologists who undertook ultrasound-guided injections to shoulders re-scanned the joints looking for haemarthroses: they found none. A similar outcome was noted clinically after injections in the outpatient setting. With a mean INR of 2.77 (range, 1.7-5.5) and a maximum INR within this group of 5.5, joint injections to the shoulder and knee can be undertaken safely in primary or secondary care settings despite the patient taking warfarin.

  10. Post-operative computed tomographic imaging of the shoulder joint

    International Nuclear Information System (INIS)

    Helweg, G.; Zur Nedden, D.; Wicke, K.; Knapp, R.; Oberhauser, A.; Resch, H.; Sperner, G.

    1992-01-01

    Between 1984 and 1990 312 patients underwent surgery for habitual or recurrent shoulder dislocation. Out then, 65 had a post-operative CT examination. This retrospective study was launched to demonstrate the value of CT in post-operative shoulder imaging. In most cases, CT was done using standardised techniques without contrast medium. Except in 4 cases, an intra-articular double-contrast technique was used. Evaluation was focused on 41 cases after implantation of a wedged bone graft in cases of primary or secondary flat glenoid or widening of a small glenoid with cortical consoles and bone block. The results demonstrate the effectiveness of standardised CT technique in that all necessary information concerning stabilisation of the shoulder joint, sufficient implant of bone grafts and assessment of correct inclination after osteotomy were obtained. (orig.)

  11. Methods on simple radiogaphy of impingement syndrome in shoulder joint

    International Nuclear Information System (INIS)

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

    2000-01-01

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

  12. Methods on simple radiogaphy of impingement syndrome in shoulder joint

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Marcel Jun Sugawara Tamaoki

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

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

    Science.gov (United States)

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

    2012-01-01

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

  15. Synovial response to intraarticular injections of hyaluronate in frozen shoulder. A quantitative assessment with dynamic magnetic resonance imaging

    International Nuclear Information System (INIS)

    Tamai, Kazuya; Mashitori, Hirotaka; Ohno, Wataru; Hamada, Jun'ichiro; Sakai, Hiroya; Saotome, Koichi

    2004-01-01

    To clarify the response of frozen shoulder (FS) to intraarticular injections of high-molecular-weight sodium hyaluronate (HA), a mixture of 2.5 ml of HA and 1.5 ml of 1% lidocaine was injected into the glenohumeral joint of 11 patients with FS, 8 of whom received five weekly injections. The patients were assessed using the Japanese Orthopaedic Association shoulder score (JOA score) before the first injection, 1 week after the first injection, and 1 week after the final injection. Following each clinical evaluation, the patients underwent dynamic magnetic resonance imaging enhanced with Gd-DTPA, and the coefficient of enhancement (CE) in the glenohumeral synovium was calculated, with the examiners blinded to the clinical information. The JOA score tended to be greater and the CE smaller after injection than before injection. The changes in the CE following both single and repeated injections were negatively correlated with changes in the JOA score. Thus, clinical improvement in patients with FS was associated with a decrease in the CE. Because the CE depends on the degree of synovitis, the therapeutic effect of intraarticular HA injection for FS results, at least in part, from suppression of synovitis in the glenohumeral joint through an antiinflammatory effect. (author)

  16. Effect of Intra-articular Hyaluronic Acid Injection on Hemiplegic Shoulder Pain After Stroke.

    Science.gov (United States)

    Jang, Myung Hun; Lee, Chang-Hyung; Shin, Yong-Il; Kim, Soo-Yeon; Huh, Sung Chul

    2016-10-01

    To evaluate the efficacy of intra-articular hyaluronic acid (IAHA) injection for hemiplegic shoulder pain (HSP) after stroke. Thirty-one patients with HSP and limited range of motion (ROM) without spasticity of upper extremity were recruited. All subjects were randomly allocated to group A (n=15) for three weekly IAHA injection or group B (n=16) for a single intra-articular steroid (IAS) injection. All injections were administered by an expert physician until the 8th week using a posterior ultrasonography-guided approach. Shoulder joint pain was measured using the Wong-Baker Scale (WBS), while passive ROM was measured in the supine position by an expert physician. There were no significant intergroup differences in WBS or ROM at the 8th week. Improvements in forward flexion and external rotation were observed from the 4th week in the IAHA group and the 8th week in the IAS group. Subjects experienced a statistically significant improvement in pain from the 1st week in the IAS and from the 8th week in IAHA group, respectively. IAHA seems to have a less potent ability to reduce movement pain compared to steroid in the early period. However, there was no statistically significant intergroup difference in WBS and ROM improvements at the 8th week. IAHA might be a good alternative to steroid for managing HSP when the use of steroid is limited.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

    , depending on anticipated shoulder pathology, is recommended. Because in posterior injections all artifacts were posterior and readily recognizable, it seems especially suitable for suspected anterior rotator cuff, joint capsule, and labral pathologies

  18. Steroid injection for painful shoulder: Usefulness of ultrasound-guided approach

    International Nuclear Information System (INIS)

    Lee, Min Hee

    2004-01-01

    To evaluate the efficacy of steroid injection into the subacromial bursa and biceps tendon sheath for painful shoulders and the usefulness of ultrasound-guided approach. Seventeen shoulders of twelve patients with shoulder pain and limited motion were included, and these patient were clinically diagnosed as a painful arc syndrome. Under ultrasound guidance, steroid injection was performed into the subacormial bursa (13 cases) and biceps tendon sheath (4 cases). In 7 cases, 1 mL of steroid was used while the remaining six patients received a mixture of 1 mL of steroid and 1 ml of lidocaine. Both shoulders of two patients received 0.5 mL of steroid. The location of needle and injection duration of fluid were continuously monitored, and complications such as leakage of steroid were recorded. Medical records were reviewed for the presence of pain relief and increasing range of motion following the injection. On ultrasonogram, the needle within the subacromial bursa and biceps tendon sheath was seen as a linear echogenic structure, and injected fluid was identified. There was neither the leakage of steroid injection nor any other complications. In 16 (94%) of 17 shoulders, there was decreased intensity of shoulder pain while increased range of motion was noted in three patients following the injection. Steroid injection into the subacormial bursa and biceps tendon sheath is effective in treating shoulder pain and limited range of motion of the shoulder, and ultrasound is useful guiding method.

  19. 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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-12-15

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

  1. Accuracy of non assisted glenohumeral joint injection in the office setting

    Energy Technology Data Exchange (ETDEWEB)

    Sidon, Eliezer, E-mail: eli.sidon@gmail.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Velkes, Steven, E-mail: velkes@yahoo.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Shemesh, Shai, E-mail: shai.shemesh@gmail.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Levy, Jakob, E-mail: Jlevy@clalit.org.il [Department of Imaging, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Glaser, Ernesto, E-mail: glaser.ernesto@gmail.com [Department of Imaging, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel); Kosashvili, Yona, E-mail: yonasofi@gmail.com [Department of Orthopedics, Rabin Medical Center, Beilinson Campus, Petach Tikva 49100 (Israel)

    2013-12-01

    Purpose: The diagnostic and therapeutic success of shoulder joint injection depends on its accuracy. Two recent studies reported high success (93–96%) for non-imaging-assisted anterior injection in anesthetized patients. This study examined the accuracy of anterior shoulder injection in awake patients under conditions similar to the office setting. Methods: The study group consisted of 166 consecutive patients with shoulder pain who underwent diagnostic magnetic resonance arthrography at a tertiary medical center in 2011–2012. As part of the examination, contrast material was injected into the glenohumeral joint via an anterior approach by a certified musculoskeletal radiologist without any image assistance. Success was defined as contrast material limited to the intra-articular joint on the scan, without scatter to the periauricular tissue. Results: A successful injection was verified by magnetic resonance arthography in 163 patients (98.2%). Conclusions: Non-assisted anterior shoulder injection is highly accurate (98.2%) in the hands of an experienced radiologist, even in awake patients.

  2. Steroid injection for shoulder pain causes prolonged increased glucose level in type 1 diabetics.

    Science.gov (United States)

    Povlsen, Bo; Povlsen, Sebastian D

    2014-09-08

    Shoulder pain is very common in diabetic patients and often treated with steroid injections, with subsequent increases in blood glucose levels or the need for additional insulin being questioned. We report a case of significant and prolonged elevation of blood glucose levels and resultant insulin requirement in a type 1 diabetic man after a single 40 mg injection of triamcinolone for shoulder pain. Within 48 h, the shoulder pain as assessed by a visual analogue scale (0-10) was reduced to zero, but the elevated insulin requirements continued for 4 weeks after the injection. This finding suggests that steroid injections for shoulder pain in diabetics may not always be as safe as previously thought. We propose that medical practitioners advise their patients to monitor their glucose levels more carefully after such injections and that caution is exercised when considering administrating these injections to those who have poorly controlled blood glucose levels preinjection to avoid ketoacidosis. 2014 BMJ Publishing Group Ltd.

  3. Towards computer-assisted surgery in shoulder joint replacement

    Science.gov (United States)

    Valstar, Edward R.; Botha, Charl P.; van der Glas, Marjolein; Rozing, Piet M.; van der Helm, Frans C. T.; Post, Frits H.; Vossepoel, Albert M.

    A research programme that aims to improve the state of the art in shoulder joint replacement surgery has been initiated at the Delft University of Technology. Development of improved endoprostheses for the upper extremities (DIPEX), as this effort is called, is a clinically driven multidisciplinary programme consisting of many contributory aspects. A part of this research programme focuses on the pre-operative planning and per-operative guidance issues. The ultimate goal of this part of the DIPEX project is to create a surgical support infrastructure that can be used to predict the optimal surgical protocol and can assist with the selection of the most suitable endoprosthesis for a particular patient. In the pre-operative planning phase, advanced biomechanical models of the endoprosthesis fixation and the musculo-skeletal system of the shoulder will be incorporated, which are adjusted to the individual's morphology. Subsequently, the support infrastructure must assist the surgeon during the operation in executing his surgical plan. In the per-operative phase, the chosen optimal position of the endoprosthesis can be realised using camera-assisted tools or mechanical guidance tools. In this article, the pathway towards the desired surgical support infrastructure is described. Furthermore, we discuss the pre-operative planning phase and the per-operative guidance phase, the initial work performed, and finally, possible approaches for improving prosthesis placement.

  4. Frozen shoulder

    Science.gov (United States)

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

  5. A Cadaveric Study on Sacroiliac Joint Injection

    Science.gov (United States)

    Zou, Yu-Cong; Li, Yi-Kai; Yu, Cheng-Fu; Yang, Xian-Wen; Chen, Run-Qi

    2015-01-01

    The scope of this study was to explore the possibility as well as the feasibility of sacroiliac joint injection following simple X-ray clip location. For the cadaveric study, 10 fixed sacroiliac joint (SIJ) sectional specimens, 4 dried cadaveric pelvises and 21 embalmed adult cadaveric pelvises were dissected, followed by an injection of contrast agent into the joint. The irrigation of the agent was observed through CT scanning. For the radiologic study, 188 CT scans of ankylosing spondylitis patients (143 male, 45 female) were collected from 2010 to 2012, in Nanfang Hospital. What was measured was (1) Distance between the posterior midline and sagittal synovium; (2) Length of the sagittal synovium; (3) Distance between the midpoint of the sagittal synovium and posterior superior iliac spine; and (4) Distance between the superficial skin vertical to the sagittal synovium point were measured. For the practice-based study: 20 patients (17 males and 3 females) with early ankylosing spondylitis, from Nanfang Hospital affiliated with Southern Medical University were recruited, and sacroiliac joint unguided injections were done on the basis of the cadaveric and radiologic study. Only the inferior 1/3rd portion parallel to the posterior midline could be injected into since the superior 2/3rd portion were filled with interosseous ligaments. Thirteen of the 20 patients received successful injections as identified by CT scan using the contrast agent. Sacroiliac joint injection following simple X-ray clip location is possible and feasible if the operation is performed by trained physicians familiar with the sacroiliac joint and its surrounding anatomic structures. PMID:25692437

  6. Consideration of Shoulder Joint's Image with the Changed Tube Angle of the Shoulder Oblique Projection in Supine Position

    International Nuclear Information System (INIS)

    Seo, Jae Hyun; Choi, Nam Gil

    2008-01-01

    There is a standard shoulder oblique method (Grashey method) available to view the shoulder joint. This method projects AP view of the shoulder joint so that the Humerus head's subuxation or joint degeneration can be easily visualized. However, in this view, the patients, with supine or sitting or erect position, have to keep their body obliquely. Whereas, the patients who are not well or operated, usually feel very uncomfortable to keep their body in this position and hence, we need other persons' help and much efforts will be needed to get the good quality shoulder joint view. Therefore, we thought of examining a method which shows the joint well by angling the tube to Medio-Lateral direction and without keeping the patients' one side upward in supine position. For this study, total 15 subjects with no history of neurological or psychiatric illness, were recruited for examinations. They consisted of 9 males and 6 females. Statistic group analysis was performed with ANOVA test. Scores of the evaluation of the experts were 1.01±0.54 at 25 degrees, 2.50±0.50 at 30 degrees, 2.85±0.36 at 35 degrees and 2.33±0.47 at 40 degrees, respectively, and they were significant(p<0.05, Table 1). Joint space of the Humerus head and Scapula were well distinguished at 35 degrees, 30 degrees and 40 degrees with the almost same score. However, the degree of distortion at 40 degrees was more severe than that at 30 degrees. Ultimately, 30-35 degrees views were shown to yield good quality shoulder oblique images. In conclusion, this method may be very useful for the patients who are uncomfortable and for the emergency patients. In order to get similar or comparable view, the same X-tube angle is recommended to be used before and after the operation. Therefore, we hope that this new angled method seems to be efficient.

  7. Sensorimotor control and neuromuscular activity of the shoulder in adolescent competitive swimmers with generalized joint hypermobility

    DEFF Research Database (Denmark)

    Frydendal, Thomas; Eshøj, Henrik; Liaghat, Behnam

    2018-01-01

    INTRODUCTION: Shoulder pain is highly prevalent in competitive swimmers, and generalized joint hypermobility (GJH) is considered a risk factor. Sensorimotor control deficiencies and altered neuromuscular activation of the shoulder may represent underlying factors. RESEARCH QUESTION: To investigate...... whether competitive swimmers with GJH including shoulder hypermobility (GJHS) differ in shoulder sensorimotor control and muscle activity from those without GJH and no shoulder hypermobility (NGJH). METHODS: Competitive swimmers (aged 13-17) were recruited. GJHS or NGJH status was determined using...... (29%) pectoralis major activity during BL-EO compared to NGJH (5.35 ± 1.77%MVE vs. 7.51 ± 1.96%MVE; p = 0.043). SIGNIFICANCE: Adolescent competitive swimmers with GJHS displayed no shoulder sensorimotor control deficiencies and no generally altered shoulder muscle activity pattern, except...

  8. Questions and Answers About Shoulder Problems

    Science.gov (United States)

    ... injury. Injection of a cortisone medicine into your shoulder joint. Surgery to repair the tear if you don’t ... TENS). Injection of a corticosteroid drug if your shoulder is not better. Surgery if the shoulder does not improve with other ...

  9. Evaluation of traction stirrup distraction technique to increase the joint space of the shoulder joint in the dog: A cadaveric study.

    Science.gov (United States)

    Devesa, V; Rovesti, G L; Urrutia, P G; Sanroman, F; Rodriguez-Quiros, J

    2015-06-01

    The objective of this study was to evaluate technical feasibility and efficacy of a joint distraction technique by traction stirrup to facilitate shoulder arthroscopy and assess potential soft tissue damage. Twenty shoulders were evaluated radiographically before distraction. Distraction was applied with loads from 40 N up to 200 N, in 40 N increments, and the joint space was recorded at each step by radiographic images. The effects of joint flexion and intra-articular air injection at maximum load were evaluated. Radiographic evaluation was performed after distraction to evaluate ensuing joint laxity. Joint distraction by traction stirrup technique produces a significant increase in the joint space; an increase in joint laxity could not be inferred by standard and stress radiographs. However, further clinical studies are required to evaluate potential neurovascular complications. A wider joint space may be useful to facilitate arthroscopy, reducing the likelihood for iatrogenic damage to intra-articular structures. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Steroid injection for shoulder pain causes prolonged increased glucose level in type 1 diabetics

    OpenAIRE

    Povlsen, Bo; Povlsen, Sebastian D

    2014-01-01

    Shoulder pain is very common in diabetic patients and often treated with steroid injections, with subsequent increases in blood glucose levels or the need for additional insulin being questioned. We report a case of significant and prolonged elevation of blood glucose levels and resultant insulin requirement in a type 1 diabetic man after a single 40 mg injection of triamcinolone for shoulder pain. Within 48 h, the shoulder pain as assessed by a visual analogue scale (0–10) was reduced to zer...

  11. Estimation of the mechanical loading of the shoulder joint in daily conditions

    NARCIS (Netherlands)

    De Vries, W.H.K.

    2015-01-01

    The goal of this thesis is to assemble a method to estimate shoulder joint reaction forces, in daily conditions, based on long term collection of ambulatory measurable variables, to obtain the desired long term mechanical load profile of the shoulder. Chapter 2 examines, and discusses one of the

  12. Suprascapular block in the therapy of chronic pain in the shoulder and the shoulder joint: Suprascapular block

    Directory of Open Access Journals (Sweden)

    Palibrk Ivan

    2016-01-01

    Full Text Available Introduction: Chronic pain in the shoulder and the shoulder joint is a very common pathology in modern human population. The etiology of chronic pain is often unknown, although the trauma, degenerative diseases, inflammation, tumors and neurological disease appear as common etiologic factors. Patients with this pain had a significantly reduced quality of life.1,2 Method: During the two years, twelve patients diagnosed painful shoulder syndrome. Eleven of the twelve patients involved in the study had started physical therapy. Under the physical treatment pain intensity decreased, but not completely. Hand had reduced mobility. We applied a suprascapular block. We used 1 ml (7 mg betamethasone. Results: Suprascapular block was applied to the eleven patients in physical therapy. After three days of application, the pain was significantly reduced, by 50% in seven patients. Mobility of the hand was greatly improved. In three of the remaining four patients the block was repeated after one month. The pain was significantly smaller after that. Physical therapy is done all the time. Conclusion: The treatment of chronic pain in the shoulder and the shoulder joint is multidisciplinary. In some cases, the use of corticosteroids suprascapular block is very useful.

  13. Mycobacterium avium-intracellulare cellulitis occurring with septic arthritis after joint injection: a case report

    Directory of Open Access Journals (Sweden)

    Murdoch David M

    2007-02-01

    Full Text Available Abstract Background Cellulitis caused by Mycobacterium avium-intracellulare has rarely been described. Mycobacterium avium-intracellulare is a rare cause of septic arthritis after intra-articular injection, though the causative role of injection is difficult to ascertain in such cases. Case presentation A 57-year-old with rheumatoid arthritis treated with prednisone and azathioprine developed bilateral painful degenerative shoulder arthritis. After corticosteroid injections into both acromioclavicular joints, he developed bilateral cellulitis centered over the injection sites. Skin biopsy showed non-caseating granulomas, and culture grew Mycobacterium avium-intracellulare. Joint aspiration also revealed Mycobacterium avium-intracellulare infection. Conclusion Although rare, skin and joint infections caused by Mycobacterium avium-intracellulare should be considered in any immunocompromised host, particularly after intra-articular injection. Stains for acid-fast bacilli may be negative in pathologic samples even in the presence of infection; cultures of tissue specimens should always be obtained.

  14. A 200-m All-out Front-crawl Swim Modifies Competitive Swimmers' Shoulder Joint Position Sense

    NARCIS (Netherlands)

    Uematsu, A.; Kurita, Y.; Inoue, K.; Okuno, K.; Hortobagyi, T.; Suzuki, S.

    2015-01-01

    We tested the hypothesis that an all-out-effort 200-m front-crawl swim trial affects competitive swimmers' shoulder joint position sense. On Day 1, we measured shoulder joint position sense before and after the swim trial, and on Day 2 before and after 2 min of seated rest. On both days, shoulder

  15. Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device with an Application to the Shoulder Joint

    OpenAIRE

    McQuade, Kevin; Price, Robert; Liu, Nelson; Ciol, Marcia A

    2012-01-01

    Examination of articular joints is largely based on subjective assessment of the “end-feel” of the joint in response to manually applied forces at different joint orientations. This technical report aims to describe the development of an objective method to examine joints in general, with specific application to the shoulder, and suitable for clinical use. We adapted existing hardware and developed laptop-based software to objectively record the force/displacement behavior of the glenohumeral...

  16. Effects of hand grip exercise on shoulder joint internal rotation and external rotation peak torque.

    Science.gov (United States)

    Lee, Dong-Rour; Jong-Soon Kim, Laurentius

    2016-08-10

    The goal of this study is to analyze the effects of hand grip training on shoulder joint internal rotation (IR)/external rotation (ER) peak torque for healthy people. The research was conducted on 23 healthy adults in their 20 s-30 s who volunteered to participate in the experiment. Hand grip power test was performed on both hands of the research subjects before/after the test to study changes in hand grip power. Isokinetic machine was used to measure the concentric IRPT (internal rotation peak torque) and concentric ERPT (external rotation peak torque) at the velocity of 60°/sec, 90°/sec, and 180°/sec before/after the test. Hand grip training was performed daily on the subject's right hand only for four weeks according to exercise program. Finally, hand grip power of both hands and the maximum torque values of shoulder joint IR/ER were measured before/after the test and analyzed. There was a statistically significant difference in the hand grip power of the right hand, which was subject to hand grip training, after the experiment. Also, statistically significant difference for shoulder ERPT was found at 60°/sec. Hand grip training has a positive effect on shoulder joint IRPT/ERPT and therefore can help strengthen muscles around the shoulder without using weight on the shoulder. Consequently, hand grip training would help maintain strengthen the muscles around the shoulder in the early phase of rehabilitation process after shoulder surgery.

  17. The association between Generalized Joint Hypermobility and shoulder mobility in young, competitive swimmers

    DEFF Research Database (Denmark)

    Knudsen, Hans Kromann; Junge, Tina

    2016-01-01

    The association between Generalized Joint Hypermobility and shoulder mobility in young, competitive swimmers. Junge, T.1, 2, 3, Henriksen, P. 2, 4, Knudsen, H.K.1, Juul-Kristensen, B.3, 4 1Institute of Regional Health Services, University of Southern Denmark, Odense, Denmark 2Department...... (Zemek et al., 1995). Increased shoulder mobility as well as Generalised Joint Hypermobility (GJH), are both suggested being predisposing risk factors for shoulder injuries (Pink et al., 2000, Zemek et al., 1995). An association between GJH and shoulder mobility among young, competitive swimmers has......) participated. GJH was evaluated by the Beighton test (BT) a 0-9 scoring system. GJH was classified at cut points ≥5/9, ≥6/9 and ≥7/9. Shoulder mobility was measured as HSA using an inclinometer in a standardized protocol format. A multiple regression analysis was used to reveal associations between GJH...

  18. Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation.

    Science.gov (United States)

    Chen, Chang-Hong; Dong, Qi-Rong; Zhou, Rong-Kui; Zhen, Hua-Qing; Jiao, Ya-Jun

    2014-01-01

    Internal fixation with hook plate has been used to treat acromioclavicular joint dislocation. This study aims to evaluate the effect of its use on shoulder function, to further analyze the contributing factors, and provide a basis for selection and design of improved internal fixation treatment of the acromioclavicular joint dislocation in the future. A retrospective analysis was performed on patients treated with a hook plate for acromioclavicular joint dislocation in our hospital from January 2010 to February 2013. There were 33 cases in total, including 25 males and 8 females, with mean age of 48.27 ± 8.7 years. There were 29 cases of Rockwood type III acromioclavicular dislocation, 4 cases of type V. The Constant-Murley shoulder function scoring system was used to evaluate the shoulder function recovery status after surgery. Anteroposterior shoulder X-ray was used to assess the position of the hook plate, status of acromioclavicular joint reduction and the occurrence of postoperative complications. According to the Constant-Murley shoulder function scoring system, the average scores were 78 ± 6 points 8 to 12 months after the surgery and before the removal of the hook plate, the average scores were 89 ± 5 minutes two months after the removal of hook plate. Postoperative X-ray imaging showed osteolysis in 10 cases (30.3%), osteoarthritis in six cases (18.1%), osteolysis associated with osteoarthritis in four cases(12.1%), and steel hook broken in one case (3%). The use of hook plate on open reduction and internal fixation of the acromioclavicular joint dislocation had little adverse effect on shoulder function and is an effective method for the treatment of acromioclavicular joint dislocation. Osteoarthritis and osteolysis are the two common complications after hook plate use, which are associated with the impairment of shoulder function. Shoulder function will be improved after removal of the hook plate.

  19. Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

    Science.gov (United States)

    Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

    2016-08-01

    The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate

  20. Objective Assessment of Joint Stiffness: A Clinically Oriented Hardware and Software Device with an Application to the Shoulder Joint.

    Science.gov (United States)

    McQuade, Kevin; Price, Robert; Liu, Nelson; Ciol, Marcia A

    2012-08-30

    Examination of articular joints is largely based on subjective assessment of the "end-feel" of the joint in response to manually applied forces at different joint orientations. This technical report aims to describe the development of an objective method to examine joints in general, with specific application to the shoulder, and suitable for clinical use. We adapted existing hardware and developed laptop-based software to objectively record the force/displacement behavior of the glenohumeral joint during three common manual joint examination tests with the arm in six positions. An electromagnetic tracking system recorded three-dimensional positions of sensors attached to a clinician examiner and a patient. A hand-held force transducer recorded manually applied translational forces. The force and joint displacement were time-synchronized and the joint stiffness was calculated as a quantitative representation of the joint "end-feel." A methodology and specific system checks were developed to enhance clinical testing reproducibility and precision. The device and testing protocol were tested on 31 subjects (15 with healthy shoulders, and 16 with a variety of shoulder impairments). Results describe the stiffness responses, and demonstrate the feasibility of using the device and methods in clinical settings.

  1. Intraoperative intra-articular injection of gentamicin: will it decrease the risk of infection in total shoulder arthroplasty?

    Science.gov (United States)

    Lovallo, Jeffrey; Helming, Jarrett; Jafari, S Mehdi; Owusu-Forfie, Afia; Donovan, Skye; Minnock, Christopher; Adib, Farshad

    2014-09-01

    Deep infection is a debilitating complication after shoulder arthroplasty. Intra-articular injection of antibiotic can give a higher concentration compared with intravenous administration. We hypothesized that a group of patients given an intra-articular, intraoperative injection of gentamicin would report a lower infection rate than a group without local antibiotics. Between 2005 and 2011, the senior author performed 507 shoulder arthroplasties. We retrospectively reviewed all of those cases. All patients were administered systemic prophylactic antibiotics. Beginning in June 2007, patients were also injected with 160 mg of gentamicin in the glenohumeral joint at the end of their surgery. Patient records were examined for preexisting medical conditions, type of surgery, and presence of infection. Patients receiving surgery before 2007 were compared with those after to determine the effect of prophylactic gentamicin administration in preventing deep infection associated with surgery. All patients were observed for a minimum of 1 year. Of the 507 surgeries, 164 were performed before 2007 (without intra-articular injection of gentamicin; group A) and 343 were performed with addition of gentamicin (group B). In group A, 5 patients presented with infection (3.0%) compared with 1 in group B (0.29%). The gender, mean age, mean body mass index, and prevalence of comorbidities were similar between the groups. The data from this study support the conclusion that intra-articular intraoperative gentamicin administration may reduce postoperative infection. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  2. Ultrasound-guided sacroiliac joint injection technique.

    LENUS (Irish Health Repository)

    Harmon, Dominic

    2008-07-01

    We describe a case report and technique for using a portable ultrasound scanner and a curvilinear transducer (4-5MHz) (SonoSite Micromaxx SonoSite, Inc. 21919 30th Drive SE Bothwell W. A.) to guide sacroiliac joint (SIJ) injection. A 42-year-old male presented with chronic lower back pain centered on his left SIJ. His pain averaged 7 out of 10 (numerical rating scale). For the ultrasound-guided SIJ injection the patient was placed in the prone position. The ultrasound transducer was oriented in a transverse orientation at the level of the sacral hiatus. Here the sacral cornuae were identified. Moving the transducer laterally from here, the lateral edge of the sacrum was identified. This bony edge was followed in a cephalad direction with the transducer maintained in a transverse orientation. A second bony contour, the ileum, was identified. The cleft between both bony contours represented the sacroiliac joint. This was found at 4.5 cm depth. Real-time imaging was used to direct a 22G spinal needle into the SIJ, where solution was injected under direct vision. The patient\\'s pain intensity decreased to a 2 out of 10 (numerical rating scale). Function improved and the patient was able to return to work. These improvements were maintained at 16 weeks. Ultrasound guidance does not expose patients and personnel to radiation and is readily accessible. Ultrasound-guided SIJ injections may have particular applications in the management of chronic lower back pain in certain clinical scenarios (e.g. pregnancy). Future studies to demonstrate efficacy and reproducibility are needed.

  3. Shoulder joint velocity during fastball pitching in baseball

    NARCIS (Netherlands)

    Gasparutto, X.; van der Graaff, E; van der Helm, F.C.T.; Veeger, H.E.J.; Colloud, F.; Domalain, M.; Monnet, T.

    2015-01-01

    The purpose of this study was to assess the rotation and translation velocity of the shoulder complex during fastball pitching in baseball. 8 pitchers from the Dutch AAA team performed each 3 fastball pitches. Their motion was recorded by an opto-electronic device. Kinematic computation was

  4. Joint Kinetics to Assess the Influence of the Racket on a Tennis Player’s Shoulder

    Science.gov (United States)

    Creveaux, Thomas; Dumas, Raphaël; Hautier, Christophe; Macé, Pierre; Chèze, Laurence; Rogowski, Isabelle

    2013-01-01

    This study aimed at investigating the influence of three rackets on shoulder net joint moments, power and muscle activity during the flat tennis serve under field- conditions. A 6-camera Eagle® motion analysis system, operating at 256 Hz, captured racket and dominant upper limb kinematics of the serve in five tennis players under three racket conditions (A: low mass, high balance and polar moment, B: low three moments of inertia, and C: high mass, swingweight and twistweight). The electromyographic activity of six trunk and arm muscles was simultaneously recorded. Shoulder net joint moments and power were computed by 3D inverse dynamics. The results showed that greater shoulder joint power and internal/external rotation peak moments were found to accelerate and decelerate racket A in comparison with the racket C. Moreover, serving with the racket A resulted in less activity in latissimus dorsi muscle during the acceleration phase, and biceps brachii muscle during the follow-through phase when compared with racket C. These initial findings encourage studying the biomechanical measurements to quantify the loads on the body during play in order to reduce them, and then prevent shoulder injuries. Racket specifications may be a critical point for coaches who train players suffering from shoulder pain and chronic upper limb injuries should be considered in relation to the racket specifications of the players. Key Points Light racket required more joint power than heavy one to achieve similar post impact ball velocity. Serving with a light racket resulted in higher shoulder internal and external rotation moments than using a heavy one for similar performance. Chronic shoulder pain should encourage coaches to check for potentially inappropriate racket specifications of their players. PMID:24149804

  5. 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

  6. Development of an Arthroscopic Joint Capsule Injury Model in the Canine Shoulder.

    Directory of Open Access Journals (Sweden)

    David Kovacevic

    Full Text Available The natural history of rotator cuff tears can be unfavorable as patients develop fatty infiltration and muscle atrophy that is often associated with a loss of muscle strength and shoulder function. To facilitate study of possible biologic mechanisms involved in early degenerative changes to rotator cuff muscle and tendon tissues, the objective of this study was to develop a joint capsule injury model in the canine shoulder using arthroscopy.Arthroscopic surgical methods for performing a posterior joint capsulectomy in the canine shoulder were first defined in cadavers. Subsequently, one canine subject underwent bilateral shoulder joint capsulectomy using arthroscopy, arthroscopic surveillance at 2, 4 and 8 weeks, and gross and histologic examination of the joint at 10 weeks.The canine subject was weight-bearing within eight hours after index and follow-up surgeries and had no significant soft tissue swelling of the shoulder girdle or gross lameness. Chronic synovitis and macroscopic and microscopic evidence of pathologic changes to the rotator cuff bony insertions, tendons, myotendinous junctions and muscles were observed.This study demonstrates feasibility and proof-of-concept for a joint capsule injury model in the canine shoulder. Future work is needed to define the observed pathologic changes and their role in the progression of rotator cuff disease. Ultimately, better understanding of the biologic mechanisms of early progression of rotator cuff disease may lead to clinical interventions to halt or slow this process and avoid the more advanced and often irreversible conditions of large tendon tears with muscle fatty atrophy.

  7. Rotator cuff ruptures of the shoulder joint, sonography - arthrography

    International Nuclear Information System (INIS)

    Triebel, H.J.; Wening, V.; Witte, G.; Hamburg Univ.

    1986-01-01

    47 patients suspected of rutpure of the rotator cuff were sonographed and arthrographed. Rupture of the rotator cuff was diagnosed in 12 cases, both diagnostic methods yielding the same result. In 29 patients sonography and arthrography did not reveal any abnormal findings. Six ruptures evident in sonography were not confirmed by arthrography and were considered false positive. Direct pointers towards rupture of the cuff would be: echoless defects, cuff cannot be visualised fully or in part and irregularities of movement during dynamic examination. Echoless 'cystic' areas in the periarticular soft parts must be considered an indirect pointer. Echorich focal findings in the echopoor cuff represent a differential diagnostic problem and we cannot give a final assessment as yet. Shoulder sonography is justified as a screening method in suspicion of rotator cuff rupture before initiating arthrography. If sonography reveals no abnormal findings, shoulder arthrography need not be performed. (orig.) [de

  8. JOINT KINETICS TO ASSESS THE INFLUENCE OF THE RACKET ON A TENNIS PLAYER'S SHOULDER

    Directory of Open Access Journals (Sweden)

    Thomas Creveaux

    2013-06-01

    Full Text Available This study aimed at investigating the influence of three rackets on shoulder net joint moments, power and muscle activity during the flat tennis serve under field- conditions. A 6-camera Eagle® motion analysis system, operating at 256 Hz, captured racket and dominant upper limb kinematics of the serve in five tennis players under three racket conditions (A: low mass, high balance and polar moment, B: low three moments of inertia, and C: high mass, swingweight and twistweight. The electromyographic activity of six trunk and arm muscles was simultaneously recorded. Shoulder net joint moments and power were computed by 3D inverse dynamics. The results showed that greater shoulder joint power and internal/external rotation peak moments were found to accelerate and decelerate racket A in comparison with the racket C. Moreover, serving with the racket A resulted in less activity in latissimus dorsi muscle during the acceleration phase, and biceps brachii muscle during the follow-through phase when compared with racket C. These initial findings encourage studying the biomechanical measurements to quantify the loads on the body during play in order to reduce them, and then prevent shoulder injuries. Racket specifications may be a critical point for coaches who train players suffering from shoulder pain and chronic upper limb injuries should be considered in relation to the racket specifications of the players

  9. Mathematical modelling as a tool to assessment of loads in volleyball player's shoulder joint during spike.

    Science.gov (United States)

    Jurkojć, Jacek; Michnik, Robert; Czapla, Krzysztof

    2017-06-01

    This article deals with kinematic and kinetic conditions in volleyball attack and identifies loads in the shoulder joint. Joint angles and velocities of individual segments of upper limb were measured with the use of the motion capture system XSENS. Muscle forces and loads in skeletal system were calculated by means of mathematical model elaborated in AnyBody system. Spikes performed by players in the best and worst way were compared with each other. The relationships were found between reactions in shoulder joint and flexion/extension, abduction/adduction and rotation angles in the same joint and flexion/extension in the elbow joint. Reactions in shoulder joint varied from 591 N to 2001 N (in relation to body weight [BW] 83-328%). The analysis proved that hand velocity at the moment of the ball hit (which varied between 6.8 and 13.3 m s -1 ) influences on the value of reaction in joints, but positions of individual segments relative to each other are also crucial. It was also proved in objective way, that position of the upper limb during spike can be more or less harmful assuming that bigger reaction increases possibility of injury, what can be an indication for trainers and physiotherapists how to improve injury prevention.

  10. Compensating for intersegmental dynamics across the shoulder, elbow, and wrist joints during feedforward and feedback control.

    Science.gov (United States)

    Maeda, Rodrigo S; Cluff, Tyler; Gribble, Paul L; Pruszynski, J Andrew

    2017-10-01

    Moving the arm is complicated by mechanical interactions that arise between limb segments. Such intersegmental dynamics cause torques applied at one joint to produce movement at multiple joints, and in turn, the only way to create single joint movement is by applying torques at multiple joints. We investigated whether the nervous system accounts for intersegmental limb dynamics across the shoulder, elbow, and wrist joints during self-initiated planar reaching and when countering external mechanical perturbations. Our first experiment tested whether the timing and amplitude of shoulder muscle activity account for interaction torques produced during single-joint elbow movements from different elbow initial orientations and over a range of movement speeds. We found that shoulder muscle activity reliably preceded movement onset and elbow agonist activity, and was scaled to compensate for the magnitude of interaction torques arising because of forearm rotation. Our second experiment tested whether elbow muscles compensate for interaction torques introduced by single-joint wrist movements. We found that elbow muscle activity preceded movement onset and wrist agonist muscle activity, and thus the nervous system predicted interaction torques arising because of hand rotation. Our third and fourth experiments tested whether shoulder muscles compensate for interaction torques introduced by different hand orientations during self-initiated elbow movements and to counter mechanical perturbations that caused pure elbow motion. We found that the nervous system predicted the amplitude and direction of interaction torques, appropriately scaling the amplitude of shoulder muscle activity during self-initiated elbow movements and rapid feedback control. Taken together, our results demonstrate that the nervous system robustly accounts for intersegmental dynamics and that the process is similar across the proximal to distal musculature of the arm as well as between feedforward (i

  11. Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 1: Sternoclavicular, Acromioclavicular, and Scapulothoracic Joints

    Science.gov (United States)

    LAWRENCE, REBEKAH L.; BRAMAN, JONATHAN P.; LAPRADE, ROBERT F.; LUDEWIG, PAULA M.

    2015-01-01

    STUDY DESIGN Cross-sectional. OBJECTIVES To compare sternoclavicular, acromioclavicular, and scapulothoracic joint motion between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Differences in scapulothoracic kinematics are associated with shoulder pain. Several studies have measured these differences using surface sensors, but the results of this technique may be affected by skin-motion artifact. Furthermore, previous studies have not included the simultaneous measurement of sternoclavicular and acromioclavicular joint motion. METHODS Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals for direct, bone-fixed tracking using electromagnetic sensors. Angular positions for the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups were found for sternoclavicular and scapulothoracic joint positions. Symptomatic individuals consistently demonstrated less sternoclavicular posterior rotation, regardless of angle, phase, or plane of shoulder motion. Symptomatic individuals also demonstrated less scapulothoracic upward rotation at 30° and 60° of humerothoracic elevation during shoulder abduction and scapular plane abduction. CONCLUSION The results of this study show that differences in shoulder complex kinematics exist between symptomatic and asymptomatic individuals. However, the magnitude of these differences was small, and the resulting clinical implications are not yet fully understood. The biomechanical coupling of the sternoclavicular and acromioclavicular joints requires further research to better understand scapulothoracic movement deviations and to improve manual therapy and exercise-based physical therapy interventions. PMID:25103135

  12. Luxation of the shoulder joint in a horse. A case report

    International Nuclear Information System (INIS)

    Rapp, H.J.; Weinreuter, S.

    1996-01-01

    Etiology, diagnosis and therapy of the luxation of the shoulder joint in the horse are described. The traumatic luxation is diagnosed by physical examination and radiography. Without complicating changings (like fractures) and in case of early correction the prognosis is good

  13. Modulation of shoulder muscle and joint function using a powered upper-limb exoskeleton.

    Science.gov (United States)

    Wu, Wen; Fong, Justin; Crocher, Vincent; Lee, Peter V S; Oetomo, Denny; Tan, Ying; Ackland, David C

    2018-04-27

    Robotic-assistive exoskeletons can enable frequent repetitive movements without the presence of a full-time therapist; however, human-machine interaction and the capacity of powered exoskeletons to attenuate shoulder muscle and joint loading is poorly understood. This study aimed to quantify shoulder muscle and joint force during assisted activities of daily living using a powered robotic upper limb exoskeleton (ArmeoPower, Hocoma). Six healthy male subjects performed abduction, flexion, horizontal flexion, reaching and nose touching activities. These tasks were repeated under two conditions: (i) the exoskeleton compensating only for its own weight, and (ii) the exoskeleton providing full upper limb gravity compensation (i.e., weightlessness). Muscle EMG, joint kinematics and joint torques were simultaneously recorded, and shoulder muscle and joint forces calculated using personalized musculoskeletal models of each subject's upper limb. The exoskeleton reduced peak joint torques, muscle forces and joint loading by up to 74.8% (0.113 Nm/kg), 88.8% (5.8%BW) and 68.4% (75.6%BW), respectively, with the degree of load attenuation strongly task dependent. The peak compressive, anterior and superior glenohumeral joint force during assisted nose touching was 36.4% (24.6%BW), 72.4% (13.1%BW) and 85.0% (17.2%BW) lower than that during unassisted nose touching, respectively. The present study showed that upper limb weight compensation using an assistive exoskeleton may increase glenohumeral joint stability, since deltoid muscle force, which is the primary contributor to superior glenohumeral joint shear, is attenuated; however, prominent exoskeleton interaction moments are required to position and control the upper limb in space, even under full gravity compensation conditions. The modeling framework and results may be useful in planning targeted upper limb robotic rehabilitation tasks. Copyright © 2018 Elsevier Ltd. All rights reserved.

  14. Ultrasound-guided intraarticular injection for MR arthrography of the shoulder; Ultraschallgesteuerte intraartikulaere Kontrastmittelapplikation fuer die MR-Arthrografie der Schulter

    Energy Technology Data Exchange (ETDEWEB)

    Schaeffeler, Christoph; Bruegel, M.; Waldt, S.; Rummeny, E.J.; Woertler, K. [Inst. fuer Roentgendiagnostik, Klinikum rechts der Isar der Technischen Univ. Muenchen (Germany)

    2010-03-15

    Purpose: To evaluate ultrasound guidance for intraarticular contrast injection via an anterolateral approach in comparison with fluoroscopic guidance. Materials and Methods: Contrast agent injection was performed in 40 consecutive patients, 20 under sonographic guidance and 20 under fluoroscopic guidance. None of the patients had previous shoulder surgery. The procedure time was measured and the efficiency of joint distension, incidence of extravasation and intraarticular air on the consecutive MR arthrograms were assessed by three blinded radiologists with musculoskeletal radiology experience. Statistical analysis was performed using the Kruskal-Wallis test. Results: Intraarticular contrast injection was successfully accomplished in all 40 patients. Subsequent MR arthrograms did not show any significant difference between sonographic and fluoroscopic guidance with respect to diagnostic quality, joint distension (p = 0.6665), intraarticular air bubbles (p = 0.1567) and occurrence of contrast extravasation (p = 0.8565). The mean duration of ultrasound-guided injection was 7:30 min compared to a shorter procedure time of 4:15 min for fluoroscopic guidance. In both groups, no procedural complications were observed. Conclusion: Ultrasound-guided injection for MR arthrography of the shoulder via an anterolateral approach represents a simple, safe, and effective technique which yields comparable results to those of injection under fluoroscopic guidance, but is slightly more time-consuming. (orig.)

  15. 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.

  16. ECHOGRAPHIC AND KINETIC CHANGES IN THE SHOULDER JOINT AFTER MANUAL WHEELCHAIR PROPULSION UNDER TWO DIFFERENT WORKLOAD SETTINGS

    Directory of Open Access Journals (Sweden)

    Ángel eGil-Agudo

    2014-12-01

    Full Text Available AbstractManual wheelchair users with spinal cord injury have a high prevalence of shoulder pain, due to the use of the upper extremity for independent mobility, transfers and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with spinal cord injury while they performed high and low intensity wheelchair propulsion tests (constant and incremental. Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.

  17. Echographic and Kinetic Changes in the Shoulder Joint after Manual Wheelchair Propulsion Under Two Different Workload Settings

    Science.gov (United States)

    Gil-Agudo, Ángel; Solís-Mozos, Marta; Crespo-Ruiz, Beatriz; del-Ama Eng, Antonio J.; Pérez-Rizo, Enrique; Segura-Fragoso, Antonio; Jiménez-Díaz, Fernando

    2014-01-01

    Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics. PMID:25566539

  18. Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects.

    Science.gov (United States)

    Lin, Yin-Liang; Karduna, Andrew

    2016-10-01

    Proprioception is essential for shoulder neuromuscular control and shoulder stability. Exercise of the rotator cuff and scapulothoracic muscles is an important part of shoulder rehabilitation. The purpose of this study was to investigate the effect of rotator cuff and scapulothoracic muscle exercises on shoulder joint position sense. Thirty-six healthy subjects were recruited and randomly assigned into either a control or training group. The subjects in the training group received closed-chain and open-chain exercises focusing on rotator cuff and scapulothoracic muscles for four weeks. Shoulder joint position sense errors in elevation, including the humerothoracic, glenohumeral and scapulothoracic joints, was measured. After four weeks of exercise training, strength increased overall in the training group, which demonstrated the effect of exercise on the muscular system. However, the changes in shoulder joint position sense errors in any individual joint of the subjects in the training group were not different from those of the control subjects. Therefore, exercises specifically targeting individual muscles with low intensity may not be sufficient to improve shoulder joint position sense in healthy subjects. Future work is needed to further investigate which types of exercise are more effective in improving joint position sense, and the mechanisms associated with those changes. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Clinical radiation diagnostics of shoulder joint impingement syndrome

    International Nuclear Information System (INIS)

    Litvin, Yu.P.; Logvinenko, V.V.

    2014-01-01

    46 patients about an impingement are investigated by a syndrome of a humeral joint. Among them men was 28 (60,9 %) the person, women 18 (39,1 %). Middle age of the surveyed has made 52,6 ± 2,0 year. The traditional roentgenography is executed to all patients, a spiral computer tomography - 5 (10,9 %), an ultrasonography - 44 (95,7 %), a magnetic resonance imaging - 11 (23,9 %). Operative treatment is spent 16 (34,8 %) by the patient. Direct radial symptoms are what specify an impingement of a syndrome of a humeral joint in the reasons, indirect - symptoms of an inflammation both degenerate and dystrophic changes of structures of area of a humeral joint which are involved in pathological process. The best results are given by complex radial research at which it is possible to find out direct and indirect symptoms a syndrome impingement

  20. Calcific shoulder joint periarthritis. Disappearance of calcifications after laser therapy

    Energy Technology Data Exchange (ETDEWEB)

    Gussetti, P; Moroso, P; Palazzo, C

    1986-01-01

    The authors report their results in the laser therapy of 30 calcific joint periarthritis. In two out of the ten radiographed cases, at the end of therapy, the complete disappearance of calcifications has been shown and in one case a decrease in calcification volume has been demonstrated. In the follow up after 6 months, 80% of clinically checked patients had no painful relapse.

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

    International Nuclear Information System (INIS)

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

    1987-01-01

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

  2. Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Tshering Vogel, Dechen W.; Anderson, Suzanne E. [University Hospital of Bern, Department of Diagnostic, Interventional and Pediatric Radiology, Bern (Switzerland); Steinbach, Lynne S. [University of California San Francisco, Department of Radiology, San Francisco, California (United States); Hertel, Ralph [University Hospital of Bern, Department of Orthopedics, Plastic and Hand Surgery, Bern (Switzerland); Bernhard, Juerg [Burgerspital, Department of Rheumatology, Solothurn (Switzerland); Stauffer, Edouard [University Hospital of Bern, Department of Pathology, Bern (Switzerland)

    2005-05-01

    (1) To analyse the imaging appearances of nine patients with acromioclavicular joint cysts presenting as shoulder masses for tumor staging with operative, histopathological and joint aspiration findings. Retrospective review of imaging and correlation with clinical, operative and surgical notes. Images were reviewed by two musculoskeletal radiologists by consensus. Nine patients who presented clinically with a shoulder mass were evaluated by radiographs (n=9), ultrasound (n=1), conventional arthrography (n=3), MRI (n=6; with direct MR arthrography n=2, indirect MR arthrography n=4). All patients had a focal mass superior to the AC joint, with a size ranging from 1.5 cm to 6 cm and a mean of 3.27 cm. Correlation was available with surgery (n=7), histopathology (n=2) and cyst aspiration (n=2). Two patients were managed conservatively. Geyser sign was positive in all three arthrograms. All MRIs revealed extensive rotator cuff tears with a column of fluid extending from the glenohumeral joint through the rotator cuff tear into the acromioclavicular joint and acromioclavicular cyst. Chondrocalcinosis was seen in the acromioclavicular joint cyst (n=2) and in the glenohumeral joint (n=1). Aspirate in two patients contained calcium pyrophosphate dihydrate crystals. (orig.)

  3. Acromioclavicular joint cyst: nine cases of a pseudotumor of the shoulder

    International Nuclear Information System (INIS)

    Tshering Vogel, Dechen W.; Anderson, Suzanne E.; Steinbach, Lynne S.; Hertel, Ralph; Bernhard, Juerg; Stauffer, Edouard

    2005-01-01

    (1) To analyse the imaging appearances of nine patients with acromioclavicular joint cysts presenting as shoulder masses for tumor staging with operative, histopathological and joint aspiration findings. Retrospective review of imaging and correlation with clinical, operative and surgical notes. Images were reviewed by two musculoskeletal radiologists by consensus. Nine patients who presented clinically with a shoulder mass were evaluated by radiographs (n=9), ultrasound (n=1), conventional arthrography (n=3), MRI (n=6; with direct MR arthrography n=2, indirect MR arthrography n=4). All patients had a focal mass superior to the AC joint, with a size ranging from 1.5 cm to 6 cm and a mean of 3.27 cm. Correlation was available with surgery (n=7), histopathology (n=2) and cyst aspiration (n=2). Two patients were managed conservatively. Geyser sign was positive in all three arthrograms. All MRIs revealed extensive rotator cuff tears with a column of fluid extending from the glenohumeral joint through the rotator cuff tear into the acromioclavicular joint and acromioclavicular cyst. Chondrocalcinosis was seen in the acromioclavicular joint cyst (n=2) and in the glenohumeral joint (n=1). Aspirate in two patients contained calcium pyrophosphate dihydrate crystals. (orig.)

  4. Effect of linear polarized near-infrared light irradiation on flexibility of shoulder and ankle joints.

    Science.gov (United States)

    Demura, S; Yamaji, S; Ikemoto, Y

    2002-12-01

    There is a possibility that heat stimulus by linear polarized near-infrared light irradiation (PL: Super Lizer HA-30, Tokyo Medical Laboratory) improves the range of joint motion, because the flexibility of soft-part tissues, such as a muscle or a tendon, is improved by increasing the muscle temperature. The purpose of this study was to examine the influence of PL-irradiation on the ranges of shoulder and ankle motions. 30 healthy young adults (15 males: mean+/-SD, age 19.1+/-0.8 yrs, height 173.3+/-4.6 cm, body mass 68.5+/-8.0 kg and 15 females: mean+/-SD, age 19.2+/-0.7 yrs, height 162.3+/-4.5 cm, body mass 58.1+/-6.6 kg) participated in the experiment under PL-irradiation and no-irradiation (placebo) conditions. the angles of shoulder and ankle joint motions were measured twice, before and after the PL- and placebo-irradiations. The angle of a motion was defined as the angle connecting 3 points at linearity as follows: for the shoulder, the greater trochanter, acromion, and caput ulnare, and for the ankle, the knee joint, fassa of lateral malleolus and metacarpal bone. Each angle was measured when a subject extended or flexed maximally without support. The trial-to-trial reliability of each range of joint motion was very high. All parameters in PL-irradiation were significantly larger in postirradiation than pre-irradiation, and the value of postirradiation in PL-irradiation was significantly greater than that for placebo. The ranges of shoulder and ankle motions in placebo-irradiation were also significantly greater in postirradiation than pre-irradiation. Moreover, the change rate for each range of joint motion between pre- and postirradiations was significantly greater in PL-irradiation in both joints. In PL-irradiation, most subject's motions were greater in postirradiation than pre-irradiation, but not in the placebo-irradiation. The effect of PL-irradiation tended to be greater on subjects with a small range of a joint motion. It is considered from the

  5. Joint Kinetics to Assess the Influence of the Racket on a Tennis Player’s Shoulder

    OpenAIRE

    Creveaux, Thomas; Dumas, Raphaël; Hautier, Christophe; Macé, Pierre; Chèze, Laurence; Rogowski, Isabelle

    2013-01-01

    This study aimed at investigating the influence of three rackets on shoulder net joint moments, power and muscle activity during the flat tennis serve under field- conditions. A 6-camera Eagle® motion analysis system, operating at 256 Hz, captured racket and dominant upper limb kinematics of the serve in five tennis players under three racket conditions (A: low mass, high balance and polar moment, B: low three moments of inertia, and C: high mass, swingweight and twistweight). The electromyog...

  6. Pain in the neck and shoulder joint in a rheumatologist's practice

    Directory of Open Access Journals (Sweden)

    Yuri Aleksandrovich Olyunin

    2012-09-01

    Full Text Available Diseases accompanied by pain in the neck and shoulder joint are rather numerous, frequently result in permanent functional failure, and are encountered in a considerable number of patients followed up by rheumatologists, neurologists, orthopedics, and therapists. The frequency of these impairments may vary from 7 to 47% according to the characteristics of the study population and used definition. The list of nosological entities to be excluded in the differential diagnosis includes diseases caused by lesions in the cervical spinal area, its muscles, ligaments, and tendons, neurological changes, systemic inflammatory diseases, myofascial pain syndrome, as well as diseases that can induce referred pain in the neck and shoulder joint (pneumonia, coronary heart disease, gastroduodenal ulcer disease. To follow a sparing regimen plays a large role in the treatment of soft tissue diseases in the shoulder joint. The use of analgesics, primarily nonsteroidal anti-inflammatory drugs (NSAIDs, such as nimesulide (nayz, is an important component of therapy. The drug has been successfully used for back pain, osteoarthrosis, and extraarticular soft tissue diseases. The local administration of glucocorticoids is worth consideration if a reduced load on the affected area and the use of NSAIDs produce no desirable effect.

  7. Characteristics of clinical shoulder research over the last decade: a review of shoulder articles in The Journal of Bone & Joint Surgery from 2004 to 2014.

    Science.gov (United States)

    Gartsman, Gary M; Morris, Brent J; Unger, R Zackary; Laughlin, Mitzi S; Elkousy, Hussein A; Edwards, T Bradley

    2015-03-04

    The purpose of this study was to determine characteristics and trends in published shoulder research over the last decade in a leading orthopaedic journal. We examined all clinical shoulder articles published in The Journal of Bone & Joint Surgery from 2004 to 2014. The number of citations, authorship, academic degrees of the authors, country and institution of origin, topic, level of evidence, positive or nonpositive outcome, and inclusion of validated patient-reported outcome measures were assessed for each article. Shoulder articles that included an author with an advanced research degree (MD [Doctor of Medicine] with a PhD [Doctor of Philosophy] or other advanced degree) increased during the study period (p = 0.047). Level-I, II, and III studies were more likely to have an author with an advanced research degree, and Level-IV studies were more likely to have MDs only (p = 0.03). Overall, there was great variability of outcome measures, with at least thirty-nine different validated or nonvalidated outcome measures reported. Over the last decade, there was an improvement in the level of evidence of shoulder articles published in The Journal of Bone & Joint Surgery that corresponds with recent emphasis on evidence-based medicine. A consensus is needed in shoulder research for more consistent application of validated patient-reported outcome measurement tools. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

  8. Pain and Opioid Use After Total Shoulder Arthroplasty With Injectable Liposomal Bupivacaine Versus Interscalene Block.

    Science.gov (United States)

    Angerame, Marc R; Ruder, John A; Odum, Susan M; Hamid, Nady

    2017-09-01

    Postoperative pain control is a significant concern after total shoulder arthroplasty. Injectable periarticular liposomal bupivacaine, which has been found to decrease opioid use after orthopedic procedures, has been proposed as a viable alternative to regional anesthesia. This study compared the efficacy of liposomal bupivacaine vs interscalene block among patients undergoing total shoulder arthroplasty. A retrospective review was conducted of 79 patients who underwent anatomic total shoulder arthroplasty performed by a single surgeon between January 2013 and April 2015. Patient demographics, in-hospital Numeric Pain Rating Scale (NPRS) score obtained at 12-hour intervals, length of stay, and total in-hospital morphine equivalents in both the bupivacaine (n=25) and block (n=44) groups were recorded. Differences in length of stay, morphine equivalents, and age were assessed with Wilcoxon tests. Sex differences were assessed with the chi-square test. Repeated measures analysis with least square means was used to assess longitudinal changes in NPRS scores. No significant differences were found between groups for sex (P=.89), age (P=.81), American Society of Anesthesiologists classification (P=.50), preoperative opioid use (P=.41), length of stay (P=.32), or morphine equivalents (P=.71). The average NPRS score in the first 12 hours was 3.01 for the bupivacaine group and 4.41 for the interscalene block group (P=.25). By 48 hours postoperatively, average NPRS scores were similar (P=.93) for the 2 groups, 4.90 for the bupivacaine group and 4.19 for the interscalene block group. The findings for this cohort of patients undergoing anatomic total shoulder arthroplasty showed no significant difference for pain scores, postoperative narcotic use, or length of stay with injectable liposomal bupivacaine vs interscalene block. [Orthopedics. 2017; 40(5):e806-e811.]. Copyright 2017, SLACK Incorporated.

  9. Consideration of Shoulder Joint's Image with the Changed Tube Angle of the Shoulder Oblique Projection in Supine Position

    Energy Technology Data Exchange (ETDEWEB)

    Seo, Jae Hyun; Choi, Nam Gil [Dept. of Radiology, Chonnam National University Hospital, Kwangju (Korea, Republic of)

    2008-06-15

    There is a standard shoulder oblique method (Grashey method) available to view the shoulder joint. This method projects AP view of the shoulder joint so that the Humerus head's subuxation or joint degeneration can be easily visualized. However, in this view, the patients, with supine or sitting or erect position, have to keep their body obliquely. Whereas, the patients who are not well or operated, usually feel very uncomfortable to keep their body in this position and hence, we need other persons' help and much efforts will be needed to get the good quality shoulder joint view. Therefore, we thought of examining a method which shows the joint well by angling the tube to Medio-Lateral direction and without keeping the patients' one side upward in supine position. For this study, total 15 subjects with no history of neurological or psychiatric illness, were recruited for examinations. They consisted of 9 males and 6 females. Statistic group analysis was performed with ANOVA test. Scores of the evaluation of the experts were 1.01{+-}0.54 at 25 degrees, 2.50{+-}0.50 at 30 degrees, 2.85{+-}0.36 at 35 degrees and 2.33{+-}0.47 at 40 degrees, respectively, and they were significant(p<0.05, Table 1). Joint space of the Humerus head and Scapula were well distinguished at 35 degrees, 30 degrees and 40 degrees with the almost same score. However, the degree of distortion at 40 degrees was more severe than that at 30 degrees. Ultimately, 30-35 degrees views were shown to yield good quality shoulder oblique images. In conclusion, this method may be very useful for the patients who are uncomfortable and for the emergency patients. In order to get similar or comparable view, the same X-tube angle is recommended to be used before and after the operation. Therefore, we hope that this new angled method seems to be efficient.

  10. [Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization: a randomized controlled trial].

    Science.gov (United States)

    Wang, Yanwu; Wang, Chongmin; Chen, Huade; Ye, Xinmiao

    2018-01-12

    To verify the clinical therapeutic effects on shoulder joint pain of rotator cuff injury treated with electroacupuncture (EA) and Mulligan's mobilization. A total of 120 patients of shoulder joint pain of rotator cuff injury were randomized into an EA group, a rehabilitation group and a combined therapy group, 40 cases in each one. In the EA group, EA was applied to Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Tianzong (SI 11), Jianqian (extra) and Binao (LI 14) in the affected side. Of these acupoints, Jianliao (TE 14) and Jianyu (LI 15), Jianzhen (SI 9) and Tianzong (SI 11) were stimulated with Han 's electric apparatus. In the rehabilitation group, Mulligan's mobilization was used, including scapular mobilization, static joint mobilization and dynamic joint mobilization. In the combined therapy group, EA was used in combination with Mulligan mobilization. The treatment was given once a day in each group, 5 sessions a week, totally for 6 weeks. The pain intensity of shoulder joint (VAS), the University of California at Los Angeles shoulder rating scale (UCLA) and the range of motion (ROM) of shoulder joint were evaluated before and 6 weeks after treatment separately. The adverse reactions were recorded in each group. VAS scores were all reduced, UCLA scores increased and ROM improved after treatment as compared with those before treatment in the patients of the three groups (all P joint pain of rotator cuff injury, better than the simple application of either EA or Mulligan's mobilization.

  11. Fluid Signal Intensity That Mimicked A Supraspinatus Tendon Tear In A Subacromial Injected Shoulder: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Hun; Kim, Tae Eun; Shin, Hyun Woong [Daegu Fatima Hospital, Daegu (Korea, Republic of)

    2010-06-15

    Subacromial steroid injections are a common procedure for treating shoulder pain. Several studies have reported on the difficulty of performing an accurate injection into the subacromial bursa, as well as the injected material infiltrated into other regional structures even when an accurate injection was done into the subacromial space. These misplacements, and especially in the rotator cuff, creates high signal intensity on T2WI that can mimic a rotator cuff tear. Bergman and Fredericson found that the bursal and extrabursal fluid is resolved or decreased 3 days after the injection, so they recommended a 3-day delay after the shoulder injection before performing MRI to prevent misinterpretation of the signal changes. We report here on a case of a false fullthickness tear of the supraspinatus tendon on MRI one month after subacromial injection, and the supraspinatus tendon turned out to be intact on the follow up ultrasonography and arthroscopic examination

  12. Blood Glucose Levels in Diabetic Patients Following Corticosteroid Injections into the Subacromial Space of the Shoulder.

    Science.gov (United States)

    Aleem, Alexander W; Syed, Usman Ali M; Nicholson, Thema; Getz, Charles L; Namdari, Surena; Beredjiklian, Pedro K; Abboud, Joseph A

    2017-09-01

    Corticosteroid injections are used to treat a variety of orthopedic conditions with the goal of decreasing pain and inflammation. Administration of systemic or local corticosteroids risks temporarily increasing blood glucose levels, especially diabetic patients. The purpose of this study is to quantify the effects of corticosteroid injections on blood glucose levels in diabetic patients with shoulder pathology. Diabetic patients who regularly monitored their blood glucose levels and were indicated for a subacromial corticosteroid injection were included in this prospective investigation. The typical normal morning fasting glucose and most recent hemoglobin A1c level was recorded for each patient. After injection, patients were contacted daily to confirm their fasting morning glucose level for 10 days post-injection. Seventeen consecutive patients were enrolled. Patients with hemoglobin A1c of patients' glucose levels returned to near baseline levels around post-injection day 8, while poorly controlled patients levels remained elevated. Similarly, insulin-dependent diabetic patients had an average increase in fasting glucose level of 99 mg/dL versus 50 mg/dL in non-insulin-dependent diabetic patients ( P patients with well-controlled diabetes experience smaller elevations and faster return to baseline glucose levels than patients with poor control. Insulin dependent diabetics experienced similar findings as patients with poor control. Future studies are needed to evaluate dosing to optimize the risks of blood glucose elevation while maintaining therapeutic benefit.

  13. Estimation of distal arm joint angles from EMG and shoulder orientation for transhumeral prostheses.

    Science.gov (United States)

    Akhtar, Aadeel; Aghasadeghi, Navid; Hargrove, Levi; Bretl, Timothy

    2017-08-01

    In this paper, we quantify the extent to which shoulder orientation, upper-arm electromyography (EMG), and forearm EMG are predictors of distal arm joint angles during reaching in eight subjects without disability as well as three subjects with a unilateral transhumeral amputation and targeted reinnervation. Prior studies have shown that shoulder orientation and upper-arm EMG, taken separately, are predictors of both elbow flexion/extension and forearm pronation/supination. We show that, for eight subjects without disability, shoulder orientation and upper-arm EMG together are a significantly better predictor of both elbow flexion/extension during unilateral (R 2 =0.72) and mirrored bilateral (R 2 =0.72) reaches and of forearm pronation/supination during unilateral (R 2 =0.77) and mirrored bilateral (R 2 =0.70) reaches. We also show that adding forearm EMG further improves the prediction of forearm pronation/supination during unilateral (R 2 =0.82) and mirrored bilateral (R 2 =0.75) reaches. In principle, these results provide the basis for choosing inputs for control of transhumeral prostheses, both by subjects with targeted motor reinnervation (when forearm EMG is available) and by subjects without target motor reinnervation (when forearm EMG is not available). In particular, we confirm that shoulder orientation and upper-arm EMG together best predict elbow flexion/extension (R 2 =0.72) for three subjects with unilateral transhumeral amputations and targeted motor reinnervation. However, shoulder orientation alone best predicts forearm pronation/supination (R 2 =0.88) for these subjects, a contradictory result that merits further study. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Syawash Mirsaid Ghazi

    2008-11-01

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

  15. Segmentation and measurement of collagen fibers for shoulder and joint therapy studies

    Energy Technology Data Exchange (ETDEWEB)

    Mascio, L. [Lawrence Livermore National Lab., CA (United States)

    1994-11-15

    Various shoulder instabilities are debilitating, especially in individuals who perform overhead activities. Thermal modification of soft tissues in joints may allow precise alteration of these tissues` mechanical and/or structural properties to enhance joint function without inducing cell death or an inflammatory response. Several studies have evaluated laser energy for tissue welding. The collective findings are promising, and the next step is to identify the mechanisms responsible for laser-induced capsular tissue alternation, and the short- and long-term effects of non-ablative laser energy on joint capsular tissue. One step toward this goal is to compare the effect of three laser energy densities on the histologic properties of the tissue evaluating the architecture of the collagen (including density, fibril diameter distribution, and interfibrillar space) in sheep at various time intervals after surgery. The specific computer algorithms that are being used to make these measurements will be described.

  16. Augmented Reality-Guided Lumbar Facet Joint Injections.

    Science.gov (United States)

    Agten, Christoph A; Dennler, Cyrill; Rosskopf, Andrea B; Jaberg, Laurenz; Pfirrmann, Christian W A; Farshad, Mazda

    2018-05-08

    The aim of this study was to assess feasibility and accuracy of augmented reality-guided lumbar facet joint injections. A spine phantom completely embedded in hardened opaque agar with 3 ring markers was built. A 3-dimensional model of the phantom was uploaded to an augmented reality headset (Microsoft HoloLens). Two radiologists independently performed 20 augmented reality-guided and 20 computed tomography (CT)-guided facet joint injections each: for each augmented reality-guided injection, the hologram was manually aligned with the phantom container using the ring markers. The radiologists targeted the virtual facet joint and tried to place the needle tip in the holographic joint space. Computed tomography was performed after each needle placement to document final needle tip position. Time needed from grabbing the needle to final needle placement was measured for each simulated injection. An independent radiologist rated images of all needle placements in a randomized order blinded to modality (augmented reality vs CT) and performer as perfect, acceptable, incorrect, or unsafe. Accuracy and time to place needles were compared between augmented reality-guided and CT-guided facet joint injections. In total, 39/40 (97.5%) of augmented reality-guided needle placements were either perfect or acceptable compared with 40/40 (100%) CT-guided needle placements (P = 0.5). One augmented reality-guided injection missed the facet joint space by 2 mm. No unsafe needle placements occurred. Time to final needle placement was substantially faster with augmented reality guidance (mean 14 ± 6 seconds vs 39 ± 15 seconds, P Augmented reality-guided facet joint injections are feasible and accurate without potentially harmful needle placement in an experimental setting.

  17. Low-field MR arthrography of the shoulder joint: technique, indications, and clinical results

    International Nuclear Information System (INIS)

    Kreitner, K.-F.; Thelen, M.; Loew, R.; Runkel, M.; Zoellner, J.

    2003-01-01

    In the age of cost containment and urgent reductions in health care expenditures, new options have to be explored to satisfy both diagnostic requirements and economic limitations. The introduction of low-field MR systems for assessment of joint disorders seemed to be an option for lower costs. The purpose of this article is to summarize available experiences with low-field MR arthrography of the glenohumeral joint with respect to image quality and diagnostic accuracy in detecting labral and rotator cuff lesions. Up to now, there has been only a limited number of studies available dealing with low-field MR arthrography of the glenohumeral joint. They reveal that, despite a minor image quality in comparison with high-field imaging, low-field MR arthrography of the shoulder allows for sufficient evaluation of intra- and extra-articular structures in the detection of major abnormalities such as glenohumeral instability or rotator cuff disease. Furthermore, open-configured MR scanners enable kinematic studies: Besides the analysis of normal motion, pathological findings in patients with instabilities and impingement syndrome can be delineated. They further offer the possibility for performing MR imaging-guided arthrography of the shoulder. This was first described using an open C-arm scanner with a vertically oriented magnetic field so that MR arthrography may be performed in one setting. (orig.)

  18. Sex differences in the shoulder joint position sense acuity: a cross-sectional study.

    Science.gov (United States)

    Vafadar, Amir K; Côté, Julie N; Archambault, Philippe S

    2015-09-30

    Work-related musculoskeletal disorders (WMSD) is the most expensive form of work disability. Female sex has been considered as an individual risk factor for the development of WMSD, specifically in the neck and shoulder region. One of the factors that might contribute to the higher injury rate in women is possible differences in neuromuscular control. Accordingly the purpose of this study was to estimate the effect of sex on shoulder joint position sense acuity (as a part of shoulder neuromuscular control) in healthy individuals. Twenty-eight healthy participants, 14 females and 14 males were recruited for this study. To test position sense acuity, subjects were asked to flex their dominant shoulder to one of the three pre-defined angle ranges (low, mid and high-ranges) with eyes closed, hold their arm in that position for three seconds, go back to the starting position and then immediately replicate the same joint flexion angle, while the difference between the reproduced and original angle was taken as the measure of position sense error. The errors were measured using Vicon motion capture system. Subjects reproduced nine positions in total (3 ranges × 3 trials each). Calculation of absolute repositioning error (magnitude of error) showed no significant difference between men and women (p-value ≥ 0.05). However, the analysis of the direction of error (constant error) showed a significant difference between the sexes, as women tended to mostly overestimate the target, whereas men tended to both overestimate and underestimate the target (p-value ≤ 0.01, observed power = 0.79). The results also showed that men had a significantly more variable error, indicating more variability in their position sense, compared to women (p-value ≤ 0.05, observed power = 0.78). Differences observed in the constant JPS error suggest that men and women might use different neuromuscular control strategies in the upper limb. In addition, higher JPS

  19. Improper trunk rotation sequence is associated with increased maximal shoulder external rotation angle and shoulder joint force in high school baseball pitchers.

    Science.gov (United States)

    Oyama, Sakiko; Yu, Bing; Blackburn, J Troy; Padua, Darin A; Li, Li; Myers, Joseph B

    2014-09-01

    In a properly coordinated throwing motion, peak pelvic rotation velocity is reached before peak upper torso rotation velocity, so that angular momentum can be transferred effectively from the proximal (pelvis) to distal (upper torso) segment. However, the effects of trunk rotation sequence on pitching biomechanics and performance have not been investigated. The aim of this study was to investigate the effects of trunk rotation sequence on ball speed and on upper extremity biomechanics that are linked to injuries in high school baseball pitchers. The hypothesis was that pitchers with improper trunk rotation sequence would demonstrate lower ball velocity and greater stress to the joint. Descriptive laboratory study. Three-dimensional pitching kinematics data were captured from 72 high school pitchers. Subjects were considered to have proper or improper trunk rotation sequences when the peak pelvic rotation velocity was reached either before or after the peak upper torso rotation velocity beyond the margin of error (±3.7% of the time from stride-foot contact to ball release). Maximal shoulder external rotation angle, elbow extension angle at ball release, peak shoulder proximal force, shoulder internal rotation moment, and elbow varus moment were compared between groups using independent t tests (α ways that may influence injury risk. As such, exercises that reinforce the use of a proper trunk rotation sequence during the pitching motion may reduce the stress placed on the structures around the shoulder joint and lead to the prevention of injuries. © 2014 The Author(s).

  20. The friction coefficient of shoulder joints remains remarkably low over 24 h of loading.

    Science.gov (United States)

    Jones, Brian K; Durney, Krista M; Hung, Clark T; Ateshian, Gerard A

    2015-11-05

    The frictional response of whole human joints over durations spanning activities of daily living has not been reported previously. This study measured the friction of human glenohumeral joints during 24 h of reciprocal loading in a pendulum testing device, at moderate (0.2 mm/s, 4320 cycles) and low (0.02 mm/s, 432 cycles) sliding speeds, under a 200 N load. The effect of joint congruence was also investigated by testing human humeral heads against significantly larger mature bovine glenoids. Eight human joints and six bovine joints were tested in four combinations: human joints tested at moderate (hHCMS, n=6) and low speed (hHCLS, n=3), human humeral heads tested against bovine glenoids at moderate speed (LCMS, n=3), and bovine joints tested at moderate speed (bHCMS, n=3). In the first half hour the mean±standard deviation of the friction coefficient was hHCMS: 0.0016±0.0011, hHCLS: 0.0012±0.0002, LCMS: 0.0008±0.0002 and bHCMS: 0.0024±0.0008; in the last four hours it was hHCMS: 0.0057±0.0025, hHCLS: 0.0047±0.0017, LCMS: 0.0012±0.0003 and bHCMS: 0.0056±0.0016. The initial value was lower than the final value (pfriction coefficient of natural human shoulders remains remarkably low (averaging as little as 0.0015 and no greater than 0.006) for up to 24 h of continuous loading. The sustained low friction coefficients observed in incongruent joints (~0.001) likely represent rolling rather than sliding friction. Copyright © 2015. Published by Elsevier Ltd.

  1. The Friction Coefficient of Shoulder Joints Remains Remarkably Low Over 24 h of Loading

    Science.gov (United States)

    Jones, Brian K.; Durney, Krista M.; Hung, Clark T.; Ateshian, Gerard A.

    2015-01-01

    The frictional response of whole human joints over durations spanning activities of daily living has not been reported previously. This study measured the friction of human glenohumeral joints during 24 h of reciprocal loading in a pendulum testing device, at moderate (0.2 mm/s, 4320 cycles) and low (0.02 mm/s, 432 cycles) sliding speeds, under a 200 N load. The effect of joint congruence was also investigated by testing human humeral heads against significantly larger mature bovine glenoids. Six human joints and six bovine joints were tested in four combinations: human joints tested at moderate (hHCMS, n=6) and low speed (hHCLS, n=3), human humeral heads tested against bovine glenoids at moderate speed (LCMS, n=3), and bovine joints tested at moderate speed (bHCMS, n=3). In the first half hour the mean ± standard deviation of the friction coefficient was hHCMS: 0.0016±0.0011, hHCLS: 0.0012±0.0002, LCMS: 0.0008±0.0002 and bHCMS: 0.0024±0.0008; in the last four hours it was hHCMS: 0.0057±0.0025, hHCLS: 0.0047±0.0017, LCMS: 0.0012±0.0003 and bHCMS: 0.0056±0.0016. The initial value was lower than the final value (pfriction coefficient of natural human shoulders remains remarkably low (averaging as little as 0.0015 and no greater than 0.006) for up to 24 h of continuous loading. The sustained low friction coefficients observed in incongruent joints (~0.001) likely represent rolling rather than sliding friction. PMID:26472306

  2. Technical guide to evaluate upper limb joints (shoulder, elbow and wrist) by ultrasound

    International Nuclear Information System (INIS)

    Obregon Baez, Luis Rafael

    2014-01-01

    A guideline to follow is offered to radiologists and residents of radiology service of medical imaging, when evaluating by ultrasound the shoulder joints, elbow, wrist. The importance to performing of musculoskeletal ultrasound by its pathology variable is established. The use of appropriate equipment and effective application of the techniques exposed of echography exploration have made enable the valuation of many pathologies with high sensitivity and specificity. The echography has been the musculoskeletal imaging technique that more rapidly has evolved. Currently, this technique has been replaced by magnetic resonance imaging in various clinical fields and also serves as a complement to other techniques. Exposed techniques have been of great benefit for radiologists medical and residents, obtaining with its use a quick guide for the realization of upper limb musculoskeletal ultrasounds. The appropriate and easy techniques are better known for the evaluation of these structures, and so document both sports injuries, as joint and rheumatic diseases [es

  3. Differences Regarding Branded HA in Italy, Part 2: Data from Clinical Studies on Knee, Hip, Shoulder, Ankle, Temporomandibular Joint, Vertebral Facets, and Carpometacarpal Joint

    Science.gov (United States)

    Migliore, A.; Bizzi, E.; De Lucia, O.; Delle Sedie, A.; Tropea, S.; Bentivegna, M.; Mahmoud, A.; Foti, C.

    2016-01-01

    OBJECTIVES The aim of the current study is to collect scientific data on all branded hyaluronic acid (HA) products in Italy that are in use for intra-articular (IA) injection in osteoarthritis (OA) compared with that reported in the leaflet. METHODS An extensive literature research was performed for all articles reporting data on the IA use of HA in OA. Selected studies were taken into consideration only if they are related to products based on HAs that are currently marketed in Italy with the specific joint indication for IA use in patients affected by OA. RESULTS Sixty-two HA products are marketed in Italy: 30 products are indicated for the knee but only 8 were proved with some efficacy; 9 products were effective for the hip but only 6 had hip indication; 7 products proved to be effective for the shoulder but only 3 had the indication; 5 products proved effective for the ankle but only one had the indication; 6 products were effective for the temporomandibular joint but only 2 had the indication; only 2 proved effective for vertebral facet joints but only 1 had the indication; and 5 products proved effective for the carpometacarpal joint but only 2 had the indication. CONCLUSIONS There are only a few products with some evidences, while the majority of products remain without proof. Clinicians and regulators should request postmarketing studies from pharmaceuticals to corroborate with that reported in the leaflet and to gather more data, allowing the clinicians to choose the adequate product for the patient. PMID:27279754

  4. Microstructure and mechanical properties of friction stir lap welded Mg/Al joint assisted by stationary shoulder

    Science.gov (United States)

    Ji, Shude; Li, Zhengwei

    2017-11-01

    Using magnesium alloy as upper sheet, 3 mm-thick AZ31 magnesium alloy and 6061 aluminum alloy were joined using friction stir lap welding assisted by stationary shoulder. The effects of tool rotating speed on cross-sections, microstructure and mechanical properties of Mg/Al lap joints were mainly discussed. Results showed that stationary shoulder contributed to joint formation, by which stir zones (SZ) were characterized by big onion rings after welding. Because of the big forging force exerted by stationary shoulder, the upper region of hook was well bonded. SZ showed much higher hardness because of intermetallic compounds (IMCs). The bonding conditions at the base material (BM)/SZ interface at advancing side and the hook region played important roles on joint lap shear properties. The X-ray diffraction pattern analysis revealed that the main IMCs were Al3Mg2 and Al12Mg17.

  5. [Arthroscopic therapy of the unstable shoulder joint--acceptance and critical considerations].

    Science.gov (United States)

    Jerosch, J

    1997-01-01

    The purpose of this study was to document and to present the acceptance of arthroscopically performed stabilising procedures of the glenohumeral joint. In a nationwide survey of instructors of the association of arthroscopy, members of the arthroscopy group of the german orthopedic society, and orthopedic and trauma surgeons with special interest in joint surgery we evaluated the current treatment modalities for patients with unstable shoulder joints. After an average of 2.09 +/- 1.0 shoulder redislocations surgery is recommended. The Bankart-operation (63.4%) is the favourite procedure for open surgery. In a descended order the Weber rotation-osteotomie, the Putti-Platt operation, the Max-Lange procedure, and in a minimal amount of the cases the Bristow-procedure are performed. Looking at the arthroscopic procedures, the distribution is much more equal. The Caspari technique is used by 27.6% and the Morgan technique by 25.1%. Bone anchors are used by 20.4% and the Suretac is used by 18.9% of the surgeons. The anchor knot technique (8%) is only rarely performed. In case of an elongated capsule the majority of the surgeons would not perform arthroscopic surgery. 42.4% of the surgeons judge the arthroscopic technique less secure. However, 38.9% do not see any difference to open procedures. Taking the available information, arthroscopic stabilising procedures seems to have slightly inferior results compared to standard open surgery. The Bankart procedure with or without a capsular shift is still the golden standard.

  6. An instrumented implant for in vivo measurement of contact forces and contact moments in the shoulder joint.

    Science.gov (United States)

    Westerhoff, P; Graichen, F; Bender, A; Rohlmann, A; Bergmann, G

    2009-03-01

    To improve implant design, fixation and preclinical testing, implant manufacturers depend on realistic data of loads acting on the shoulder joint. Furthermore, these data can help to optimize physiotherapeutic treatment and to advise patients in their everyday living conditions. Calculated shoulder joint loads vary extremely among different authors [Anglin C, Wyss UP, Pichora DR. Glenohumeral contact forces. Proc Inst Mech Eng [H] 2000;214:637-44]. Additionally the moments acting in the joint caused by friction or incongruent articular surfaces, for example, are not implemented in most models. An instrumented shoulder joint implant was developed to measure the contact forces and the contact moments acting in the glenohumeral joint. This article provides a detailed description of the implant, containing a nine-channel telemetry unit, six load sensors and an inductive power supply, all hermetically sealed inside the implant. The instrumented implant is based on a clinically proven BIOMET Biomodular shoulder replacement and was calibrated before implantation by using complex mathematical calculation routines in order to achieve an average measuring precision of approximately 2%.

  7. Knee joint mobilization reduces secondary mechanical hyperalgesia induced by capsaicin injection into the ankle joint.

    Science.gov (United States)

    Sluka, K A; Wright, A

    2001-01-01

    Joint mobilization is a treatment approach commonly used by physical therapists for the management of a variety of painful conditions. However, the clinical effectiveness when compared to placebo and the neurophysiological mechanism of action are not known. The purpose of this study was to establish that application of a manual therapy technique will produce antihyperalgesia in an animal model of joint inflammation and that the antihyperalgesia produced by joint mobilization depends on the time of treatment application. Capsaicin (0.2%, 50 microl) was injected into the lateral aspect of the left ankle joint and mechanical withdrawal threshold assessed before and after capsaicin injection in Sprague-Dawley rats. Joint mobilization of the ipsilateral knee joint was performed 2 h after capsaicin injection for a total of 3 min, 9 min or 15 min under halothane anaesthesia. Control groups included animals that received halothane for the same time as the group that received joint mobilization and those whose limbs were held for the same duration as the mobilization (no halothane). Capsaicin resulted in a decreased mechanical withdrawal threshold by 2 h after injection that was maintained through 4 h. Both 9 and 15 min of mobilization, but not 3 min of mobilization, increased the withdrawal threshold to mechanical stimuli to baseline values when compared with control groups. The antihyperalgesic effect of joint mobilization lasted 30 min. Thus, joint mobilization (9 or 15 min duration) produces a significant reversal of secondary mechanical hyperalgesia induced by intra-articular injection of capsaicin. Copyright 2001 European Federation of Chapters of the International Association for the Study of Pain.

  8. The effect of glenosphere diameter in reverse shoulder arthroplasty on muscle force, joint load, and range of motion.

    Science.gov (United States)

    Langohr, G Daniel G; Giles, Joshua W; Athwal, George S; Johnson, James A

    2015-06-01

    Little is known about the effects of glenosphere diameter on shoulder joint loads. The purpose of this biomechanical study was to investigate the effects of glenosphere diameter on joint load, load angle, and total deltoid force required for active abduction and range of motion in internal/external rotation and abduction. A custom, instrumented reverse shoulder arthroplasty implant system capable of measuring joint load and varying glenosphere diameter (38 and 42 mm) and glenoid offset (neutral and lateral) was implanted in 6 cadaveric shoulders to provide at least 80% power for all variables. A shoulder motion simulator was used to produce active glenohumeral and scapulothoracic motion. All implant configurations were tested with active and passive motion with joint kinematics, loads, and moments recorded. At neutral and lateralized glenosphere positions, increasing diameter significantly increased joint load (+12 ± 21 N and +6 ± 9 N; P  .8). Passive internal rotation was reduced with increased diameter at both neutral and lateralized glenosphere positions (-6° ± 6° and -12° ± 6°; P  .05). At neutral glenosphere position, increasing diameter increased the maximum angles of both adduction (+1° ± 1°; P = .03) and abduction (+8° ± 9°; P < .05). Lateralization also increased abduction range of motion compared with neutral (P < .01). Although increasing glenosphere diameter significantly increased joint load and deltoid force, the clinical impact of these changes is presently unclear. Internal rotation, however, was reduced, which contradicts previous bone modeling studies, which we postulate is due to increased posterior capsular tension as it is forced to wrap around a larger 42 mm implant assembly. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  9. Dynamic Analysis of the Abnormal Isometric Strength Movement Pattern between Shoulder and Elbow Joint in Patients with Hemiplegia.

    Science.gov (United States)

    Liu, Yali; Hong, Yuezhen; Ji, Linhong

    2018-01-01

    Patients with hemiplegia usually have weak muscle selectivity and usually perform strength at a secondary joint (secondary strength) during performing a strength at one joint (primary strength). The abnormal strength pattern between shoulder and elbow joint has been analyzed by the maximum value while the performing process with strength changing from 0 to maximum then to 0 was a dynamic process. The objective of this study was to develop a method to dynamically analyze the strength changing process. Ten patients were asked to perform four group asks (maximum and 50% maximum voluntary strength in shoulder abduction, shoulder adduction, elbow flexion, and elbow extension). Strength and activities from seven muscles were measured. The changes of secondary strength had significant correlation with those of primary strength in all tasks ( R > 0.76, p strength ( R > 0.4, p strength pattern (all p strength pattern. The muscles, deltoid muscles, biceps brachii, triceps brachii, and brachioradialis, much influenced the stereotyped movement pattern between shoulder and elbow joint.

  10. Dynamic Analysis of the Abnormal Isometric Strength Movement Pattern between Shoulder and Elbow Joint in Patients with Hemiplegia

    Directory of Open Access Journals (Sweden)

    Yali Liu

    2018-01-01

    Full Text Available Patients with hemiplegia usually have weak muscle selectivity and usually perform strength at a secondary joint (secondary strength during performing a strength at one joint (primary strength. The abnormal strength pattern between shoulder and elbow joint has been analyzed by the maximum value while the performing process with strength changing from 0 to maximum then to 0 was a dynamic process. The objective of this study was to develop a method to dynamically analyze the strength changing process. Ten patients were asked to perform four group asks (maximum and 50% maximum voluntary strength in shoulder abduction, shoulder adduction, elbow flexion, and elbow extension. Strength and activities from seven muscles were measured. The changes of secondary strength had significant correlation with those of primary strength in all tasks (R>0.76, p0.4, p<0.01. Deltoid muscles, biceps brachii, triceps brachii, and brachioradialis had significant influences on the abnormal strength pattern (all p<0.01. The dynamic method was proved to be efficient to analyze the different influences of muscles on the abnormal strength pattern. The muscles, deltoid muscles, biceps brachii, triceps brachii, and brachioradialis, much influenced the stereotyped movement pattern between shoulder and elbow joint.

  11. Coupled Viscous Fluid Flow and Joint Deformation Analysis for Grout Injection in a Rock Joint

    Science.gov (United States)

    Kim, Hyung-Mok; Lee, Jong-Won; Yazdani, Mahmoud; Tohidi, Elham; Nejati, Hamid Reza; Park, Eui-Seob

    2018-02-01

    Fluid flow modeling is a major area of interest within the field of rock mechanics. The main objective of this study is to gain insight into the performance of grout injection inside jointed rock masses by numerical modeling of grout flow through a single rock joint. Grout flow has been widely simulated using non-Newtonian Bingham fluid characterized by two main parameters of dynamic viscosity and shear yield strength both of which are time dependent. The increasing value of these properties with injection time will apparently affect the parameters representing the grouting performance including grout penetration length and volumetric injection rate. In addition, through hydromechanical coupling a mutual influence between the injection pressure from the one side and the joint opening/closing behavior and the aperture profile variation on the other side is anticipated. This is capable of producing a considerable impact on grout spread within the rock joints. In this study based on the Bingham fluid model, a series of numerical analysis has been conducted using UDEC to simulate the flow of viscous grout in a single rock joint with smooth parallel surfaces. In these analyses, the time-dependent evolution of the grout fluid properties and the hydromechanical coupling have been considered to investigate their impact on grouting performance. In order to verify the validity of these simulations, the results of analyses including the grout penetration length and the injection flow rate were compared with a well-known analytical solution which is available for the simple case of constant grout properties and non-coupled hydraulic analysis. The comparison demonstrated that the grout penetration length can be overestimated when the time-dependent hardening of grout material is not considered. Moreover, due to the HM coupling, it was shown that the joint opening induced by injection pressure may have a considerable increasing impression on the values of penetration length and

  12. [Case-control study on shoulder pain caused by hook palte for the treatment of acromioclavicular joint dislocation].

    Science.gov (United States)

    Yang, Ying-guo; Cai, Xiao-bing; Wang, Xiao-min; Zhu, Yong-gan; Pan, He-yong

    2015-06-01

    To explore causes of shoulder pain and propose prevention measures in treating acromioclavicular joint dislocation. From January 2005 to January 2013, 86 patients with acromioclavicular joint dislocation (Tossy III) were treated with hook plate fixation, and were divided into two groups. Bsaed on recovery of shoulder function mostly, the patients who suffered from rest pain, motion pain were named as shoulder pain group, while the patients without pain were named as painless group. In shoulder pain group, there were 21 cases including 15 males and and 6 females ranging the age from 22 to 62 years old with an average of (40.6±11.2) years old. There were 8 cases were on the left side and 13 cases were on the right side. In painless group, there were 65 cases including 36 males and and 29 females ranging the age from 19 to 65 years old with an average of (40.0±11.3) years old. There were 33 cases were on the left side and 32 cases were on the right side. The time from injury to operation ranged from 3 h to 8 d with an average of 34.6 h. Shoulder function of all patients were normal before injuried. Postoperative pain, activity of daily living (ADL), range of motion, deltoid muscle strength were compared. Anteflexion,rear protraction, abduction and upthrow of shoulder joint were also compared. Postoperative complications between two groups were observed and compared. All patients were followed up from 12 to 48 months with an average of 18.5 months. Constant-Murley score were used to evaluate clinical efficacy at the least following up, and 13 cases got an excellent results, 5 moderate, 2 good and 1 poor in shoulder pain group ; while 61 cases were obtained excellent results, 3 moderate and 1 good in painless group. There were significantly differences between two groups in Constant-Murley score and activity of shoulder joint (Pacromioclavicular arthritis. Chosing individual clavicular hook plate, fulfilling anatomic reset, paying attention to the repair of articular

  13. 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.

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

    Directory of Open Access Journals (Sweden)

    Abby Choke

    2018-06-01

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

  15. 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.

  16. A comparative study of the value of four imaging methods for the diagnosis of rheumatoid arthritis of the shoulder joint

    International Nuclear Information System (INIS)

    Tsvetkova, S.; Semova, R.; Matalova, A.

    2008-01-01

    The shoulder joint becomes involved later than the peripheral joints of the lower and upper limb in rheumatoid arthritis. The aim of the current study is to determine the value of plain radiography (PR), ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI) in detecting bone erosions and soft tissue changes of the shoulder joint in patients with rheumatoid arthritis. 27 patients - 21 women and 6 men, mean age 59 years (range 39 - 78) with confirmed rheumatoid arthritis and a painful shoulder are included in the study. The mean duration of the disease is 10 years and the mean duration of the shoulder symptoms is 4 years. In every patient all the imaging modalities were performed within 30 days. PR shows depicted changes in 20 patients (74%), US - in 25 patients (93%), CT - in 23 patients (85%) and MRI - in 26 patients (96%). US and MRI are more sensitive than CT in depicting small erosions of the humeral head and soft tissue changes. MRI and CT are the best methods for the diagnosis of subchondral and intraosseous bone lesions. The traditionally used PR is less sensitive than the other methods, especially in the evaluation of the soft tissues and the small erosions. (authors)

  17. 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.

  18. Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

    International Nuclear Information System (INIS)

    Zanetti, Marco; Hodler, Juerg

    2000-01-01

    This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician's degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair

  19. Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Zanetti, Marco E-mail: mzanetti@balgrist.unizh.ch; Hodler, Juerg

    2000-08-01

    This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician's degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair.

  20. 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 ...

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

    Science.gov (United States)

    2014-06-01

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

  2. Effectiveness of ultrasound-guided injections combined with shoulder exercises in the treatment of subacromial adhesive bursitis.

    Science.gov (United States)

    Gasparre, Giuseppe; Fusaro, Isabella; Galletti, Stefano; Volini, Silvia; Benedetti, Maria Grazia

    2012-05-01

    The aim of this study was to evaluate whether the association of exercises for the shoulder with ultrasound-guided injection into the bursa significantly improves the treatment outcome in adhesive bursitis. Two groups of 35 patients, one treated with ultrasound-guided injection (UGI) and the other one with ultrasound-guided injection and home exercise program (UGI-exercise) for 1 month, were assessed for pain and shoulder function before treatment, 1 and 3 months post-treatment. Fourteen patients in UGI group and 23 patients in the UGI-exercises group were completely free of pain after 1 month (p = 0.031). At 3 months' follow-up, patients in the UGI-exercise group showed a significant improvement with respect to the other group (p = 0.005). No differences were found in function assessment. The UGI combined with shoulder exercises in the treatment of subacromial adhesive bursitis is effective to ensure a more frequent complete pain relief in the medium term.

  3. Comparison of two ultrasound-guided injection techniques targeting the sacroiliac joint region in equine cadavers.

    Science.gov (United States)

    Stack, John David; Bergamino, Chiara; Sanders, Ruth; Fogarty, Ursula; Puggioni, Antonella; Kearney, Clodagh; David, Florent

    2016-09-20

    To compare the accuracy and distribution of injectate for cranial (CR) and caudomedial (CM) ultrasound-guided injections of equine sacroiliac joints. Both sacroiliac joints from 10 lumbosacropelvic specimens were injected using cranial parasagittal (CR; curved 18 gauge, 25 cm spinal needles) and caudomedial (CM; straight 18 gauge, 15 cm spinal needles) ultrasound-guided approaches. Injectate consisted of 4 ml iodinated contrast and 2 ml methylene blue. Computed tomographical (CT) scans were performed before and after injections. Time for needle guidance and repositioning attempts were recorded. The CT sequences were analysed for accuracy and distribution of contrast. Intra-articular contrast was detected in sacroiliac joints following 15/40 injections. The CR and CM approaches deposited injectate ≤2 cm from sacroiliac joint margins following 17/20 and 20/20 injections, respectively. Median distance of closest contrast to the sacroiliac joint was 0.4 cm (interquartile range [IQR]: 1.5 cm) for CR approaches and 0.6 cm (IQR: 0.95 cm) for CM approaches. Cranial injections resulted in injectate contacting lumbosacral intertransverse joints 15/20 times. Caudomedial injections were perivascular 16/20 times. Safety and efficacy could not be established. Cranial and CM ultrasound-guided injections targeting sacroiliac joints were very accurate for periarticular injection, but accuracy was poor for intra-articular injection. Injectate was frequently found in contact with interosseous sacroiliac ligaments, as well as neurovascular and synovial structures in close vicinity of sacroiliac joints.

  4. Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC) of Cadaveric Shoulders: Comparison of Contrast Dynamics in Hyaline and Fibrous Cartilage after Intraarticular Gadolinium Injection

    Energy Technology Data Exchange (ETDEWEB)

    Wiener, E. (Dept. of Radiology, Charite Universitaetsmedizin Berlin (Germany)); Hodler, J.; Pfirrmann, C.W.A. (Dept. of Radiology, Orthopedic Univ. Hospital Balgrist, Zuerich (Switzerland))

    2009-01-15

    Background: Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a novel method to investigate cartilaginous and fibrocartilaginous structures. Purpose: To investigate the contrast dynamics in hyaline and fibrous cartilage of the glenohumeral joint after intraarticular injection of gadopentetate dimeglumine. Material and Methods: Transverse T1 maps were acquired on a 1.5T scanner before and after intraarticular injection of 2.0 mmol/l gadopentetate dimeglumine in five cadaveric shoulders using a dual flip angle three-dimensional gradient echo (3D-GRE) sequence. The acquisition time for the T1 maps was 5 min 5 s for the whole shoulder. Measurements were repeated every 15 min over 2.5 hours. Regions of interest (ROIs) covering the glenoid cartilage and the labrum were drawn to assess the temporal evolution of the relaxation parameters. Results: T1 of unenhanced hyaline cartilage of the glenoid was 568+-34 ms. T1 of unenhanced fibrous cartilage of the labrum was 552+-38 ms. Significant differences (P=0.002 and 0.03) in the relaxation parameters were already measurable after 15 min. After 2 to 2.5 hours, hyaline and fibrous cartilage still demonstrated decreasing relaxation parameters, with a larger range of the T1(Gd) values in fibrous cartilage. T1 and ?R1 values of hyaline and fibrous cartilage after 2.5 hours were 351+-16 ms and 1.1+-0.09/s, and 332+-31 ms and 1.2+-0.1/s, respectively. Conclusion: A significant decrease in T1(Gd) was found 15 min after intraarticular contrast injection. Contrast accumulation was faster in hyaline than in fibrous cartilage. After 2.5 hours, contrast accumulation showed a higher rate of decrease in hyaline cartilage, but neither hyaline nor fibrous cartilage had reached equilibrium

  5. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) of cadaveric shoulders: comparison of contrast dynamics in hyaline and fibrous cartilage after intraarticular gadolinium injection.

    Science.gov (United States)

    Wiener, E; Hodler, J; Pfirrmann, C W A

    2009-01-01

    Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a novel method to investigate cartilaginous and fibrocartilaginous structures. To investigate the contrast dynamics in hyaline and fibrous cartilage of the glenohumeral joint after intraarticular injection of gadopentetate dimeglumine. Transverse T(1) maps were acquired on a 1.5T scanner before and after intraarticular injection of 2.0 mmol/l gadopentetate dimeglumine in five cadaveric shoulders using a dual flip angle three-dimensional gradient echo (3D-GRE) sequence. The acquisition time for the T(1) maps was 5 min 5 s for the whole shoulder. Measurements were repeated every 15 min over 2.5 hours. Regions of interest (ROIs) covering the glenoid cartilage and the labrum were drawn to assess the temporal evolution of the relaxation parameters. T(1) of unenhanced hyaline cartilage of the glenoid was 568+/-34 ms. T(1) of unenhanced fibrous cartilage of the labrum was 552+/-38 ms. Significant differences (P=0.002 and 0.03) in the relaxation parameters were already measurable after 15 min. After 2 to 2.5 hours, hyaline and fibrous cartilage still demonstrated decreasing relaxation parameters, with a larger range of the T(1)(Gd) values in fibrous cartilage. T(1) and triangle Delta R(1) values of hyaline and fibrous cartilage after 2.5 hours were 351+/-16 ms and 1.1+/-0.09 s(-1), and 332+/-31 ms and 1.2+/-0.1 s(-1), respectively. A significant decrease in T(1)(Gd) was found 15 min after intraarticular contrast injection. Contrast accumulation was faster in hyaline than in fibrous cartilage. After 2.5 hours, contrast accumulation showed a higher rate of decrease in hyaline cartilage, but neither hyaline nor fibrous cartilage had reached equilibrium.

  6. Subacromial triamcinolone acetonide, hyaluronic acid and saline injections for shoulder pain an RCT investigating the effectiveness in the first days.

    Science.gov (United States)

    Penning, Ludo I F; de Bie, Rob A; Walenkamp, Geert H I M

    2014-10-23

    Subacromial impingement is a common cause of shoulder complaints in general practice. When the initial treatment with acetaminophen and low dose Non Steroidal Anti Inflammatory Drugs fails, triamcinolone acetonide injections are commonly used. Triamcinolone acetonide injections are effective at four to six weeks. Little is known about the pain relief effect of triamcinolone acetonide injections in the first days after injection and the effect of repeated injection. In this study we investigate the effect of triamcinolone acetonide injections compared to hyaluronic acid and NaCl injections using a pain diary. 159 Patients recruited for an RCT comparing the effect of subacromial injections of triamcinolone acetonide, hyaluronic acid and sodium chloride (NaCl) were used in this study. They were blinded for their treatment and could receive up to three injections. Primary outcome consisted of the patient perceived pain on a VAS score recorded on a daily basis during 21 days following injection. Secondary outcome consisted of the amount of taken escape medication following injection and adverse effects. All patients received the first injection. 150 patients also received the second and third injections. 97% Of the paper and pencil pain diaries were returned for data analysis.The triamcinolone acetonide group showed the largest decrease in pain on the VAS scores after injection compared to the hyaluronic acid and NaCl group in the first week after injection. The reduction in pain was best achieved after the first injection, the second triamcinolone acetonide injection showed a further reduction in pain. The third triamcinolone acetonide injection only showed a slight improvement in pain reduction. In this study we could show a booster effect in pain reduction after repeated triamcinolone acetonide injection. The triamcinolone acetonide group showed a faster reduction in pain after injection compared to the hyaluronic acid and NaCl group. The effect was best seen after

  7. Shoulder pain in primary care: diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain

    Science.gov (United States)

    2013-01-01

    Background Despite numerous methodological flaws in previous study designs and the lack of validation in primary care populations, clinical tests for identifying acromioclavicular joint (ACJ) pain are widely utilised without concern for such issues. The aim of this study was to estimate the diagnostic accuracy of traditional ACJ tests and to compare their accuracy with other clinical examination features for identifying a predominant ACJ pain source in a primary care cohort. Methods Consecutive patients with shoulder pain were recruited prospectively from primary health care clinics. Following a standardised clinical examination and diagnostic injection into the subacromial bursa, all participants received a fluoroscopically guided diagnostic block of 1% lidocaine hydrochloride (XylocaineTM) into the ACJ. Diagnostic accuracy statistics including sensitivity, specificity, predictive values, positive and negative likelihood ratios (LR+ and LR-) were calculated for traditional ACJ tests (Active Compression/O’Brien’s test, cross-body adduction, localised ACJ tenderness and Hawkins-Kennedy test), and for individual and combinations of clinical examination variables that were associated with a positive anaesthetic response (PAR) (P≤0.05) defined as 80% or more reduction in post-injection pain intensity during provocative clinical tests. Results Twenty two of 153 participants (14%) reported an 80% PAR. None of the traditional ACJ tests were associated with an 80% PAR (P0.05). Five clinical examination variables (repetitive mechanism of pain onset, no referred pain below the elbow, thickened or swollen ACJ, no symptom provocation during passive glenohumeral abduction and external rotation) were associated with an 80% PAR (P<0.05) and demonstrated an ability to accurately discriminate between an PAR and NAR (AUC 0.791; 95% CI 0.702, 0.880; P<0.001). Less than two positive clinical features resulted in 96% sensitivity (95% CI 0.78, 0.99) and a LR- 0.09 (95% CI 0.02, 0

  8. Intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer for geriatric and stroke patients

    OpenAIRE

    Hirano, Masahiro; Katoh, Munenori; Kawaguchi, Saori; Uemura, Tomomi

    2016-01-01

    [Purpose] This study aimed to verify the appropriate number of measurements and the intrarater reliabilities of shoulder joint horizontal adductor muscle strength measurements using a handheld dynamometer (HHD) for geriatric and stroke patients. [Subjects and Methods] The subjects were 40 inpatients, who were divided into two groups: 20 stroke patients in the stroke group (SG), and 20 geriatric patients in the no-stroke group (N-SG). Measurements were performed three times using an HHD with a...

  9. Surgical versus injection treatment for injection-confirmed chronic sacroiliac joint pain

    Science.gov (United States)

    Spiker, William Ryan; Lawrence, Brandon D.; Raich, Annie L.; Skelly, Andrea C.; Brodke, Darrel S.

    2012-01-01

    Study design: Systematic review. Study rationale: Chronic sacroiliac joint pain (CSJP) is a common clinical entity with highly controversial treatment options. A recent systematic review compared surgery with denervation, but the current systematic review compares outcomes of surgical intervention with therapeutic injection for the treatment of CSJP and serves as the next step for evaluating current evidence on the comparative effectiveness of treatments for non-traumatic sacroiliac joint pain. Objective or clinical question: In adult patients with injection-confirmed CSJP, does surgical treatment lead to better outcomes and fewer complications than injection therapy? Methods: A systematic review of the English-language literature was undertaken for articles published between 1970 and June 2012. Electronic databases and reference lists of key articles were searched to identify studies evaluating surgery or injection treatment for injection-confirmed CSJP. Studies involving traumatic onset or non-injection–confirmed CSJP were excluded. Two independent reviewers assessed the level of evidence quality using the grading of recommendations assessment, development and evaluation (GRADE) system, and disagreements were resolved by consensus. Results: We identified twelve articles (seven surgical and five injection treatment) meeting our inclusion criteria. Regardless of the type of treatment, most studies reported over 40% improvement in pain as measured by Visual Analog Scale or Numeric rating Scale score. Regardless of the type of treatment, most studies reported over 20% improvement in functionality. Most complications were reported in the surgical studies. Conclusion: Surgical fusion and therapeutic injections can likely provide pain relief, improve quality of life, and improve work status. The comparative effectiveness of these interventions cannot be evaluated with the current literature. PMID:23526911

  10. Technical tips to perform safe and effective ultrasound guided steroid joint injections in children.

    Science.gov (United States)

    Parra, Dimitri A

    2015-01-01

    The aim of this article is to describe the technique used to perform ultrasound guided steroid joint injections in children in a group of joints that can be injected using ultrasound as the only image guidance modality. The technique is described and didactic figures are provided to illustrate key technical concepts. It is very important to be familiar with the sonographic appearance of the pediatric joints and the developing bone when performing ultrasound-guided joint injections in children.

  11. 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

  12. Botulinum toxin type a injections for cervical and shoulder girdle myofascial pain using an enriched protocol design.

    Science.gov (United States)

    Nicol, Andrea L; Wu, Irene I; Ferrante, F Michael

    2014-06-01

    Myofascial pain syndrome is a regional condition of muscle pain and stiffness and is classically characterized by the presence of trigger points in affected musculature. Botulinum toxin type A (BoNT-A) has been shown to have antinociceptive properties and elicit sustained muscle relaxation, thereby possibly affording even greater relief than traditional strategies. Our goal was to determine whether direct injection of BoNT-A into painful muscle groups is effective for cervical and shoulder girdle myofascial pain. An enriched protocol design was used, wherein 114 patients with cervical and shoulder girdle myofascial pain underwent injection of BoNT-A to determine their response to the drug. Fifty-four responders were then enrolled in a 12-week, randomized, double-blind, placebo-controlled trial. Pain scales and quality of life measures were assessed at baseline and at routine follow-up visits until completion of the study after 26 weeks. Injection of BoNT-A into painful muscle groups improved average visual numerical pain scores in subjects who received a second dose of BoNT-A compared to placebo (P = 0.019 [0.26, 2.78]). Subjects who received a second dose of BoNT-A had a reduced number of headaches per week (P = 0.04 [0.07, 4.55]). Brief Pain Inventory interference scores for general activity and sleep were improved (P = 0.046 [0.038, 3.700] and 0.02 [0.37, 4.33], respectively) in those who received a second dose of BoNT-A. BoNT-A injected directly into painful muscle groups improves average pain scores and certain aspects of quality of life in patients experiencing severe cervical and shoulder girdle myofascial pain.

  13. Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints?

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Cynthia; Hodler, Juerg [Orthopaedic University Hospital of Balgrist, Radiology, Zuerich (Switzerland)

    2010-01-15

    This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified. Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone. When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief. (orig.)

  14. Evidence-based radiology (part 2): Is there sufficient research to support the use of therapeutic injections into the peripheral joints?

    International Nuclear Information System (INIS)

    Peterson, Cynthia; Hodler, Juerg

    2010-01-01

    This review article addresses the best evidence currently available for the effectiveness of injection therapy for musculoskeletal conditions involving the peripheral joints. The research is presented by anatomical region and areas of controversy and the need for additional research are identified. Randomized controlled trials, meta-analyses and systematic reviews are lacking that address the effectiveness of therapeutic injections to the sternoclavicular, acromioclavicular, ankle and foot joints. No research studies of any kind have been reported for therapeutic injections of the sternoclavicular joint. With the exception of the knee, possibly the hip and patients with inflammatory arthropathies, research does not unequivocally support the use of therapeutic joint injections for most of the peripheral joints, including the shoulder. Additionally, controversy exists in some areas as to whether or not corticosteroids provide better outcomes compared to local anesthetic injections alone. When viscosupplementation injections are compared to corticosteroids in patients with osteoarthritis of the knee, the evidence supports the use of viscosupplementation for more prolonged improvement in outcomes, with corticosteroids being good for short-term relief. (orig.)

  15. Influence of adjuvant irradiation on shoulder joint function after mastectomy for breast carcinoma

    International Nuclear Information System (INIS)

    Ryttov, N.; Blichert-Toft, M.; Madsen, E.L.; Weber, J.

    1983-01-01

    The influence of postoperative radiation therapy on ipsilateral shoulder function following mastectomy was evaluated from a series of 52 women with primarily operable carcinoma of the breast. Mastectomy and partial axillary dissection were carried out in all patients. In addition, 29 of the patients received postoperative irradiation with 36.6 Gy applied mid-axillarily in 12 fractions with irradiation twice a week. A significant impairment of the active shoulder mobility was found in the irradiated group (p<0.01). The passive mobility did not differ significantly between the two groups. The impairment of active shoulder mobility is suggested to be caused by radiation induced subcutaneous fibrosis. (Auth.)

  16. MANAGEMENT OF PRIMARY FROZEN SHOULDER PROSPECTIVE EVALUATION OF FUNCTIONAL OUTCOME BETWEEN HYDRODILATATION AND INTRA-ARTICULAR STEROID INJECTION

    Directory of Open Access Journals (Sweden)

    Dinesh Mitra R. P

    2017-01-01

    Full Text Available BACKGROUND The aim of this prospective randomized control study is to compare the functional outcome between hydrodilatation and intraarticular steroid injection in patients with primary frozen shoulder. MATERIALS AND METHODS A total number of 52 patients who attended the orthopaedic outpatient between November 2014 and January 2016 were included in this study. The patients were categorized into two groups. Group I patients were treated with hydrodilatation method and Group II patients were treated with intra-articular steroids. Both the group of patients were advised to perform home exercise programs. The patients were assessed at baseline (before the procedure at two weeks, six weeks, three months and six months. All patients were evaluated for functional improvement by measuring the range of active movements and Constant and Murley shoulder outcome scores. RESULTS Up to three months patients treated with hydrodilatation have significantly better functional outcome as evaluated by active range of movements and Constant and Murley score. But at six months there is no significant difference in functional outcome between two methods of treatment. CONCLUSION There was improvement in functional outcome in both the methods of treatment. But patients treated by hydrodilatation showed more significant increase in functional outcome for the first three months. Home exercise forms an integral part in the management of primary frozen shoulder.

  17. Long-Acting Diclofenac Ester Prodrugs for Joint Injection

    DEFF Research Database (Denmark)

    Mertz, Nina; Larsen, Susan Weng; Kristensen, Jesper

    2016-01-01

    A prodrug approach for local and sustained diclofenac action after injection into joints based on ester prodrugs having a pH-dependent solubility is presented. Inherent ester prodrug properties influencing the duration of action include their pH-dependent solubility and charge state, as well...... as susceptibility to undergo esterase facilitated hydrolysis. In this study, physicochemical properties and pH rate profiles of 3 diclofenac ester prodrugs differing with respect to the spacer carbon chain length between the drug and the imidazole-based promoiety were determined and a rate equation for prodrug...... degradation in aqueous solution in the pH range 1-10 was derived. In the pH range 6-10, the prodrugs were subject to parallel degradation to yield diclofenac and an indolinone derivative. The prodrug degradation was found to be about 6-fold faster in 80% (vol/vol) human plasma as compared to 80% (vol...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Chandrashekara Chowdipalya Maliyappa

    2013-01-01

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

  20. Correlations among visual analogue scale, neck disability index, shoulder joint range of motion, and muscle strength in young women with forward head posture.

    Science.gov (United States)

    Shin, Young Jun; Kim, Won Hyo; Kim, Seong Gil

    2017-08-01

    This study investigated the correlation between the neck disability index (NDI) and visual analogue scale (VAS), which are indicators of neck pain, shoulder joint range of motion (ROM), and muscle strength in women with a slight forward head posture. This study was carried out on 42 female college students attending Uiduk University in Gyeongju, Korea. The neck pain and disability index for each subject was measured using VAS and NDI, respectively. Two physiotherapists measured the shoulder joint ROM and muscle strengths of the subjects using a goniometer and a dynamometer, respectively. External rotation, internal rotation, and abduction of the shoulder joint were measured for each subject. A significant negative correlation between neck pain and shoulder joint ROM in external rotation and the muscle strength of the shoulder joint in abduction was found in the subjects. In addition, a significant positive correlation was observed between ROM in external rotation and muscle strength in abduction. This study showed a significant negative correlation between neck pain and ROM in external rotation as well as between neck pain and the muscle strength in abduction.

  1. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians.

    Science.gov (United States)

    Skedros, John G; Hunt, Kenneth J; Pitts, Todd C

    2007-07-06

    Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1) fluorinated vs. non-fluorinated corticosteroids, 2) acetate vs. phosphate types, 3) patient age, and 4) adjustments for special considerations including young athletes and diabetics. 169 (64% response rate, RR) surveys were returned: 105/163 orthopaedic surgeons (64%RR), 44/77 PCSMs/PMRs (57%RR), 20/24 rheumatologists (83%RR). Although corticosteroid doses do not differ significantly between specialties (p > 0.3), anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol(R) (methylprednisolone acetate) and Kenalog(R) (triamcinolone acetonide) are most commonly used. More rheumatologists (80%) were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76%) and orthopaedists (60%). However, relatively fewer rheumatologists (25%) than PCSMs/PMRs (32%) or orthopaedists (32%) knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37% orthopaedists. Nearly 85% use the same

  2. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    Directory of Open Access Journals (Sweden)

    Skedros John G

    2007-07-01

    Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

  3. The utility of international shoulder joint replacement registries and databases: a comparative analytic review of two hundred and sixty one thousand, four hundred and eighty four cases.

    Science.gov (United States)

    Bayona, Carlos Eduardo Afanador; Somerson, Jeremy S; Matsen, Frederick A

    2018-02-01

    National registries are valuable tools for understanding the results of shoulder arthroplasty across populations. These databases provide an unselected view of shoulder joint replacement within geographical areas that cannot be obtained from case series or prospective studies. They can be particularly helpful in determining which diagnoses, patients, procedures, and prostheses have higher than expected rates of revision. In an attempt to determine the generalizability of registry data, we asked, 'how similar are the patients and procedures among the different national registries?' We analyzed national shoulder arthroplasty registries and databases accessed via Internet portals and through a PubMed literature search. Seven national/regional registries and five publications regarding national shoulder arthroplasty data were identified; these sources contained a combined total of 261,484 shoulder arthroplasty cases. The percentages of hemiarthroplasty, anatomic (aTSA) and reverse total shoulders (rTSA), the diagnoses leading to arthroplasty, the mean patient age, and the distribution of patient gender varied significantly among these different databases. This study indicates that the indications for and application of shoulder arthroplasty have important geographical variations and that these variations must be considered when comparing outcomes of shoulder arthroplasty from different locations. Without controlling for age, gender, diagnosis and procedure type, the results from one national registry may not be applicable to patients from a different location. In that national data provide the opportunity to reduce costs by identifying implants and procedures with higher failure rates, the funding of registries needs to be free of conflicts of interest.

  4. The use of imatinib in the treatment of inoperable dermatofibrosarcoma protuberans in the area of the shoulder joint

    Directory of Open Access Journals (Sweden)

    Joanna Huszno

    2014-06-01

    Full Text Available Introduction. Dermatofibrosarcoma protuberans (DFSP is a rare sarcoma of the skin and subcutaneous tissue. The most common clinical problem is its local recurrence. The therapeutic procedure of choice is radical surgery. In the case of inoperable disease, targeted therapy with imatinib, a tyrosine kinase inhibitor, may cause significant reduction of tumor volume and even enable radical surgery. Objective. We present the effectiveness of imatinib for the treatment of unresectable DFSP localized in the area of the shoulder joint of a 62-year-old woman. Case report. The patient met the criteria for inclusion in treatment with imatinib. After 3 cycles of treatment, partial regression of the lesions (above 50% was observed. Therapy was complicated by hepatological side effects during the sixth cycle. Treatment was continued with a reduced dose when transaminase levels normalized. In a physical examination and imaging studies, further regression was observed. The patient has regained considerable mobility of the shoulder joint. A decision to continue the treatment has been made. Conclusions. The use of imatinib allowed a clinical benefit to be gained in the form of significant regression of lesions. A very good treatment response and significant improvement in quality of life of the patient were achieved. The patient has been treated with imatinib for 30 months.

  5. Shoulder Fractures

    Science.gov (United States)

    ... All Topics A-Z Videos Infographics Symptom Picker Anatomy Bones Joints Muscles Nerves Vessels Tendons About Hand Surgery What is a Hand Surgeon? What is a Hand Therapist? Media Find a Hand Surgeon Home Anatomy Shoulder Fractures Email to a friend * required fields ...

  6. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    OpenAIRE

    Skedros John G; Hunt Kenneth J; Pitts Todd C

    2007-01-01

    Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs) and physical medicine and rehabilitation (PMRs) physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anest...

  7. Using the American alligator and a repeated-measures design to place constraints on in vivo shoulder joint range of motion in dinosaurs and other fossil archosaurs.

    Science.gov (United States)

    Hutson, Joel D; Hutson, Kelda N

    2013-01-15

    Using the extant phylogenetic bracket of dinosaurs (crocodylians and birds), recent work has reported that elbow joint range of motion (ROM) studies of fossil dinosaur forearms may be providing conservative underestimates of fully fleshed in vivo ROM. As humeral ROM occupies a more central role in forelimb movements, the placement of quantitative constraints on shoulder joint ROM could improve fossil reconstructions. Here, we investigated whether soft tissues affect the more mobile shoulder joint in the same manner in which they affect elbow joint ROM in an extant archosaur. This test involved separately and repeatedly measuring humeral ROM in Alligator mississippiensis as soft tissues were dissected away in stages to bare bone. Our data show that the ROMs of humeral flexion and extension, as well as abduction and adduction, both show a statistically significant increase as flesh is removed, but then decrease when the bones must be physically articulated and moved until they separate from one another and/or visible joint surfaces. A similar ROM pattern is inferred for humeral pronation and supination. All final skeletonized ROMs were less than initial fully fleshed ROMs. These results are consistent with previously reported elbow joint ROM patterns from the extant phylogenetic bracket of dinosaurs. Thus, studies that avoid separation of complementary articular surfaces may be providing fossil shoulder joint ROMs that underestimate in vivo ROM in dinosaurs, as well as other fossil archosaurs.

  8. Vision System-Based Design and Assessment of a Novel Shoulder Joint Mechanism for an Enhanced Workspace Upper Limb Exoskeleton

    Directory of Open Access Journals (Sweden)

    Eduardo Piña-Martínez

    2018-01-01

    Full Text Available Exoskeletons arise as the common ground between robotics and biomechanics, where rehabilitation is the main field in which these two disciplines find cohesion. One of the most relevant challenges in upper limb exoskeleton design relies in the high complexity of the human shoulder, where current devices implement elaborate systems only to emulate the drifting center of rotation of the shoulder joint. This paper proposes the use of 3D scanning vision technologies to ease the design process and its implementation on a variety of subjects, while a motion tracking system based on vision technologies is applied to assess the exoskeleton reachable workspace compared with an asymptomatic subject. Furthermore, the anatomic fitting index is proposed, which compares the anatomic workspace of the user with the exoskeleton workspace and provides insight into its features. This work proposes an exoskeleton architecture that considers the clavicle motion over the coronal plane whose workspace is determined by substituting the direct kinematics model with the dimensional parameters of the user. Simulations and numerical examples are used to validate the analytical results and to conciliate the experimental results provided by the vision tracking system.

  9. Intra-articular injection of dexketoprofen in rat knee joint: histopathologic assessment of cartilage & synovium.

    Science.gov (United States)

    Ekici, Aycan Guner; Akyol, Onat; Ekici, Murat; Sitilci, Tolga; Topacoglu, Hakan; Ozyuvaci, Emine

    2014-08-01

    Effective pain control following outpatient surgical procedures is an important aspect of patient discharge. This study was carried out with an aim to investigate the histopathological effects of intra-articular dexketoprofen trometamol injection in knee joint on synovium and cartilage in an experimental rat model. In each of 40 rats, the right knee was designated as the study group and the left knee as the control group (NS group). Under aseptic conditions, 35 rats received an injection of 0.25 ml (6.25 mg) dexketoprofen trometamol into the right knee joint and an injection of 0.25 ml 0.9 per cent normal saline solution into the left knee joint. On the 1st, 2nd, 7th, 14th, and 21st days after intra-articular injection, rats in specified groups were sacrificed by intraperitoneal injection of 120 mg/kg sodium thiopental. Knee joints were separated and sectioned for histopathological examination. Inflammatory changes in the joints were recorded according to a grade scale. No significant difference in terms of pathological changes both in synovium and cartilage was observed between the NS group and the study group on days 1, 2, 7, 14 and 21 after intra-articular injection of dexketoprofen or saline in the knee joint. The findings showed no evidence of significant histopathological damage to the cartilage and synovia for a period up to 21 days following intra-articular administration of dexketoprofen trometamol in the knee joints of rats.

  10. Shoulder function, pain and health related quality of life in adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type

    DEFF Research Database (Denmark)

    Johannessen, Elise Christine; Reiten, Helle Sundnes; Løvaas, Helene

    2016-01-01

    Purpose To investigate shoulder function, pain and Health-Related Quality of life (HRQoL) among adults with joint hypermobility syndrome/Ehlers-Danlos syndrome-hypermobility type (JHS/EDS-HT), compared with the general population (controls). Method In a cross-sectional study using postal survey...

  11. Fluoroscopy-Guided Sacroiliac Intraarticular Injection via the Middle Portion of the Joint.

    Science.gov (United States)

    Kurosawa, Daisuke; Murakami, Eiichi; Aizawa, Toshimi

    2017-09-01

    Sacroiliac intraarticular injection is necessary to confirm sacroiliac joint (SIJ) pain and is usually performed via the caudal one-third portion of the joint. However, this is occasionally impossible for anatomical reasons, and the success rate is low in clinical settings. We describe a technique via the middle portion of the joint. Observational study. Enrolled were 69 consecutive patients (27 men and 42 women, with an average age of 53 years) in whom the middle portion of 100 joints was targeted. With the patient lying prone-oblique with the painful side down, a spinal needle was inserted into the middle portion of the joint. Subsequently, the fluoroscopy tube was angled at a caudal tilt of 25-30° to clearly detect the recess between the ilium and sacrum and the needle depth and direction. When the needle reached the posterior joint line, 2% lidocaine was injected after the contrast medium outlined the joint. The success rate of the injection method was 80% (80/100). Among 80 successful cases, four were previously unsuccessful when the conventional method was used. Intraarticular injection using the new technique was unsuccessful in 20 joints; in three of these cases, the conventional method proved successful, and no techniques were successful in the other 17 cases. The injection technique via the middle portion of the joint can overcome some of the difficulties of the conventional injection method and can improve the chances of successful intraarticular injection. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  12. Postoperative MR arthography of the shoulder joint; MR-Arthographie des Schultergelenks im postoperativen Patientenkollektiv

    Energy Technology Data Exchange (ETDEWEB)

    Rand, T. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Trattnig, S. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Breitenseher, M. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria); Freilinger, W. [Orthopaedisches Krankenhaus Speising (Austria); Cochole, M. [Orthopaedische Abt., Allgemein Oeffentliches Krankenhaus Amstetten (Austria); Imhof, H. [Einrichtung fuer Magnetresonanz, Ludwig Boltzmann-Inst. fuer Radiologische Tumordiagnostik, Univ. Wien (Austria)

    1996-12-01

    Indications of MR arthrography were analyzed in this prospective study. The aim was to evaluate possible advantages over conventional MRI, establish diagnostic criteria and to analyze its meaning further for the therapeutic management of postoperative patients. MR arthrography was performed in eight patients who had undergone surgical repair of rotator cuff lesions (modified Neer acromioplasty) and in six patients who had undergone arthroscopic therapy of recurrent unidirectional dislocation of the shoulder by combined arthroscopic intra- and extracapsular repair. MR investigations were performed before and after application of a contrast solution (2 mmol Gd-DTPA). All patients suffered from chronic postoperative pain. In patients with rotator cuff lesions, a partial tear could be verified in one patient and excluded in all others. In patients after arthroscopic therapy by combined intra- and extracapsular repair, a radiologically patulous-appearing capsule correlated with clinically recurrent dislocations. In all other patients diagnostic criteria, such as distribution of the intra-articular contrast solution, proliferation of scar tissue, nodular appearance of the glenohumeral ligaments and capsule thickness, correlated with a regular postoperative status. MR arthrography of the shoulder represents a promising method in the evaluation of the postoperative shoulder. It might further improve the evaluation of reactive capsule alterations, scar tissue proliferation, and the labroligamentous complex, as well as the ability to differentiate partial and complete rerupture from degenerative changes of the rotator cuff. (orig.) [Deutsch] In einer prospektiven Studie sollten die Einsatzmoeglichkeiten der MR-Arthrographie am operierten Schultergelenk erfasst werden. Ziel der Studie war einerseits eine gegenueber der konventionellen MR-Untersuchung verbesserten Diagnosestellung und andererseits die Erstellung von fuer die Rezidivdiagnostik relevanten Diagnosekriterien

  13. Accelerated avascular necrosis after single intra-articular injection of corticosteroid into the hip joint

    OpenAIRE

    Kassam, A M

    2010-01-01

    Avascular necrosis (AVN) involves destruction of the hip joint. Long-term use of steroids has been shown to cause AVN. This article presents a case of intra-articular injection of steroid causing a rapid onset of AVN in the hip joint. Bone histology at time of total hip replacement showed evidence of AVN and no evidence of infection.

  14. Single-needle temporomandibular joint arthrocentesis with hyaluronic acid injections. Preliminary data after a five-injection protocol.

    Science.gov (United States)

    Manfredini, D; Guarda-Nardini, L; Ferronato, G

    2009-10-01

    The classical technique for temporomandibular joint (TMJ) arthrocentesis provides a double access to the joint space, which may lead to patient's postoperatory discomfort. For this reason, a less invasive, single-needle approach has been recently described, and the present investigation reports findings on a case series of patients with TMJ osteoarthritis treated with hyaluronic acid injections following a single needle arthrocentesis. METHODS. Fourteen consecutive patients with a diagnosis of TMJ osteoarthritis according to the Research Diagnostic Criteria for Temporo-mandibular Disorders were treated with a cycle of five weekly injections of hyaluronic acid after arthrocentesis. A number of subjective (pain at rest and mastication, masticatory efficiency, functional limitation, subjective efficacy of treatment, tolerability of treatment) and objective (maximum assisted and unassited mouth opening, protrusive and laterotrusive movements) outcome variables were assessed before and after the treatment period. At the end of the five-injection protocol, significant improvements were showed in almost all the subjective outcome variables. Tolerability of the treatment was good on a four-point ordinal scale since the time of the first injection. The present investigation suggested that the single needle technique for TMJ hyaluronic injection following arthrocentesis in osteoarthritic joints may have promising applications in the clinical setting, which have to be confirmed with future studies.

  15. Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

    Science.gov (United States)

    Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

    2016-01-01

    Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  16. Shoulder arthrography: A study for the correlation of anatomy and radiology

    International Nuclear Information System (INIS)

    Sung, K. J.; Kim, I. Y.; Park, C. Y.

    1983-01-01

    Shoulder arthrogram and dissection in cadaver were performed for clinical application. Puncture site for contrast injection was studied. The results were as follows: 1. Shoulder joints is located above the axillar and arthrography of shoulder is a simple, safe and easily interpreted. 2. The land mark for injection is a point 1.5 cm below the tip of coracoid process and very slightly medial to it. 3. There were contrast material leak from subscapular recess and distal end of the synovial sheath surrounding the long head of the biceps tendon in normal shoulder arthrogram. 4. Synoviad cavity margin show smoothness and no abnormal filling defect. 5. There were no communication between synovial cavity and subdeltoid bursa. 6. There were no specific anatomic variation in shoulder joint

  17. Coracoclavicular joint

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kun Sang; Park, Chan Il; Ahn, Jae Doo; Lim, Chong Won [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1970-10-15

    The coracoclvicular joint, a rear abnormality which may be the cause of pain in the shoulder and limitation of motion of the shoulder joint, is discussed. A case of coracoclvicular joint with shoulder pain was observed in 65 yrs old Korean male.

  18. Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

    International Nuclear Information System (INIS)

    Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W.; Jhangri, G.S.

    2006-01-01

    Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 (±15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation

  19. Transverse morphology of the sacroiliac joint: effect of angulation and implications for fluoroscopically guided sacroiliac joint injection

    Energy Technology Data Exchange (ETDEWEB)

    Ling, B.C.; Lee, J.W.; Man, H.S.J.; Grace, M.G.A.; Lambert, R.G.W. [Department of Radiology and Diagnostic Imaging, University of Alberta Hospital, Edmonton (Canada); Jhangri, G.S. [Department of Public Health Sciences, University of Alberta Hospital, Edmonton (Canada)

    2006-11-15

    Effects of angulation of computed tomography (CT) reconstruction plane on sacroiliac (SI) joint morphology were studied, and factors influencing the approach to fluoroscopically guided SI joint injection were assessed. CT scans of pelvises were reformatted on 41 subjects, aged 51.7 ({+-}15.1) years. Transverse images were reconstructed at the caudal 3 cm of the SI joint tilting plane of reconstruction from -30 to +30 at 15 increments. Anteroposterior diameter of joint (depth), angle from sagittal plane (orientation angle), and distance from skin were measured. Joint contour was classified, and presence of bone blocking access to the joint was recorded. Comparison between angles were analysed by t-test. Relationships between variables were assessed by a Pearson correlation test. Depth was shorter with angulation in the inferior direction (P<0.01). Orientation angle increased with superior angulation (P<0.01). Distance from skin increased (P<0.01) with angulation in either direction. Joint contour was significantly different from baseline at each angle (P<0.001) but highly variable. Inferior angulation resulted in interposition of ilium between skin and SI joint, and superior angulation caused bone block due to the lower sacrum. None of these features was identified without tilting of the reconstruction plane, and effects were more pronounced with steeper angulation.

  20. Radiologic Analysis and Clinical Study of the Upper One-third Joint Technique for Fluoroscopically Guided Sacroiliac Joint Injection.

    Science.gov (United States)

    Park, Junghyun; Park, Hue Jung; Moon, Dong Eon; Sa, Gye Jeol; Kim, Young Hoon

    2015-01-01

    Sacroiliac intraarticular injection by the traditional technique can be challenging to perform when the joint is covered with osteophytes or is extremely narrow. To examine whether there is enough space for the needle to be advanced from the L5-S1 interspinous space to the upper one-third sacroiliac joint (SIJ) by magnetic resonance image (MRI) analysis as an alternative to fluoroscopically guided SIJ injection with the lower one-third joint technique, and to determine the feasibility of this novel technique in clinical practice. MRI analysis and observational study. An interventional pain management practice at a university hospital. We analyzed 200 axial T2-weighted MRIs between the L5 and S1 vertebrae of 100 consecutive patients. The following measurements were obtained on both sides: 1) the thickness of fat in the midline; 2) the distance between the midline (Point C) and the junction (Point A) of the skin and the imaginary line that connects the SIJ and the most medial cortex of the ilium; 3) the distance between the midline (Point C) and the junction (Point B) of the skin and the imaginary line that connects the SIJ and the L5 spinous process; 4) the distance between the SIJ and midline (Point C) on the skin, or between the SIJ and the midpoint (Point C') of the line from Point A to Point B; and 5) the angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin. The upper one-third joint technique was performed to establish the feasibility of the alternative technique in 20 patients who had unsuccessful sacroiliac intraarticular injections using the lower one-third joint technique. The mean distances from the midline to Point A and to Point B were 21.9 ± 13.7 mm and 27.8 ± 13.6 mm, respectively. The mean distance between the SIJ and Point C (or Point C') was 81.0 ± 13.3 mm. The angle between the sagittal line and the imaginary line that connects the SIJ and the midline on the skin was 42.8 ± 5.1°. The success

  1. Capsule-Preserving Hydrodilatation With Corticosteroid Versus Corticosteroid Injection Alone in Refractory Adhesive Capsulitis of Shoulder: A Randomized Controlled Trial.

    Science.gov (United States)

    Lee, Doo-Hyung; Yoon, Seung-Hyun; Lee, Michael Y; Kwack, Kyu-Sung; Rah, Ueon Woo

    2017-05-01

    To determine whether capsule-preserved hydrodilatation with corticosteroid improves pain and function in patients with refractory adhesive capsulitis (AC) better than intra-articular corticosteroid injection (IACI) alone. Prospective randomized controlled study. University-affiliated tertiary care hospital. Subjects with primary AC (N=64) with shoulder pain level of visual analog scale (VAS) score ≥5, even after the initial administration of IACI alone. Participants randomly received ultrasound-guided IACI alone with 1mL of 40mg/mL triamcinolone acetonide and 3mL of 1% lidocaine (n=32) or ultrasound-guided capsule-preserved hydrodilatation with corticosteroid with a mixture of 1mL of 40mg/mL triamcinolone acetonide, 6mL of 1% lidocaine, and normative saline (n=32). The primary outcome measure was the Shoulder Pain and Disability Index score. Secondary outcomes were the VAS of shoulder pain level and angles of shoulder passive range of motion, including flexion, abduction, extension, external rotation, and internal rotation at pretreatment and weeks 3, 6, and 12 of posttreatment. There were no significant differences between the 2 groups in terms of demographic characteristics (age, sex, duration of symptoms, shoulder affected, and body mass index) at baseline. Repeated-measures analysis of variance showed significant effect of time in all outcome measurements in both groups. However, group-by-time interactions were not significantly different for any of the outcomes between groups. This study shows that compared with pretreatment, all outcome measures improved significantly in both groups by time; however, there was no significant difference between the 2 groups. Therefore, we recommend IACI alone over capsule-preserved hydrodilatation with corticosteroid when considering the corticosteroid injection as a secondary option after the initial IACI fails to improve symptoms for patients with refractory AC. Copyright © 2016 American Congress of Rehabilitation

  2. Intra-articular injection of dexketoprofen in rat knee joint : Histopathologic assessment of cartilage & synovium

    Directory of Open Access Journals (Sweden)

    Aycan Guner Ekici

    2014-01-01

    Full Text Available Background & objectives: Effective pain control following outpatient surgical procedures is an important aspect of patient discharge. This study was carried out with an aim to investigate the histopathological effects of intra-articular dexketoprofen trometamol injection in knee joint on synovium and cartilage in an experimental rat model. Methods: In each of 40 rats, the right knee was designated as the study group and the left knee as the control group (NS group. Under aseptic conditions, 35 rats received an injection of 0.25 ml (6.25 mg dexketoprofen trometamol into the right knee joint and an injection of 0.25 ml 0.9 per cent normal saline solution into the left knee joint. On the 1 st , 2 nd , 7 th , 14 th , and 21 st days after intra-articular injection, rats in specified groups were sacrificed by intraperitoneal injection of 120 mg/kg sodium thiopental. Knee joints were separated and sectioned for histopathological examination. Inflammatory changes in the joints were recorded according to a grade scale. Results: No significant difference in terms of pathological changes both in synovium and cartilage was observed between the NS group and the study group on days 1, 2, 7, 14 and 21 after intra-articular injection of dexketoprofen or saline in the knee joint. Interpretation & conclusions: The findings showed no evidence of significant histopathological damage to the cartilage and synovia for a period up to 21 days following intra-articular administration of dexketoprofen trometamol in the knee joints of rats.

  3. US of the shoulder

    International Nuclear Information System (INIS)

    Gardellin, G.; Perin, B.

    1987-01-01

    Twenty five healty people and 25 patients with shoulder pain underwent US control over a 12-month period: 24 patients with shoulder pain had rotator cuff and/or biceps tendon lesions. The US findings on rotator cuff and biceps tendon lesions are compared with those of arthrography and/or surgery (96% sensitivity). US is rapid, safe, non invasive, inexpensive and often more accurate, and its use is recommended for the routine examination of the shoulder joint insteat of arthrography

  4. [Shoulder injuries in golf].

    Science.gov (United States)

    Liem, D; Gosheger, G; Schmidt, C

    2014-03-01

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

  5. Effects of LLLT on the periarthritis of the shoulder: a clinical study on different treatments with corticosteroid injections or a wait-and-see policy

    Science.gov (United States)

    Tam, Giuseppe

    2005-11-01

    The aim of this study was to compare the efficacy of three types of treatments in the periarthritis of the shoulder: corticosteroid injections, Low Level Laser Therapy (LLLT) or wait-and-see-policy. BACKGROUND DATA: Low level laser irradiation is a treatment method widely used in medical science. Many disorders, such as osteoarthritis and musculoskeletal conditions with pain, have been treated with LLLT. METHODS: Patients, suffering from periarthritis of the shoulder of at least 6 weeks' duration, were recruited by family doctors. We randomly allocated eligible patients to 6 weeks of treatment n. 20 (33%) with corticosteroid injection, n. 21 (35%) with LLLT and with wait-and-see policy n.19 (31%). We applied a number of 12 sessions with infrared Diode Laser Ga-As (904 nm), 60 W maximum power, peak power per pulse 27 W, pulse frequency 1280 Hz, average point region 2-8 J; dose/point = 3-4 J; total energy density 24 J/cm2. Outcome measures included general improvement, severity of the main complaint, pain, shoulder disability, and patient satisfaction. Severity of shoulder complaints, abduction and elevation of the arm, and the pressure pain threshold were assessed. The principal analysis was done on an intention treatment basis. We assessed all outcomes at 3,6, 12, 26, 52 weeks. RESULTS: We randomly assigned 60 patients. At 6 weeks, corticosteroid injections were significantly better than all other therapy options for all outcome measures. Success rates were 90% (18) compared with 52% (11) for LLLT and 35% (7) for wait-and-see policy. Long-term differences between injections and LLLT were significantly in favour of LLLT. Success rate at 52 weeks were 14 (70%) for injections, 19 (90.5%) for LLLT, and 16 (84%) for wait-and-see policy. LLLT had better results than a wait-and-see policy, but differences were not significant ( p disadvantages of the treatment options for the periarthritis of the shoulder. The decision to treat with LLLT or to adopt a wait-and-see policy

  6. A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities.

    Science.gov (United States)

    Izadpanah, Kaywan; Winterer, Jan; Vicari, Marco; Jaeger, Martin; Maier, Dirk; Eisebraun, Leonie; Ute Will, Jutta; Kotter, Elmar; Langer, Mathias; Südkamp, Norbert P; Hennig, Jürgen; Weigel, Mathias

    2013-06-01

    To show the feasibility of a stress magnetic resonance imaging (MRI) as a new method for simultaneous evaluation of the morphology and the functional integrity of the acromioclavicular joint (ACJ) ligamentous stabilizers. MRI of four volunteers, 10 patients with acute, and six with chronic ACJ injuries was performed using a 0.25 T open MRI scanner. A 2D-proton-density and a 3D-gradient-echo sequence at rest and under 6.5 kg shoulder traction were performed. Comparative measurements of the coracoclavicular and the acromioclavicular distance were performed. Additionally, the conoid and trapezoid ligament lengths were measured with multiplanar reconstructions. MRI at rest correctly identified tears of the coracoclavicular and the acromioclavicular ligaments in eight patients suffering acute ACJ injuries. Stress application helped to distinguish between partial and complete coracoclavicular ligament tears in two cases. Insufficiency of the ACJ ligaments was present in all acute and chronic ACJ injuries. Stress application in chronic ACJ ligaments revealed isolated insufficiency of the conoid ligament in three cases and of the trapezoid ligament in one case. Combined insufficiency was present in two cases. Stress MRI facilitates simultaneous acquisition of morphologic and functional information of the ACJ stabilizers. In acute ACJ injuries it helps to distinguish between partial and complete ligament tears. In chronic ACJ injuries it provides functional information of the ligament regrinds. Copyright © 2012 Wiley Periodicals, Inc.

  7. Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles.

    Science.gov (United States)

    Vorobeichik, L; Brull, R; Bowry, R; Laffey, J G; Abdallah, F W

    2018-04-01

    Major shoulder surgery is associated with moderate-to-severe pain, but consensus on the optimal analgesic approach is lacking. Continuous catheter-based interscalene block (CISB) prolongs the analgesic benefits of its single-injection counterpart (SISB), but concerns over CISB complications and difficulties in interpreting comparative evidence examining major and minor shoulder procedures simultaneously, despite their differences in postoperative pain, have limited CISB popularity. This meta-analysis evaluates the CISB analgesic role and complications compared with SISB for major shoulder surgery. We retrieved randomised controlled trials (RCTs) comparing the effects of CISB to SISB on analgesic outcomes and side-effects after major shoulder surgery. Postoperative opioid consumption at 24 h was designated as the primary outcome. Secondary outcomes included 24-48 h opioid consumption, postoperative rest and dynamic pain scores up to 72 h, time-to-first analgesic, recovery room and hospital stay durations, patient satisfaction, postoperative nausea and vomiting, respiratory function, and block-related complications. Data from 15 RCTs were pooled using random-effects modelling. Compared with SISB, CISB reduced 24- and 48-h oral morphine consumption by a weighted mean difference [95% confidence interval] of 50.9 mg [-81.6, -20.2], (P=0.001) and 44.7 mg [-80.9, -8.7], (Pshoulder surgery, without increasing side-effects, compared with SISB. The importance of CISB-related changes in respiratory indices is questionable. Copyright © 2017 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  8. Shoulder pain

    Science.gov (United States)

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

  9. Relationship Between the Range of Motion and Isometric Strength of Elbow and Shoulder Joints and Ball Velocity in Women Team Handball Players.

    Science.gov (United States)

    Schwesig, René; Hermassi, Souhail; Wagner, Herbert; Fischer, David; Fieseler, Georg; Molitor, Thomas; Delank, Karl-Stefan

    2016-12-01

    Schwesig, R, Hermassi, S, Wagner, H, Fischer, D, Fieseler, G, Molitor, T, and Delank, K-S. Relationship between the range of motion and isometric strength of elbow and shoulder joints and ball velocity in women team handball players. J Strength Cond Res 30(12): 3428-3435, 2016-The aims of this study were to investigate relationships between isometric strength and range of motion (ROM) of shoulder and elbow joints and compare 2 different team handball throwing techniques in women team handball. Twenty highly experienced women team handball players (age: 20.7 ± 2.9 years; body mass: 68.4 ± 6.0 kg; and height: 1.74 ± 0.06 m) participated in this study. The isometric strength (hand-held dynamometer) and ROM (goniometer) of shoulder and elbow joints were measured at the beginning of the preseasonal training. After clinical examination, the subjects performed 3 standing throws with run-up (10 m) and 3 jump throws over a hurdle (0.20 m). The mean ball velocity was calculated from 3 attempts and measured using a radar gun. The results showed that the ball velocity of the standing throw with run-up (vST) was significantly higher than that of the jump throw (vJT) (25.5 ± 1.56 vs. 23.2 ± 1.31 m·s; p handball players.

  10. Utilization and growth patterns of sacroiliac joint injections from 2000 to 2011 in the medicare population.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Hansen, Hans; Pampati, Vidyasagar; Falco, Frank J E

    2013-01-01

      The high prevalence of persistent low back pain and growing number of diagnostic and therapeutic modalities employed to manage chronic low back pain and the subsequent impact on society and the economy continue to hold sway over health care policy. Among the multiple causes responsible for chronic low back pain, the contributions of the sacroiliac joint have been a subject of debate albeit a paucity of research. At present, there are no definitive conservative, interventional or surgical management options for managing sacroiliac joint pain. It has been shown that the increases were highest for facet joint interventions and sacroiliac joint blocks with an increase of 310% per 100,000 Medicare beneficiaries from 2000 to 2011. There has not been a systematic assessment of the utilization and growth patterns of sacroiliac joint injections. Analysis of the growth patterns of sacroiliac joint injections in Medicare beneficiaries from 2000 to 2011. To evaluate the utilization and growth patterns of sacroiliac joint injections. This assessment was performed utilizing Centers for Medicare and Medicaid Services (CMS) Physician/Supplier Procedure Summary (PSPS) Master data from 2000 to 2011. The findings of this assessment in Medicare beneficiaries from 2000 to 2011 showed a 331% increase per 100,000 Medicare beneficiaries with an annual increase of 14.2%, compared to an increase in the Medicare population of 23% or annual increase of 1.9%. The number of procedures increased from 49,554 in 2000 to 252,654 in 2011, or a rate of 125 to 539 per 100,000 Medicare beneficiaries. Among the various specialists performing sacroiliac joint injections, physicians specializing in physical medicine and rehabilitation have shown the most increase, followed by neurology with 1,568% and 698%, even though many physicians from both specialties have been enrolling in interventional pain management and pain management. Even though the numbers were small for nonphysician providers including

  11. Fluoroscopically Guided Sacroiliac Joint Injections: Comparison of the Effects of Intraarticular and Periarticular Injections on Immediate and Short-Term Pain Relief.

    Science.gov (United States)

    Nacey, Nicholas C; Patrie, James T; Fox, Michael G

    2016-11-01

    The purpose of this study was to determine whether intraarticular sacroiliac joint injections provide greater immediate and short-term pain relief than periarticular sacroiliac joint injections do. The records of all fluoroscopically guided sacroiliac joint injections performed over a 4-year period were identified. Patients who received an injection of 0.5 mL of bupivacaine and 0.5 mL (20 mg) of triamcinolone and who had preinjection, immediate, and 1-week postinjection pain scores (0-10 numeric scale) were included. Images from the procedures were retrospectively reviewed by two musculoskeletal radiologists to determine intraarticular or periarticular administration of the injection with discrepancies resolved by consensus. One hundred thirteen injections in 99 patients (65 women, 34 men; mean age, 59.4 years) met the inclusion criteria. There were 55 intraarticular and 58 periarticular injections. The mean preinjection, immediate, and 1-week postinjection pain scores for the intraarticular injections were 6.0, 1.6, and 4.1 and for the periarticular injections were 6.1, 2.0, and 4.2. The mean immediate and 1-week postinjection pain reduction were statistically significant in both groups (p sacroiliac joint injections provide statistically significant immediate and 1-week postinjection pain relief, no significant difference in the degree of pain relief achieved with intraarticular and periarticular injections was noted.

  12. Autologous blood injection to the temporomandibular joint: magnetic resonance imaging findings

    Energy Technology Data Exchange (ETDEWEB)

    Candirili, Celal; Yuece, Serdar; Cavus, Umut Yuecel; Akin, Kayihan; Cakir, Banu [Fatih University Hospital, Ankara (Turkmenistan)

    2012-03-15

    The aim of this study was to investigate the effect of the autologous blood injection (ABI) for chronic recurrent temporomandibular joint (TMJ) dislocation using magnetic resonance imaging (MRI). ABI was applied to 14 patients who had chronic recurrent TMJ dislocation. MRIs of the patients were taken and compared before and one month after the injection. All of the patients had no dislocations of their TMJs on clinical examination one month after the injection. In the pre-injection, unilateral or bilateral TMJ dislocations were observed on MRIs in all patients. One month after the injection, TMJ dislocations were not observed in MRI evaluation of any patients. A significant structural change that caused by ABI was not observed. The procedure was easy to perform and it caused no foreign body reaction. However, it was unclear how the procedure prevented the dislocation.

  13. Shoulder pain in hemiplegia.

    Science.gov (United States)

    Andersen, L T

    1985-01-01

    Development of a painful shoulder in the hemiplegic patient is a significant and serious problem, because it can limit the patient's ability to reach his or her maximum functional potential. Several etiologies of shoulder pain have been identified, such as immobilization of the upper extremity, trauma to the joint structures, including brachial plexus injuries, and subluxation of the gleno-humeral joint. A review of the literature explains the basic anatomy and kinesiology of the shoulder complex, the various etiologies of hemiplegic shoulder pain, and the pros and cons of specific treatment techniques. This knowledge is essential for the occupational therapist to evaluate effectively techniques used to treat the patient with hemiplegic shoulder pain. More effective management of this problem will facilitate the patient's ability to reach his or her maximum functional potential.

  14. Lumbar facet syndrome - Lumbar facet joint injection and low back pain

    International Nuclear Information System (INIS)

    Acevedo Gonzalez, Juan Carlos; Jimenez Hakim, Enrique; Rodriguez, Jose Maria; Hakim Daccach, Fernando; Quinonez, German; Rodriguez Munera, Andres

    2004-01-01

    The authors conducted a retrospective study lo evaluate the effectiveness of injection therapy in the lumbar zygapophysial joints with anesthetics and steroids in patients with persisting low back pain and lumbar facer syndrome. Thirty-seven patients with low back pain who reported immediate relief of their pain after controlled blocks into the facet joints between the fourth and fifth lumbar vertebrae and the fifth lumbar and first sacral vertebrae were evaluated. Outcome was evaluated using the visual analog pain scales. All outcome measures were repeated at eight days and six weeks alter controlled injection. At six-week follow-up examination 83,7% of thirty-seven patients experienced a good response to controlled blocks of the lumbar zygaphyseal (facet) joints. Good result is the pain relief of 50% or more. Fifteen patients experienced a good response with pain relief of eight points or more in the VAS

  15. Induction of osteoarthritis by injecting monosodium iodoacetate into the patellofemoral joint of an experimental rat model.

    Science.gov (United States)

    Takahashi, Ikufumi; Matsuzaki, Taro; Kuroki, Hiroshi; Hoso, Masahiro

    2018-01-01

    This study aimed to investigate the histopathological changes in the patellofemoral joint using a rat model of osteoarthritis that was induced using monosodium iodoacetate, and to establish a novel model of patellofemoral osteoarthritis in a rat model using histopathological analysis. Sixty male rats were used. Osteoarthritis was induced through a single intra-articular injection of monosodium iodoacetate in both knee joints. Animals were equally divided into two experimental groups based on the monosodium iodoacetate dose: 0.2 mg and 1.0 mg. Histopathological changes in the articular cartilage of the patellofemoral joint and the infrapatellar fat pad were examined at 3 days, 1 week, 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the monosodium iodoacetate injection. In the 1.0-mg group, the representative histopathological findings of osteoarthritis were observed in the articular cartilage of the patellofemoral joint over time. Additionally, the Osteoarthritis Research Society International scores of the patellofemoral joint increased over time. The synovitis scores of the infrapatellar fat pad in both groups were highest at 3 days, and then the values decreased over time. The fibrosis score of the infrapatellar fat pad in the 1.0-mg group increased with time, whereas the fibrosis score in the 0.2-mg group remained low. Representative histopathological findings of osteoarthritis were observed in the articular cartilage of the patellofemoral joint in a rat model of osteoarthritis induced using monosodium iodoacetate. With appropriate selection, this model may be regarded as an ideal patellofemoral osteoarthritis model.

  16. MRI of symptomatic shoulders

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  17. 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

  18. A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain.

    Science.gov (United States)

    Kim, Woong Mo; Lee, Hyung Gon; Jeong, Cheol Won; Kim, Chang Mo; Yoon, Myung Ha

    2010-12-01

    Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies. It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy. The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection. This was a prospective, randomized, controlled trial. The study was conducted at an outpatient pain medicine clinic at Chonnam National University Hospital in Gwang-ju, Korea. The study included patients with sacroiliac joint pain, confirmed by ≥50% improvement in response to local anesthetic block, lasting 3 months or longer, and who failed medical treatment. The treatment involved intra-articular dextrose water prolotherapy or triamcinolone acetonide injection using fluoroscopic guidance, with a biweekly schedule and maximum of three injections. Pain and disability scores were assessed at baseline, 2 weeks, and monthly after completion of treatment. The numbers of recruited patients were 23 and 25 for the prolotherapy and steroid groups, respectively. The pain and disability scores were significantly improved from baseline in both groups at the 2-week follow-up, with no significant difference between them. The cumulative incidence of ≥50% pain relief at 15 months was 58.7% (95% confidence interval [CI] 37.9%-79.5%) in the prolotherapy group and 10.2% (95% CI 6.7%-27.1%) in the steroid group, as determined by Kaplan-Meier analysis; there was a statistically significant difference between the groups (log-rank p prolotherapy provided significant relief of sacroiliac joint pain, and its effects lasted longer than those of steroid injections. Further studies

  19. Shoulder arthroscopy (image)

    Science.gov (United States)

    ... is a type of surgery to examine or repair the tissues inside or around your shoulder joint. The procedure ... small incision. If the surgeon is going to repair the joint, small surgical instruments are also used, such as a shaver to remove unwanted tissue.

  20. The cost-effectiveness of CT-guided sacroiliac joint injections: a measure of QALY gained.

    Science.gov (United States)

    Bydon, Mohamad; Macki, Mohamed; De la Garza-Ramos, Rafael; Youssef, Mina; Gokaslan, Ziya L; Meleka, Sherif; Bydon, Ali

    2014-10-01

    The purpose of this study is to estimate the total cost and the quality of life years (QALY) gained for computer tomography (CT)-guided sacroiliac joint (SIJ) injections. The cost per QALY gained for the procedure is the primary end-point of this study. In our 1-year prospective institutional study, we gathered 30 patients undergoing CT-guided SIJ injections for degenerative changes at the SIJ space. Patient-reported outcomes included both the US population-based EQ-5D (EuroQol) index score and the EQ-visual analog scale (VAS). The EQ-5D is based on mobility, self-care, usual activities, pain/discomfort, and anxiety depression. Utility expenditures were based on hospital charges at our institution. All 30 patients had one pre-injection physician visit followed by 43 initial injections (13 bilateral). Each patient underwent one CT scan, and three patients required additional plain films. In the 1 year following the injections, 26 physician visits were documented. Five patients required repeat CT-guided injections. Total 1-year cost for all 30 patients was $34 874·00. Mean decrease in EQ-VAS was 0·60 (P  =  0·187). The mean 1-year gain of 0·58 EQ-5D QALY reached statistical significance (P sacroiliac injections was $2004·29. In one of the first cost analyses of CT-guided sacroiliac injections, we found that the procedure improves pain and activities of daily living. The cost per QALY gained by CT-guided sacroiliac injections falls well below the threshold cost of 1 QALY, suggesting that the procedure is strongly cost-effective.

  1. Range of motion and isometric strength of shoulder joints of team handball athletes during the playing season, Part II: changes after midseason.

    Science.gov (United States)

    Fieseler, Georg; Jungermann, Philipp; Koke, Alexander; Irlenbusch, Lars; Delank, Karl-Stefan; Schwesig, Rene

    2015-03-01

    Our objective was to investigate the influence of workload and consecutive changes on active range of motion and isometric strength of team handball athletes' throwing shoulders (TSs) because the available data are insufficient. In a longitudinal investigation, 31 professional male handball athletes underwent a clinical shoulder examination. Athletes were examined at the beginning (week 0), at the end (week 6) of the preseasonal training, and at the end of the half-season (week 22) on both shoulders to determine isometric rotational strength (hand held dynamometer) and active range of motion (goniometer). This analysis demonstrates the results subsequently from week 6 to week 22 and from week 0 to week 22. The glenohumeral internal rotation (IR) deficit (GIRD), external rotation (ER) gain, and ER at the TS increased significantly (P 0.10, d > 0.30) in the first sequence (week 6 to week 22) but not significantly from week 0 to week 22. The total range of motion remained stable, and IR changed but not significantly. There was no influence on IR, ER, and total range of motion at the non-TS. The isometric strength of the TS and non-TS IR did not change. The isometric strength in ER significantly increased bilaterally during the investigation period. Our data verify changes and influences, such as an increasing GIRD, at the overhead TS joint in accordance with the workload during team handball season. ER gain did improve after the half-season period but did not fully compensate the GIRD at the TS. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  2. Cost-effectiveness of exercise therapy after corticosteroid injection for moderate to severe shoulder pain due to subacromial impingement syndrome: a trial-based analysis.

    Science.gov (United States)

    Jowett, Sue; Crawshaw, Dickon P; Helliwell, Philip S; Hensor, Elizabeth M A; Hay, Elaine M; Conaghan, Philip G

    2013-08-01

    To perform a cost-effectiveness analysis of subacromial corticosteroid injection combined with exercise compared with exercise alone in patients with moderate to severe shoulder pain from subacromial impingement syndrome. A within-trial cost-effectiveness analysis with 232 patients randomized to physiotherapy-led injection combined with exercise (n = 115) or exercise alone (n = 117). The analysis was from a health care perspective with 24-week follow-up. Resource use information was collected from all patients on interventions, medication, primary and secondary care contacts, private health care use and over-the-counter purchases. The measure of outcome was quality-adjusted life years (QALYs), calculated from EQ-5D responses at baseline and three further time points. An incremental cost-effectiveness analysis was conducted. Mean per patient NHS costs (£255 vs £297) and overall health care costs (£261 vs £318) were lower in the injection plus exercise arm, but this difference was not statistically significant. Total QALYs gained were very similar in the two trial arms (0.3514 vs 0.3494 QALYs), although slightly higher in the injection plus exercise arm, indicating that injection plus exercise may be the dominant treatment option. At a willingness to pay of £20,000 per additional QALY gained, there was a 61% probability that injection plus exercise was the most cost-effective option. Injection plus exercise delivered by therapists may be a cost-effective use of resources compared with exercise alone and lead to lower health care costs and less time off work. International Standard Randomised Controlled Trial Number Register, http://www.controlled-trials.com/isrctn/, ISRCT 25817033.

  3. Intra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Boesen, Mikael; Jensen, Karl Erik; Torp-Pedersen, Søren

    2007-01-01

    OBJECTIVE: To investigate the distribution of an ultrasound-guided intra-articular (IA) injection in the wrist joint of patients with rheumatoid arthritis (RA). METHODS: An ultrasound-guided IA drug injection into the wrist joint was performed in 17 patients with 1 ml methylprednisolone (40 mg...... with the MRI OMERACT synovitis score (r=0.60, p=0.014), but not with the erosions, bonemarrow oedema scores or any clinical parameters. CONCLUSION: The distribution of contrast on MRI showed patient specific and random patterns after IA injections in active RA wrist joints. The degree of distribution increased...

  4. Comparison of 3D turbo spin-echo SPACE sequences with conventional 2D MRI sequences to assess the shoulder joint

    Energy Technology Data Exchange (ETDEWEB)

    Kloth, Jost Karsten, E-mail: jost.kloth@med.uni-heidelberg.de [Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Winterstein, Marianne, E-mail: marianne.winterstein@med.uni-heidelberg.de [Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Akbar, Michael, E-mail: michael.akbar@med.uni-heidelberg.de [Orthopedic and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstraße 200a, D-69118 Heidelberg (Germany); Meyer, Esther, E-mail: esther.meyer@siemens.com [Siemens Healthcare, Erlangen (Germany); Paul, Dominik, E-mail: dominik.paul@siemens.com [Siemens Healthcare, Erlangen (Germany); Kauczor, Haus-Ulrich, E-mail: hans-ulrich.kauczor@med.uni-heidelberg.de [Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany); Weber, Marc-André, E-mail: marcandre.weber@med.uni-heidelberg.de [Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, D-69120 Heidelberg (Germany)

    2014-10-15

    Highlights: • 3D SPACE and conventional 2D TSE MRI for assessment of the shoulder joint were compared. • Concordance for most pathologys was substantial to almost perfect. • Examination time could be reduced up to 8 min (27%). • Regarding rotator cuff injuries an additional sagittal T2w TSE sequence in 3D protocol is recommended. - Abstract: Purpose: To determine the accuracy and reliability of three-dimensional (3D) T1- and proton density (PD)-weighted turbo spin-echo (TSE) sampling perfection with application-optimized contrasts using different flip-angle evolution (SPACE) compared with conventional 2D sequences in assessment of the shoulder-joint. Materials and methods: Ninety-three subjects were examined on a 3-T MRI system with both conventional 2D-TSE sequences in T1-, T2- and PD-weighting and 3D SPACE sequences in T1- and PD-weighting. All examinations were assessed independently by two reviewers for common pathologies of the shoulder-joint. Agreement between 2D- and 3D-sequences and inter-observer-agreement was evaluated using kappa-statistics. Results: Using conventional 2D TSE sequences as standard of reference, sensitivity, specificity, and accuracy values of 3D SPACE were 81.8%, 95.1%, and 93.5% for injuries of the supraspinatus-tendon (SSP), 81.3%, 93.5%, and 91.4% for the cartilage layer and 82.4%, 98.5%, and 97.5% for the long biceps tendon. Concordance between 2D and 3D was almost perfect for tendinopathies of the SSP (κ = 0.85), osteoarthritis (κ = 1), luxation of the biceps tendon (κ = 1) and adjacent bone marrow (κ = 0.92). Inter-observer-agreement was generally higher for conventional 2D TSE sequences (κ, 0.23–1.0), when compared to 3D SPACE sequences (κ, −0.33 to 1.0) except for disorders of the long biceps tendon and supraspinatus tendon rupture. Conclusion: Because of substantial and almost perfect concordance with conventional 2D TSE sequences for common shoulder pathologies, MRI examination-time can be reduced by nearly 40

  5. Scapulohumeral rhythm in shoulders with reverse shoulder arthroplasty.

    Science.gov (United States)

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

    2015-07-01

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

  6. Case series of ultrasound-guided platelet-rich plasma injections for sacroiliac joint dysfunction.

    Science.gov (United States)

    Ko, Gordon D; Mindra, Sean; Lawson, Gordon E; Whitmore, Scott; Arseneau, Leigh

    2017-01-01

    Two-thirds of adults worldwide will experience low back pain at some point in their life. In the following case series, we present four patients with sacroiliac (SI) joint instability and severe chronic low back pain, which was refractory to other treatment modalities. We investigated the efficacy of platelet-rich plasma (PRP) injections, a novel orthobiologic therapy, for reducing SI joint pain, improving quality of life, and maintaining a clinical effect. Short-form McGill Pain Questionnaire (SFM), Numeric Rating Scale (NRS), and Oswestry Low Back Pain and Disability Index were used for evaluation of treatment at pretreatment, 12-months and 48-months after treatment. At follow-up 12-months post-treatment, pooled data from all patients reported a marked improvement in joint stability, a statistically significant reduction in pain, and improvement in quality of life. The clinical benefits of PRP were still significant at 4-years post-treatment. Platelet-rich plasma therapy exhibits clinical usefulness in both pain reduction and for functional improvement in patients with chronic SI joint pain. The improvement in joint stability and low back pain was maintained at 1- and 4-years post-treatment.

  7. Fluoroscopy-guided Sacroiliac Joint Steroid Injection for Low Back Pain in a Patient with Osteogenesis Imperfecta.

    Science.gov (United States)

    Dawson, P U; Rose, R E; Wade, N A

    2015-09-01

    Osteogenesis imperfecta, also known as 'brittle bone disease', is a genetic connective tissue disease. It is characterized by bone fragility and osteopenia (low bone density). In this case, a 57-year old female presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation Clinic with left low back pain rated 6/10 on the numeric rating scale (NRS). Clinically, the patient had sacroiliac joint mediated pain although X-rays did not show the sacroiliac joint changes. Fluoroscopy-guided left sacroiliac joint steroid injection was done. Numeric rating scale and Oswestry Disability Index (ODI) questionnaire were used to evaluate outcome. This was completed at baseline, one week follow-up and at eight weeks post fluoroscopy-guided sacroiliac joint steroid injection. Numeric rating scale improved from 6/10 before the procedure to 0/10 post procedure, and ODI questionnaire score improved from a moderate disability score of 40% to a minimal disability score of 13%. Up to eight weeks, the NRS was 0/10 and ODI remained at minimal disability of 15%. Fluoroscopy-guided sacroiliac joint injection is a known diagnostic and treatment method for sacroiliac joint mediated pain. To our knowledge, this is the first case published on the use of fluoroscopy-guided sacroiliac joint steroid injection in the treatment of sacroiliac joint mediated low back pain in a patient with osteogenesis imperfecta.

  8. Diaphragm-Sparing Nerve Blocks for Shoulder Surgery.

    Science.gov (United States)

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

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

  9. 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.

  10. Heads, Shoulders, Elbows, Knees, and Toes: Modular Gdf5 Enhancers Control Different Joints in the Vertebrate Skeleton.

    Science.gov (United States)

    Chen, Hao; Capellini, Terence D; Schoor, Michael; Mortlock, Doug P; Reddi, A Hari; Kingsley, David M

    2016-11-01

    Synovial joints are crucial for support and locomotion in vertebrates, and are the frequent site of serious skeletal defects and degenerative diseases in humans. Growth and differentiation factor 5 (Gdf5) is one of the earliest markers of joint formation, is required for normal joint development in both mice and humans, and has been genetically linked to risk of common osteoarthritis in Eurasian populations. Here, we systematically survey the mouse Gdf5 gene for regulatory elements controlling expression in synovial joints. We identify separate regions of the locus that control expression in axial tissues, in proximal versus distal joints in the limbs, and in remarkably specific sub-sets of composite joints like the elbow. Predicted transcription factor binding sites within Gdf5 regulatory enhancers are required for expression in particular joints. The multiple enhancers that control Gdf5 expression in different joints are distributed over a hundred kilobases of DNA, including regions both upstream and downstream of Gdf5 coding exons. Functional rescue tests in mice confirm that the large flanking regions are required to restore normal joint formation and patterning. Orthologs of these enhancers are located throughout the large genomic region previously associated with common osteoarthritis risk in humans. The large array of modular enhancers for Gdf5 provide a new foundation for studying the spatial specificity of joint patterning in vertebrates, as well as new candidates for regulatory regions that may also influence osteoarthritis risk in human populations.

  11. 99mTc-HDP SPECT-CT Aids Localization of Joint Injections in Degenerative Joint Disease of the Foot and Ankle.

    Science.gov (United States)

    Parthipun, Arum; Moser, Joanna; Mok, Wing; Paramithas, Anton; Hamilton, Paul; Sott, Andrea Helene

    2015-08-01

    Pain relating to degenerative joint disease within the foot and ankle can be difficult to localize with clinical examination alone due to the complex anatomy of the joints. The aim of this study was to determine whether single-photon emission computed tomography combined with conventional computed tomography (SPECT-CT) could be used to localize the site of degenerative joint disease for intra-articular injection and thereby improve the clinical success of the procedure. A prospective study was performed involving 203 patients who had undergone triple-phase (99m)Tc-hydroxymethylene diphosphonate bone scans with SPECT-CT of the foot and ankle for degenerative joint disease. Fifty-two patients went on to have joint injections for degenerative joint disease, with clinical follow-up. Correlation with the clinical diagnosis and the outcome of intra-articular injections with 0.5% bupivacaine and 80 mg of Depo-Medrone was performed. A successful outcome was determined by an improvement in the visual analog pain score of at least 50%. In 19 (37%) patients, the site of degenerative joint disease determined by SPECT-CT differed from the initial clinical assessment and resulted in a change in management. Overall, 46 (88%) patients showed an improvement in symptoms. The study demonstrated a high clinical success rate for SPECT-CT-guided joint injections. The technique was useful in localizing degenerative joint disease of the ankle, hindfoot, and midfoot as an adjunct to clinical examination. Level IV, case series. © The Author(s) 2015.

  12. 99mTc-MDP combined blood pool and bone phase radionuclide imaging in papain-injected carpal joints

    International Nuclear Information System (INIS)

    Metcalf, M.R.; Twardock, A.R.; Sanecki, R.K.

    1985-01-01

    Scintigraphic changes, i.e., increased activity, were induced by 1% papain, dissolved in phosphate-buffered physiologic saline (pH 7.4), injected into one antebrachiocarpal joint in each of eight dogs. Scintigraphic evaluation was by the use of combined blood pool and bone phase scintigraphy of affected and normal carpi over a 28-day period. The qualitative and quantitative scintigraphic appearance in injected carpal joints were very similar in both blood pool and bone phases. The clinical use of combined blood pool and bone phase scintigraphy to diagnose early inflammatory joint changes appears limited

  13. Shoulder distention arthrography as a treatment modality

    International Nuclear Information System (INIS)

    Kang, Heung Sik; Park, Chan Sup; Kim, Jin Ho; Kim, Sang Bum

    1987-01-01

    18 patients with painful stiff shoulder joint were underwent shoulder distension arthrography as a treatment modality, followed by physical therapy. Range of motion of shoulder joint was evaluated at 1 week and 4 weeks after arthrography. The results were as follows; 1. Arthrographic findings were decreased volume of joint cavity, obliteration of axillary recess, small subscapularis bursa, serrated capsular margin and non-filling of biceps tendon sheath. In 3 cases, rotator cuff tear was found. 2. Range of motion of shoulder joint was improved after distension arthrography. 3. In 3 patients have rotator cuff tear, range of motion was not improved

  14. Shoulder Instability

    Science.gov (United States)

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

  15. Shoulder arthroscopy

    Science.gov (United States)

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

  16. Factors affecting results of fluoroscopy-guided facet joint injection: Probable differences in the outcome of treatment between pure facet joint hypertrophy and concomitant diseases

    Directory of Open Access Journals (Sweden)

    Akif Albayrak

    2016-01-01

    Full Text Available Study Design: Retrospective cohort study. Purpose: Facet joints are considered a common source of chronic low-back pain. To determine whether pathogens related to the facet joint arthritis have any effect on treatment failure. Materials and Methods: Facet joint injection was applied to 94 patients treated at our hospital between 2011 and 2012 (mean age 59.5 years; 80 women and 14 men. For the purpose of analysis, the patients were divided into two groups. Patients who only had facet hypertrophy were placed in group A (47 patients, 41 women and 6 men, mean age 55.3 years and patients who had any additional major pathology to facet hypertrophy were placed in group B (47 patients, 39 women and 8 men, mean age 58.9 years. Injections were applied around the facet joint under surgical conditions utilizing fluoroscopy device guidance. A mixture of methylprednisolone and lidocaine was used as the injection ingredient. Results: In terms of Oswestry Disability Index (ODI and visual analog scale (VAS scores, no significant difference was found between preinjection and immediate postinjection values in both groups, and the scores of group A patients were significantly lower (P < 0.005 compared with that of group B patients at the end of the third, sixth, and twelfth month. Conclusion: For low-back pain caused by facet hypertrophy, steroid injection around the facet joint is an effective treatment, but if there is an existing major pathology, it is not as effective.

  17. Spine epidural and sacroiliac joints injections – when and how to perform

    International Nuclear Information System (INIS)

    D’Orazio, Federico; Gregori, Lorenzo Maria; Gallucci, Massimo

    2015-01-01

    Highlights: • Image guided interventions focused to administer drugs inside the epidural space are effective in reducing the perceived spinal pain, but their efficacy seems to be limited in time. • To treat spinal pain with image guided interventions is safe and repeatable. • Sacroiliac dysfunction is a common cause of sciatica-like pain which can be treated with CT-guided interventions (both steroids and pulsed RF denervation). - Abstract: Objectives: To review the state-of-the-art of image – guided techniques used to treat painful syndromes of the lower back, their indications, how they should be performed, their related risks and the expected results. Methods: We describe the actual standards about image-guided infiltrative therapies both on spine and on sacroiliac joints. Results: Both spinal epidural and sacroiliac injections appear useful in a large percentage of treated patients to get control of the perceived pain. Performing these therapies under CT or fluoroscopic guidance is the best and safest way to obtain satisfactory results because it is possible to target the use of drugs directly to the involved painful structures. Conclusions: Image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time but considering the low associated risk when performed by trained personnel, they can be easily repeated

  18. Spine epidural and sacroiliac joints injections – when and how to perform

    Energy Technology Data Exchange (ETDEWEB)

    D’Orazio, Federico, E-mail: federico.dorazio@gmail.com; Gregori, Lorenzo Maria, E-mail: lollog@hotmail.it; Gallucci, Massimo, E-mail: massimo.gallucci@cc.univaq.it

    2015-05-15

    Highlights: • Image guided interventions focused to administer drugs inside the epidural space are effective in reducing the perceived spinal pain, but their efficacy seems to be limited in time. • To treat spinal pain with image guided interventions is safe and repeatable. • Sacroiliac dysfunction is a common cause of sciatica-like pain which can be treated with CT-guided interventions (both steroids and pulsed RF denervation). - Abstract: Objectives: To review the state-of-the-art of image – guided techniques used to treat painful syndromes of the lower back, their indications, how they should be performed, their related risks and the expected results. Methods: We describe the actual standards about image-guided infiltrative therapies both on spine and on sacroiliac joints. Results: Both spinal epidural and sacroiliac injections appear useful in a large percentage of treated patients to get control of the perceived pain. Performing these therapies under CT or fluoroscopic guidance is the best and safest way to obtain satisfactory results because it is possible to target the use of drugs directly to the involved painful structures. Conclusions: Image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time but considering the low associated risk when performed by trained personnel, they can be easily repeated.

  19. Spine epidural and sacroiliac joints injections--when and how to perform.

    Science.gov (United States)

    D'Orazio, Federico; Gregori, Lorenzo Maria; Gallucci, Massimo

    2015-05-01

    To review the state-of-the-art of image-guided techniques used to treat painful syndromes of the lower back, their indications, how they should be performed, their related risks and the expected results. We describe the actual standards about image-guided infiltrative therapies both on spine and on sacroiliac joints. Both spinal epidural and sacroiliac injections appear useful in a large percentage of treated patients to get control of the perceived pain. Performing these therapies under CT or fluoroscopic guidance is the best and safest way to obtain satisfactory results because it is possible to target the use of drugs directly to the involved painful structures. Image-guided injections of the epidural space and of the sacroiliac joints are effective techniques for the treatment of pain; their effectiveness is sometimes not lasting for long periods of time but considering the low associated risk when performed by trained personnel, they can be easily repeated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  20. A Simple Technique for Shoulder Arthrography

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-09-15

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

  1. Ultrasound-guided versus fluoroscopy-guided sacroiliac joint intra-articular injections in the noninflammatory sacroiliac joint dysfunction: a prospective, randomized, single-blinded study.

    Science.gov (United States)

    Jee, Haemi; Lee, Ji-Hae; Park, Ki Deok; Ahn, Jaeki; Park, Yongbum

    2014-02-01

    To compare the short-term effects and safety of ultrasound (US)-guided sacroiliac joint (SIJ) injections with fluoroscopy (FL)-guided SIJ injections in patients with noninflammatory SIJ dysfunction. Prospective, randomized controlled trial. University hospital. Patients (N=120) with noninflammatory sacroiliac arthritis were enrolled. All procedures were performed using an FL or US apparatus. Subjects were randomly assigned to either the FL or US group. Immediately after the SIJ injections, fluoroscopy was applied to verify the correct placement of the injected medication and intravascular injections. Treatment effects and functional improvement were compared at 2 and 12 weeks after the procedures. The verbal numeric pain scale and Oswestry Disability Index improved at 2 and 12 weeks after the injections without statistical significances between groups. Of 55 US-guided injections, 48 (87.3%) were successful and 7 (12.7%) were missed. The FL-guided SIJ approach exhibited a greater accuracy (98.2%) than the US-guided approach. Vascularization around the SIJ was seen in 34 of 55 patients. Among the 34 patients, 7 had vascularization inside the joint, 23 had vascularization around the joint, and 4 had vascularization both inside and around the joint. Three cases of intravascular injections occurred in the FL group. The US-guided approach may facilitate the identification and avoidance of the critical vessels around or within the SIJ. Function and pain relief significantly improved in both groups without significant differences between groups. The US-guided approach was shown to be as effective as the FL-guided approach in treatment effects. However, diagnostic application in the SIJ may be limited because of the significantly lower accuracy rate (87.3%). Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  2. Vascular endothelial growth factor 121 and 165 in the subacromial bursa are involved in shoulder joint contracture in type II diabetics with rotator cuff disease.

    Science.gov (United States)

    Handa, Akiyoshi; Gotoh, Masafumi; Hamada, Kazutoshi; Yanagisawa, Kazuhiro; Yamazaki, Hitoshi; Nakamura, Masato; Ueyama, Yoshito; Mochida, Joji; Fukuda, Hiroaki

    2003-11-01

    Vascular endothelial growth factor (VEGF) is a glycoprotein that plays an important role in neovascularization and increases vascular permeability. We reported that VEGF is involved in motion pain of patients with rotator cuff disease by causing synovial proliferation in the subacromial bursa (SAB). The present study investigates whether VEGF is also involved in the development of shoulder contracture in diabetics with rotator cuff disease. We examined 67 patients with rotator cuff disease, including 36 with complete cuff tears, 20 with incomplete tears, and 11 without apparent tears (subacromial bursitis). The patients were into groups according to the presence or absence of diabetes (14 type II diabetics and 53 non-diabetics). Specimens of the synovium of the SAB were obtained from all patients during surgery. Expression of the VEGF gene in the synovium of the subacromial bursa was evaluated by using the reverse transcriptase polymerase chain reaction. The VEGF protein was localized by immunohistochemistry, and the number of vessels was evaluated based on CD34 immunoreactivity. The results showed that VEGF mRNA was expressed in significantly more diabetics (100%, 14/14) than in non-diabetics (70%, 37/53) (P=0.0159, Fisher's test). Investigation of VEGF isoform expression revealed VEGF121 in all 14 diabetics and in 37 of the 53 non-diabetics, VEGF165 in 12 of the 14 diabetics and in 21 of the 53 non-diabetics, and VEGF189 in 1 of the 14 diabetics and in 2 of the 53 non-diabetics. No VEGF206 was expressed in either group. VEGF protein was localized in both vascular endothelial cells and synovial lining cells. The mean number of VEGF-positive vessels and the vessel area were also significantly greater in the diabetics (pshoulder joint contracture were more common in the diabetics (P=0.0329 and P=0.073, respectively; Fisher's test). The mean preoperative range of shoulder motion significantly differed in terms of elevation between two groups: 103.8 degrees in

  3. 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)

  4. 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)

  5. Generalised joint hypermobility and shoulder joint hypermobility, - risk of upper body musculoskeletal symptoms and reduced quality of life in the general population

    DEFF Research Database (Denmark)

    Juul-Kristensen, Birgit; Østengaard, Lasse; Hansen, Sebrina

    2017-01-01

    BACKGROUND: Generalised Joint Hypermobility (GJH) is a hereditary condition with an ability to exceed the joints beyond the normal range. The prevalence of GJH in the adult population and its impact on upper body musculoskeletal health and quality of life has mostly been studied in selected popul...

  6. Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis

    International Nuclear Information System (INIS)

    Al-Jaziri, Ahmed A.; Mahmoodi, Seyed M.

    2008-01-01

    Objective was to analyze the painkilling effect of ozone-oxygen injection on joint and spine osteoarthritis. This prospective study was completed at the Ozone Clinic, Rashid Hospital, Dubai, United Arab Emirates on 220 mainly local patients (12 women, mean age 47.05 years; 98 men, mean age 52.8 years) with radiographic documented spine or extremities osteoarthritis. The patients were treated over 3 years (September 2002 to August 2005) by ozone-oxygen injection twice a week for at least 12 sessions. Using the 6 faces pain scale; the patient's pain was recorded at the beginning and at the 4th, 8th and 12th sessions. They were followed for a mean of 8.48 months and their pain scale was recorded at that time too. Comparison of the patient's 1st day pains with their 4th, 8th and 12th sessions pain showed a significant decrease (1st day to 4th session p=0.005, 1st day to 8th week p=0.005, 1st day to 12th session p=0.0043). Comparison of the 1st day pain with the final follow-up pain, which was around 10 months from the first treatment, showed a meaningful decrease of pain (p=0.0048). This study validates the painkilling effect of ozone-oxygen injection on osteoarthritis of the joints and spine. Its long term effect on pain advocates the likelihood of some histological changes as mechanism of its action. (author)

  7. Shoulder reflexes

    DEFF Research Database (Denmark)

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

    2002-01-01

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

  8. Can combined use of low-level lasers and hyaluronic acid injections prolong the longevity of degenerative knee joints?

    Science.gov (United States)

    Ip, David; Fu, Nga Yue

    2015-01-01

    This study evaluated whether half-yearly hyaluronic acid injection together with low-level laser therapy in addition to standard conventional physical therapy can successfully postpone the need for joint replacement surgery in elderly patients with bilateral symptomatic tricompartmental knee arthritis. In this prospective, double-blind, placebo-controlled study, 70 consecutive unselected elderly patients with bilateral tricompartmental knee arthritis were assigned at random to either one of two conservative treatment protocols to either one of the painful knees. Protocol A consisted of conventional physical therapy plus a sham light source plus saline injection, and protocol B consisted of protocol A with addition of half-yearly hyaluronic acid injection as well as low-level laser treatment instead of using saline and a sham light source. Treatment failure was defined as breakthrough pain necessitating joint replacement. Among the 140 painful knees treated with either protocol A or protocol B, only one of the 70 painful knees treated by protocol B required joint replacement, whereas 15 of the 70 painful knees treated by protocol A needed joint replacement surgery (Phyaluronic acid injections together with low-level laser therapy should be incorporated into the standard conservative treatment protocol for symptomatic knee arthritis, because it may prolong the longevity of the knee joint without the need for joint replacement.

  9. Botulinum Neurotoxin Injection for the Treatment of Recurrent Temporomandibular Joint Dislocation with and without Neurogenic Muscular Hyperactivity

    Directory of Open Access Journals (Sweden)

    Kazuya Yoshida

    2018-04-01

    Full Text Available The aim of this study was to compare treatment outcomes following intramuscular injection of botulinum neurotoxin (BoNT in patients with recurrent temporomandibular joint dislocation, with and without muscle hyperactivity due to neurological diseases. Thirty-two patients (19 women and 13 men, mean age: 62.3 years with recurrent temporomandibular joint dislocation were divided into two groups: neurogenic (8 women and 12 men and habitual (11 women and 1 man. The neurogenic group included patients having neurological disorders, such as Parkinson’s disease or oromandibular dystonia, that are accompanied by muscle hyperactivity. BoNT was administered via intraoral injection to the inferior head of the lateral pterygoid muscle. In total, BoNT injection was administered 102 times (mean 3.2 times/patient. The mean follow-up duration was 29.5 months. The neurogenic group was significantly (p < 0.001 younger (47.3 years than the habitual group (84.8 years and required significantly (p < 0.01 more injections (4.1 versus 1.7 times to achieve a positive outcome. No significant immediate or delayed complications occurred. Thus, intramuscular injection of BoNT into the lateral pterygoid muscle is an effective and safe treatment for habitual temporomandibular joint dislocation. More injections are required in cases of neurogenic temporomandibular joint dislocation than in those of habitual dislocation without muscle hyperactivity.

  10. Rheumatoid arthritis of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

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

    1985-02-01

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

  11. Rheumatoid arthritis of the shoulder

    International Nuclear Information System (INIS)

    Dijkstra, J.; Dijkstra, P.F.; Jan van Breemen Inst., Amsterdam; Klundert, W. v. d.

    1985-01-01

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

  12. Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study.

    Directory of Open Access Journals (Sweden)

    Uwe Schütz

    Full Text Available The diagnosis "lumbar facet syndrome" is common and often indicates severe lumbar spine surgery procedures. It is doubtful whether a painful facet joint (FJ can be identified by a single FJ block. The aim of this study was to clarify the validity of a single and placebo controlled bilateral FJ blocks using local anesthetics. A prospective single blinded triple cross-over study was performed. 60 patients (31 f, 29 m, mean age 53.2 yrs (22-73 with chronic low back pain (mean pain persistance 31 months, 6 months of conservative treatment without success admitted to a local orthopaedic department for surgical or conservative therapy of chronic LBP, were included in the study. Effect on pain reduction (10 point rating scale was measured. The 60 subjects were divided into six groups with three defined sequences of fluoroscopically guided bilateral monosegmental lumbar FJ test injections in "oblique needle" technique: verum-(local anaesthetic-, placebo-(sodium chloride- and sham-injection. Carry-over and periodic effects were evaluated and a descriptive and statistical analysis regarding the effectiveness, difference and equality of the FJ injections and the different responses was performed. The results show a high rate of non-response, which documents the lack of reliable and valid predictors for a positive response towards FJ blocks. There was a high rate of placebo reactions noted, including subjects who previously or later reacted positively to verum injections. Equivalence was shown among verum vs. placebo and partly vs. sham also. With regard to test validity criteria, a single intraarticular FJ block with local anesthetics is not useful to detect the pain-responsible FJ and therefore is no valid and reliable diagostic tool to specify indication of lumbar spine surgery. Comparative FJ blocks with local anesthetics and placebo-controls have to be interpretated carefully also, because they solely give no proper diagnosis on FJ being main pain

  13. Magnetic resonance imaging of shoulders with idiopathic adhesive capsulitis: reliability of measures

    Energy Technology Data Exchange (ETDEWEB)

    Lefevre-Colau, Marie-Martine; Fayad, Fouad; Rannou, Francois; Demaille-Wlodyka, Samantha; Mayoux-Benhamou, Marie-Anne; Poiraudeau, Serge; Revel, Michel [Universite Rene Descartes, Department of Physical and Rehabilitation Medicine, Hopital Cochin (AP-HP), Paris (France); Drape, Jean-Luc; Diche, Thierry; Minvielle, Francois [Hopital Cochin (AP-HP), Department of Radiology B, Paris (France); Fermanian, Jacques [Universite Rene Descartes, Department of Biostatistics, Hopital Necker (AP-HP), Paris (France)

    2005-12-01

    The magnetic resonance imaging (MRI) findings in idiopathic adhesive capsulitis (AC) were compared with those of contralateral healthy shoulders and the reliability of measures assessed. Twenty-six consecutive patients (26 AC and 14 healthy shoulders) were prospectively assessed. The main measurements were thickness of the joint capsule and synovial membrane in the axillary recess and rotator interval in T1-weighted spin-echo sequence enhanced with intravenous (IV) gadolinium chelate (Gd-chelate). Reliability was studied by use of the intraclass correlation coefficient (ICC). The mean thickness of the axillary recess on the coronal plane was 9.0{+-}2.2 mm in AC shoulders and 0.4{+-}0.7 mm in healthy shoulders. The mean thickness of the rotator interval on the sagittal plane was 8.4{+-}2.8 in AC shoulders and 0.6{+-}0.8 mm in healthy shoulders. Interobserver reliability was good for the axillary recess, with ICC values of 0.84 for the coronal plane, and good for the rotator interval, with ICC values of 0.80 for the sagittal plane. MRI with IV Gd-chelate injection can show, with acceptable reliability, signal and thickness abnormalities of the shoulder joint capsule and synovial membrane in AC. (orig.)

  14. Magnetic resonance imaging of shoulders with idiopathic adhesive capsulitis: reliability of measures

    International Nuclear Information System (INIS)

    Lefevre-Colau, Marie-Martine; Fayad, Fouad; Rannou, Francois; Demaille-Wlodyka, Samantha; Mayoux-Benhamou, Marie-Anne; Poiraudeau, Serge; Revel, Michel; Drape, Jean-Luc; Diche, Thierry; Minvielle, Francois; Fermanian, Jacques

    2005-01-01

    The magnetic resonance imaging (MRI) findings in idiopathic adhesive capsulitis (AC) were compared with those of contralateral healthy shoulders and the reliability of measures assessed. Twenty-six consecutive patients (26 AC and 14 healthy shoulders) were prospectively assessed. The main measurements were thickness of the joint capsule and synovial membrane in the axillary recess and rotator interval in T1-weighted spin-echo sequence enhanced with intravenous (IV) gadolinium chelate (Gd-chelate). Reliability was studied by use of the intraclass correlation coefficient (ICC). The mean thickness of the axillary recess on the coronal plane was 9.0±2.2 mm in AC shoulders and 0.4±0.7 mm in healthy shoulders. The mean thickness of the rotator interval on the sagittal plane was 8.4±2.8 in AC shoulders and 0.6±0.8 mm in healthy shoulders. Interobserver reliability was good for the axillary recess, with ICC values of 0.84 for the coronal plane, and good for the rotator interval, with ICC values of 0.80 for the sagittal plane. MRI with IV Gd-chelate injection can show, with acceptable reliability, signal and thickness abnormalities of the shoulder joint capsule and synovial membrane in AC. (orig.)

  15. INJECTION MOLDING AND STRUCTURAL ANALYSIS IN METAL TO PLASTIC CONVERSION OF BOLTED FLANGE JOINT BY CAE

    Directory of Open Access Journals (Sweden)

    Marian Blaško

    2014-12-01

    Full Text Available Many metal parts in various applications are being replaced by plastic parts. There are several reasons for that depending on actual application - minimize part cost, enhance corrosion resistance, integrating more components into one part etc. Most important steps of metal to plastic conversion are material selection and design of plastic part. Plastic part has to withstand the same load as metal part. To fulfill this requirement fiber reinforced engineering plastics are often used. Also it is convenient to substitute heavy wall sections with ribbed structure to increase load-carrying ability of part and decrease cycle time, eliminate voids, sink marks etc. Mechanical properties of such part could be highly affected by fiber orientation. Results of fiber orientation from injection molding filling analysis can be used in stress analysis for better prediction of part response to mechanical load. Such coupled analysis is performed here in this case study on bolted flange joint.

  16. Effects of Facet Joint Injection Reducing the Need for Percutaneous Vertebroplasty in Vertebral Compression Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Im, Tae Seong; Lee, Joon Woo; Lee, Eugene; Kang, Yusuhn; Ahn, Joong Mo, E-mail: joongmoahn@gmail.com; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of)

    2016-05-15

    ObjectiveTo evaluate the effects of facet joint injection (FJI) reducing the need for percutaneous vertebroplasty (PVP) in cases of vertebral compression fracture (VCF).Materials and MethodsA total of 169 patients who were referred to the radiology department of our institution for PVP between January 2011 and December 2014 were retrospectively evaluated. The effectiveness of FJI was evaluated by the proportion of patients who cancelled PVP and who experienced reduced pain. In addition, by means of medical chart and MRI review, those clinical factors (age, sex, history of trauma, amount of injected steroids and interval days elapsed between VCF and FJI) and MR image factors (kyphosis angle, height loss, single or multiple level of VCF, burst fracture, central canal compromise, posterior element injury) that were believed to be significant for the effectiveness of FJI were statistically analysed.ResultsIn the 26 patients with FJI prior to PVP, six (23 %) patients cancelled PVP with considerable improvement in reported pain. In the 20 patients with PVP after FJI, improvement in pain after FJI was reported by six patients, resulting in a total of 12 patients (46 %) who experienced reduced pain after FJI. Clinical factors and MR image factors did not show any statistically significant difference between those groups, divided by PVP cancellation and by improvement of pain.ConclusionAfter FJI prior to PVP, about one quarter of patients cancelled PVP due to reduced pain and overall about half of the patients experienced reduced pain.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

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

  18. A New Sacroiliac Joint Injection Technique and Its Short-Term Effect on Chronic Sacroiliac Region Pain.

    Science.gov (United States)

    Do, Kyung Hee; Ahn, Sang Ho; Jones, Rodney; Jang, Sung Ho; Son, Su Min; Lee, Dong Gyu; Cho, Hee Kyung; Choi, Gyu Sik; Cho, Yun-Woo

    2016-10-01

    Sacroiliac joint (SIJ) injections have been used to provide short-term relief of SIJ pain. In this study, the authors investigated a new technique using a superior approach. Twenty four patients with chronic SI joint paint were recruited. Each patient was treated with a single SIJ intra-articular injection plus a periarticular injection of local anesthetic and corticosteroid in one procedure. Technical accuracy of the intra-articular procedure was determined by having 2 independent observers review and rate the quality of arthrograms obtained. Treatment effects were evaluated using a numerical rating scale, the Oswestry disability index (ODI) and global perceived effect (GPE). Both independent observers agreed that satisfactory arthrograms were obtained in all patients. Pain scores and disability were significantly reduced at 2 weeks and 4 weeks after treatment. Nineteen patients (79%) reported satisfaction with treatment. No serious adverse effects were encountered. The superior approach consistently achieves good access to the SI joint, and achieves outcomes that are compatible with those of other techniques. The superior approach constitutes an alternative to other techniques for injections into the SI joint. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  19. A Prodrug Approach Involving In Situ Depot Formation to Achieve Localized and Sustained Action of Diclofenac After Joint Injection

    DEFF Research Database (Denmark)

    Thing, Mette; Agårdh, Li; Larsen, Susan

    2014-01-01

    Long-acting nonsteroidal anti-inflammatory drug formulations for intra-articular injection might be effective in the management of joint pain and inflammation associated sports injuries and osteoarthritis. In this study, a prodrug-based delivery system was evaluated. The synthesized diclofenac...

  20. Shoulder reflexes

    DEFF Research Database (Denmark)

    Diederichsen, Louise; Krogsgaard, Michael; Voigt, Michael

    2002-01-01

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

  1. CT-guided intradiscal ozone injection combined with intervertebral facet joint steroid injection for lumbar disk herniation accompanied with intervertebral arthritis

    International Nuclear Information System (INIS)

    Zhang Li; Chen Zhaohui; Sun Xijun; Liu Jianping; Li Jiakai

    2009-01-01

    Objective: To compare the clinical effectiveness of ozone (O 3 ) nucleus pulposus ablation only with that of O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome in treating lumbar disk herniation accompanied with intervertebral facet arthritis. Methods: Eighty patients with lumbar disk herniation and intervertebral facet arthritis were equally and randomly divided into two groups. Under CT guidance, O 3 nucleus pulposus ablation was performed in patients of group A(n=40), while O 3 nucleus pulposus ablation combined with intervertebral facet joint injection of compound Betamethasome (0.5-1 ml) was carried out in patients of group B(n=40). Using double blind method the therapeutic effectiveness was evaluated before and 1 week,3,6-months after the procedure by an Oswestry Low Back Pain Disability Questionnaire. Results: One week after the procedure the effective rate of group A and group B was 65% and 82.5% respectively. Three and six months after the treatment, the effective rate was 75% and 70% respectively for group A, while it was 90% and 92.5% respectively for group B. The difference between two groups was significant (P 3 combined with intervertebral facet joint injection of compound Betamethasome is an effective and safe treatment for lumbar disk herniation accompanied with intervertebral facet arthritis.It is worth popularizing this technique in clinical practice. (authors)

  2. Is There a Relationship Between Body Mass Index and Fluoroscopy Time During Sacroiliac Joint Injection? A Multicenter Cohort Study.

    Science.gov (United States)

    McCormick, Zachary L; Cushman, Daniel; Lee, David T; Scholten, Paul; Chu, Samuel K; Babu, Ashwin N; Caldwell, Mary; Ziegler, Craig; Ashraf, Humaira; Sundar, Bindu; Clark, Ryan; Gross, Claire; Cara, Jeffrey; McCormick, Kristen; Ross, Brendon; Smith, Clark C; Press, Joel; Smuck, Matthew; Walega, David R

    2016-07-01

    To determine the relationship between BMI and fluoroscopy time during intra-articular sacroiliac joint (SIJ) injections performed for a pain indication. Multicenter retrospective cohort study. Three academic, outpatient pain treatment centers. Patients who underwent fluoroscopy guided SIJ injection with encounter data regarding fluoroscopy time during the procedure and body mass index (BMI). Median and 25-75% Interquartile Range (IQR) fluoroscopy time. 459 SIJ injections (350 patients) were included in this study. Patients had a median age of 57 (IQR 44, 70) years, and 72% were female. The median BMI in the normal weight, overweight, and obese groups were 23 (IQR 21, 24), 27 (IQR 26, 29), and 35 (IQR 32, 40), respectively. There was no significant difference in the median fluoroscopy time recorded between these BMI classes (p = 0.45). First-time SIJ injection (p = 0.53), bilateral injection (p = 0.30), trainee involvement (p = 0.47), and new trainee involvement (trainee participation during the first 2 months of the academic year) (p = 0.85) were not associated with increased fluoroscopy time for any of the three BMI categories. Fluoroscopy time during sacroiliac joint injection is not increased in patients who are overweight or obese, regardless of whether a first-time sacroiliac joint injection was performed, bilateral injections were performed, a trainee was involved, or a new trainee was involved. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. 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.

  4. 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

  5. Heterotopic bone formation following total shoulder arthroplasty

    DEFF Research Database (Denmark)

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

    1989-01-01

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

  6. A randomized, double-blind, controlled study of ultrasound-guided corticosteroid injection into the joint of patients with inflammatory arthritis.

    LENUS (Irish Health Repository)

    Cunnington, Joanna

    2010-07-01

    Most corticosteroid injections into the joint are guided by the clinical examination (CE), but up to 70% are inaccurately placed, which may contribute to an inadequate response. The aim of this study was to investigate whether ultrasound (US) guidance improves the accuracy and clinical outcome of joint injections as compared with CE guidance in patients with inflammatory arthritis.

  7. Evaluation of intra-articular injection of autologous platelet lysate (PL) in horses with osteoarthritis of the distal interphalangeal joint.

    Science.gov (United States)

    Tyrnenopoulou, Panagiota; Diakakis, Nikolaos; Karayannopoulou, Maria; Savvas, Ioannis; Koliakos, Georgios

    2016-06-01

    Regenerative medicine has become one of the most promising therapies of equine osteoarthritis. Platelet lysate (PL) is rich in bioactive proteins and growth factors that play a crucial role in tissue healing. To evaluate the efficacy of intra-articularly injected autologous PL in equine athletes with naturally occurring osteoarthritis. Fifteen warmblood geldings aged 8-19 years with osteoarthritis of the distal interphalangeal joint were included in this study. They were randomly divided into two groups; 10 horses received intra-articular injections of PL and 5 of normal saline (controls). Before treatment, platelet-derived growth factor (PDGF) levels in basal plasma and prepared PL were estimated. Each joint was injected twice within a three-week period. Lameness was evaluated using the American Association of Equine Practitioners grading system, before treatment and 10 days after each intra-articular injection. Horses were examined fortnightly for one year. Radiographic examination was performed six months post-treatment. The generalized estimating equation test was used for statistical analysis. Acceptable levels of PDGF were detected in PLs (mean ± SD: 258.0 ± 52.3 pg/ml). The majority of horses (9/10) responded positively to PL treatment presenting lower lameness grades (p < 0.0005) compared to controls 10 days after the second injection, and returned to normal athletic activity. Radiographs revealed no changes in osteoarthritis lesions six months after treatment. One year post-injections, however, all horses relapsed to their initial degree of lameness. Intra-articularly injected autologous PL is an efficient method for temporarily managing osteoarthritis of the distal interphalangeal joint in athletic horses.

  8. 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

  9. [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.

  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. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam (Korea, Republic of); Chai, Jae Won [Dept. of Radiology, SMG-SNU Boramae Medical Center, Seoul (Korea, Republic of); Ahn, Joong Mo [Dept. of Radiology, University of Pittsburgh Medical Center, Pittsburgh (United States)

    2015-09-15

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases.

  12. Fluoroscopy-guided intrA-articular facet joint steroid injection for the management of low back pain: Therapeutic effectiveness and arthrographic pattern

    International Nuclear Information System (INIS)

    Kim, Su Jin; Lee, Jun Woo; Lee, Guen Young; You, Ja Yeon; Kang, Heung Sik; Chai, Jae Won; Ahn, Joong Mo

    2015-01-01

    To evaluate the effectiveness of fluoroscopy-guided intra-articular facet joint steroid injection for the management of low back pain, and to document the incidence of epidural leakage. In total, 320 facet joint injections of 244 consecutive patients were included in this study. All patients had undergone an intra-articular facet joint steroid injection in 2007 and had follow-up post-treatment medical records. The response to treatment was analyzed on the basis of chart documentation (aggravated, no change, slightly improved, much improved, no pain). Fluoroscopic arthrograms of the injections were retrospectively analyzed by two radiologists. Of the 244 patients, 85.2% (n = 208) showed improvement after an initial intra-articular facet joint steroid injection. A total of 77.9% (n = 162) of the patients showed symptom recurrence, with a median of a 69 day symptom-free interval, while 30.3% (n = 74) of the patients showed symptom-free intervals of more than six months. Overall, 74 (33.3%) of the 222 cases of intra-articular facet joint steroid injections without concomitant epidural steroid injection showed epidural leakage in fluoroscopic arthrograms. Fluoroscopy-guided intra-articular facet joint injection is a reliable technique for the management of low back pain, with excellent immediate effectiveness and good prolonged (> 2 months) pain relief. Epidural leakage during injection was detected in one-third of the cases

  13. Shoulder MRI scan

    Science.gov (United States)

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

  14. MR-guided facet joint injection therapy using an open 1.0-T MRI system: an outcome study

    International Nuclear Information System (INIS)

    Freyhardt, Patrick; Bucourt, Maximilian de; Maurer, Martin; Renz, Diane; Gebauer, Bernhard; Hamm, Bernd; Streitparth, Florian; Hartwig, Tony; Teichgraeber, Ulf K.M.

    2013-01-01

    To evaluate the accuracy, safety and efficacy of magnetic resonance imaging (MRI)-guided facet joint injection therapy using a 1.0-T open MRI. One hundred and sixty-six facet joint blocks in 45 patients with lower back pain were performed under MR fluoroscopic guidance using a proton-density-weighted turbo-spin-echo sequence. An in-room monitor, wireless MR-mouse for operator-controlled multiplanar navigation, a flexible surface coil and MR-compatible 20-G needle were used. Clinical outcome was evaluated by questionnaire before intervention and after 1 week, 3, 6 and 12 months using a numerical visual analogue scale (VAS). All facet joint blocks were considered technically successful with distribution of the injectant within and/or around the targeted facet joint. No major complications occurred. The final outcome analysis included 38 patients. An immediate effect was reported by 63 % of the patients. A positive mid-/long-term effect was seen in 13 patients (34 %) after 6 months and in 9 patients (24 %) after 12 months. Mean VAS was reduced from 7.1 ± 1.7 (baseline) to 3.5 ± 2.2, 4.1 ± 3.0, 3.8 ± 2.9 and 4.6 ± 2.9 at 1 week, 3, 6 and 12 months (P < 0.01). MR-guided facet joint injection therapy of the lumbosacral spine is accurate, safe and efficient in the symptomatic treatment of lower back pain. (orig.)

  15. Computational reverse shoulder prosthesis model: Experimental data and verification.

    Science.gov (United States)

    Martins, A; Quental, C; Folgado, J; Ambrósio, J; Monteiro, J; Sarmento, M

    2015-09-18

    The reverse shoulder prosthesis aims to restore the stability and function of pathological shoulders, but the biomechanical aspects of the geometrical changes induced by the implant are yet to be fully understood. Considering a large-scale musculoskeletal model of the upper limb, the aim of this study is to evaluate how the Delta reverse shoulder prosthesis influences the biomechanical behavior of the shoulder joint. In this study, the kinematic data of an unloaded abduction in the frontal plane and an unloaded forward flexion in the sagittal plane were experimentally acquired through video-imaging for a control group, composed of 10 healthy shoulders, and a reverse shoulder group, composed of 3 reverse shoulders. Synchronously, the EMG data of 7 superficial muscles were also collected. The muscle force sharing problem was solved through the minimization of the metabolic energy consumption. The evaluation of the shoulder kinematics shows an increase in the lateral rotation of the scapula in the reverse shoulder group, and an increase in the contribution of the scapulothoracic joint to the shoulder joint. Regarding the muscle force sharing problem, the musculoskeletal model estimates an increased activity of the deltoid, teres minor, clavicular fibers of the pectoralis major, and coracobrachialis muscles in the reverse shoulder group. The comparison between the muscle forces predicted and the EMG data acquired revealed a good correlation, which provides further confidence in the model. Overall, the shoulder joint reaction force was lower in the reverse shoulder group than in the control group. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    International Nuclear Information System (INIS)

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

    2000-01-01

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

  17. 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…

  18. Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations

    Directory of Open Access Journals (Sweden)

    Artner J

    2012-08-01

    Full Text Available Juraj Artner, Balkan Cakir, Heiko Reichel, Friederike LattigDepartment of Orthopaedic Surgery, University of Ulm, RKU, GermanyBackground: The sacroiliac (SI joint is frequently the primary source of low back pain. Over the past decades, a number of different SI injection techniques have been used in its diagnosis and therapy. Despite the concerns regarding exposure to radiation, image-guided injection techniques are the preferred method to achieve safe and precise intra-articular needle placement. The following study presents a comparison of radiation doses, calculated for fluoroscopy and CT-guided SI joint injections in standard and low-dose protocol and presents the technical possibility of CT-guidance with maximum radiation dose reduction to levels of fluoroscopic-guidance for a precise intra-articular injection technique.Objective: To evaluate the possibility of dose reduction in CT-guided sacroiliac joint injections to pulsed-fluoroscopy-guidance levels and to compare the doses of pulsed-fluoroscopy-, CT-guidance, and low-dose CT-guidance for intra-articular SI joint injections.Study design: Comparative study with technical considerations.Methods: A total of 30 CT-guided intra-articular SI joint injections were performed in January 2012 in a developed low-dose mode and the radiation doses were calculated. They were compared to 30 pulsed-fluoroscopy-guided SI joint injections, which were performed in the month before, and to five injections, performed in standard CT-guided biopsy mode for spinal interventions. The statistical significance was calculated with the SPSS software using the Mann–Whitney U-Test. Technical details and anatomical considerations were provided.Results: A significant dose reduction of average 94.01% was achieved using the low-dose protocol for CT-guided SI joint injections. The radiation dose could be approximated to pulsed-fluoroscopy-guidance levels.Conclusion: Radiation dose of CT-guided SI joint injections can be

  19. Enhancement of C/C-LAS joint using aligned carbon nanotubes prepared by injection chemical vapor deposition

    Energy Technology Data Exchange (ETDEWEB)

    Zhao, Feng-Ling; Fu, Qian-Gang, E-mail: fuqiangang@nwpu.edu.cn; Feng, Lei; Shen, Qing-Liang

    2016-01-05

    Carbon nanotubes (CNTs) enhanced carbon/carbon-lithium aluminum silicate (C/C-LAS) joint was prepared by a three-step technique of pack cementation, injection chemical vapor deposition (ICVD) and hot-pressing. A layer of aligned CNTs was grown on the surface of SiC coated C/C composites by ICVD method, and the joint was obtained by hot-pressing with magnesium aluminum silicate (MAS) as the interlayer. SEM observation reveals that the introduced CNTs result in the formation of a dense and crack-free CNT/MAS nanocomposite interface between SiC and MAS. Compared with the joints without CNTs, the average shear strength of the joints reinforced by CNTs was improved by 48% accompanied by an obvious change in failure mode from brittle fracture without CNTs to plastic fracture with CNTs. The pulling-out and bridging of CNTs on the fracture surfaces had a positive effect on the strength enhancement of the C/C-LAS joint.

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

    International Nuclear Information System (INIS)

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

    1995-01-01

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

  1. Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies.

    LENUS (Irish Health Repository)

    Mandl, Peter

    2012-01-01

    To document the practice and training opportunities of US-guided arthrocentesis and joint injection (UGAJ) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR).

  2. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    International Nuclear Information System (INIS)

    Paik, Nam Chull

    2016-01-01

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  3. Intraarticular Sacroiliac Joint Injection Under Computed Tomography Fluoroscopic Guidance: A Technical Note to Reduce Procedural Time and Radiation Dose

    Energy Technology Data Exchange (ETDEWEB)

    Paik, Nam Chull, E-mail: pncspine@gmail.com [Arumdaun Wooldul Spine Hospital, Department of Radiology (Korea, Republic of)

    2016-07-15

    PurposeA technique for computed tomography fluoroscopy (CTF)-guided intraarticular (IA) sacroiliac joint (SIJ) injection was devised to limit procedural time and radiation dose.MethodsOur Institutional Review Board approved this retrospective analysis and waived the requirement for informed consent. Overall, 36 consecutive diagnostic or therapeutic IA SIJ injections (unilateral, 20; bilateral, 16) performed in 34 patients (female, 18; male, 16) with a mean age of 45.5 years (range 20–76 years) under CTF guidance were analyzed, assessing technical success (i.e., IA contrast spread), procedural time, and radiation dose.ResultsAll injections were successful from a technical perspective and were free of serious complications. Respective median procedural times and effective doses of SIJ injection were as follows: unilateral, 5.28 min (range 3.58–8.00 min) and 0.11 millisievert (mSv; range 0.07–0.24 mSv); and bilateral, 6.72 min (range 4.17–21.17 min) and 0.11 mSv (range 0.09–0.51 mSv).ConclusionsGiven the high rate of technical success achieved in limited time duration and with little radiation exposure, CTF-guided IA SIJ injection is a practical and low-risk procedure.

  4. Efficacy of Arthrocentesis with Injection of Hyaluronic Acid in the Treatment of Internal Derangement of Temporomandibular Joint

    Directory of Open Access Journals (Sweden)

    Pramila Shakya

    2010-07-01

    Full Text Available This cross-sectional study was designed to find out the effect of arthrocentesis with injection hyaluronic acid in thetreatment of internal derangement of temporomandibular joint (TMJ ID for the restoration of TMJ function. The studyincluded 25 patients, aged 13 to 50 years with symptoms of TMJ pain and clicking during function and limited mouthopening. TMJ ID was assessed with clinical examination and conformed with MRI. Arthrocentesis was done withinsertion of two 21gauze needles in the upper joint compartment and joint lavaged with 200 ml of ringer’s lactate solutionand at the end 1ml of hyaluronic acid was injected. Intensity of TMJ pain and clicking was assessed using visual analogscale, maximum mouth opening, lateral jaw movement and protrusion were assessed with millimeter scale. All theparameters were measured before the procedure , immediately after the procedure then after 2 weeks, 1 month , 3 monthsand 6 months procedure. During 6 months follow-up, clinical examination and comparison of the results showed 84%reduction in TMJ pain, 92% improvement in mouth opening and clicking disappear in 80% of patients.Key words: TMJ pain; clicking; internal derangement; arthrocentesis; hyaluronic acid.DOI: 10.3329/bsmmuj.v3i1.5509BSMMU J 2010; 3(1: 18-22

  5. Accuracy of ultrasound-guided injections of thoracolumbar articular process joints in horses

    DEFF Research Database (Denmark)

    Fuglbjerg, Vibeke; Nielsen, J.V.; Thomsen, Preben Dybdahl

    2010-01-01

    in the literature. Objectives: To evaluate factors of affecting the accuracy of intra-articular injections of the APJs in the caudal thoracolumbar region. Method: One-hundred-and-fifty-four injections with blue dye were performed on APJs including the T14-L6 region in 12 horses subjected to euthanasia for reasons...

  6. 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

  7. 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

  8. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    Energy Technology Data Exchange (ETDEWEB)

    Sopov, V.; Groshar, D. [Dept. of Nuclear Medicine, Technion-Israel Inst. of Technology, Haifa (Israel); Fuchs, D. [Dept. of Orthopaedics, Technion-Israel Inst. of Technology, Haifa (Israel); Bar-Meir, E. [Dept. of Radiology, Technion-Israel Inst. of Technology, Haifa (Israel)

    2001-02-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  9. Stress-induced osteolysis of distal clavicle: imaging patterns and treatment using CT-guided injection

    International Nuclear Information System (INIS)

    Sopov, V.; Groshar, D.; Fuchs, D.; Bar-Meir, E.

    2001-01-01

    Osteolysis of distal clavicle (ODC) may occur in patients who experience repeated stress or microtrauma to the shoulder. This entity has clinical and radiological findings similar to post-traumatic ODC. We describe a case of successful treatment of stress-induced ODC with CT-guided injection of corticosteroid and anesthetic drug into the acromioclavicular joint. (orig.)

  10. The utility of MR imaging of the shoulder joint: comparison of the MR imaging between conventional MR imaging and arthrographic MR imaging

    International Nuclear Information System (INIS)

    Choi, Dong Sik; Ryu, Kyung Nam; Kim, Ihn Sub; Rhee, Yong Girl

    1998-01-01

    To evaluate the diagnostic value of MRI of the shoulder. Between January and June 1997, shoulder MRI and arthroscopy were performed in a total of 48 patients with shoulder pain (n=3D30) or shoulder instability (n=3D18). Forty-five were males and three were females; their ages ranged from 16 to 67 (mean 32.5) years. The period between shoulder MRI and arthroscopy was between one and 390 (mean, 42.2) days. Twenty-six patents underwent MR arthrography (AMR), and 22 conventional MRI(CMR). Each image was analyzed for rotator cuff injury, glenoid labral injury, SLAP lesion, and biceps tendon injury. On arthroscopy, one disease was found in 34 patients, two were found in six, three diseases were found in seven, and one patient had four diseases. Arthroscopic diagnosis was as follows:rotator cuff injury, 29;SLAP lesion, 12;glenoid labral injury, 10;biceps tendon injury, 4;subacromial bursitis, 2;chronic synovitis, 1;adhesive capsulitis, 1;superior glenohumeral ligament injury, 1;normal, 1. For rotator cuff injury, the sensitivity of MRI was 65.5% and specificity was 93.0% (AMR:66.7%, 95.8%, CMR:65.2%, 86.4%). For SLAP lesion, sensitivity was 58.3% and specificity was 97.2% (AMR:66.7%, 100%, CMR:50%, 93.8%);for glenoid labral injury, sensitivity was 80.0% and specificity was 89.5% (AMR:85.7%, 84.2%, CMR:66.7%, 94.7%), and for biceps tendon injury, the false negative rate was 100%. In cases involving glenoid labral injury, the diagnostic accuracy of shoulder MRI was relatively high;in rotator cuff injury and SLAP lesion, however, diagnosis was limited, and in biceps tendon injury was difficult. We suggest, however, that MR arthrography has certain diagnostic advantages over conventional MRI.=20

  11. The utility of MR imaging of the shoulder joint: comparison of the MR imaging between conventional MR imaging and arthrographic MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Dong Sik; Ryu, Kyung Nam; Kim, Ihn Sub; Rhee, Yong Girl [Kyunghee Univ., College of Medicine, Seoul (Korea, Republic of)

    1998-09-01

    To evaluate the diagnostic value of MRI of the shoulder. Between January and June 1997, shoulder MRI and arthroscopy were performed in a total of 48 patients with shoulder pain (n=3D30) or shoulder instability (n=3D18). Forty-five were males and three were females; their ages ranged from 16 to 67 (mean 32.5) years. The period between shoulder MRI and arthroscopy was between one and 390 (mean, 42.2) days. Twenty-six patents underwent MR arthrography (AMR), and 22 conventional MRI(CMR). Each image was analyzed for rotator cuff injury, glenoid labral injury, SLAP lesion, and biceps tendon injury. On arthroscopy, one disease was found in 34 patients, two were found in six, three diseases were found in seven, and one patient had four diseases. Arthroscopic diagnosis was as follows:rotator cuff injury, 29;SLAP lesion, 12;glenoid labral injury, 10;biceps tendon injury, 4;subacromial bursitis, 2;chronic synovitis, 1;adhesive capsulitis, 1;superior glenohumeral ligament injury, 1;normal, 1. For rotator cuff injury, the sensitivity of MRI was 65.5% and specificity was 93.0% (AMR:66.7%, 95.8%, CMR:65.2%, 86.4%). For SLAP lesion, sensitivity was 58.3% and specificity was 97.2% (AMR:66.7%, 100%, CMR:50%, 93.8%);for glenoid labral injury, sensitivity was 80.0% and specificity was 89.5% (AMR:85.7%, 84.2%, CMR:66.7%, 94.7%), and for biceps tendon injury, the false negative rate was 100%. In cases involving glenoid labral injury, the diagnostic accuracy of shoulder MRI was relatively high;in rotator cuff injury and SLAP lesion, however, diagnosis was limited, and in biceps tendon injury was difficult. We suggest, however, that MR arthrography has certain diagnostic advantages over conventional MRI.=20.

  12. Does intravenous ketamine enhance analgesia after arthroscopic shoulder surgery with ultrasound guided single-injection interscalene block?: a randomized, prospective, double-blind trial.

    Science.gov (United States)

    Woo, Jae Hee; Kim, Youn Jin; Baik, Hee Jung; Han, Jong In; Chung, Rack Kyung

    2014-07-01

    Ketamine has anti-inflammatory, analgesic and antihyperalgesic effect and prevents pain associated with wind-up. We investigated whether low doses of ketamine infusion during general anesthesia combined with single-shot interscalene nerve block (SSISB) would potentiate analgesic effect of SSISB. Forty adult patients scheduled for elective arthroscopic shoulder surgery were enrolled and randomized to either the control group or the ketamine group. All patients underwent SSISB and followed by general anesthesia. During an operation, intravenous ketamine was infused to the patients of ketamine group continuously. In control group, patients received normal saline in volumes equivalent to ketamine infusions. Pain score by numeric rating scale was similar between groups at 1, 6, 12, 24, 36, and 48 hr following surgery, which was maintained lower than 3 in both groups. The time to first analgesic request after admission on post-anesthesia care unit was also not significantly different between groups. Intraoperative low dose ketamine did not decrease acute postoperative pain after arthroscopic shoulder surgery with a preincisional ultrasound guided SSISB. The preventive analgesic effect of ketamine could be mitigated by SSISB, which remains one of the most effective methods of pain relief after arthroscopic shoulder surgery.

  13. 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 ...

  14. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder

    Directory of Open Access Journals (Sweden)

    Raphael Micheroli

    2015-03-01

    Full Text Available Objective: High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the fi ndings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder. Methods: Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa. Results: In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86 whereas the Jobe supraspinatus test showed the highest specifi city (0.55. To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specifi city (0.72. The infraspinatus test showed a high sensitivity (0.90 and specifi city (0.74. All AC tests (painful arc IIa, AC joint tendernessb, cross body adduction stress testc showed high specifi cities (a0.96, b0.99, c 0.96. Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47 and the Yergason test the highest specifi city (0.88. Conclusion: Knowledge of sensitivity and specifi city of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis.

  15. Pre-injection of hyaluronic acid does not affect the systemic effects of intra-articular depot betamethasone injection at the knee joint.

    Science.gov (United States)

    Habib, George; Khatib, Muhamad; Sakas, Fahed; Artul, Suheil; Jabaly-Habib, Haneen

    2017-01-01

    Intra-articular injection (IAI) of both hyaluronic acid (HA) and depot-steroid preparations had the advantage of quick and prolonged favorable effects on pain relief among patients with symptomatic osteoarthritis of the knee (OAK). The effect of IAI of HA on the systemic effects of the intra-articular steroids had not been investigated. Non-selected patients attending the rheumatology clinic with symptomatic OAK who failed NSAIDS and physical therapy were offered an IAI of HA at the knee joint followed 20 min later by an IAI of 1 ml of Celestone Chronodose at the same joint (group 1). Morning serum levels of cortisol were obtained just prior to the IAI and 1, 2 and 8 days later. Demographic, clinical, and laboratory parameters were obtained also from all the patients. Age- and sex-matched group of patients from the same clinic were recruited as a control group (group 2). Mean baseline serum cortisol levels in group 1 was 381 ± 154 mmol/l vs. 376 ± 119 in group 2 (p = 0.954). Morning serum cortisol levels at day 1 and day 2 were 24 ± 6 and 22 ± 6 mmol/l, respectively, in group 1 patients vs. 27 ± 5.8 (p = 0.214) and 25 ± 5.6 mmol/l (p = 0.200), respectively, in group 2. These levels were significantly lower than baseline levels in each group. Morning serum cortisol levels at day 8 in group 1 and group 2 were 349 ± 128 and 314 ± 99 mmol/l, respectively (p = 0.419). Pre-injection of HA at the knee joint did not affect the systemic effect on the hypothalamic-pituitary-adrenal axis of IAI of Celestone Chronodose.

  16. Delayed onset of a spinal epidural hematoma after facet joint injection

    Directory of Open Access Journals (Sweden)

    Mirko Velickovic

    2016-10-01

    Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

  17. Evidence-based radiology (part 1): Is there sufficient research to support the use of therapeutic injections for the spine and sacroiliac joints?

    Energy Technology Data Exchange (ETDEWEB)

    Peterson, Cynthia; Hodler, Juerg [Orthopaedic University Hospital of Balgrist, Radiology, Zuerich (Switzerland)

    2010-01-15

    This review article addresses the best evidence currently available for therapeutic injection therapy for conditions targeting the spine and sacroiliac joints. The article is presented by spinal region. Controversies and areas of interest for further studies are identified. There is conclusive evidence supporting the effectiveness of the caudal approach for the administration of epidural steroid injections for patients with low back pain from a variety of causes. In general, there is moderate-to-strong evidence supporting the use of transforaminal therapeutic epidural injections for lumbar nerve-root compression and facet injections for joint pain arising from these joints in the cervical, thoracic and lumbar spine, but further subgroup analysis is needed to help predict which specific patients may receive the most benefit from these procedures. No randomized controlled trials, meta-analyses or systematic reviews addressing the effectiveness of therapeutic sacroiliac joint injections have been found. For some injections, corticosteroids may not provide better outcomes compared to local anesthetic injections alone. (orig.)

  18. A prodrug approach involving in situ depot formation to achieve localized and sustained action of diclofenac after joint injection.

    Science.gov (United States)

    Thing, Mette; Ågårdh, Li; Larsen, Susan; Rasmussen, Rune; Pallesen, Jakob; Mertz, Nina; Kristensen, Jesper; Hansen, Martin; Østergaard, Jesper; Larsen, Claus Selch

    2014-12-01

    Long-acting nonsteroidal anti-inflammatory drug formulations for intra-articular injection might be effective in the management of joint pain and inflammation associated sports injuries and osteoarthritis. In this study, a prodrug-based delivery system was evaluated. The synthesized diclofenac ester prodrug, a weak base (pKa 7.52), has relatively high solubility at low pH (6.5 mg mL(-1) at pH 4) and much lower solubility at physiological pH (4.5 μg mL(-1) at pH 7.4) at 37°C. In biological media including 80% (v/v) human synovial fluid (SF), the prodrug was cleaved to diclofenac mediated by esterases. In situ precipitation of the prodrug was observed upon addition of a concentrated slightly acidic prodrug solution to phosphate buffer or SF at pH 7.4. The degree of supersaturation accompanying the precipitation process was more pronounced in SF than in phosphate buffer. In the rotating dialysis cell model, a slightly acidic prodrug solution was added to the donor cell containing 80% SF resulting in a continuous appearance of diclofenac in the acceptor phase for more than 43 h after an initial lag period of 8 h. Detectable amounts of prodrug were found in the rat joint up to 8 days after knee injection of the acidic prodrug solution. © 2014 Wiley Periodicals, Inc. and the American Pharmacists Association.

  19. Joint inversion of time-lapse VSP data for monitoring CO2 injection at the Farnsworth EOR field in Texas

    Science.gov (United States)

    Zhang, M.; Gao, K.; Balch, R. S.; Huang, L.

    2016-12-01

    During the Development Phase (Phase III) of the U.S. Southwest Regional Partnership on Carbon Sequestration (SWP), time-lapse 3D vertical seismic profiling (VSP) data were acquired to monitor CO2 injection/migration at the Farnsworth Enhanced Oil Recovery (EOR) field, in partnership with the industrial partner Chaparral Energy. The project is to inject a million tons of carbon dioxide into the target formation, the deep oil-bearing Morrow Formation in the Farnsworth Unit EOR field. Quantitative time-lapse seismic monitoring has the potential to track CO2 movement in geologic carbon storage sites. Los Alamos National Laboratory (LANL) has recently developed new full-waveform inversion methods to jointly invert time-lapse seismic data for changes in elastic and anisotropic parameters in target monitoring regions such as a CO2 reservoir. We apply our new joint inversion methods to time-lapse VSP data acquired at the Farnsworth EOR filed, and present some preliminary results showing geophysical properties changes in the reservoir.

  20. Sensitivity Analysis for Residual Stress on DVI (Direct Vessel Injection) Nozzle Welded Joint

    Energy Technology Data Exchange (ETDEWEB)

    Noh, Byeong Wook; Chung, Sung Ho; Lee, Jung Hun; Kim, Oak Sug [DOOSAN Heavy Industries and Construction Co. LTD, Reactor Design Team, 555 Guygok-dong Changwon (Korea, Republic of)

    2008-07-01

    Generally, any welding process produces high compressive or tensile residual stresses in the heat affected zone depending on the method, shape and procedures of the weldment. In particular, the tensile residual stresses have a considerable effect on the material strength, fatigue strength and corrosion cracking. For this reason, it is important that some knowledge of the internal stress state be deduced either from measurements or from modeling predictions. In this study, the residual stresses after a multi-pass welding process for DVI nozzle welding joint were evaluated by a numerical simulation method. The welding joint considered three weld joint angles of 40 deg., 6 deg. and 2 deg. Computations were made using a 2-D finite element model based on the simulation of cooling from the heat treatment temperature to room temperature with two cooling conditions at the inside surface. In these results, it is shown that the residual stress increased at the inner surface, when water cooling was applied to the inner surface, and axial compressive residual stress increased at the inner surface when the joint angle was decreased. (authors)

  1. Sensitivity Analysis for Residual Stress on DVI (Direct Vessel Injection) Nozzle Welded Joint

    International Nuclear Information System (INIS)

    Noh, Byeong Wook; Chung, Sung Ho; Lee, Jung Hun; Kim, Oak Sug

    2008-01-01

    Generally, any welding process produces high compressive or tensile residual stresses in the heat affected zone depending on the method, shape and procedures of the weldment. In particular, the tensile residual stresses have a considerable effect on the material strength, fatigue strength and corrosion cracking. For this reason, it is important that some knowledge of the internal stress state be deduced either from measurements or from modeling predictions. In this study, the residual stresses after a multi-pass welding process for DVI nozzle welding joint were evaluated by a numerical simulation method. The welding joint considered three weld joint angles of 40 deg., 6 deg. and 2 deg. Computations were made using a 2-D finite element model based on the simulation of cooling from the heat treatment temperature to room temperature with two cooling conditions at the inside surface. In these results, it is shown that the residual stress increased at the inner surface, when water cooling was applied to the inner surface, and axial compressive residual stress increased at the inner surface when the joint angle was decreased. (authors)

  2. Progression of cartilage degradation, bone resorption and pain in rat temporomandibular joint osteoarthritis induced by injection of iodoacetate.

    Directory of Open Access Journals (Sweden)

    Xue-Dong Wang

    Full Text Available BACKGROUND: Osteoarthritis (OA is an important subtype of temporomandibular disorders. A simple and reproducible animal model that mimics the histopathologic changes, both in the cartilage and subchondral bone, and clinical symptoms of temporomandibular joint osteoarthritis (TMJOA would help in our understanding of its process and underlying mechanism. OBJECTIVE: To explore whether injection of monosodium iodoacetate (MIA into the upper compartment of rat TMJ could induce OA-like lesions. METHODS: Female rats were injected with varied doses of MIA into the upper compartment and observed for up to 12 weeks. Histologic, radiographic, behavioral, and molecular changes in the TMJ were evaluated by light and electron microscopy, MicroCT scanning, head withdrawal threshold test, real-time PCR, immunohistochemistry, and TUNEL assay. RESULTS: The intermediate zone of the disc loosened by 1 day post-MIA injection and thinned thereafter. Injection of an MIA dose of 0.5 mg or higher induced typical OA-like lesions in the TMJ within 4 weeks. Condylar destruction presented in a time-dependent manner, including chondrocyte apoptosis in the early stages, subsequent cartilage matrix disorganization and subchondral bone erosion, fibrosis, subchondral bone sclerosis, and osteophyte formation in the late stages. Nociceptive responses increased in the early stages, corresponding to severe synovitis. Furthermore, chondrocyte apoptosis and an imbalance between anabolism and catabolism of cartilage and subchondral bone might account for the condylar destruction. CONCLUSIONS: Multi-level data demonstrated a reliable and convenient rat model of TMJOA could be induced by MIA injection into the upper compartment. The model might facilitate TMJOA related researches.

  3. Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography.

    NARCIS (Netherlands)

    Rutten, M.J.; Collins, J.M.; Maresch, B.J.; Smeets, J.H.R.; Janssen, C.M.; Kiemeney, L.A.L.M.; Jager, G.J.

    2009-01-01

    To assess the variability in accuracy of contrast media introduction, leakage, required time and patient discomfort in four different centres, each using a different image-guided glenohumeral injection technique. Each centre included 25 consecutive patients. The ultrasound-guided anterior (USa) and

  4. Accurate intra-articular knee joint injection in the obese? 'Fat Chance!'-A clinical lesson and recommendations for secondary referral.

    LENUS (Irish Health Repository)

    McGarry, James G

    2011-04-12

    Abstract Corticosteroid joint injections are perceived as being an effective treatment for symptomatic knee osteoarthritis, with a very low risk of complications. While the procedure is often performed in secondary care by orthopaedic surgeons and rheumatologists (and trainees in either specialty), the role of general practitioners (GPs) in chronic disease management has long existed with joint injections also frequently performed in primary care. The perception that serious complications from corticosteroid knee joint injections are rare and that their benefits in treating symptomatic knee osteoarthritis significantly outweigh the risks has not been well addressed. We present a case of a 71-year-old obese female who presented to her general practitioner (GP) with worsening left knee pain and radiographic changes consistent with osteoarthritis. She was administered a corticosteroid joint injection, which gave minimal relief, and over the next few days resulted in worsening severe pain, erythema and swelling. She returned to the GP who commenced oral antibiotics and referred her to casualty. A large knee abscess was diagnosed and intravenous antibiotics were commenced. The patient was admitted under the orthopaedic surgeons with her treatment consisting of multiple surgical procedures over a prolonged duration. Although lengthy, her postoperative recovery was unremarkable. Based on this case report and our review of the literature, we highlight the potential complications associated with corticosteroid knee joint injections and suggest certain patients for whom we would recommend secondary referral before any intervention in primary care.

  5. Pregnancy Complications: Shoulder Dystocia

    Science.gov (United States)

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

  6. [Intra-articular injections of hyaluronic acid for anterior disc displacement of temporomandibular joint].

    Science.gov (United States)

    Long, X

    2017-03-09

    Anterior disc displacement (ADD) of temporomandibular joint (TMJ) is regarded as one of the major findings in temporomandibular disorders (TMD). It is related to joint noise, pain, mandibular dysfunction, degenerative change and osteoarthritis. In the mean time, the pathological changes were found in synovial membrane and synovial fluid. Hyaluronic acid is a principal component of the synovial fluid which plays an important role in nutrition, lubrication, anti-inflammation and cartilage repair. The synthesis, molecule weight, and concentration of hyaluronic acid are decreased during TMD and cause TMJ degenerative changes. The clinical conditions, pathological changes, the mechanism of action for hyaluronic acid and the treatment of anterior disc displacement of TMJ are discussed in this article.

  7. 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.

  8. The Incidence of Propionibacterium acnes in Open Shoulder Surgery: A Controlled Diagnostic Study.

    Science.gov (United States)

    Mook, William R; Klement, Mitchell R; Green, Cynthia L; Hazen, Kevin C; Garrigues, Grant E

    2015-06-17

    Propionibacterium acnes has arisen as the most common microorganism identified at the time of revision shoulder arthroplasty. There is limited evidence to suggest how frequently false-positive cultures occur. The purpose of this prospective controlled study was to evaluate culture growth from specimens obtained during open shoulder surgery. Patients undergoing an open deltopectoral approach to the shoulder were prospectively enrolled. Patients with a history of shoulder surgery or any concern for active or previous shoulder infection were excluded. Three pericapsular soft-tissue samples were taken from the shoulder for bacterial culture and were incubated for fourteen days. A sterile sponge was also analyzed in parallel with the tissue cultures. In addition, similar cultures were obtained from patients who had undergone previous shoulder surgery. Overall, 20.5% of surgeries (twenty-four of 117) yielded at least one specimen removed for culture that was positive for bacterial growth, and 13.0% of sterile control specimens (seven of fifty-four) had positive culture growth (p = 0.234). P. acnes represented 83.0% of all positive cultures (thirty-nine of forty-seven) at a median incubation time of fourteen days. Among the subjects who had not undergone previous surgery, 17.1% (fourteen of eighty-two) had at least one positive P. acnes culture. Male sex was univariably associated with a greater likelihood of bacterial growth (p surgery and had received two or more preoperative corticosteroid injections had a higher likelihood of bacterial growth (p = 0.047). The clinical importance of positive P. acnes cultures from specimens obtained from open shoulder surgery remains uncertain. Male sex and preoperative corticosteroid injections were associated with a higher likelihood of bacterial growth on culture and are risk factors that merit further investigation. Previously reported incidences of positive P. acnes culture results from specimens from primary and revision shoulder

  9. Auto-aggressive metallic mercury injection around the knee joint: a case report

    Directory of Open Access Journals (Sweden)

    Friesenbichler Joerg

    2011-11-01

    Full Text Available Abstract Background Accidental or intentional subcutaneous and/or intramuscular injection of metallic mercury is an uncommon form of poisoning. Although it does not carry the same risk as mercury vapour inhalation, it may cause destructive early and late reactions. Case Presentation Herein we present the case of a 29-year-old male patient who developed an obsessive-compulsive disorder causing auto-aggressive behaviour with injection of elemental mercury and several other foreign bodies into the soft tissues around the left knee about 15 years before initial presentation. For clinical examination X-rays and a CT-scan of the affected area were performed. Furthermore, blood was taken to determine the mercury concentration in the blood, which showed a concentration 17-fold higher than recommended. As a consequence, the mercury depots and several foreign bodies were resected marginally. Conclusion Blood levels of mercury will decrease rapidly following surgery, especially in combination with chelating therapy. In case of subcutaneous and intramuscular injection of metallic mercury we recommend marginal or wide excision of all contaminated tissue to prevent migration of mercury and chronic inflammation. Nevertheless, prolonged clinical and biochemical monitoring should be performed for several years to screen for chronic intoxication.

  10. Positive contrast shoulder arthrography in dogs with uropolin

    International Nuclear Information System (INIS)

    Goranov, N.; Philipov, J.; Stamoulis, Y.

    2002-01-01

    Positive contrast radiography of both shoulder joints with different concentrations of Uropolin (containing 1.6 g sodium amidotrizoate and 10.4 g meglumine amidotrizoate in 20 ml ampules; Polfa, Poland) has been performed in six dogs, divided into 3 groups. The first group was injected with 20% Uropolin, the second - with 30% Uropolin and the third - with 30% Uropolin and 0.2 ml 0.1% adrenaline hydrochloride. Shoulder radiographs were performed 2, 5 and 10 min after the injection of the contrast medium in mediolateral and craniocaudal views. The quality of radiographs was assessed visually using a four score system for five independent parameters in both views. The results showed a better quality of mediolateral radiographs 5 minutes after injection of 30% Uropolin (average score 12.5) compared to 20% Uropolin (average score 8.5), at p<0.05. The addition of 0.1% adrenaline hydrochloride to 30% Uropolin resulted in a better quality of arthrographs up to 10 minutes following the administration (average score 10 compared to 8.5 in the group with independent application, p<0.01)

  11. 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.

  12. 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.

  13. Physiotherapy in frozen shoulder syndrome - literature review

    Directory of Open Access Journals (Sweden)

    Katarzyna Korabiusz

    2017-08-01

    Full Text Available Introduction: The frozen shoulder syndrome is seen as civilization illness. A significant amount of people suffer from it. The frozen shoulder syndrome is one of the most frequent dysfunctions of pectoral girdle. It is seen as a second frequent reason for visits at General Practicioner. There are three stages of this illness, there are a lot of symptoms, but one that occurs most commonly is pain. This illness can be completely curable. Research goal: Goal of this dissertation is a review of literature about available physiotherapy methods used in frozen shoulder syndrome. Conclusion: Kinesiotherapy, kinesiotaping, criotherapy, LASER, Traebert’s currents, iontophoresis, magnetic fields, ultrasounds, massage, manual therapy and combined therapy   are effective physiotherapy methods used in treating frozen shoulder syndrome. Those methods reduce pain indispositions and increase range of movement in shoulder joint.

  14. Adipose Derived Stromal Cell (ADSC) Injections for Pain Management of Osteoarthritis in the Human Knee Joint.

    Science.gov (United States)

    Fodor, Peter B; Paulseth, Stephen G

    2016-02-01

    This safety and feasibility study used autologous adipose-derived stromal vascular cells (the stromal vascular fraction [SVF] of adipose tissue), to treat 8 osteoarthritic knees in 6 patients of grade I to III (K-L scale) with initial pain of 4 or greater on a 10-point Visual Analog Scale (VAS). The primary objective of the study was evaluation of the safety of intra-articular injection of SVF. The secondary objective was to assess initial feasibility for reduction of pain in osteoarthritic knees. Adipose-derived SVF cells were obtained through enzymatic disaggregation of lipoaspirate, resuspension in 3 mL of Lactated Ringer's Solution, and injection directly into the intra-articular space of the knee, with a mean of 14.1 million viable, nucleated SVF cells per knee. Metrics included monitoring of adverse events and preoperative to postoperative changes in the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the VAS pain scale, range of motion (ROM), timed up-and-go (TUG), and MRI. No infections, acute pain flares, or other adverse events were reported. At 3-months postoperative, there was a statistically significant improvement in WOMAC and VAS scores (P knee pain. Autologous SVF was shown to be safe and to present a new potential therapy for reduction of pain for osteoarthritis of the knee. LEVEL OF EVIDENCE 4: Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  15. Prevalence of Propionibacterium acnes in the glenohumeral compared with the subacromial space in primary shoulder arthroscopies.

    Science.gov (United States)

    Patzer, Thilo; Petersdorf, Sabine; Krauspe, Ruediger; Verde, Pablo Emilio; Henrich, Birgit; Hufeland, Martin

    2018-05-01

    We hypothesized that the prevalence of Propionibacterium acnes in patients undergoing primary shoulder arthroscopy is equal in the glenohumeral space compared with the subacromial space. Patients aged 18 years or older with shoulder arthroscopies were included. The exclusion criteria were prior shoulder operations, complete rotator cuff tears, systemic inflammatory diseases, tumors, shoulder injections within 6 months of surgery, and antibiotic therapy within 14 days preoperatively. After standardized skin disinfection with Kodan Tinktur Forte Gefärbt, a skin swab was taken at the posterior portal. Arthroscopy was performed without cannulas, prospectively randomized to start either in the glenohumeral space or in the subacromial space, with direct harvesting of a soft-tissue biopsy specimen. Sample cultivation was conducted according to standardized criteria for bone and joint aspirate samples and incubated for 14 days. Matrix-assisted laser desorption-ionization time-of-flight spectrometry was used for specimen identification in positive culture results. The study prospectively included 115 consecutive patients with normal C-reactive protein levels prior to surgery (54.8% men; mean age, 47.2 ± 14.6 years). P acnes was detected on the skin after disinfection in 36.5% of patients, in the glenohumeral space in 18.9%, and in the subacromial space in 3.5% (P = .016). The prevalence of P acnes is significantly higher in the glenohumeral space compared with the subacromial space in primary shoulder arthroscopies. The results do not confirm the contamination theory but also cannot clarify whether P acnes is a commensal or enters the joint hematologically or even lymphatically or via an unknown pathway. Despite standardized surgical skin disinfection, P acnes can be detected in skin swab samples in more than one-third of patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  16. Frozen shoulder contracture syndrome - Aetiology, diagnosis and management.

    Science.gov (United States)

    Lewis, Jeremy

    2015-02-01

    Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. Although function improves overtime, full and pain free range, may not be restored in everyone. Frozen shoulder is also known as adhesive capsulitis, however the evidence for capsular adhesions is refuted and arguably, this term should be abandoned. The aim of this Masterclass is to synthesise evidence to provide a framework for assessment and management for Frozen Shoulder. Although used in the treatment of this condition, manipulation under anaesthetic has been associated with joint damage and may be no more effective than physiotherapy. Capsular release is another surgical procedure that is supported by expert opinion and published case series, but currently high quality research is not available. Recommendations that supervised neglect is preferable to physiotherapy have been based on a quasi-experimental study associated with a high risk of bias. Physiotherapists in the United Kingdom have developed dedicated care pathways that provide; assessment, referral for imaging, education, health screening, ultrasound guided corticosteroid and hydro-distension injections, embedded within physiotherapy rehabilitation. The entire pathway is provided by physiotherapists and evidence exists to support each stage of the pathway. Substantial on-going research is required to better understand; epidemiology, patho-aetiology, assessment, best management, health economics, patient satisfaction and if possible prevention. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Merolla, G; Nastrucci, G; Porcellini, G

    Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

  18. Magnetic resonance imaging of traumatic anterior instability of the shoulder

    International Nuclear Information System (INIS)

    Horii, Motoyuki

    1994-01-01

    The diagnostic capability of MRI in depicting abnormalities in traumatic anterior instability of the shoulder (TAI) was evaluated with special attention to MR arthrogram enhanced by joint effusion or saline solution. Sixty five shoulders with TAI and 19 control shoulders were scanned using the field gradient echo method (STAGE technique) on axial plane with a 1.0 or 1.5 Tesla system. MR arthrogram was obtained in 36 shoulders with TAI (Group A) and 11 control shoulders (Group C). Conventional MRI was obtained in 29 shoulders with TAI (Group B) and 8 control shoulders (Group D). Abnormalities in Bankart lesion were assessed according to signal intensity and labral shape. Abnormal signal was obtained in 8 shoulders (27.6%) in group B. Changes in shape were seen in 35 shoulders (97.2%) in group A and 18 (62.1%) in group B. Interruption of the anterior capsule was suspected in 3 (8.3%) in group A. Hill-Sachs lesion was suspected in 60 shoulders. Shoulders in the control group showed no abnormal change. Details of Bankart lesion confirmed by subsequent arthroscopy were diagnosed correctly in all of 14 shoulders on MR arthrogram and 8 of 16 shoulders on conventional MRI. These results show that MRI, MR arthrogram in particular, is useful for depicting abnormalities in TAI. (author)

  19. 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

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

    Science.gov (United States)

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

    2008-12-01

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

  1. Can combined use of low-level lasers and hyaluronic acid injections prolong the longevity of degenerative knee joints?

    Directory of Open Access Journals (Sweden)

    Ip D

    2015-08-01

    Full Text Available David Ip, Nga Yue FuAsia Medical Pain Centre, Grand Plaza, Mong Kok, Hong KongBackground: This study evaluated whether half-yearly hyaluronic acid injection together with low-level laser therapy in addition to standard conventional physical therapy can successfully postpone the need for joint replacement surgery in elderly patients with bilateral symptomatic tricompartmental knee arthritis.Methods: In this prospective, double-blind, placebo-controlled study, 70 consecutive unselected elderly patients with bilateral tricompartmental knee arthritis were assigned at random to either one of two conservative treatment protocols to either one of the painful knees. Protocol A consisted of conventional physical therapy plus a sham light source plus saline injection, and protocol B consisted of protocol A with addition of half-yearly hyaluronic acid injection as well as low-level laser treatment instead of using saline and a sham light source. Treatment failure was defined as breakthrough pain necessitating joint replacement.Results: Among the 140 painful knees treated with either protocol A or protocol B, only one of the 70 painful knees treated by protocol B required joint replacement, whereas 15 of the 70 painful knees treated by protocol A needed joint replacement surgery (P<0.05.Conclusion: We conclude that half-yearly hyaluronic acid injections together with low-level laser therapy should be incorporated into the standard conservative treatment protocol for symptomatic knee arthritis, because it may prolong the longevity of the knee joint without the need for joint replacement.Keywords: knee osteoarthritis, hyaluronic acid injection, low-level laser, outcome

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

    International Nuclear Information System (INIS)

    Bardet, J.F.

    1998-01-01

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

  3. Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach

    Energy Technology Data Exchange (ETDEWEB)

    Gokalp, Gokhan; Dusak, Abdurrahim; Yazici, Zeynep [Uludag University Medical Faculty, Goeruekle Kampusu, Department of Radiology, Bursa (Turkey)

    2010-06-15

    Shoulder MR arthrography has an important role in the assessment of rotator cuff lesions, labral tears, glenohumeral ligaments, rotator interval lesions, and postoperative shoulder status. Injection in direct MR arthrography can be performed with palpation, fluoroscopy, ultrasonography (US), or MRI. Recently, the posterior approach is the preferred method due to the presence of fewer stabilizers, absence of important articular structures and less extravasation, has been advocated. Our aim was to assess the efficacy of US-guided MR arthrography via a posterior approach on the glenohumeral joint. Thirty MR arthrographies were performed on 29 patients. Ultrasonography (Xario, Toshiba) examinations were conducted by a wide-band 5-12 Mhz linear array transducer set to muscle-skeleton. Diluted contrast medium (1 ml gadolinium chelate and 100 ml saline, approximately 15 ml) was delivered into the glenohumeral joint space from between the humeral head and posterior labrum with a 20-gauge spinal needle. MRI examination was conducted by a 1.5 T scanner. Fat-saturated T1-weighted spin echo was applied on coronal, axial, and sagittal planes within the first 30 min after contrast material injection. One (3.3%) arthrography was not successful due to technical reasons associated with obesity. Contrast extravasation around the infraspinatus and teres minoer muscles was depicted in twelve examinations. One (3.3%) patient developed vasovagal collapse. Ultrasonography-guided posterior approach is an easy, reliable, fast, and comfortable method in experienced hands. It may be an alternative for fluoroscopy-guided shoulder MR arthrography. (orig.)

  4. Efficacy of ultrasonography-guided shoulder MR arthrography using a posterior approach

    International Nuclear Information System (INIS)

    Gokalp, Gokhan; Dusak, Abdurrahim; Yazici, Zeynep

    2010-01-01

    Shoulder MR arthrography has an important role in the assessment of rotator cuff lesions, labral tears, glenohumeral ligaments, rotator interval lesions, and postoperative shoulder status. Injection in direct MR arthrography can be performed with palpation, fluoroscopy, ultrasonography (US), or MRI. Recently, the posterior approach is the preferred method due to the presence of fewer stabilizers, absence of important articular structures and less extravasation, has been advocated. Our aim was to assess the efficacy of US-guided MR arthrography via a posterior approach on the glenohumeral joint. Thirty MR arthrographies were performed on 29 patients. Ultrasonography (Xario, Toshiba) examinations were conducted by a wide-band 5-12 Mhz linear array transducer set to muscle-skeleton. Diluted contrast medium (1 ml gadolinium chelate and 100 ml saline, approximately 15 ml) was delivered into the glenohumeral joint space from between the humeral head and posterior labrum with a 20-gauge spinal needle. MRI examination was conducted by a 1.5 T scanner. Fat-saturated T1-weighted spin echo was applied on coronal, axial, and sagittal planes within the first 30 min after contrast material injection. One (3.3%) arthrography was not successful due to technical reasons associated with obesity. Contrast extravasation around the infraspinatus and teres minoer muscles was depicted in twelve examinations. One (3.3%) patient developed vasovagal collapse. Ultrasonography-guided posterior approach is an easy, reliable, fast, and comfortable method in experienced hands. It may be an alternative for fluoroscopy-guided shoulder MR arthrography. (orig.)

  5. Operation and reliability of a pneumatic hydrogen pellet injection system on the Joint European Torus

    International Nuclear Information System (INIS)

    Combs, S.K.; Jernigan, T.C.; Baylor, L.R.; Milora, S.L.; Foust, C.R.; Kupschus, P.; Gadeberg, M.; Bailey, W.; Commission of the European Communities, Abingdon

    1989-01-01

    A pneumatic-based, hydrogen isotope pellet injector that was developed at the Oak Ridge National Laboratory for the plasma fueling application on the Joint European Torus (JET) was described at the last Symposium on Fusion Engineering (1987). The injector was installed on JET during 1987 and has since been used in plasma fueling experiments. The injector consists of three independent machine-gun-like mechanisms (nominal pellet sizes of 2.7, 4.0, and 6.0 mm in diameter), and it features repetitive operation (1-5 Hz) for quasi-steady-state conditions (>10 s). An extensive set of injector diagnostics permits evaluation of parameters for each pellet shot, including speed, mass, and integrity. Pellet speeds can be varied but typically range from 1.0 to 1.5 km/s. Over 5000 pellets have been fired with the equipment at JET, including about 2000 pellets shot for plasma fueling experiments. In recent experiments, the system performance has been outstanding, including excellent reproducibility in pellet speed and mass and a reliability of >98% in delivery of pellets to the plasma. 7 refs., 5 figs

  6. The determination of histopathological and biochemical effects of the rabbit knee joint injected dexketoprofen trometamol.

    Science.gov (United States)

    Hacibeyoğlu, Gülçin; Saritaş, Tuba Berra; Saritaş, Zülfikar Kadir; Korkmaz, Musa; Sevimli, Alper; Mehmetoğlu, İdris; Otelcioğlu, Şeref

    2015-02-01

    This study was conducted to investigate possible histopathological effects and biochemical reflections of intra-articular dexketoprofen trometamol. A total of 24 New Zealand rabbits were included in the study. Blood sampling was carried out from all animals on the first day, then they were randomly allocated either to the control group (Group C, n = 9) or the dexketoprofen trometamol group (Group D, n = 15). Group C underwent each two intra-articular injections of saline, 0.25 mL into right and 0.50 mL into left knee. Group D was injected 0.25 mL (6.25 mg) dexketoprofen trometamol into the right knee and 0.50 mL (12.5 mg) into the left. The groups were divided randomly into three. Tissue and blood samples were collected from Groups C1 and D1 on the first day, C2 and D2 on the second day and C3 and D3 on the 10th day of the study. Interleukin-1 (IL-1β), interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α) and C-reactive protein (CRP) levels were studied. The histopathological examination of C and D groups did not present any deterioration. IL-6 basal levels were significantly higher in Group D2 compared with C2 and C3 compared with D3. Basal TNF-α levels were higher compared with day 1 in Group C1, and IL-6 and CRP levels were higher in Group D3. Also, none of the increases in these values are supported by histopathological evaluation results. Consequently, we suppose that dexketoprofen trometamol does not cause histopathological deterioration in articular cartilage of rabbits, and the increases in biochemical parameters exclusively are not clinically significant. © 2014 Société Française de Pharmacologie et de Thérapeutique.

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

    Directory of Open Access Journals (Sweden)

    Marcel Jun Sugawara Tamaoki

    2012-01-01

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

  8. A New Technique for the Treatment of Lumbar Facet Joint Syndrome Using Intra-articular Injection with Autologous Platelet Rich Plasma.

    Science.gov (United States)

    Wu, Jiuping; Du, Zhenwu; Lv, Yang; Zhang, Jun; Xiong, Wei; Wang, Ruiqiang; Liu, Rui; Zhang, Guizhen; Liu, Qinyi

    2016-01-01

    Lumbar facet joint syndrome is currently suggested to be a main source of axial low back pain, and a large portion of axial low back pain is caused by disorders in lumbar facet joints. Intra-articular injection is one of the most common treatment methods in the early clinical application. Therefore, we attempt to seek a new injectable material, autologous platelet rich plasma (PRP), to treat lumbar facet syndrome, as well as to assess its therapeutic effectiveness and safety. A prospective clinic evaluation. The outpatient clinic of a single academic medical center. Total 19 patients with lumbar facet joint syndrome (8 men, 11 women; mean ages: 52.53 ± 6.79 years, range: 38 - 62 years) were enrolled to receive lumbar facet joint injection with autologous PRP under x-ray fluoroscopic control. Patients were followed up immediately, at one week, one month, 2 months, and 3 months following treatment, and the elements of this analysis included low back pain visual analogue scale (VAS) at rest and during flexion, Roland-Morris Disability Questionnaire (RMQ), Oswestry Disability Index (ODI), and modified MacNab criteria for the pain relief. All the 19 patients completed the intra-articular injections with autologous PRP successfully. At one week after treatment, low back pain reduced significantly compared with prior to treatment both at rest and during flexion. The outcomes were assessed as "good" or "excellent" for 9 patients (47.37%) immediately after treatment, 14 patients (73.68%) at one week, 15 patients (78.95%) at one month, 15 patients (78.95%) at 2 months, and 15 patients (78.95%) at 3 months. Statistically significant differences were observed based on RMQ and a more than 10% improvement in lumbar functional capacity was observed based on ODI between pre-treatment and post-treatment. In addition, there were no severe relevant complications during the whole process of injection and follow-up period. A control group and the curative effect observations with

  9. Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis

    International Nuclear Information System (INIS)

    Fritz, J.; Tzaribachev, N.; Thomas, C.; Claussen, C.D.; Carrino, J.A.; Lewin, J.S.; Pereira, P.L.

    2011-01-01

    To test the hypothesis that MR imaging guided triamcinolone acetonide injection into the sacroiliac joints of children with enthesitis-related arthritis is feasible, accurate and safe; and effectively reduces sacroiliac inflammation and disease progression. A retrospective analysis of 14 children (6/14 [43%] female, 8/14 (57%) male; mean age, 13.2 years; range, 6-16 years) who received MR imaging guided sacroiliac joint injections at 0.2 Tesla or 1.5 Tesla for enthesitis-related arthritis and acute sacroilitis refractory to medical therapy was performed. 20 mg triamcinolone acetonide were injected. Assessed were intra-articular drug delivery; image quality, duration, and complications. Success of therapy was defined by change of sacroiliac inflammation. Remission time and erosions were assessed by follow-up MRI (range, 10-22 months). Twenty four procedures resulted in intra-articular injection. Image quality was sufficient. No complications occurred. Procedure time was 40 min. Sedation time was 22 min. Success of therapy was achieved in 11/14 (79%) children. Sacroiliac inflammation decreased significantly (-59%). Median remission time was 13.7 months. No erosions occurred. MR imaging guided steroid injection of the sacroiliac joints is feasible, accurate, and safe and can effectively reduce sacroiliac inflammatory activity and may therefore aid in the prevention of disease progression. (orig.)

  10. Evaluation of MR imaging guided steroid injection of the sacroiliac joints for the treatment of children with refractory enthesitis-related arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Fritz, J. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Eberhard-Karls-University Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); Tzaribachev, N. [Eberhard-Karls-University Tuebingen, Department of Hematology, Oncology and General Pediatrics, University Children' s Hospital, Tuebingen (Germany); Klinikum Bad Bramstedt, Department of Pediatric Rheumatology, Bad Bramstedt (Germany); Thomas, C.; Claussen, C.D. [Eberhard-Karls-University Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); Carrino, J.A.; Lewin, J.S. [Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Pereira, P.L. [Eberhard-Karls-University Tuebingen, Department of Diagnostic Radiology, Tuebingen (Germany); SLK-Kliniken Heilbronn, Department of Radiology, Minimally Invasive Therapies and Nuclearmedicine, Heilbronn (Germany)

    2011-05-15

    To test the hypothesis that MR imaging guided triamcinolone acetonide injection into the sacroiliac joints of children with enthesitis-related arthritis is feasible, accurate and safe; and effectively reduces sacroiliac inflammation and disease progression. A retrospective analysis of 14 children (6/14 [43%] female, 8/14 (57%) male; mean age, 13.2 years; range, 6-16 years) who received MR imaging guided sacroiliac joint injections at 0.2 Tesla or 1.5 Tesla for enthesitis-related arthritis and acute sacroilitis refractory to medical therapy was performed. 20 mg triamcinolone acetonide were injected. Assessed were intra-articular drug delivery; image quality, duration, and complications. Success of therapy was defined by change of sacroiliac inflammation. Remission time and erosions were assessed by follow-up MRI (range, 10-22 months). Twenty four procedures resulted in intra-articular injection. Image quality was sufficient. No complications occurred. Procedure time was 40 min. Sedation time was 22 min. Success of therapy was achieved in 11/14 (79%) children. Sacroiliac inflammation decreased significantly (-59%). Median remission time was 13.7 months. No erosions occurred. MR imaging guided steroid injection of the sacroiliac joints is feasible, accurate, and safe and can effectively reduce sacroiliac inflammatory activity and may therefore aid in the prevention of disease progression. (orig.)

  11. Prolonged naproxen joint residence time after intra-articular injection of lipophilic solutions comprising a naproxen glycolamide ester prodrug in the rat

    DEFF Research Database (Denmark)

    Thing, Mette; Lu, Yi; Agårdh, Li

    2013-01-01

    time. Two oils, medium-chain triglycerides and castor oil, differing with respect to viscosity were tested. After intra-articular administration of oil prodrug solutions, a significant increase in the time to maximum naproxen serum concentration from around 40 to 245min, an increase in the MRTj from......Intra-articular injection of oil solutions of lipophilic prodrugs that rapidly degrade to their parent compound in synovial fluid may constitute a feasible approach to increase the joint residence time of non-steroidal anti-inflammatory drugs. In this in vivo study, oil solutions of the N......,N-diethyl glycolamide ester prodrug of naproxen (16mg/ml) were injected into the rat knee joint by dosing 6μl formulation per 100g body weight. The sustained release properties were compared to those of intra-articularly injected aqueous and oil solutions of naproxen by monitoring the naproxen serum concentrations over...

  12. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion

    Science.gov (United States)

    Galisteo, Carlos; García-Manrique, María; Navarro, Noemí; Caixàs, Assumpta; Larrosa, Marta; Gratacós, Jordi

    2018-01-01

    Objectives Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. Methods One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VASeffusion. PMID:29351562

  13. Risk of subacromial shoulder disorder in airport baggage handlers

    DEFF Research Database (Denmark)

    Møller, Sanne Pagh; Brauer, Charlotte; Mikkelsen, Sigurd

    2018-01-01

    age,exposure variables showed close to significant associations with subacromial shoulder disorder.Results could not confirm our hypothesis that combined information on work task duration and shoulder load intensity was stronger associated with subacromial shoulder disorder than seniority.......Musculoskeletal shoulder-load among baggage handlers measured by combining duration and intensity based on biomechanical and epidemiological information may be a stronger predictor of subacromial shoulder disordersthanbaggage handler seniority.In 2012, a cohort of baggage handlers employed...... at Copenhagen Airport in 1990-2012, and a cohort of unskilledotherwise employed men answered a survey.Self-reported information on work tasks during employment in the airport in combination with work task specific biomechanically modelled forces in the shoulder joint was used to estimate shoulder-load. Exposure...

  14. Quasi-static analysis of muscle forces in the shoulder mechanism during wheelchair propulsion

    NARCIS (Netherlands)

    van der Helm, Frans C T; Veeger, H. E J

    During wheelchair propulsion the largest net joint moments and net joint powers are generated around the shoulder. The analysis of the contribution of arm- and shoulder muscles to the joint moments could explain the low efficiency of wheelchair propulsion. Basically, it is assumed that a large

  15. Intra-articular injection of hyaluronic acid for the reduction in joint adhesion formation in a rabbit model of knee injury.

    Science.gov (United States)

    Wang, Min; Liu, Chao; Xiao, Wei

    2014-07-01

    Our purpose was to evaluate the effectiveness of intra-articular injections of hyaluronic acid (HA) into immobilized joints for reducing rigidity and formation of joint adhesions following surgery and prolonged joint immobilization. Twenty-four New Zealand white rabbits were randomly divided into experimental (n = 12) and control groups (n = 12). A model of knee injury was created in the right hind leg, and external plaster fixation was performed for 8 weeks. The experimental and control groups received weekly intra-articular injections of 0.3 mL HA solution or normal saline, respectively, in the knee joint. The degree of adhesions, range of motion (ROM), and collagen content of the synovium of the knee joint were observed after 8 weeks. At the end of 8 weeks, the experimental compared with control group had significantly higher mean ROM (70.3° ± 11.1° vs. 54.6° ± 11.2°, respectively; P = 0.002) and mean adhesion score. The experimental group compared with the control group had significantly lower mean adhesion score (2.2 ± 0.9 vs. 3.1 ± 0.7, respectively; P = 0.012) and collagen content (32.4 ± 4.7 vs. 39.0 ± 4.2 μg/mg, P = 0.001). In a rabbit model of knee injury, intra-articular injection of HA decreased adhesion formation and collagen content and increased ROM after prolonged immobilization. These results indicate that HA may be clinically useful to prevent adhesions and improve joint mobility in patients who require joint immobilization for up to 8 weeks.

  16. Effects of intra-articular hyaluronic acid injection on immunohistochemical characterization of joint afferents in a rat model of knee osteoarthritis.

    Science.gov (United States)

    Ikeuchi, M; Izumi, M; Aso, K; Sugimura, N; Kato, T; Tani, T

    2015-03-01

    Intra-articular hyaluronic acid (HA) injection, known as viscosupplementation, is a widely used therapy for pain relief in knee osteoarthritis (OA). Long-term clinical efficacy of HA has been reported in spite of a relatively short residence time. Herein, we evaluated our hypothesis that intra-articular HA injection could reduce the OA-associated changes in joint afferents. OA was induced by intra-articular injection of mono-iodoacetate in rats. Animals in the OA + HA group were given three weekly intra-articular HA injections. Pain-related behaviours, including weight-bearing asymmetry and mechanical hyperalgesia of the paw, knee joint histology and immunohistochemistry of joint afferents identified by retrograde labelling, were compared between groups (naïve, OA and OA + HA). OA rats showed pain-related behaviours and up-regulation of pain-related neurochemical markers [calcitonin gene-related peptide (CGRP), tyrosine receptor kinase A (TrkA) and acid-sensing ion channel 3 (ASIC3)] in joint afferents. HA injections reduced not only the severity of OA and pain behaviours but also OA-associated neurochemical changes in joint afferents. The differences between OA and OA + HA were statistically significant in CGRP (61 ± 10% vs. 51 ± 10%; p = 0.0406) but not significant in TrkA (62 ± 10% vs. 54 ± 9%; p = 0.0878) and ASIC3 (38 ± 9% vs. 32 ± 8%; p = 0.3681). Intra-articular HA injections reduced the severity of OA, decreased mechanical hyperalgesia of the paw, but not weight-bearing asymmetry, and attenuated OA-associated up-regulation of CGRP, but not TrkA and ASIC3, in joint afferents. The modulatory effects of HA on joint afferents is one of the underlying mechanisms of the gap between HA residence time and duration of clinical efficacy. © 2014 European Pain Federation - EFIC®

  17. Comparison Between Image-Guided and Landmark-Based Glenohumeral Joint Injections for the Treatment of Adhesive Capsulitis: A Cost-Effectiveness Study.

    Science.gov (United States)

    Gyftopoulos, Soterios; Abballe, Valentino; Virk, Mandeep S; Koo, James; Gold, Heather T; Subhas, Naveen

    2018-04-09

    The purpose of this study was to determine the cost-effectiveness of landmark-based and image-guided intraarticular steroid injections for the initial treatment of a population with adhesive capsulitis. A decision analytic model from the health care system perspective over a 6-month time frame for 50-year-old patients with clinical findings consistent with adhesive capsulitis was used to evaluate the incremental cost-effectiveness of three techniques for administering intraarticular steroid to the glenohumeral joint: landmark based (also called blind), ultrasound guided, and fluoroscopy guided. Input data on cost, probability, and utility estimates were obtained through a comprehensive literature search and from expert opinion. The primary effectiveness outcome was quality-adjusted life years (QALY). Costs were estimated in 2017 U.S. dollars. Ultrasound-guided injections were the dominant strategy for the base case, because it was the least expensive ($1280) and most effective (0.4096 QALY) strategy of the three options overall. The model was sensitive to the probabilities of getting the steroid into the joint by means of blind, ultrasound-guided, and fluoroscopy-guided techniques and to the costs of the ultrasound-guided and blind techniques. Two-way sensitivity analyses showed that ultrasound-guided injections were favored over blind and fluoroscopy-guided injections over a range of reasonable probabilities and costs. Probabilistic sensitivity analysis showed that ultrasound-guided injections were cost-effective in 44% of simulations, compared with 34% for blind injections and 22% for fluoroscopy-guided injections and over a wide range of willingness-to-pay thresholds. Ultrasound-guided injections are the most cost-effective option for the initial steroid-based treatment of patients with adhesive capsulitis. Blind and fluoroscopy-guided injections can also be cost-effective when performed by a clinician likely to accurately administer the medication into the

  18. The influence of experimentally induced pain on shoulder muscle activity

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  19. 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.

  20. Using your shoulder after surgery

    Science.gov (United States)

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... rotator cuff surgery or other ligament or labral surgery, you need to be careful with your shoulder. Ask the surgeon what arm movements are safe ...

  1. Multimodal assessment of sensorimotor shoulder function in patients with untreated anterior shoulder instability and asymptomatic handball players.

    Science.gov (United States)

    Mornieux, Guillaume; Hirschmüller, Anja; Gollhofer, Albert; Südkamp, Norbert P; Maier, Dirk

    2018-04-01

    Functional evaluation of sensorimotor function of the shoulder joint is important for guidance of sports-specific training, prevention and rehabilitation of shoulder instability. Such assessment should be multimodal and comprise all qualities of sensorimotor shoulder function. This study evaluates feasibility of such multimodal assessment of glenohumeral sensorimotor function in patients with shoulder instability and handball players. Nine patients with untreated anterior instability of their dominant shoulder and 15 asymptomatic recreational handball players performed proprioceptive joint position sense and dynamic stabilization evaluations on an isokinetic device, as well as a functional throwing performance task. Outcome measures were analysed individually and equally weighted in a Shoulder-Specific Sensorimotor Index (S-SMI). Finally, isokinetic strength evaluations were conducted. We observed comparable sensorimotor functions of unstable dominant shoulders compared to healthy, contralateral shoulders (e.g. P=0.59 for S-SMI). Handball players demonstrated superior sensorimotor function of their dominant shoulders exhibiting a significantly higher throwing performance and S-SMI (P0.22). The present study proves feasibility of multimodal assessment of shoulder sensorimotor function in overhead athletes and patients with symptomatic anterior shoulder instability. Untreated shoulder instability led to a loss of dominance-related sensorimotor superiority indicating functional internal rotation deficiency. Dominant shoulders of handball players showed a superior overall sensorimotor function but weakness of dominant internal rotation constituting a risk factor for occurrence of posterior superior impingement syndrome. The S-SMI could serve as a diagnostic tool for guidance of sports-specific training, prevention and rehabilitation of shoulder instability.

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-04-15

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

  4. Shoulder surgery - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000179.htm Shoulder surgery - discharge To use the sharing features on this page, please enable JavaScript. You had shoulder surgery to repair the tissues inside or around your ...

  5. MR imaging after therapeutic injection of the subacromial bursa

    Energy Technology Data Exchange (ETDEWEB)

    Major, N.M. [Duke University Medical Center, Department of Radiology, Division Musculoskeletal, Durham, NC (United States)

    1999-11-01

    Objective. As a therapeutic injection into the subacromial bursa (SAB) is commonly performed for impingement syndrome, it is important to know whether this fluid can be retained for a period of time and cause confusion with a pathologic collection of fluid. This study identifies and describes the appearance of recent subacromial injection using MR imaging, and the appearance of a potential complication.Design and patients. Fourteen asymptomatic shoulders were studied with MR imaging using fast spin echo T2-weighted imaging (1.5 T) prior to injection with 7 cm{sup 3} of xylocaine. Four shoulders had subacromial fluid and were eliminated from the study. The remaining 10 (9 men, 1 woman; age range 27-36 years, average age 33 years) were then re-imaged immediately, and at 6, 12 and 24 h after the injection or until fluid resolved. Each set of images was reviewed for the presence of fluid in the SAB and for additional abnormalities.Results. Fluid was identified in all subjects in the SAB in the immediate, 6 and 12 h post-injection images. At 24 h, fluid was not identified within the SAB in eight of 10 patients. In one patient fluid resolved in 48 h. The other continued to demonstrate fluid in the SAB and in the joint as well as abnormal signal in the infraspinatus muscle from a presumed myositis. Imaging was performed up to 10 days after the injection in this patient.Conclusions. It is known that fluid identified in the SAB without evidence of a cuff tear may be due to bursitis. However, if MR imaging is performed within 24 h of injection, the presence of the fluid may be iatrogenic. In addition, the history of recent therapeutic injection is very important as complications such as myositis can occur as a result of the injection. Knowledge of injection prior to imaging is vital for accurate interpretation of MR shoulder examinations. (orig.)

  6. MR imaging after therapeutic injection of the subacromial bursa

    International Nuclear Information System (INIS)

    Major, N.M.

    1999-01-01

    Objective. As a therapeutic injection into the subacromial bursa (SAB) is commonly performed for impingement syndrome, it is important to know whether this fluid can be retained for a period of time and cause confusion with a pathologic collection of fluid. This study identifies and describes the appearance of recent subacromial injection using MR imaging, and the appearance of a potential complication.Design and patients. Fourteen asymptomatic shoulders were studied with MR imaging using fast spin echo T2-weighted imaging (1.5 T) prior to injection with 7 cm 3 of xylocaine. Four shoulders had subacromial fluid and were eliminated from the study. The remaining 10 (9 men, 1 woman; age range 27-36 years, average age 33 years) were then re-imaged immediately, and at 6, 12 and 24 h after the injection or until fluid resolved. Each set of images was reviewed for the presence of fluid in the SAB and for additional abnormalities.Results. Fluid was identified in all subjects in the SAB in the immediate, 6 and 12 h post-injection images. At 24 h, fluid was not identified within the SAB in eight of 10 patients. In one patient fluid resolved in 48 h. The other continued to demonstrate fluid in the SAB and in the joint as well as abnormal signal in the infraspinatus muscle from a presumed myositis. Imaging was performed up to 10 days after the injection in this patient.Conclusions. It is known that fluid identified in the SAB without evidence of a cuff tear may be due to bursitis. However, if MR imaging is performed within 24 h of injection, the presence of the fluid may be iatrogenic. In addition, the history of recent therapeutic injection is very important as complications such as myositis can occur as a result of the injection. Knowledge of injection prior to imaging is vital for accurate interpretation of MR shoulder examinations. (orig.)

  7. The effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps strength and pain in individuals with knee synovitis: a prospective observational study.

    Science.gov (United States)

    Rice, David Andrew; McNair, Peter John; Lewis, Gwyn Nancy; Dalbeth, Nicola

    2015-07-28

    Substantial weakness of the quadriceps muscles is typically observed in patients with arthritis. This is partly due to ongoing neural inhibition that prevents the quadriceps from being fully activated. Evidence from animal studies suggests enhanced flexion reflex excitability may contribute to this weakness. This prospective observational study examined the effects of joint aspiration and intra-articular corticosteroid injection on flexion reflex excitability, quadriceps muscle strength and knee pain in individuals with knee synovitis. Sixteen patients with chronic arthritis and clinically active synovitis of the knee participated in this study. Knee pain flexion reflex threshold, and quadriceps peak torque were measured at baseline, immediately after knee joint aspiration alone and 5 ± 2 and 15 ± 2 days after knee joint aspiration and the injection of 40 mg of methylprednisolone acetate. Compared to baseline, knee pain was significantly reduced 5 (p = 0.001) and 15 days (p = 0.009) post intervention. Flexion reflex threshold increased immediately after joint aspiration (p = 0.009) and 5 (p = 0.01) and 15 days (p = 0.002) post intervention. Quadriceps peak torque increased immediately after joint aspiration (p = 0.004) and 5 (p = 0.001) and 15 days (p knee synovitis.

  8. Like father, like son: assessment of the morphological affinities of A.L. 288-1 (A. afarensis, Sts 7 (A. africanus and Omo 119-73-2718 (Australopithecus sp. through a three-dimensional shape analysis of the shoulder joint.

    Directory of Open Access Journals (Sweden)

    Julia Arias-Martorell

    Full Text Available The postcranial evidence for the Australopithecus genus indicates that australopiths were able bipeds; however, the morphology of the forelimbs and particularly that of the shoulder girdle suggests that they were partially adapted to an arboreal lifestyle. The nature of such arboreal adaptations is still unclear, as are the kind of arboreal behaviors in which australopiths might have engaged. In this study we analyzed the shape of the shoulder joint (proximal humerus and glenoid cavity of the scapula of three australopith specimens: A.L. 288-1 (A. afarensis, Sts 7 (A. africanus and Omo 119-73-2718 (Australopithecus sp. with three-dimensional geometric morphometrics. The morphology of the specimens was compared with that of a wide array of living anthropoid taxa and some additional fossil hominins (the Homo erectus specimen KNM-WT 15000 and the H. neanderthalensis specimen Tabun 1. Our results indicate that A.L. 288-1 shows mosaic traits resembling H. sapiens and Pongo, whereas the Sts 7 shoulder is most similar to the arboreal apes and does not present affinities with H. sapiens. Omo 119-73-2718 exhibits morphological affinities with the more arboreal and partially suspensory New World monkey Lagothrix. The shoulder of the australopith specimens thus shows a combination of primitive and derived traits (humeral globularity, enhancement of internal and external rotation of the joint, related to use of the arm in overhead positions. The genus Homo specimens show overall affinities with H. sapiens at the shoulder, indicating full correspondence of these hominin shoulders with the modern human morphotype.

  9. 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.

  10. Are joint and soft tissue injections painful? Results of a national French cross-sectional study of procedural pain in rheumatological practice

    Directory of Open Access Journals (Sweden)

    Poncet Coralie

    2010-01-01

    Full Text Available Abstract Background Joint, spinal and soft tissue injections are commonly performed by rheumatologists in their daily practice. Contrary to other procedures, e.g. performed in pediatric care, little is known about the frequency, the intensity and the management of procedural pain observed in osteo-articular injections in daily practice. Methods This observational, prospective, national study was carried out among a French national representative database of primary rheumatologists to evaluate the prevalence and intensity of pain caused by intra-and peri-articular injections, synovial fluid aspirations, soft tissue injections, and spinal injections. For each physician, data were collected over 1 month, for up to 40 consecutive patients (>18-years-old for whom a synovial fluid aspiration, an intra or peri-articular injection or a spinal injection were carried out during consultations. Statistical analysis was carried out in order to compare patients who had suffered from pain whilst undergoing the procedure to those who had not. Explanatory analyses were conducted by stepwise logistic regression with the characteristics of the patients to explain the existence of pain. Results Data were analysed for 8446 patients (64% female, mean age 62 ± 14 years recruited by 240 physicians. The predominant sites injected were the knee (45.5% and spine (19.1%. Over 80% of patients experienced procedural pain which was most common in the small joints (42% and spine (32% Pain was severe in 5.3% of patients, moderate in 26.6%, mild in 49.8%, and absent in 18.3%. Pain was significantly more intense in patients with severe pain linked to their underlying pathology and for procedures performed in small joints. Preventative or post-procedure analgesia was rarely given, only to 5.7% and 36.3% of patients, respectively. Preventative analgesia was more frequently prescribed in patients with more severe procedural pain. Conclusion Most patients undergoing intra-or peri

  11. 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.…

  12. Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed.

    Science.gov (United States)

    Challoumas, Dimitrios; Artemiou, Andreas; Dimitrakakis, Georgios

    2017-01-01

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

  13. Shoulder strengthening exercises adapted to specific shoulder pathologies can be selected using new simulation techniques: a pilot study.

    Science.gov (United States)

    Charbonnier, Caecilia; Lädermann, Alexandre; Kevelham, Bart; Chagué, Sylvain; Hoffmeyer, Pierre; Holzer, Nicolas

    2018-02-01

    Shoulder strength training exercises represent a major component of rehabilitation protocols designed for conservative or postsurgical management of shoulder pathologies. Numerous methods are described for exercising each shoulder muscle or muscle group. Limited information is available to assess potential deleterious effects of individual methods with respect to specific shoulder pathologies. Thus, the goal of this pilot study was to use a patient-specific 3D measurement technique coupling medical imaging and optical motion capture for evaluation of a set of shoulder strength training exercises regarding glenohumeral, labral and subacromial compression, as well as elongation of the rotator cuff muscles. One volunteer underwent magnetic resonance imaging (MRI) and motion capture of the shoulder. Motion data from the volunteer were recorded during three passive rehabilitation exercises and twenty-nine strengthening exercises targeting eleven of the most frequently trained shoulder muscles or muscle groups and using four different techniques when available. For each exercise, glenohumeral and labral compression, subacromial space height and rotator cuff muscles elongation were measured on the entire range of motion. Significant differences in glenohumeral, subacromial and labral compressions were observed between sets of exercises targeting individual shoulder muscles. Muscle lengths computed by simulation compared to MRI measurements showed differences of 0-5%. This study represents the first screening of shoulder strengthening exercises to identify potential deleterious effects on the shoulder joint. Motion capture combined with medical imaging allows for reliable assessment of glenohumeral, labral and subacromial compression, as well as muscle-tendon elongation during shoulder strength training exercises.

  14. Joint Injection/Aspiration

    Science.gov (United States)

    ... OII) Timed Up & Go (TUG) Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) Young Investigators Resources for Doctoral Students/Post-Doctoral Fellows Evidence-Based Practice for Academic Researchers Responsible Data Management in Research Career Planning Treatments Patient ...

  15. Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies

    DEFF Research Database (Denmark)

    Mandl, Peter; Naredo, Esperanza; Conaghan, Philip G

    2012-01-01

    Objectives. To document the practice and training opportunities of US-guided arthrocentesis and joint injection (UGAJ) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR). Methods. An English-language questionnaire, containing questions on demographics......, clinical and practical aspects of UGAJ, training options in UGAJ for rheumatologists, UGAJ education in the rheumatology training curriculum and other structured education programmes in UGAJ was sent to three different groups: (i) all national rheumatology societies of EULAR; (ii) all national societies...... countries responded to the questionnaire (61.3% of national rheumatology societies, 25% of the national US societies and 100% of expert ultrasonographers). In the majority of countries (85%) 80%) rate of rheumatologists performing conventional joint injection in most of the surveyed countries. The reported...

  16. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging (dGEMRIC) of Hip Joint Cartilage: Better Cartilage Delineation after Intra-Articular than Intravenous Gadolinium Injection

    DEFF Research Database (Denmark)

    Boesen, M.; Jensen, K.E.; Quistgaard, E.

    2006-01-01

    years) with clinical and radiographic hip osteoarthritis (OA; Kellgren score II-III), MRI of the hip was performed twice on a clinical 1.5T MR scanner: On day 1, before and 90-180 min after 0.3 mmol/kg body weight i.v. Gd-DTPA and, on day 8, 90-180 min after ultrasound-guided i.a. injection of a 4 mmol......PURPOSE: To investigate and compare delayed gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in the hip joint using intravenous (i.v.) or ultrasound-guided intra-articular (i.a.) Gd-DTPA injection. MATERIAL AND METHODS: In 10 patients (50% males, mean age 58......) in the joint cartilage compared to the non-enhanced images (P I.a. Gd-DTPA provided significantly higher SNR and CNR compared to i.v. Gd-DTPA (P

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

    Directory of Open Access Journals (Sweden)

    Arno Celliers

    2017-01-01

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

  18. 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

  19. Effectiveness of hydroplasty and therapeutic exercise for treatment of frozen shoulder.

    Science.gov (United States)

    Callinan, Nancy; McPherson, Scott; Cleaveland, Susan; Voss, Debra Gardiner; Rainville, Darcel; Tokar, Nancy

    2003-01-01

    The purpose of this retrospective review was to evaluate the effectiveness of a hydraulic distention technique (hydroplasty) combined with a therapy program for treatment of idiopathic frozen shoulder. Over a two-year period, 60 patients with idiopathic frozen shoulder were identified as having undergone the hydroplasty procedure and therapy protocol at the authors' hand center. Distention of the glenohumeral joint was achieved by an injection of a 10-mL combination of bupivacaine (Marcaine), lidocaine (Xylocaine), and corticosteroid followed by injection of 30 mL of chilled sterile normal saline. Therapy was initiated immediately after the surgeon had completed the hydroplasty. The mean active range of motion improvement was as follows: flexion 28 degrees, abduction 42 degrees, internal rotation 22 degrees, and external rotation 26 degrees. There was no significant difference in outcomes between diabetics and nondiabetics or subjects with symptoms less than six months' duration compared with subjects with symptom duration greater than six months. At discharge, only two (3%) of the subjects reported persistent pain during sleep. The hydroplasty procedure combined with a therapy program is a successful treatment for idiopathic frozen shoulder.

  20. Investigation of CT picture in so-called loose shoulder

    International Nuclear Information System (INIS)

    Kuroda, Shigehito; Sakamaki, Hiroshi; Matsuoka, Akira; Moriishi, Takeji; Takada, Keiichi.

    1985-01-01

    CT picture of the shoulder joint was analyzed in 124 shoulders (114 patients). A line perpendicular to a given line between the precornu of acetabular tegmen (A) and the postcornu of acetabular tegmen (B) was drawn and the intersection where the line and the caput humeri meet (C) was obtained. The angle of CAB was defined as the backward angular aperture of the acetabular tegmen. The angular aperture was 26.2 0 +-1.9 in 16 so-called loose shoulders, 17.3 0 +-1.0 in 28 loose shoulders restricted to the inward rotation, and 12.2 0 +-0.4 in 80 normal shoulders, showing a distinct correlation between the angular aperture and the degree of loose shoulder. An increased backward angular aperture of the acetabular tegmen was considered greatly attributable to the forward glenohumeral movement resulting from malformation of the acetabular tegmen and flaccidity of the joint. Glenoid osteotomy was thus performed in 9 patients, 6 of whom underwent CT scanning before and after osteotomy. Coronal and transverse CT images of the shoulder joint disclosed a noticeable improvement of the glenohumeral alignment. The angular aperture shown on CT seems to be of major importance not only in the diagnosis of so-called loose shoulder but also in surgical choice. (Namekawa, K.)

  1. Radiation dose and intra-articular access: comparison of the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Ambrose J.; Torriani, Martin; Bredella, Miriam A.; Chang, Connie Y.; Simeone, Frank J.; Palmer, William E. [Massachusetts General Hospital, Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Boston, MA (United States); Balza, Rene [Centro Medico de Occidente, Department of Radiology, Maracaibo (Venezuela, Bolivarian Republic of)

    2016-03-15

    To compare the lateral mortise and anterior midline approaches to fluoroscopically guided tibiotalar joint injections with respect to successful intra-articular needle placement, fluoroscopy time, radiation dose, and dose area product (DAP). This retrospective study was IRB-approved and HIPAA-compliant. 498 fluoroscopically guided tibiotalar joint injections were performed or supervised by one of nine staff radiologists from 11/1/2010-12/31/2013. The injection approach was determined by operator preference. Images were reviewed on a PACS workstation to determine the injection approach (lateral mortise versus anterior midline) and to confirm intra-articular needle placement. Fluoroscopy time (minutes), radiation dose (mGy), and DAP (μGy-m{sup 2}) were recorded and compared using the student's t-test (fluoroscopy time) or the Wilcoxon rank sum test (radiation dose and DAP). There were 246 lateral mortise injections and 252 anterior midline injections. Two lateral mortise injections were excluded from further analysis because no contrast was administered. Intra-articular location of the needle tip was documented in 242/244 lateral mortise injections and 252/252 anterior midline injections. Mean fluoroscopy time was shorter for the lateral mortise group than the anterior midline group (0.7 ± 0.5 min versus 1.2 ± 0.8 min, P < 0.0001). Mean radiation dose and DAP were less for the lateral mortise group than the anterior midline group (2.1 ± 3.7 mGy versus 2.5 ± 3.5 mGy, P = 0.04; 11.5 ± 15.3 μGy-m{sup 2} versus 13.5 ± 17.3 μGy-m{sup 2}, P = 0.006). Both injection approaches resulted in nearly 100 % rates of intra-articular needle placement, but the lateral mortise approach used approximately 40 % less fluoroscopy time and delivered 15 % lower radiation dose and DAP to the patient. (orig.)

  2. Avaliação ultra-sonográfica da articulação do ombro em nadadores de nível competitivo Sonographic evaluation of the shoulder joint in competitive swimmers

    Directory of Open Access Journals (Sweden)

    Guilherme Moura da Cunha

    2007-12-01

    s lesões do manguito rotador.OBJECTIVE: To evaluate the shoulders of symptomatic or asymptomatic competitive swimmers, quantifying the incidence of rotator cuff lesions in these athletes MATERIALS AND METHODS: Eleven (eight male and three female symptomatic and asymptomatic, competitive swimmers (master category in the age range between 28 and 52 years, had both shoulders prospectively evaluated by ultrasonography for determining the prevalence of injuries in correlation with clinical findings. The studies included at least two orthogonal planes of rotator cuff tendons, as well as non-tendinous components of the shoulder joint. Tendinous findings were classified into tendinosis, probable full-thickness tears and partial-thickness tears. Non-tendinous findings were classified into present or absent. Additionally to the sonographic studies results, the analysis has taken the presence or absence of symptoms and the patients' age into consideration. RESULTS: Overall, the prevalence of symptomatic patients was higher (63.6%; seven athletes, with 75% of patients with bursitis, and 100% of those with partial-thickness tendon tears. Among isolated tendinous findings, the supraspinatus tendon was the most frequently involved, showing echographic pattern alteration in 36.36% of cases. Tendinosis was the most prevalent finding, present in at least one tendon in 50% of the studied shoulders. The incidence of partial-thickness tendon tears was similar to the incidence reported for non-athlete individuals (13%, always present in individuals above 40 years of age. CONCLUSION: Swimmers do not seem to present a higher incidence of tendon tears or degeneration when compared with the general population. Individuals' age is the most relevant determining factor, as far as rotator cuff lesions are concerned, no matter these individuals practice or not activities involving an overload of the shoulder joint.

  3. Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions

    NARCIS (Netherlands)

    van Gelein Vitringa, V. M.; van Noort, A.; Ritt, M.J.P.F.; van Royen, B.J.; van der Sluijs, J.A.

    2015-01-01

    Background and Objectives Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of

  4. Cationic PLGA/Eudragit RL nanoparticles for increasing retention time in synovial cavity after intra-articular injection in knee joint

    Directory of Open Access Journals (Sweden)

    Kim SR

    2015-08-01

    Full Text Available Sung Rae Kim,1 Myoung Jin Ho,2 Eugene Lee,3 Joon Woo Lee,3 Young Wook Choi,1 Myung Joo Kang21College of Pharmacy, Chung-Ang University, Dongjak-gu, Seoul, 2College of Pharmacy, Dankook University, Dongnam-gu, Cheonan, Chungnam, 3Department of Radiology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Gyeonggi-do, South KoreaAbstract: Positively surface-charged poly(lactide-co-glycolide (PLGA/Eudragit RL nanoparticles (NPs were designed to increase retention time and sustain release profile in joints after intra-articular injection, by forming micrometer-sized electrostatic aggregates with hyaluronic acid, an endogenous anionic polysaccharide found in high amounts in synovial fluid. The cationic NPs consisting of PLGA, Eudragit RL, and polyvinyl alcohol were fabricated by solvent evaporation technique. The NPs were 170.1 nm in size, with a zeta potential of 21.3 mV in phosphate-buffered saline. Hyperspectral imaging (CytoViva® revealed the formation of the micrometer-sized filamentous aggregates upon admixing, due to electrostatic interaction between NPs and the polysaccharides. NPs loaded with a fluorescent probe (1,1'-dioctadecyl-3,3,3',3' tetramethylindotricarbocyanine iodide, DiR displayed a significantly improved retention time in the knee joint, with over 50% preservation of the fluorescent signal 28 days after injection. When DiR solution was injected intra-articularly, the fluorescence levels rapidly decreased to 30% of the initial concentration within 3 days in mice. From these findings, we suggest that PLGA-based cationic NPs could be a promising tool for prolonged delivery of therapeutic agents in joints selectively.Keywords: PLGA, Eudragit RL, hyaluronic acid, cationic nanoparticles, intra-articular injection, electrostatic interaction

  5. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion.

    Science.gov (United States)

    Calvet, Joan; Orellana, Cristóbal; Galisteo, Carlos; García-Manrique, María; Navarro, Noemí; Caixàs, Assumpta; Larrosa, Marta; Gratacós, Jordi

    2018-01-01

    Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm. One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year. The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.

  6. 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.

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

    Directory of Open Access Journals (Sweden)

    Aaron Sciascia

    2012-01-01

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

  8. Proposal for SICSeG guidelines for rehabilitation after anatomical shoulder prosthesis in concentric shoulder osteoarthritis.

    Science.gov (United States)

    Fusaro, I; Orsini, S; Stignani, S; Creta, D; Cava, F C; Benedetti, M G

    2013-06-01

    The purpose of this paper is to provide up-to-date guidelines on rehabilitation after anatomical shoulder prosthesis for concentric shoulder osteoarthritis, as previous guidelines date back to late 1970s and are no longer adequate due to the evolution of prosthesis models and surgical techniques. The physiatric committee of the Italian Society of Shoulder and Elbow Surgery (SICSeG-Società Italiana di Chirurgia della Spalla e del Gomito) performed a search for all the existing literature related to rehabilitation after shoulder replacement. A total of 29 papers concerning shoulder rehabilitation were reviewed. In addition, the main Italian orthopedic surgeons and physiatrists dealing with shoulder surgery and rehabilitation were interviewed to obtain indications when literature was not conclusive. From literature evaluation and expert consultation, we produced guidelines concerning: patient evaluation by means of adequate rating scales, preoperative treatment, early intermediate and advanced postoperative phases, rehabilitation of scapulo-thoracic joint, return to work and sports, length of rehabilitation and follow-up. This proposal for guidelines was presented during the 11th SICSeG Congress on May 2012 and to the main scientific societies concerned in shoulder surgery and rehabilitation. A consensus conference is needed in order to formalize and make them usable from all the professional figures involved in this field.

  9. Ironman triathletes: MRI assessment of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-08-15

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

  10. Ironman triathletes: MRI assessment of the shoulder

    International Nuclear Information System (INIS)

    Hiller, W.D.; Dierenfield, Laura; Ainge, George R.; Brown, David W.; Shellock, Frank G.; Crues, John V.; Reuter, Robert M.

    2008-01-01

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

  11. Synovial chondromatosis of the shoulder: imaging findings

    International Nuclear Information System (INIS)

    Terazaki, Carlos Renato Ticianelli; Trippia, Carlos Henrique; Caboclo, Maria Fernanda Sales Ferreira; Medaglia, Carla Regina Miranda

    2014-01-01

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

  12. Synovial chondromatosis of the shoulder: imaging findings

    Directory of Open Access Journals (Sweden)

    Carlos Renato Ticianelli Terazaki

    2014-02-01

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

  13. The change of chromosome aberration rate for peripheral blood lymphocytes after injection of colloidal chromic phosphate 32P into rabbit knee joint cavities

    International Nuclear Information System (INIS)

    Gao Yijun; Dong Qirong

    2007-01-01

    Objective: To study the impact on the chromosome aberration rate for peripheral blood lymphocytes after injecting colloidal chromic phosphate 32 P into knee joint cavities of rabbit models of rheumatoid arthritis. Methods: Nine rabbits were divided into three groups randomly. Three rabbits in group A were for normal comparison and three rabbits in group B for model comparison. One week after the three rabbits in group C have been induced as models, 44.4 MBq colloidal chromic phosphate 32 P was injected into the right knee joint cavity. In all of the three groups blood samples were taken from the ear-rim veins upon two months after the nuclein injection in group C. For group C, a blood sampling three days before and after the nuclein injection was conducted. After cultivation, examination and comparison of the changes in lymphocytes chromosome aberration rate were conducted during the interim division in different groups. Results: No obvious twin-centromere in the lymphocytes chromosome of peripheral blood was observed in all three groups. No distinct differences was observed (P>0.05) in comparison of fragment rates. No twin-centromere was discovered in lymphocytes chromosome in peripheral blood, and no obvious difference (P>0.05) in fragment rates at all scheduled time in group C. Conclusion: After injecting colloidal chromic phosphate 32 P in lab test dosages into articular cavities, the fluctuation of lymph cell chromosome aberration rate in peripheral blood of the rabbit is within the normal range, which proves that radioisotope synovectomy is a safe treatment method. (authors)

  14. Combination therapy with intra-articular injection of mesenchymal stem cells and articulated joint distraction for repair of a chronic osteochondral defect in the rabbit.

    Science.gov (United States)

    Harada, Yohei; Nakasa, Tomoyuki; Mahmoud, Elhussein Elbadry; Kamei, Goki; Adachi, Nobuo; Deie, Masataka; Ochi, Mitsuo

    2015-10-01

    The present study investigated intra-articular injection of bone-marrow-derived mesenchymal stem cells (MSCs) combined with articulated joint distraction as treatment for osteochondral defects. Large osteochondral defects were created in the weight-bearing area of the medial femoral condyle in rabbit knees. Four weeks after defect creation, rabbits were divided into six groups: control group, MSC group, distraction group, distraction + MSC group, temporary distraction group, and temporary distraction + MSC group. Groups with MSC received intra-articular injection of MSCs. Groups with distraction underwent articulated distraction arthroplasty. Groups with temporary distraction discontinued the distraction after 4 weeks. The rabbits were euthanized at 4, 8, and 12 weeks after treatment except temporary distraction groups which were euthanized at only 12 weeks. Histological scores in the distraction + MSC group were significantly better than in the control, MSC group or distraction group at 4 and 8 weeks, but showed no further improvement. At 12 weeks, the temporary distraction + MSC group showed the best results, demonstrating hyaline cartilage repair with regeneration of the osteochondral junction. In conclusion, joint distraction with intra-articular injection of MSCs promotes early cartilage repair, and compressive loading of the repair tissue after temporary distraction stimulates articular cartilage regeneration. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  15. 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

  16. Results of treatment of the calcific tendinitis of the shoulder supraspinatus muscle tendon

    Directory of Open Access Journals (Sweden)

    S. S. Strafun

    2017-12-01

    Full Text Available The aim of the study was to identify and compare the results of conservative and surgical treatment of the calcific tendinitis of the shoulder supraspinatus muscle tendon. Materials and methods. The clinical group consisted of 120 patients with calcific tendinitis of supraspinatus tendon. All patients were divided into two groups, according to the operative or conservative treatment, each of these groups have been subdivided into two (with calcific deposits less or more than 1.5 cm in length according to Bosworth radiological classification. Conservative treatment ("needling" included: evacuation of calcific deposits with saline under ultrasound control with subsequent injection of prolonged corticosteroid into the subacromial space, use of nonsteroid anti-inflammatory drugs, physiotherapy. Surgical treatment included: evacuation of calcium deposits from the tendon followed by rotator cuff repair and biceps tendon tenodesis at the proximal third of the intertubercular groove. Results. In the majority of patients, after the "needling" of little - 1.5 cm calcific deposits (55 patients - 45.8% clinical and radiographic healing occurred in 2 weeks after procedure. The level of pain in average was 2,39 ± 0,39 points according to VAS scale and function of the shoulder joint has increased in average to 40,26 ± 4,39 points on Oxford Shoulder Score. In 3 months after treatment begining, the best average results were obtained in patients with calcific deposits less than 1.5 cm - 43 ± 3,8 points on Oxford Shoulder Score, the worst 26 ± 4,8 points - in patients with calcific deposits bigger than 1.5 cm who underwent conservative treatment (р≤0,05. Conclusions. In group of patients after surgical treatment, size of calcific deposits did not significantly affect the treatment result (р≤0,01. Slightly better results were obtained in patients with calcific deposits size less than1.5 cm - 39 ± 3,8 points on Oxford Shoulder Score.

  17. Joint Instability and Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Darryl Blalock

    2015-01-01

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

  18. Joint instability and osteoarthritis.

    Science.gov (United States)

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

    2015-01-01

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

  19. 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.

  20. Magnetic resonance imaging (MR) of the shoulder

    International Nuclear Information System (INIS)

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

    1990-01-01

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

  1. Ten questions on prosthetic shoulder infection.

    Science.gov (United States)

    Pinder, Elizabeth M; Ong, Joshua Cy; Bale, R Stephen; Trail, Ian A

    2016-07-01

    Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes.

  2. A comparative study on the impact of intra-articular injections of hyaluronic acid, tenoxicam and betametazon on the relief of temporomandibular joint disorder complaints.

    Science.gov (United States)

    Gencer, Zeliha Kapusuz; Özkiriş, Mahmut; Okur, Aylin; Korkmaz, Murat; Saydam, Levent

    2014-10-01

    The aim of this study was to compare the efficacy of intra-articular injections of three different agents with well known anti-inflammatory properties. Between April 2010 and January 2013 a total of 100 patients who were diagnosed as temporomandibular joint disorder in the Department of Otolaryngology at Bozok University School of Medicine were prospectively studied. Patients with symptoms of jaw pain, limited or painful jaw movement, clicking or grating within the joint, were evaluated with temporomandibular CT to investigate the presence of cartilage or capsule degeneration. In the study group there were 55 female and 45 male patients who were non-responders to conventional anti-inflammatory treatment for TMJ complaints. The patients were randomly divided into four groups consisting of a control group and three different groups who underwent intra-articular injection of one given anti-inflammatory agent for each group. We injected saline solution to intra-articular space in the control group. Of three anti-inflammatory agents including hyaluronic acid (HA, Hyalgan intra-articular injection, Sodium hyaluronate 10 mg/ml, 2 ml injection syringe, Bilim Pharmaceutical Company, Istanbul, Turkey); betamethasone (CS, Diprospan flacon, 7.0 mg betamethasone/1 ml, Schering-Plough Pharmaceutical Company, Istanbul, Turkey) and; tenoxicam (TX, Tilcotil flacon, 20 mg tenoxicam/ml, Roche Pharmaceutical Company, Istanbul, Turkey) were administered intra-articularly under, ultrasonographic guidance. Following the completion of injections the, changes in subjective symptoms were compared with visual analogue scales, (VAS) scores at 1st and 6th weeks' follow-up visits between four groups. The HA group did significantly better pain relief scores compared to the, other groups at 1st and 6th weeks (p 0.05). We found that HA produced better pain relief scores when compared to the other anti-inflammatory agents studied. The main disadvantage of HA is its relatively higher cost

  3. Online resources for shoulder instability: what are patients reading?

    Science.gov (United States)

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

    2014-10-15

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

  4. 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.

  5. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging (dGEMRIC) of Hip Joint Cartilage: Better Cartilage Delineation after Intra-Articular than Intravenous Gadolinium Injection

    International Nuclear Information System (INIS)

    Boesen, M.; Jensen, K. E.; Qvistgaard, E.; Danneskiold-Samsoe, B.; Thomsen, C.; Oestergaard, M.; Bliddal, H.

    2006-01-01

    Purpose: To investigate and compare delayed gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in the hip joint using intravenous (i.v.) or ultrasound-guided intra-articular (i.a.) Gd-DTPA injection. Material and Methods: In 10 patients (50% males, mean age 58 years) with clinical and radiographic hip osteoarthritis (OA; Kellgren score II-III), MRI of the hip was performed twice on a clinical 1.5T MR scanner: On day 1, before and 90-180 min after 0.3 mmol/kg body weight i.v. Gd-DTPA and, on day 8, 90-180 min after ultrasound-guided i.a. injection of a 4 mmol/l Gd-DTPA solution. Coronal STIR, coronal T1 fat-saturated spin-echo, and a cartilage-sensitive gradient-echo sequence (3D T1 SPGR) in the sagittal plane were applied. Results: Both the post-i.v. and post-i.a. Gd-DTPA images showed significantly higher signal-to-noise (SNR) and contrast-to-noise (CNR) in the joint cartilage compared to the non-enhanced images ( P <0.002). I.a. Gd-DTPA provided significantly higher SNR and CNR compared to i.v. Gd-DTPA ( P <0.01). Furthermore, a better delineation of the cartilage in the synovial/cartilage zone and of the chondral/subchondral border was observed. Conclusion: The dGEMRIC MRI method markedly improved delineation of hip joint cartilage compared to non-enhanced MRI. The i.a. Gd-DTPA provided the best cartilage delineation. dGEMRIC is a clinically applicable MRI method that may improve identification of early subtle cartilage damage and the accuracy of volume measurements of hip joint cartilage

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

    NARCIS (Netherlands)

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

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  8. Video Analysis of Primary Shoulder Dislocations in Rugby Tackles.

    Science.gov (United States)

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

    2017-06-01

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

  9. Isometric shoulder muscle activation patterns for 3-D planar forces: a methodology for musculo-skeletal model validation

    NARCIS (Netherlands)

    Groot, J.H.; Rozendaal, L.A.; Meskers, C.G.M.; Arwert, H.J.

    2004-01-01

    Objective. To present an isometric method for validation of a shoulder model simulation by means of experimentally obtained electromyography and addressing all muscles active around the shoulder joints. Background. Analysis of muscle force distribution in the shoulder by means of electromyography

  10. Autologous Concentrated Bone Marrow Grafting for the Treatment of Osteonecrosis of the Humeral Head: A Report of Five Shoulders in Four Cases

    Directory of Open Access Journals (Sweden)

    Takeshi Makihara

    2017-01-01

    Full Text Available Five shoulders in four patients affected by advanced osteonecrosis of the humeral head were treated with autologous concentrated bone marrow grafting. Bone marrow sample was aspirated from the iliac crests, concentrated by a centrifugation technique, and injected into the necrotic site. The shoulders were evaluated radiologically with X-ray scoring and clinically with measurement of range of motion and pain score (visual analogue scale, VAS. The mean follow-up period was 49.4 (range, 24–73 months. The concentration ratio of nucleated cells was calculated and the number of transplanted mesenchymal stem cells (MSC was estimated by a colony-forming assay. All four shoulders with stage 3 disease achieved joint sparing. One shoulder with stage 4 disease required replacement surgery. Clinical evaluation of the spared joints showed improvement in range of motion in two cases and deterioration in two cases. VAS scores were 0 after surgery in three cases. The mean concentration ratio was 2.73, and the mean number of transplanted MSC was 1125. The outcomes of autologous concentrated bone marrow grafting for advanced osteonecrosis of the humeral head were varied. Further research is needed to determine the effectiveness and the indications of the present surgery.

  11. Measurement and Quantification of Gross Human Shoulder Motion

    Directory of Open Access Journals (Sweden)

    Jeremy T. Newkirk

    2013-01-01

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

  12. Management of low back pain with facet joint injections and nerve root blocks under computed tomography guidance. A prospective study

    International Nuclear Information System (INIS)

    Fotiadou, Anastasia; Wojcik, Andrew; Shaju, Antony

    2012-01-01

    The aim of this work was to assess the performance of facet joint and nerve root infiltrations under computed tomography guidance for the management of low back pain and to investigate the complications and patient tolerance. The study was board-certified and informed consent was obtained from all patients. In 1 year, 86 consecutive patients (47 male, 39 female, age range 47-87 years, mean age 63) with low back pain for more than 2 years were included. All patients were clinically examined and had cross-sectional imaging performed before the procedure. Fifty-five facet joint infiltrations and 31 nerve blocks were performed under computed tomography guidance. All patients completed two valid pain questionnaires before and 3 months after the procedures. At the same time, they were clinically examined by the referring Orthopaedic Surgeon. The pain response was assessed by comparing the scores of the questionnaires. The improvement in clinical examination findings was assessed as well. In patients who underwent facet joint infiltrations, long-term pain improvement was achieved in 79% and in those with nerve blocks in 85%. Immediate pain relief was demonstrated in 83% of patients with nerve infiltrations. No complications were observed. All procedures were very well tolerated by patients. Facet joint and nerve infiltrations under computed tomography guidance constitute an accurate and safe method that could be used to relieve low back pain and minimize the risk of disability. (orig.)

  13. Stochastic estimation of human shoulder impedance with robots: an experimental design.

    Science.gov (United States)

    Park, Kyungbin; Chang, Pyung Hun

    2011-01-01

    Previous studies assumed the shoulder as a hinge joint during human arm impedance measurement. This is obviously a vast simplification since the shoulder is a complex of several joints with multiple degrees of freedom. In the present work, a practical methodology for more general and realistic estimation of human shoulder impedance is proposed and validated with a spring array. It includes a gravity compensation scheme, which is developed and used for the experiments with a spatial three degrees of freedom PUMA-type robot. The experimental results were accurate and reliable, and thus it has shown a strong potential of the proposed methodology in the estimation of human shoulder impedance. © 2011 IEEE

  14. 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.

  15. Ontogeny, phylogeny and functional morphology of the hominoid shoulder girdle

    OpenAIRE

    Barros, A. P.

    2014-01-01

    The shoulder is of particular relevance for resolving issues of locomotor ancestry since, as a group, living hominoids can be defined by the set of functional similarities that they share at this anatomical area (such as a scapula located on the back of the ribcage, and a shoulder joint adapted to allow extensive abduction). However, there is ongoing debate over which selective pressures are responsible for these shared morphologies. The current study addresses the question of whether the sim...

  16. Usefulness of intra-articular botulinum toxin injections. A systematic review.

    Science.gov (United States)

    Khenioui, Hichem; Houvenagel, Eric; Catanzariti, Jean François; Guyot, Marc Alexandre; Agnani, Olivier; Donze, Cécile

    2016-03-01

    Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by excessive muscular contractions. Recent studies have assessed the analgesic effect of botulinum toxin in joint pain and started to unravel its mechanisms. We searched the international literature via the Medline database using the term "intraarticular botulinum toxin injection" combined with any of the following terms: "knee", "ankle", "shoulder", "osteoarthritis", "adhesive capsulitis of the shoulder". Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized controlled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after joint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indications and the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator was usually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primary outcome measure. The number of randomized trials and sample sizes are too small to provide a satisfactory level of scientific evidence or statistical power. Unanswered issues include the effective dosage and the optimal dilution and injection modalities of botulinum toxin. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  17. Does Immediate Pain Relief After an Injection into the Sacroiliac Joint with Anesthetic and Corticosteroid Predict Subsequent Pain Relief?

    Science.gov (United States)

    Schneider, Byron J; Huynh, Lisa; Levin, Josh; Rinkaekan, Pranathip; Kordi, Ramin; Kennedy, David J

    2018-02-01

    To determine if immediate pain response following an injection with local anesthetic and corticosteroid predicts subsequent relief. Prospective observational cohort. An institutional review board-approved prospective study from a single academic medical center. Patients with clinical diagnosis of sacroiliac (SIJ) pain and referred for SIJ injection were enrolled; 1 cc of 2% lidocaine and 1 cc of triamcinolone 40 mg/mL were injected into the SIJ. Pain score on 0-10 numeric rating scale (NRS) during provocation maneuvers was recorded immediately before injection, immediately after injection, and at two and four weeks of follow-up. Oswestry Disability Index (ODI) was also recorded. Various cutoffs were identified to establish positive anesthetic response and successful outcomes at follow-up. These were used to calculated likelihood ratios. Of those with 100% anesthetic response, six of 11 (54.5%, 95% confidence interval [CI]+/-29.4%, +LR 2.6, 95% CI = 1.1-5.9) demonstrated 50% or greater pain relief at follow-up, and four of 11 (36.5%, 95% CI+/-28.4%, +LR 3.00, 95% CI = 1.4-5.1) had 100% relief at two to four weeks. Fourteen of 14 (100%, 95% CI+/-21.5%, -LR 0.0, 95% CI = 0.0-2.1) with an initial negative block failed to achieve 100% relief at follow-up. Patients who fail to achieve initial relief after SIJ injection with anesthetic and steroid are very unlikely to achieve significant pain relief at follow-up; negative likelihood ratios (LR) in this study, based on how success is defined, range between 0 and 0.9. Clinically significant positive likelihood ratios of anesthetic response to SIJ injection are more limited and less robust, but are valuable in predicting 50% relief or 100% relief at two to four weeks. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  18. Shoulder Impingement Treatment

    Science.gov (United States)

    ... trunk is crucial for maximizing arm strength and power with throwing or tennis. This part of rehabilitation can usually take place while shoulder pain is subsiding. IV Restore function Resume overhead motion ...

  19. Dyspnea in a case of shoulder dislocation – to beware of this rare life-threatening symptom

    Directory of Open Access Journals (Sweden)

    Joshi Satyen Praful

    2016-01-01

    Full Text Available Shoulder dislocation is a common injury in orthopedic practice. In an acute presentation, closed reduction of the shoulder joint leads to an uneventful recovery. However, in the developing world neglected shoulder dislocation and treatments from quacks are not uncommon. Improper treatment and neglect can rarely become life threatening. We present one such case, emphasizing the need to investigate the symptom of dyspnea in a patient with history of shoulder dislocation.

  20. Shoulder arthroscopy: the basics.

    Science.gov (United States)

    Farmer, Kevin W; Wright, Thomas W

    2015-04-01

    Shoulder arthroscopy is a commonly performed and accepted procedure for a wide variety of pathologies. Surgeon experience, patient positioning, knowledge of surgical anatomy, proper portal placement, and proper use of instrumentation can improve technical success and minimize complication risks. This article details the surgical anatomy, indications, patient positioning, portal placement, instrumentation, and complications for basic shoulder arthroscopy. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  1. Development of a Finite Element Model of the Human Shoulder to Investigate the Mechanical Responses and Injuries in Side Impact

    Science.gov (United States)

    Iwamoto, Masami; Miki, Kazuo; Yang, King H.

    Previous studies in both fields of automotive safety and orthopedic surgery have hypothesized that immobilization of the shoulder caused by the shoulder injury could be related to multiple rib fractures, which are frequently life threatening. Therefore, for more effective occupant protection, it is important to understand the relationship between shoulder injury and multiple rib fractures in side impact. The purpose of this study is to develop a finite element model of the human shoulder in order to understand this relationship. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. The model also included approaches to represent bone fractures and joint dislocations. The relationships between shoulder injury and immobilization of the shoulder are discussed using model responses for lateral shoulder impact. It is also discussed how the injury can be related to multiple rib fractures.

  2. Complications of shoulder arthroscopy.

    Science.gov (United States)

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

    2014-07-01

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

  3. Efficacy of musculoskeletal injections by primary care providers in the office: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Bhagra A

    2013-04-01

    Full Text Available Anjali Bhagra,1 Husnain Syed,1 Darcy A Reed,1 Thomas H Poterucha,1 Stephen S Cha,2 Tammy J Baumgartner,1 Paul Y Takahashi1 1Department of Internal Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA Background: Musculoskeletal joint pain of varied etiology can be diagnosed and treated with joint and soft-tissue corticosteroid injections. Purpose: The purpose of our study was to compare patients’ bodily pain and quality of life (QOL, in addition to the procedural benefit and patient satisfaction, before and after musculoskeletal injections in the office setting. Patients and methods: Patients were eligible for recruitment if they were over age 18 and had an injection for musculoskeletal pain from a primary care provider in an office procedural practice. Included in our analysis were knee joint/bursa, trochanteric bursa, and shoulder joint/bursa injection sites. The variables measured were pain, benefit from the injection, QOL physical and mental components, and patient satisfaction. This was a retrospective cohort study approved by the institutional review board. Results: Patients’ pain was assessed by the patients using a six-point Likert scale (none, very mild, mild, moderate, severe, and very severe. We noted that self-perception of pain decreased from 3.10 (± standard deviation at baseline 0.96 before to 2.36 (± standard deviation after the infection 1.21 (P = 0.0001 after the injection. In terms of the impact on QOL, our patients had a pre-injection physical score of 37.25 ± 8.39 and a mental score at 52.81 ± 8.98. After the injections, the physical score improved to 42.35 ± 9.07 (P = 0.0001 and the mental to 53.54 ± 8.20 (P = 0.0001 for the overall group. Ninety-six percent of the patients reported they were satisfied or extremely satisfied in the procedure clinic. Conclusion: In this study, we found significant pain relief and improved physical QOL in patients undergoing an injection in the knee

  4. Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection -- Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS?

    DEFF Research Database (Denmark)

    Østergaard, Mikkel; Conaghan, Philip G; O'Connor, Philip

    2009-01-01

    OBJECTIVE: Gadolinium (Gd)-enhanced magnetic resonance imaging (MRI) provides highly sensitive assessment of inflammatory and destructive changes in rheumatoid arthritis (RA) joints, but intravenous (IV) Gd injection prolongs examination time and increases cost, invasiveness, and patient discomfort...... images, whereas complete image sets were available for the second reading. RESULTS: Gd contrast injection appeared unimportant to MRI scores of bone erosions and bone edema in RA wrist and MCP joints. However, when post-Gd MRI was considered the standard reference, MRI without Gd provided only moderate......: Omitting IV contrast injection did not change scores of bone erosions and bone edema, but decreased the reliability of synovitis scores. However, this disadvantage may for some purposes be outweighed by the possibility to assess more joints and/or greater feasibility....

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-05-15

    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.)

  6. MRI of the posttraumatic shoulder

    International Nuclear Information System (INIS)

    Dimitrov, N.

    2013-01-01

    functional discomfort during the joint loading. Compression on the rotator cuff from the overlying acromion and the subsequent tissue reaction in the subacromial bursa causes suffering tendons of these muscles. Unrated its diagnostic leads to deepen the ‘subacromial conflict’ and reach rotator cuff initially partial and later progressed. The shoulder stiffness is a condition in which the passive motion restriction is combined with pain in their final phase as well as during sleep. This also affects the active movements which are also reduced. ‘The shoulder hardening’ is at the organic component expense and it must be distinguished from the functional disorders such as muscle contracture and ‘subacromial conflict’. Restoration of work capacity in patients with idiopathic ‘frozen shoulder’ is faster than in post-traumatic shoulder. Diagnostic estimated joint capsule fibrosis more quickly gives a way to the treatment, which shortens the patient’s suffering. MRI imaging is a method of choice for the diagnosis of these conditions. MRI shows not only broken integrity of the rotator cuff tendons, but also the fluid in the subacromial bursa, which means that, must have a lesion. MRI provides information about fatty degeneration of the tendon. MRI registers the distance of the torn tendon retraction, the rupture size, may advise the surgeon on its mobility, and hence the expected forecast. However in the impingement indicative are only local areas with increased signal on T 2 images and data about severe osteophytosis in the area of the acromioclavicular joint. Outlined are the areas of present calcification in the subacromial bursa and, what is more important for the process of treatment, - their density. In shoulder instability MRI demonstrates the presence of lesions type Bankart, partial rotator cuff lesions, lesions of the ligament apparatus in combination with SLAP lesions, lesions of the posterior labrum and refers to the type of instability and the choice of

  7. Long-Acting Diclofenac Ester Prodrugs for Joint Injection: Kinetics, Mechanism of Degradation, and In Vitro Release From Prodrug Suspension.

    Science.gov (United States)

    Mertz, Nina; Larsen, Susan Weng; Kristensen, Jesper; Østergaard, Jesper; Larsen, Claus

    2016-10-01

    A prodrug approach for local and sustained diclofenac action after injection into joints based on ester prodrugs having a pH-dependent solubility is presented. Inherent ester prodrug properties influencing the duration of action include their pH-dependent solubility and charge state, as well as susceptibility to undergo esterase facilitated hydrolysis. In this study, physicochemical properties and pH rate profiles of 3 diclofenac ester prodrugs differing with respect to the spacer carbon chain length between the drug and the imidazole-based promoiety were determined and a rate equation for prodrug degradation in aqueous solution in the pH range 1-10 was derived. In the pH range 6-10, the prodrugs were subject to parallel degradation to yield diclofenac and an indolinone derivative. The prodrug degradation was found to be about 6-fold faster in 80% (vol/vol) human plasma as compared to 80% (vol/vol) human synovial fluid with 2-(1-methyl-1H-imidazol-2-yl)ethyl 2-(2-(2,6 dichlorophenyl)amino)phenylacetate being the poorest substrate toward enzymatic cleavage. The conversion and release of parent diclofenac from prodrug suspensions in vitro were studied using the rotating dialysis model. The results suggest that it is possible to alter and control dissolution and reconversion behavior of the diclofenac prodrugs, thus making the prodrug approach feasible for local and sustained diclofenac action after joint injection. Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.

  8. Radiographic analysis of shoulder anatomical arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

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

  9. 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.

  10. Using the Microsoft Kinect™ to assess 3-D shoulder kinematics during computer use.

    Science.gov (United States)

    Xu, Xu; Robertson, Michelle; Chen, Karen B; Lin, Jia-Hua; McGorry, Raymond W

    2017-11-01

    Shoulder joint kinematics has been used as a representative indicator to investigate musculoskeletal symptoms among computer users for office ergonomics studies. The traditional measurement of shoulder kinematics normally requires a laboratory-based motion tracking system which limits the field studies. In the current study, a portable, low cost, and marker-less Microsoft Kinect™ sensor was examined for its feasibility on shoulder kinematics measurement during computer tasks. Eleven healthy participants performed a standardized computer task, and their shoulder kinematics data were measured by a Kinect sensor and a motion tracking system concurrently. The results indicated that placing the Kinect sensor in front of the participants would yielded a more accurate shoulder kinematics measurements then placing the Kinect sensor 15° or 30° to one side. The results also showed that the Kinect sensor had a better estimate on shoulder flexion/extension, compared with shoulder adduction/abduction and shoulder axial rotation. The RMSE of front-placed Kinect sensor on shoulder flexion/extension was less than 10° for both the right and the left shoulder. The measurement error of the front-placed Kinect sensor on the shoulder adduction/abduction was approximately 10° to 15°, and the magnitude of error is proportional to the magnitude of that joint angle. After the calibration, the RMSE on shoulder adduction/abduction were less than 10° based on an independent dataset of 5 additional participants. For shoulder axial rotation, the RMSE of front-placed Kinect sensor ranged between approximately 15° to 30°. The results of the study suggest that the Kinect sensor can provide some insight on shoulder kinematics for improving office ergonomics. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging (dGEMRIC) of Hip Joint Cartilage: Better Cartilage Delineation after Intra-Articular than Intravenous Gadolinium Injection

    DEFF Research Database (Denmark)

    Boesen, M.; Jensen, K.E.; Quistgaard, E.

    2006-01-01

    PURPOSE: To investigate and compare delayed gadolinium (Gd-DTPA)-enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in the hip joint using intravenous (i.v.) or ultrasound-guided intra-articular (i.a.) Gd-DTPA injection. MATERIAL AND METHODS: In 10 patients (50% males, mean age 58...... years) with clinical and radiographic hip osteoarthritis (OA; Kellgren score II-III), MRI of the hip was performed twice on a clinical 1.5T MR scanner: On day 1, before and 90-180 min after 0.3 mmol/kg body weight i.v. Gd-DTPA and, on day 8, 90-180 min after ultrasound-guided i.a. injection of a 4 mmol....../l Gd-DTPA solution. Coronal STIR, coronal T1 fat-saturated spin-echo, and a cartilage-sensitive gradient-echo sequence (3D T1 SPGR) in the sagittal plane were applied. RESULTS Both the post-i.v. and post-i.a. Gd-DTPA images showed significantly higher signal-to-noise (SNR) and contrast-to-noise (CNR...

  12. Shoulder MRI after surgical treatment of instability

    Energy Technology Data Exchange (ETDEWEB)

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

    1999-04-01

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

  13. Shoulder MRI after surgical treatment of instability

    International Nuclear Information System (INIS)

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

    1999-01-01

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

  14. [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.

  15. Rotator cuff degeneration in the rheumatoid shoulder : 'the issue is soft tissue'

    NARCIS (Netherlands)

    Sande, Michiel Adrianus Josephus van de

    2008-01-01

    We hypothesized that shoulder pain, caused by rheumatoid arthritis (RA), can lead to disuse of the affected shoulder joint. In addition to the structural changes caused by rotator cuff tears, tendonitis or synovitis disuse may play an important role in the aetiology of fatty degeneration (FD) of the

  16. 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...

  17. 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.

  18. Association between Propionibacterium acnes and frozen shoulder: a pilot study.

    Science.gov (United States)

    Bunker, Tim D; Boyd, Matthew; Gallacher, Sian; Auckland, Cressida R; Kitson, Jeff; Smith, Chris D

    2014-10-01

    Frozen shoulder has not previously been shown to be associated with infection. The present study set out to confirm the null hypothesis that there is no relationship between infection and frozen shoulder using two modern scientific methods, extended culture and polymerase chain reaction (PCR) for bacterial nucleic acids. A prospective cohort of 10 patients undergoing arthroscopic release for stage II idiopathic frozen shoulder had two biopsies of tissue taken from the affected shoulder joint capsule at the time of surgery, along with control biopsies of subdermal fat. The biopsies and controls were examined with extended culture and PCR for microbial nucleic acid. Eight of the 10 patients had positive findings on extended culture in their shoulder capsule and, in six of these, Propionibacterium acnes was present. The findings mean that we must reject the null hypothesis that there is no relationship between infection and frozen shoulder. More studies are urgently needed to confirm or refute these findings. If they are confirmed, this could potentially lead to new and effective treatments for this common, painful and disabling condition. Could P. acnes be the Helicobacter of frozen shoulder?

  19. 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.

  20. 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....

  1. 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.

  2. The effect of intra-articular injection of ultracain in the temporomandibular joint in patients with preauricular pain - A randomized prospective double-blind placebo-controlled crossover study

    NARCIS (Netherlands)

    Tjakkes, Geerten-Has E.; TenVergert, Elisabeth M.; de Bont, Lambert G. M.; Stegenga, Boudewijn

    2007-01-01

    Objectives: To evaluate the distinguishing ability of intraarticular anesthesia from placebo in orofacial pain patients with pain located in the temporomandibular joint (TMJ) region, aiming at a validation of intra-articular anesthesia injection as a diagnostic test of pain in the TMJ region.

  3. The treatment of computer middle frequency on periarthritis of shoulder%电脑中频电治疗肩关节周围炎

    Institute of Scientific and Technical Information of China (English)

    赵丽; 夏军; 范剑非

    2003-01-01

    @@ BACKGROUND:Periarthritis of shoulder is thought as a common disease of middle aged in motor system,which chief clinical manifestations are shoulder pain,dysfunction of joint and muscular atrophy.The main treatments of periarthritis of shoulder are kinesitherapy,physiotherapy,massage and pharmacotherapy.

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  5. 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.

  6. 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

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

    Directory of Open Access Journals (Sweden)

    Mukund R Thatte

    2011-01-01

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

  8. To the question of the immobilization after the reduction of primary traumatic shoulder dislocation (review

    Directory of Open Access Journals (Sweden)

    V. A. Aslanov

    2014-01-01

    Full Text Available The article presented the evolution of views on the conservative treatment of primary traumatic shoulder dislocation. The shortcomings of common method of conservative treatment for shoulder dislocation are listed, as well as the ways to eliminate them. The trends for further investigations for this problem are marked.The authors conclude that the standard treatment for primary traumatic shoulder dislocation is the immobilization of the damaged shoulder joint immediately after atraumatic traction reposition in the position of external rotation for a period of 3 to 7 weeks.

  9. Thoracic posture, shoulder muscle activation patterns and isokinetic ...

    African Journals Online (AJOL)

    Poor posture, scapular dyskinesia, altered scapular muscle recruitment patterns and ... postural deviation and incorrect shoulder kinematics.[5]. Knowledge of the .... the contra-lateral hand was placed as far down the spinal column as possible, and the ... produced by muscle contraction for rotation around a joint.[12] During.

  10. Calcifying supracoracoid bursitis as a cause of chronic shoulder pain.

    Science.gov (United States)

    Mens, J; van der Korst, J K

    1984-01-01

    A case of chronic shoulder pain is reported with marked limitation of both active and passive elevations and a normal range of motion of the glenohumeral joint. X-ray examination demonstrated cloudy calcification in the coracoclavicular region, presumably indicating calcifying supracoracoid bursitis. Images PMID:6497468

  11. Acusector joint semiconductor laser and rehabilitation treatment of 68 cases of hemiplegia after stroke curative effect observation of shoulder pain%电针联合半导体激光及康复训练治疗68例脑卒中后偏瘫肩痛的疗效观察

    Institute of Scientific and Technical Information of China (English)

    刘琦; 晏玫

    2014-01-01

    目的:观察电针联合半导体激光及康复训练对脑卒中后偏瘫肩痛患者的疗效影响。方法:将136例脑卒中偏瘫合并肩痛患者随机分为对照组和观察组,各68例。对照组只采用单纯的康复训练治疗,观察组则采取电针联合半导体激光及康复训练治疗。于治疗前及治疗2个疗程后运用Fugl-Meyer运动量表(FMA)及疼痛数字评分(NRS)分别评定两组患者患侧肢体运动功能和疼痛程度。结果:治疗2个疗程后,两组患者较治疗前都有明显改善,NRS评分观察组低于对照组,FMA评分观察组高于对照组(P<0.05)。结论:采取电针联合半导体激光及康复训练治疗脑卒中后偏瘫肩痛疗效满意。%Objective:To observe the curative joint semiconductor laser and rehabilitation training on the curative effect of patients with hemiplegia after stroke shoulder pain. Methods: 136 cases of cerebral apoplexy hemiplegia shoulder pain patients were randomly divided into control group and observation group, 68 cases each. Treatment with the control group only simple rehabilitation training, observation group was treated with acusector joint semi-conductor laser and rehabilitation training. In before and after 2 courses of treatment using Fugl- Meyer scale (FMA) and pain score (NRS), respectively, to assess two groups of patients with lateral limb motor function and the degree of pain. Results:After 2 courses of treatment, two groups of patients before the treatment can significantly im-prove, NRS score group is lower than the control group, the FMA score observation group is higher than the control group (P<0.05). Conclusion:Acusector joint semiconductor laser and rehabilitation treatment for hemiplegia after stroke shoulder pain curative effect is satisfied.

  12. [Treatment of temporo-mandibular joint closed-lock using intra-articular injection of mepivacaine with immediate resolution durable in time (six months follow-up)].

    Science.gov (United States)

    Guarda Nardini, L; Tito, R; Beltrame, A

    2002-01-01

    The purpose of this study was to assess the value of intra-articular fluid injection under pressure, as a technique suggested for temporo-mandibular joint (TMJ) closed-lock treatment, and to determine if there is a persisting lock resolution in time. Twelve patients were studied at our centre, with a diagnosis of TMJ closed-lock, not amenable with conventional therapies. All patients underwent a MRI scan, confirming the presence of anteriorly displaced disk. This technique is based on intra-articular injection of anaesthetic (mepivacaine cloridrate) under pressure, using the so called pumping technique, that allows an inferior distraction of the condyle. The study has a six months follow-up. After closed-lock resolution all patients underwent physiotherapy with guided mouth opening, for one month. Mandibular function (maximal mouth opening) increased on average of 20.2 mm after treatment, and of 21.1 mm six months later (p=0.00000; with p<0.005). Pain decreased on average from VAS=6.75 to VAS=0.3 (p=0.00001; with p<0.005). The masticatory efficiency improved from VAS=5.25 to VAS=8.75 (p=0.002; p<0.005). Functional TMJ limitation level is significantly increased (p=0.002; p<0.005). Also, patient's efficacy judgement (mean value 3.58= good) and tolerability judgement (mean value 2.92=good) indicate that this therapy is well accepted. This technique is easy to perform, well tolerated and does not need specific instruments: it permits the resolution of TMJ closed-lock, decreases the pain and improves masticatory efficiency. All these effects persist in time. Subjects with recent closed-lock have an immediate and complete functional recovery while patients with chronic closed-lock do not.

  13. Shoulder injuries in elite rugby union football matches: Epidemiology and mechanisms.

    Science.gov (United States)

    Usman, Juliana; McIntosh, Andrew S; Quarrie, Kenneth; Targett, Stephen

    2015-09-01

    Shoulder injuries in rugby union football have been the focus of few in-depth studies, despite their frequency and severity. The study's objective was to describe the incidence, patterns and mechanisms of shoulder injuries in rugby. Prospective cohort study of shoulder injury incidence and retrospective case-series study of shoulder injury mechanisms. Data were collected from Super Rugby matches from 2005 to 2010 involving elite level adult male rugby players. 7920 player participation hours and 100 shoulder injuries were recorded during 397 Super Rugby matches. The shoulder injury incidence rate was 13 per 1000 player hours (95% confidence interval 10-16). The mean number of days unavailable for selection due to these injuries was 37 (95% confidence interval 25-54). Tacklers sustained shoulder injuries at a higher rate than ball carriers (Rate Ratio=1.7 (95% confidence interval 0.5-5.3)). The most frequently reported injuries were those to the acromio-clavicular joint; dislocations resulted in the greatest amount of missed play. Using video analysis, 47 of the 100 shoulder injury events were successfully identified and analyzed. The main mechanisms of shoulder injury were contact with the ground with the shoulder/arm in horizontal adduction, flexion, and internal rotation; and impact to the lateral aspect of the shoulder with the elbow flexed and arm at the side. Direct impact to the shoulder, either through player-to-player contact or contact with the ground, is the main cause of shoulder injury. Methods to reduce injury risk, such as shoulder pads and tackle skills, require consideration. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  14. Work related shoulder disorders

    DEFF Research Database (Denmark)

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

    2004-01-01

    and symptoms. Data were analysed by generalised estimating equation and multiple logistic regression with adjustment for potential confounders. Results: For current upper arm elevation above 90°, a duration increment of 1% of the daily working hours was associated with odds ratios of 1.23 (95% CI 1.10 to 1......Aims: To determine quantitative exposure-response relations between work with highly elevated arms and supraspinatus tendinitis, shoulder pain with disability, and shoulder pain without disability. Methods: A cross sectional study was conducted in a historical cohort of 1886 males from three...... occupational groups. Exposure measurements were performed for four consecutive working days in a random sample of 72 currently employed subjects. Individual work histories were obtained by questionnaire and register data. Health status was ascertained by physical examination blinded towards exposure...

  15. Sacroiliac Joint Interventions.

    Science.gov (United States)

    Soto Quijano, David A; Otero Loperena, Eduardo

    2018-02-01

    Sacroiliac joint (SIJ) pain is an important cause of lower back problems. Multiple SIJ injection techniques have been proposed over the years to help in the diagnosis and treatment of this condition. However, the SIJ innervation is complex and variable, and truly intra-articular injections are sometimes difficult to obtain. Different sacroiliac joint injections have shown to provide pain relief in patients suffering this ailment. Various techniques for intraarticular injections, sacral branch blocks and radiofrequency ablation, both fluoroscopy guided and ultrasound guided are discussed in this paper. Less common techniques like prolotherapy, platelet rich plasma injections and botulism toxin injections are also discussed. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with severe hemophilic arthropathy of the knee: Is this intervention really effective?

    Science.gov (United States)

    Rodriguez-Merchan, E Carlos; Valentino, Leonard A

    2018-05-10

    The aim of this review is to explore the scientific rationale and evidence for a potential benefit of joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with severe hemophilic arthropathy of the knee (SHAK). Areas covered: This article is a narrative review of the evidence for potential benefits of joint lavage followed by intra-articular injection of hyaluronic acid and corticosteroids in SHAK compared with osteoarthritis of the knee in non-hemophilia patients. Expert commentary: Although some reports on hemophilic arthropathy with a low-grade of evidence seem to indicate a benefit of joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with SHAK, the short-lived improvements afforded by hyaluronic acid, and the doubtful benefits of corticosteroids and joint lavage in hemophilia, do not warrant their use in hemophilic patients. The scientific rationale of these procedures is poor and they are not recommended.

  17. Bicycle-Related Shoulder Injuries: Etiology and the Need for Protective Gear.

    Science.gov (United States)

    Goldstein, Yariv; Dolkart, Oleg; Kaufman, Ehud; Amar, Eyal; Sharfman, Zachary T; Rath, Ehud; Mozes, Gavriel; Maman, Eran

    2016-01-01

    The popularity of bicycle riding for recreation, exercise and transportation has grown enormously in recent years, which has led to an increased incidence of bicycle-related injuries. While these injuries involve mainly the musculoskeletal system, data on shoulder-specific injuries incurred while bike riding are lacking. Classifying these shoulder injuries may provide insight and assistance in the creation and implementation of effective protective gear and measures. To investigate the types and mechanisms of shoulder injuries among cyclists. This study retrospectively examined all cyclists who incurred shoulder injuries while riding and were admitted to the emergency department and shoulder clinic between January 2008 and November 2013. The study included 157 subjects with various bicycle-related shoulder injuries treated with either conservative or surgical measures. Eighty-four percent of injuries were caused by a direct blow to the shoulder, 7% by falling on an outstretched hand, 6% were traction injuries, and 3% were due to hyperabduction. Nine different clinical types of injury were observed; the most common injuries were clavicle fractures (32%), followed by acromioclavicular joint dislocations (22%), rotator cuff tears (22%), and humeral fractures (8%). Fifty-one percent of subjects were managed with conservative care and the remaining patients required surgical interventions. Shoulder injuries incurred while riding a bicycle span the entire spectrum of shoulder injuries and often result in debilitating conditions. Although the use of helmets is increasing, there is currently no effective protective gear or measures to prevent riders from suffering shoulder injuries.

  18. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks

    Directory of Open Access Journals (Sweden)

    McNair Peter J

    2011-05-01

    Full Text Available Abstract Background The prevalence of imaged pathology in primary care has received little attention and the relevance of identified pathology to symptoms remains unclear. This paper reports the prevalence of imaged pathology and the association between pathology and response to diagnostic blocks into the subacromial bursa (SAB, acromioclavicular joint (ACJ and glenohumeral joint (GHJ. Methods Consecutive patients with shoulder pain recruited from primary care underwent standardised x-ray, diagnostic ultrasound scan and diagnostic injections of local anaesthetic into the SAB and ACJ. Subjects who reported less than 80% reduction in pain following either of these injections were referred for a magnetic resonance arthrogram (MRA and GHJ diagnostic block. Differences in proportions of positive and negative imaging findings in the anaesthetic response groups were assessed using Fishers test and odds ratios were calculated a for positive anaesthetic response (PAR to diagnostic blocks. Results In the 208 subjects recruited, the rotator cuff and SAB displayed the highest prevalence of pathology on both ultrasound (50% and 31% respectively and MRA (65% and 76% respectively. The prevalence of PAR following SAB injection was 34% and ACJ injection 14%. Of the 59% reporting a negative anaesthetic response (NAR for both of these injections, 16% demonstrated a PAR to GHJ injection. A full thickness tear of supraspinatus on ultrasound was associated with PAR to SAB injection (OR 5.02; p p p p ≤ 0.05. Conclusions Rotator cuff and SAB pathology were the most common findings on ultrasound and MRA. Evidence of a full thickness supraspinatus tear was associated with symptoms arising from the subacromial region, and a biceps tendon sheath effusion and an intact rotator cuff were associated with an intra-articular GHJ pain source. When combined with clinical information, these results may help guide diagnostic decision making in primary care.

  19. Shoulder injuries attributed to resistance training: a brief review.

    Science.gov (United States)

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

    2010-06-01

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

  20. Myositis ossificans around shoulder following military training programme

    Directory of Open Access Journals (Sweden)

    Mustafa C Kir

    2011-01-01

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

  1. The epidemiology of shoulder dislocations in Oslo.

    Science.gov (United States)

    Liavaag, S; Svenningsen, S; Reikerås, O; Enger, M; Fjalestad, T; Pripp, A H; Brox, J I

    2011-12-01

    There are few previous studies on the incidence of shoulder dislocation in the general population. The aim of the study was to report the incidence of acute shoulder dislocations in the capital of Norway (Oslo) in 2009. Patients of all ages living in Oslo, sustaining a dislocation of the glenohumeral joint, were identified using electronic diagnosis registers, patient protocols, radiological registers of the hospitals, and the Norwegian Patient Register (NPR). The overall incidence rate was 56.3 [95% confidence interval (CI) 50.2-62.4] per 100,000 person-years, with rates of 82.2 (95% CI 71.7-92.8) and 30.9 (95% CI 24.5-37.3) in men and women, respectively. The incidence of primary dislocations was 26.2 (95% CI 22.1-30.4). The overall incidence of shoulder dislocations in Oslo was higher than previously reported incidences. The incidence of primary dislocations was also higher than that in previously reported studies for the general population but it was close to the incidence reported in Malmø, Sweden. © 2011 John Wiley & Sons A/S.

  2. Shoulder Pain after Fall, Septic Shock, and Pyomyositis Associated with Breast Cancer Chemotherapy and Lymphedema

    Directory of Open Access Journals (Sweden)

    Hiromitsu Kitayama

    2016-11-01

    Full Text Available Background: As a symptom of pyomyositis, sepsis usually follows local inflammation signs. Here, we report pyomyositis with lymphedema of upper extremity in which septic shock and poor local findings initially presented during chemotherapy for breast cancer. Case Report: An 80-year-old woman presented with chronic right shoulder pain during chemotherapy for the recurrent disease. She had a history of postmastectomy lymphedema, diabetes mellitus, and repeated hyaluronic acid injections to the shoulder joint. The pain suddenly worsened with septic shock and no apparent local signs. Magnetic resonance imaging revealed myonecrosis, and no pus was yielded by ultrasound-guided needle aspiration. After 2 weeks of recovery by conservative medical management, surgical drainage was performed. Late formulated massive intramuscular pus showed severe neutrophil infiltration and myonecrosis. Conclusion: Pyomyositis can develop into septic shock with poor local signs. Myelosuppression after chemotherapy can cause myonecrosis without macroabscess, and magnetic resonance imaging was useful for the diagnosis of this condition. When unspecified local pain appears during cancer chemotherapy we should consider this disease, too.

  3. Shoulder Pain After Thoracic Surgery

    DEFF Research Database (Denmark)

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

    2017-01-01

    OBJECTIVES: To study the time course of ipsilateral shoulder pain after thoracic surgery with respect to incidence, pain intensity, type of pain (referred versus musculoskeletal), and surgical approach. DESIGN: Prospective, observational cohort study. SETTING: Odense University Hospital, Denmark...... for musculoskeletal involvement (muscle tenderness on palpation and movement) with follow-up 12 months after surgery. Clinically relevant pain was defined as a numeric rating scale score>3. Of the 60 patients included, 47 (78%) experienced ipsilateral shoulder pain, but only 25 (42%) reported clinically relevant...... shoulder pain. On postoperative day 4, 19 patients (32%) still suffered shoulder pain, but only 4 patients (7%) had clinically relevant pain. Four patients (8%) still suffered shoulder pain 12 months after surgery. In 26 patients (55%), the shoulder pain was classified as referred versus 21 patients (45...

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

    International Nuclear Information System (INIS)

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

    2004-01-01

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

  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. Thermal Shrinkage for Shoulder Instability

    OpenAIRE

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

    2010-01-01

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

  8. The failed postoperative shoulder: Role of double contrast CT arthrography

    International Nuclear Information System (INIS)

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

    1986-01-01

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

  9. 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.

  10. Short-term effect of ultrasound-guided low-molecular-weight hyaluronic acid injection on clinical outcomes and imaging changes in patients with rheumatoid arthritis of the ankle and foot joints. A randomized controlled pilot trial.

    Science.gov (United States)

    Wang, Chien-Chih; Lee, Si-Huei; Lin, Hsiao-Yi; Liu, Fu-Wei; Chiou, Hong-Jen; Chan, Rai-Chi; Chou, Chen-Liang

    2017-11-01

    To determine whether hyaluronic acid (HA) injection into rheumatoid arthritis ankles and feet can achieve improvement in foot function and reduce synovial hyper-vascularization. Forty-four patients with RA having unilateral or bilateral painful ankle and foot involvement (N = 75) were studied. All the patients were randomized to receive HA (N = 40) or lidocaine (LI) (N = 35) injection at 2-week intervals; Clinical assessments were performed using a visual analog scale (VAS) and foot function index (FFI total ) including subscales of pain (FFI pain) before injection at baseline, 4 weeks (first evaluation) and 12 weeks (secondary evaluation). Imaging evaluation based on color Doppler ultrasound (CDUS) and synovitis scores was performed simultaneously. HA injection improved the VAS score (p = .009), FFI pain (p = .041), and FFI total (p = .032) considerably more than LI injections did at the first evaluation. The CDUS values at first evaluation (p = .005) and secondary evaluation (p injections reduced the CDUS values of more than half of the joints (54%, p = .042) while the control group exhibited no change (20%, p = .56). However, HA injection did not reduce the CDUS values more than LI injection did. Regarding the evaluation of synovial hypertrophy, no significant difference was observed between or within the groups in the synovitis scores. HA injection improved short-term foot function and pain reduction. HA injection may have a modest effect in reducing synovial hyper-vascularization. Further large-scale study is warranted to confirm this result.

  11. Characterization of a frozen shoulder model using immobilization in rats.

    Science.gov (United States)

    Kim, Du Hwan; Lee, Kil-Ho; Lho, Yun-Mee; Ha, Eunyoung; Hwang, Ilseon; Song, Kwang-Soon; Cho, Chul-Hyun

    2016-12-08

    The objective of this study was to investigate serial changes for histology of joint capsule and range of motion of the glenohumeral joint after immobilization in rats. We hypothesized that a rat shoulder contracture model using immobilization would be capable of producing effects on the glenohumeral joint similar to those seen in patients with frozen shoulder. Sixty-four Sprague-Dawley rats were randomly divided into one control group (n = 8) and seven immobilization groups (n = 8 per group) that were immobilized with molding plaster for 3 days, or for 1, 2, 3, 4, 5, or 6 weeks. At each time point, eight rats were euthanized for histologic evaluation of the axillary recess and for measurement of the abduction angle. Infiltration of inflammatory cells was found in the synovial tissue until 2 weeks after immobilization. However, inflammatory cells were diminished and fibrosis was dominantly observed in the synovium and subsynovial tissue 3 weeks after immobilization. From 1 week after immobilization, the abduction angle of all immobilization groups at each time point was significantly lower than that of the control group. Our study demonstrated that a rat frozen shoulder model using immobilization generates the pathophysiologic process of inflammation leading to fibrosis on the glenohumeral joint similar to that seen in patients with frozen shoulder. This model was attained within 3 weeks after immobilization. It may serve as a useful tool to investigate pathogenesis at the molecular level and identify potential target genes that are involved in the development of frozen shoulder.

  12. [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.

  13. New technique targeting the C5 nerve root proximal to the traditional interscalene sonoanatomical approach is analgesic for outpatient arthroscopic shoulder surgery.

    Science.gov (United States)

    Dobie, Katherine H; Shi, Yaping; Shotwell, Matthew S; Sandberg, Warren S

    2016-11-01

    Regional anesthesia and analgesia for shoulder surgery is most commonly performed via interscalene nerve block. We developed an ultrasound-guided technique that specifically targets the C5 nerve root proximal to the traditional interscalene block and assessed its efficacy for shoulder analgesia. Prospective case series. Vanderbilt Bone and Joint Surgery Center. Patients undergoing shoulder arthroscopy at an ambulatory surgery center. Thirty-five outpatient shoulder arthroscopy patients underwent an analgesic nerve block using a new technique where ultrasound visualization of the C5 nerve root served as the primary target at a level proximal to the traditional interscalene approach. The block was performed with 15mL of 0.5% plain ropivicaine. Post anesthesia care unit pain scores, opioid consumption, hand strength, and duration of block were recorded. Cadaver dissection after injection with methylene blue confirmed that the primary target under ultrasound visualization was the C5 nerve root. Pain scores revealed 97% patients had 0/10 pain at arrival to PACU, with 91% having a pain score of 3/10 or less at discharge from PACU. Medical Research Council (MRC) hand strength mean (SD) score was 4.17 (0.92) on a scale of 1-5. The mean (SD) duration of the block was 13.9 (3.5) hours. A new technique for ultrasound-guided blockade at the level of the C5 nerve root proximal to the level of the traditional interscalene block is efficacious for shoulder post-operative pain control. Copyright © 2016 Elsevier Inc. All rights reserved.

  14. Suprascapular nerve block for the treatment of frozen shoulder

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    Korhan Ozkan

    2012-01-01

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

  15. 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.

  16. Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain.

    Science.gov (United States)

    Salek, K M; Mannan, M; Chowdhury, A Z; Haque, M A; Kaiser, M S; Nabi, S; Ferdousee, R A; Paul, B K; Ahmed, S M; Khan, M; Begum, M

    2011-01-01

    Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive.

  17. Imipenem and Cilastatin Injection

    Science.gov (United States)

    Imipenem and cilastatin injection is used to treat certain serious infections that are caused by bacteria, including ... area), gynecological, blood, skin, bone, and joint infections. Imipenem is in a class of medications called carbapenem ...

  18. MR-guided MR arthrography of the shoulder

    International Nuclear Information System (INIS)

    Tratting, S.; Breitenseher, M.; Pretterklieber, M.; Kontaxis, G.; Rand, T.; Imhof, H.

    1996-01-01

    Purpose: To develop an MR-guided technique for joint puncture in MR arthrography of the shoulder and to confirm the intracapsular position of the needle tip by visualization of the flow of contrast media into the joint. Materials and methods: Three unfixed human shoulder joint specimens were examined on a 1.0 T unit. The optimal point of entrance and depth for joint puncture were estimated by means of MR-compatible markers on the skin. Needle orientation and localization of the needle tip (MR-compatible 22-gauge needle) in the shoulder joint were monitored by rapid localizer gradient-echo sequences in two orthogonal planes. To confirm the intracapsular position of the needle tip, diluted gadolinium-DTPA was administered via a long connecting tube and the flow of contrast media into the joint was viewed directly on an LCD screen using real-time MR imaging (local look technique). Results: The MR-compatible markers on the skin allowed determination of the optimal point of entrance and estimation of the depth for joint puncture. Passive visualization of the MR-compatible needle due to spin dephasing and signal loss provided adequate localization of the intra-articular needle tip position in all specimens, although significant artefacts were present on rapid localizer gradient-echo sequences with an increase in width of the apparent needle shaft. Real-time MR imaging of the flow of contrast media was possible using the local look technique and the LCD screen of the MR unit and allowed confirmation of the intracapsular position. Conclusion: MR-guided joint puncture and real-time MR-assisted contrast media application results in improved MR arthrography and may replace conventional fluoroscopic guidance. (orig.) [de

  19. [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.

  20. Acromioclavicular joint separation

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    Devan Pandya, BS

    2018-04-01

    Full Text Available History of present illness: A 30-year-old male was brought in by ambulance to the emergency department as a trauma activation after a motorcycle accident. The patient was the helmeted rider of a motorcycle traveling at an unknown speed when he lost control and was thrown off his vehicle. He denied loss of consciousness, nausea, or vomiting. The patient’s vital signs were stable and his only complaint was pain around his left shoulder. On exam, the patient had a prominent left clavicle without skin compromise. He had adequate range of motion in the left shoulder with moderate pain, and his left upper extremity was neurovascularly intact. Significant findings: Plain films of the left shoulder showed elevation of the left clavicle above the acromion. There was an increase in the acromioclavicular (AC and coracoclavicular (CC distances (increased joint distances marked with red and blue arrows, respectively. A normal AC joint measures 1-3 mm whereas a normal CC distance measures 11-13 mm.1 The injury was classified as a Rockwood type III AC joint separation. Discussion: The AC joint is a synovial joint between an oval facet on the acromion and a similar facet on the distal end of the clavicle. Horizontal stability is provided by the AC joint while axial stability is provided by the CC joint.2,3 AC joint injuries account for about 9%-12% of shoulder girdle injuries, and the most common mechanism is direct trauma.4,5 Initial evaluation with imaging includes plain films with three views: the anterior-posterior (AP view with the shoulder in internal and external rotation as well as an axillary, or scapula-Y view (sensitivity 40%, specificity 90% for all films.6,7 AC joint injuries are classified by the Rockwood system.8 Type I involves a sprain or incomplete tear of the AC ligaments with an intact CC ligament. The AC joint appears normal on X-ray, but can become widened with stress, achieved by having the patient hold a 10-15 pound weight from each

  1. The consequences of shoulder pain intensity on quality of life and community participation in paraplegic wheelchair users

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    Nulle A.

    2012-10-01

    Full Text Available Background/Objective: Shoulder overuse due weight-bearing loads – wheelchair propulsion and transfers – are supposed to cause shoulder pain in active wheelchair users. Consequently, shoulder pain has been found to have a high prevalence in the spinal cord-injured population. Severity of pain levels in individuals with spinal cord injury has been shown to impact quality of life. Aim of this study was to describe the consequences of shoulder pain intensity on quality of life, physical activity, and community activities in spinal cord-injured paraplegic wheelchair users. Materials and Methods: It was a qualitative, analytical one moment study where was involved persons after spinal cord injury below Th1 with lower paraplegia, who used manually operated wheelchairs for mobility at least 50% of the time. Main outcomes measure: SF-36textregistered Health Survey, Physical Activity Scale for Individuals With Physical Disabilities, Community Activities Checklist, Wheelchair User’s Shoulder Pain Index, Functional Independence Measure, Goniometry for shoulder joint. Results and analysis: 40 participants (9 female, 31 male after spinal cord injury (SCI, mean age – 30,8 years, one to twenty years after spinal cord injury. 20 participants had pain in shoulder, 20 participants without pain in shoulder. The intensity of shoulder pain was not related to duration of SCI or the duration of shoulder pain. Shoulder pain intensity scores were inversely related to quality of life. There was a moderate, inverse relationship between shoulder pain intensity and physical activity. There was no relationship, however, between shoulder pain intensity and community activities. The level of community activity was positively related to quality of life. Conclusions: Persons with spinal cord injury who reported lower subjective quality of life and physical activity scores experienced significantly higher levels of shoulder pain. Shoulder pain intensity did not relate to

  2. The Effect of Platelet-Rich Plasma (PRP on Improvement in Pain and Symptoms of Shoulder Subacromial Impingement Syndrome

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    Parisa Nejati

    2015-08-01

    Full Text Available Abstract Background: Subacromial impingement is one of the most common complaints of shoulder. Treatments include avoiding of painful activities, oral anti-pain drugs, physical therapy modalities, corticosteroid injection and exercise therapy. Some studies have shown that platelet- rich plasma(PRP is effective on tendinitis and tearing of tendons, ligaments and muscles, but evidence that has proved PRP as a conservative treatment in shoulder pathologies is very limited. This study aims to investigate the effect of PRP injection on relieving pain and improving daily function of patients with shoulder impingement syndrome. Materials and Methods: In this clinical trial study, patients older than 40 with pain more than three months were included. If they had three of four positive diagnostic clinical tests of shoulder impingement that were confirmed by shoulder MRI, could be injected PRP twice. The time between injections was 1 month. Pain was measured by visual analog scale (VAS and function was measured by two questionnaires named disabilities of the arm, shoulder and hand (DASH and western Ontario rotator cuff index (WORC. Range of motion (ROM of shoulder was measured in five directions by goniometry . All of these parameters were evaluated before intervention and in 1, 3, 6 months later. Results: with due attention to a six-month folloe-up, PRR injection was effective in pain reduction and improvement of patient's function (p<0.05. Shoulder Rom increased in all directions except external rotation and the power of shoulder muscles was evidently improved statistically in flexion, abduction and internal toration. Conclusion: PRP injection could effectively reduce pain and improve daily activities in patients with shoulder impingement syndrome.

  3. Axillary artery injury secondary to inferior shoulder dislocation.

    Science.gov (United States)

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

    2010-11-01

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

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

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    Rajiv Gandhi

    2013-12-01

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

  5. Obesity-related adipokines predict patient-reported shoulder pain.

    Science.gov (United States)

    Gandhi, Rajiv; Perruccio, Anthony V; Rizek, Randy; Dessouki, Omar; Evans, Heather M K; Mahomed, Nizar N

    2013-01-01

    Increasingly, an inflammatory modulating effect of adipokines within synovial joints is being recognized. To date, there has been no work examining a potential association between the presence of adipokines in the shoulder and patient-reported outcomes. This study undertakes an investigation assessing these potential links. 50 osteoarthritis patients scheduled for shoulder surgery completed a pre-surgery questionnaire capturing demographic information including validated, patient-reported function (Disabilities of the Arm, Shoulder, and Hand questionnaire) and pain (Short Form McGill Pain Questionnaire) measures. Synovial fluid (SF) samples were analyzed for leptin, adiponectin, and resistin levels using Milliplex MAP assays. Linear regression modeling was used to assess the association between adipokine levels and patient-reported outcomes, adjusted for age, sex, BMI, and disease severity. 54% of the cohort was female (n = 27). The mean age (SD) of the sample was 62.9 (9.9) years and the mean BMI (SD) was 28.1 (5.4) kg/m(2). From regression analyses, greater SF leptin and adiponectin levels, but not regarding resistin, were found to be associated with greater pain (p < 0.05). Adipokine levels were not associated with functional outcome scores. The identified association between shoulder-derived SF leptin and adiponectin and shoulder pain is likely explained by the pro-inflammatory characteristics of the adipokines and represents potentially important therapeutic targets. © 2013 S. Karger GmbH, Freiburg.

  6. Multivariate analyses of rotator cuff pathologies in shoulder disability.

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    Jan F Henseler

    Full Text Available Disability of the shoulder joint is often caused by a tear in the rotator cuff (RC muscles. Four RC muscles coordinate shoulder movement and stability, among them the supraspinatus and infraspinatus muscle which are predominantly torn. The contribution of each RC muscle to tear pathology is not fully understood. We hypothesized that muscle atrophy and fatty infiltration, features of RC muscle degeneration, are predictive of superior humeral head translation and shoulder functional disability.Shoulder features, including RC muscle surface area and fatty infiltration, superior humeral translation and RC tear size were obtained from a consecutive series of Magnetic Resonance Imaging with arthrography (MRA. We investigated patients with superior (supraspinatus, n = 39 and posterosuperior (supraspinatus and infraspinatus, n = 30 RC tears, and patients with an intact RC (n = 52 as controls. The individual or combinatorial contribution of RC measures to superior humeral translation, as a sign of RC dysfunction, was investigated with univariate or multivariate models, respectively.Using the univariate model the infraspinatus surface area and fatty infiltration in both the supraspinatus and infraspinatus had a significant contribution to RC dysfunction. With the multivariate model, however, the infraspinatus surface area only affected superior humeral translation (p<0.001 and discriminated between superior and posterosuperior tears. In contrast neither tear size nor fatty infiltration of the supraspinatus or infraspinatus contributed to superior humeral translation.Our study reveals that infraspinatus atrophy has the strongest contribution to RC tear pathologies. This suggests a pivotal role for the infraspinatus in preventing shoulder disability.

  7. Multivariate Analyses of Rotator Cuff Pathologies in Shoulder Disability

    Science.gov (United States)

    Henseler, Jan F.; Raz, Yotam; Nagels, Jochem; van Zwet, Erik W.; Raz, Vered; Nelissen, Rob G. H. H.

    2015-01-01

    Background Disability of the shoulder joint is often caused by a tear in the rotator cuff (RC) muscles. Four RC muscles coordinate shoulder movement and stability, among them the supraspinatus and infraspinatus muscle which are predominantly torn. The contribution of each RC muscle to tear pathology is not fully understood. We hypothesized that muscle atrophy and fatty infiltration, features of RC muscle degeneration, are predictive of superior humeral head translation and shoulder functional disability. Methods Shoulder features, including RC muscle surface area and fatty infiltration, superior humeral translation and RC tear size were obtained from a consecutive series of Magnetic Resonance Imaging with arthrography (MRA). We investigated patients with superior (supraspinatus, n = 39) and posterosuperior (supraspinatus and infraspinatus, n = 30) RC tears, and patients with an intact RC (n = 52) as controls. The individual or combinatorial contribution of RC measures to superior humeral translation, as a sign of RC dysfunction, was investigated with univariate or multivariate models, respectively. Results Using the univariate model the infraspinatus surface area and fatty infiltration in both the supraspinatus and infraspinatus had a significant contribution to RC dysfunction. With the multivariate model, however, the infraspinatus surface area only affected superior humeral translation (ptears. In contrast neither tear size nor fatty infiltration of the supraspinatus or infraspinatus contributed to superior humeral translation. Conclusion Our study reveals that infraspinatus atrophy has the strongest contribution to RC tear pathologies. This suggests a pivotal role for the infraspinatus in preventing shoulder disability. PMID:25710703

  8. Multivariate analyses of rotator cuff pathologies in shoulder disability.

    Science.gov (United States)

    Henseler, Jan F; Raz, Yotam; Nagels, Jochem; van Zwet, Erik W; Raz, Vered; Nelissen, Rob G H H

    2015-01-01

    Disability of the shoulder joint is often caused by a tear in the rotator cuff (RC) muscles. Four RC muscles coordinate shoulder movement and stability, among them the supraspinatus and infraspinatus muscle which are predominantly torn. The contribution of each RC muscle to tear pathology is not fully understood. We hypothesized that muscle atrophy and fatty infiltration, features of RC muscle degeneration, are predictive of superior humeral head translation and shoulder functional disability. Shoulder features, including RC muscle surface area and fatty infiltration, superior humeral translation and RC tear size were obtained from a consecutive series of Magnetic Resonance Imaging with arthrography (MRA). We investigated patients with superior (supraspinatus, n = 39) and posterosuperior (supraspinatus and infraspinatus, n = 30) RC tears, and patients with an intact RC (n = 52) as controls. The individual or combinatorial contribution of RC measures to superior humeral translation, as a sign of RC dysfunction, was investigated with univariate or multivariate models, respectively. Using the univariate model the infraspinatus surface area and fatty infiltration in both the supraspinatus and infraspinatus had a significant contribution to RC dysfunction. With the multivariate model, however, the infraspinatus surface area only affected superior humeral translation (ppathologies. This suggests a pivotal role for the infraspinatus in preventing shoulder disability.

  9. Management of acromioclavicular joint injuries.

    Science.gov (United States)

    Li, Xinning; Ma, Richard; Bedi, Asheesh; Dines, David M; Altchek, David W; Dines, Joshua S

    2014-01-01

    Acromioclavicular joint injuries are among the most common shoulder girdle injuries in athletes and most commonly result from a direct force to the acromion with the arm in an adducted position. Acromioclavicular joint injuries often present with associated injuries to the glenohumeral joint, including an increased incidence of superior labrum anterior posterior (SLAP) tears that may warrant further evaluation and treatment. Anteroposterior stability of the acromioclavicular joint is conferred by the capsule and acromioclavicular ligaments, of which the posterior and superior ligaments are the strongest. Superior-inferior stability is maintained by the coracoclavicular (conoid and trapezoid) ligaments. Type-I or type-II acromioclavicular joint injuries have been treated with sling immobilization, early shoulder motion, and physical therapy, with favorable outcomes. Return to activity can occur when normal shoulder motion and strength are obtained and the shoulder is asymptomatic as compared with the contralateral normal extremity. The management of type-III injuries remains controversial and is individualized. While a return to the previous level of functional activity with nonsurgical treatment has been documented in a number of case series, surgical reduction and coracoclavicular ligament reconstruction has been associated with a favorable outcome and can be considered in patients who place high functional demands on their shoulders or in athletes who participate in overhead sports. Surgical management is indicated for high-grade (≥type IV) acromioclavicular joint injuries to achieve anatomic reduction of the acromioclavicular joint, reconstruction of the coracoclavicular ligaments, and repair of the deltotrapezial fascia. Outcomes after surgical reconstruction of the coracoclavicular ligaments have been satisfactory with regard to achieving pain relief and return to functional activities, but further improvements in the biomechanical strength of these

  10. Effects of spaceflight on the muscles of the murine shoulder.

    Science.gov (United States)

    Shen, Hua; Lim, Chanteak; Schwartz, Andrea G; Andreev-Andrievskiy, Alexander; Deymier, Alix C; Thomopoulos, Stavros

    2017-12-01

    Mechanical loading is necessary for the development and maintenance of the musculoskeletal system. Removal of loading via microgravity, paralysis, or bed rest leads to rapid loss of muscle mass and function; however, the molecular mechanisms that lead to these changes are largely unknown, particularly for the spaceflight (SF) microgravity environment. Furthermore, few studies have explored these effects on the shoulder, a dynamically stabilized joint with a large range of motion; therefore, we examined the effects of microgravity on mouse shoulder muscles for the 15-d Space Transportation System (STS)-131, 13-d STS-135, and 30-d Bion-M1 missions. Mice from STS missions were euthanized within 4 h after landing, whereas mice from the Bion-M1 mission were euthanized within 14 h after landing. The motion-generating deltoid muscle was more sensitive to microgravity than the joint-stabilizing rotator cuff muscles. Mice from the STS-131 mission exhibited reduced myogenic ( Myf5 and -6 ) and adipogenic ( Pparg , Cebpa , and Lep ) gene expression, whereas either no change or an increased expression of these genes was observed in mice from the Bion-M1 mission. In summary, muscle responses to microgravity were muscle-type specific, short-duration SF caused dramatic molecular changes to shoulder muscles and responses to reloading upon landing were rapid.-Shen, H., Lim, C., Schwartz, A. G., Andreev-Andrievskiy, A., Deymier, A. C., Thomopoulos, S. Effects of spaceflight on the muscles of the murine shoulder. © FASEB.

  11. Treatment for Frozen Shoulder Combined with Calcific Tendinitis of the Supraspinatus

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    Shen-Kai Chen

    2008-02-01

    Full Text Available Calcific tendinitis of the shoulder is a process that involves calcium deposition in the rotator cuff tendons. It is usually a self-limiting process and is often chronic in nature. However, it can lead to acute pain resulting in frozen shoulder syndrome. We report 32 cases in which frozen shoulder was associated with calcific tendinitis of the supraspinatus. The aim of this study was to use arthroscopic brisement of the glenohumeral joint and make multiple punctures in the calcific spot to treat the frozen shoulder associated with calcific tendinitis of the supraspinatus. In our study, 30 patients had satisfactory results after a 2-year follow-up. Five patients experienced some postoperative calcium shadows, but there was also greater improvement in the range of motion and pain relief in this study compared with other reports in the literature of frozen shoulder cases.

  12. Effect of forearm axially rotated posture on shoulder load and shoulder abduction / flexion angles in one-armed arrest of forward falls.

    Science.gov (United States)

    Hsu, Hsiu-Hao; Chou, You-Li; Lou, Shu-Zon; Huang, Ming-Jer; Chou, Paul Pei-Hsi

    2011-03-01

    Falling onto the outstretched hand is the most common cause of upper extremity injury. This study develops an experimental model for evaluating the shoulder load during a simulated forward fall onto one hand with three different forearm axially rotated postures, and examines the shoulder abduction angle and shoulder flexion angle in each case. Fifteen healthy young male subjects with an average age of 23.7 years performed a series of one-armed arrests from a height of 5 cm onto a force plate. The kinematics and kinetics of the upper extremity were analyzed for three different forearm postures, namely 45° externally rotated, non-rotated, and 45° internally rotated. The shoulder joint load and shoulder abduction/flexion angles were significantly dependent on the rotational posture of the forearm. The shoulder medio-lateral shear forces in the externally rotated group were found to be 1.61 and 2.94 times higher than those in the non-rotated and internally rotated groups, respectively. The shoulder flexion angles in the externally rotated, non-rotated and internally rotated groups were 0.6°, 8.0° and 19.2°, respectively, while the corresponding shoulder abduction angles were 6.1°, 34.1° and 46.3°, respectively. In falls onto the outstretched hand, an externally rotated forearm posture should be avoided in order to reduce the medio-lateral shear force acting on the shoulder joint. In falls of this type, a 45° internally rotated forearm posture represents the most effective fall strategy in terms of minimizing the risk of upper extremity injuries. Copyright © 2010 Elsevier Ltd. All rights reserved.

  13. 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.)

  14. 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.)

  15. 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.

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

    Science.gov (United States)

    Sommervold, Maria; Østerås, Håvard

    2017-01-01

    Excessively high stresses are applied to the shoulder joint of handball players, mainly caused by overhead throwing. Shoulder pain is a significant problem among junior female team handball players and both male and female top-level team handball players in Norway. A randomized selection was performed among the best female junior teams (J 16) in the Trøndelag region of Norway in the 2014-2015 season. Three teams were randomized to the intervention group and three teams to the control group. Players in the intervention group (n=53) participated in a seven-month, three-times-a-week shoulder-muscle strength-training program, while those in the control group (n=53) participated in a comparable handball training, but did not conduct any specific strength training during the season. A strength-training program had no effect on the prevention of shoulder pain. Overall, the players reported shoulder pain, but graded the pain low on visual analog scale (VAS). Both the intervention group and the control group reported pain under 1 on VAS at baseline and posttest, and there was no significant difference within or between the groups when it came to the intensity of pain reported on VAS. A significant difference ( p handball. The intervention group was significantly stronger ( p handball players.

  17. Reflexes in the shoulder muscles elicited from the human coracoacromial ligament.

    Science.gov (United States)

    Diederichsen, Louise Pyndt; Nørregaard, Jesper; Krogsgaard, Michael; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

    2004-09-01

    Morphological studies have demonstrated mechanoreceptors in the capsuloligamentous structures of the shoulder joint, however knowledge of the role these joint receptors play in the control of shoulder stability is limited. We therefore investigated the effect of electrically induced afferent activity from mechanoreceptors in the coracoacromial ligament (CAL) on the activity of voluntary activated shoulder muscles in healthy humans. In study I, wire electrodes, for electrical stimulation, were inserted into the CAL in eight normal shoulders. In study II, a needle electrode was inserted into the CAL in seven normal shoulders. Electric activity was recorded from eight shoulder muscles by surface and intramuscular electrodes. During isometric contractions, electrical stimulation was applied to the CAL at two different stimulus intensities, a weak stimulus (stim-1) and a stronger stimulus (stim-2). In both experiments, electrical stimulation of the CAL elicited a general inhibition in the voluntary activated shoulder muscles. In study I the average latencies (mean+/-SE) of the muscular inhibition were 66+/-4 ms (stim-1) and 62+/-4 ms (stim-2) during isometric flexion and 73+/-3 ms (stim-1) and 73+/-5 ms (stim-2) during isometric extension. In study II the average latency (mean+/-SE) of the response was 66+/-4 ms (stim-1) during isometric flexion. Our results demonstrated a response, probably of reflex origin, from mechanoreceptors in the CAL to the shoulder muscles. The existence of this synaptic connection between mechanoreceptors in CAL and the shoulder muscles suggest a role of these receptors in muscle coordination and in the functional joint stability.

  18. MR imaging of the shoulder

    International Nuclear Information System (INIS)

    Heuck, A.; Appel, M.; Kaiser, E.; Luttke, G.; Lukas, P.

    1990-01-01

    This paper evaluates the occurrence, frequency, and significance of increased signal intensity (SI) in the rotator cuff (RC) of normal volunteers suggestive of pathologic findings such as partial tears and tendinitis. Shoulders of 30 volunteers without evidence of prior shoulder disease or trauma were studied. MR imaging at 1.5 T included T1-weighted, proton-density, and T2-weighted spin-echo (SE) and T2*-weighted gradient-echo sequences in axial, oblique coronal, and sagittal planes. Shoulders of 30 cadavers were dissected and studied for correlation with MR findings, five of them after MR examination

  19. Postoperative imaging of the shoulder

    International Nuclear Information System (INIS)

    Woertler, K.; Rummeny, E.J.

    2004-01-01

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

  20. MR arthrography of the shoulder: possible indications for clinical use

    International Nuclear Information System (INIS)

    Kreitner, K.F.; Grebe, P.; Kersjes, W.; Runkel, M.; Kirschner, P.; Schild, H.H.

    1994-01-01

    In a prospective study possible indications for MR arthrography of the shoulder were evaluated. 37 patients were examined before and after intraarticular administration of a 2-mmolar solution of Gd-DTPA. MR arthrography was performed if there was no joint effusion and/or an uncertain finding concerning the rotator cuff or the capsulolabral complex on plain MR images. MR arthrography leads to a better demonstration of labrum pathology in 11/22 patients and to a superior delineation of the capsuloligamentous apparatus in 20/22 cases. In 9/15 patients with impingement lesions MR arthrography allowed a differentiation of severe tendinitis from partial and small full-thickness tears of the rotator cuff. MR arthrography of the shoulder joint enhances the accuracy of MR in case of an uncertain finding on plain MR images. (orig.) [de

  1. 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

  2. Importance of transthoracic X-ray in arthrography of the shoulder

    International Nuclear Information System (INIS)

    Beck, A.; Papacharalampous, X.; Grosser, G.; Noeldge, G.

    1988-01-01

    Even in this era of sonography, arthrography of the shoulder is an important diagnostic investigation, making it possible to exclude unrecognized connective tissue lesions in patients with chronic shoulder pain resisant to therapy. Sometimes standard X-ray techniques do not yield all the information the surgeon needs about ventral or dorsal localization of a rotator-cuff rupture. An Additional approach to the joint is needed: A transthoracic lateral-view X-ray provides the surgeon with adequate information to help in selection of the most appropriate operative approach to the shoulder. (orig.) [de

  3. Diskitis, Osteomyelitis, Spinal Epidural Abscess, Meningitis, and Endocarditis Following Sacroiliac Joint Injection for the Treatment of Low-Back Pain in a Patient on Therapy for Hepatitis C Virus.

    Science.gov (United States)

    Nagpal, Geeta; Flaherty, John P; Benzon, Honorio T

    Sacroiliac joint injections are frequently performed procedures in the management of acute and chronic low-back pain, including patients with various immunocompromised states. Infectious complications following these procedures along with other spinal injections are rarely reported, but the true incidence is unknown. The purpose of this report is to highlight the devastating neurologic sequela that can occur, and to discuss potential future management strategies. We present a patient who developed diskitis, osteomyelitis, spinal epidural abscess, meningitis, and endocarditis from Staphylococcus aureus, all of which developed shortly after a sacroiliac joint injection. The patient was on treatment for hepatitis C virus, and the resulting immunocompromised state likely contributed to the outcome. Immunocompromised patients should be identified prior to treatment, and the small possibility of devastating complications should be thoughtfully weighed against the potential benefit of the procedure. Conservative management should be maximized initially, and if a procedure is done, strict asepsis must be maintained. Prophylaxis for S. aureus should be considered for immunocompromised patients undergoing interventional spine procedures.

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

    Science.gov (United States)

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

    2016-08-01

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

  5. Phrenic Nerve Palsy and Regional Anesthesia for Shoulder Surgery: Anatomical, Physiologic, and Clinical Considerations.

    Science.gov (United States)

    El-Boghdadly, Kariem; Chin, Ki Jinn; Chan, Vincent W S

    2017-07-01

    Regional anesthesia has an established role in providing perioperative analgesia for shoulder surgery. However, phrenic nerve palsy is a significant complication that potentially limits the use of regional anesthesia, particularly in high-risk patients. The authors describe the anatomical, physiologic, and clinical principles relevant to phrenic nerve palsy in this context. They also present a comprehensive review of the strategies for reducing phrenic nerve palsy and its clinical impact while ensuring adequate analgesia for shoulder surgery. The most important of these include limiting local anesthetic dose and injection volume and performing the injection further away from the C5-C6 nerve roots. Targeting peripheral nerves supplying the shoulder, such as the suprascapular and axillary nerves, may be an effective alternative to brachial plexus blockade in selected patients. The optimal regional anesthetic approach in shoulder surgery should be tailored to individual patients based on comorbidities, type of surgery, and the principles described in this article.

  6. The Position and Mobility of the Shoulder, Spinal Column and Pelvis in Seated Subjects.

    Science.gov (United States)

    1985-02-01

    Considerable muscle atrophy was observed in the right shoulder. In the spinal column, tissues overlying the right sacroiliac joint felt firmer than over...subject #23 had fewer clinical findings for joint dysfunction than in the other two subjects, but the physician noted more soft tissue observations than...There was also a mild scoliotic curvature with left convexity observed at T4-6. n the pelvis, the left lumbosacral and sacroiliac joints seened to

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

    Science.gov (United States)

    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

    2012-10-01

    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 shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1 kg and elastic resistance). Shoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. The scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1 kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. Differences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Shoulder impingement syndrome : evaluation of the causes with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang [Chungang Univ. College of Medicine, Seoul (Korea, Republic of); Choi, Yun Sun [Eulji Hospital, College of Medicine, Seoul (Korea, Republic of)

    1999-12-01

    Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause.

  9. Shoulder impingement syndrome : evaluation of the causes with MRI

    International Nuclear Information System (INIS)

    Choi, Yong Ho; Song, In Sup; Chung, Hun Young; Yoon, Sang Jin; Kim, Yang Soo; Shim, Hyung Jin; Choi, Young Hee; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang; Choi, Yun Sun

    1999-01-01

    Various mechanical causes which induce shoulder impingement syndrome have been identified with the help of MRI. The aim of this study is to evaluate the incidence of such causes. A total of 54 patients with clinically confirmed shoulder impingement syndrome and a normal control group(n=20) without symptoms were included. We evaluated the incidence of hook shaped acromion, low lying acromion, downward slope of the acromion, subacromial spur, acromioclavicular joint hypertrophy, coracoacromial ligament hypertrophy, high cuff muscle bulk, and os acromiale. Among the 54 patients, the following conditions were present: acromioclavicular joint hypertrophy(n=36), coracoacromial ligament hypertrophy(n=20), subacromial spur(n=18), downward sloping of the acromion(n=16), hook shaped acromion(n=11), relatively high cuff muscle bulk(n=6), low lying acromion relative to the clavicle(n=3), and os acromiale(n=1). In the normal control group there were nine cases of acromioclavicular joint hypertrophy, nine of coracoacromial ligament hypertrophy, nine of downward sloping acromion, and three of low lying acromion, but hook shaped acromion, high cuff muscle bulk, and os acromiale were not found. Among 54 patients, the syndrome was due to five simultancous causes in one patient, four causes in two, three causes in 12, two causes in 22, and one cause in 17. Hook shaped acromion and subacromial spur are the statistically significant causes of shoulder impingement syndrome. In 69% of patients, the condition was due to more than one cause

  10. Treatment of humeral shaft fractures using antegrade nailing: functional outcome in the shoulder.

    Science.gov (United States)

    Patino, Juan Martin

    2015-08-01

    The purpose of this study was to evaluate shoulder outcomes and function after humeral shaft fractures treated with antegrade nailing. Thirty patients with acute humeral shaft fractures who underwent antegrade locked intramedullary nailing were retrospectively studied. Range of motion (ROM) of the affected shoulder was evaluated, comparing it with the nonaffected shoulder, radiologic position of the nails, complications, and need for a second surgery. The study enrolled 20 men and 10 women (average age, 41.9 years). The average follow-up was 35.8 months. The average shoulder elevation averaged 157°, internal rotation was variable (reaching the sacroiliac joint to T7), and external rotation averaged 75°. Elbow flexion-extension ROM averaged 133° (115°-145°). According to the Rodriguez-Merchan criteria, 12 patients achieved excellent results (40%), 7 good (20%), and 6 fair (23.3%); poor results were found in 5 cases (16.6%). Twelve patients achieved full mobility of the shoulder, whereas 18 had some loss of motion, with significant differences between the affected and nonaffected shoulders (P = .001). Decreased shoulder ROM is common after antegrade nailing of humeral shaft fractures. Avoidance of nail impingement can improve final outcomes. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  11. 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.

  12. A Best-Evidence Systematic Appraisal of the Diagnostic Accuracy and Utility of Facet (Zygapophysial) Joint Injections in Chronic Spinal Pain.

    Science.gov (United States)

    Boswell, Mark V; Manchikanti, Laxmaiah; Kaye, Alan D; Bakshi, Sanjay; Gharibo, Christopher G; Gupta, Sanjeeva; Jha, Sachin Sunny; Nampiaparampil, Devi E; Simopoulos, Thomas T; Hirsch, Joshua A

    2015-01-01

    Spinal zygapophysial, or facet, joints are a source of axial spinal pain and referred pain in the extremities. Conventional clinical features and other noninvasive diagnostic modalities are unreliable in diagnosing zygapophysial joint pain. A systematic review of the diagnostic accuracy of spinal facet joint nerve blocks. To determine the diagnostic accuracy of spinal facet joint nerve blocks in chronic spinal pain. A methodological quality assessment of included studies was performed using Quality Appraisal of Reliability Studies (QAREL). Only diagnostic accuracy studies meeting at least 50% of the designated inclusion criteria were utilized for analysis. The level of evidence was classified as Level I to V based on the grading of evidence utilizing best evidence synthesis. Data sources included relevant literature identified through searches of PubMed and other electronic searches published from 1966 through March 2015, Cochrane reviews, and manual searches of the bibliographies of known primary and review articles. Studies must have been performed utilizing controlled local anesthetic blocks. The criterion standard must have been at least 50% pain relief from baseline scores and the ability to perform previously painful movements. The available evidence is Level I for lumbar facet joint nerve blocks with the inclusion of a total of 17 studies with dual diagnostic blocks, with at least 75% pain relief with an average prevalence of 16% to 41% and false-positive rates of 25% to 44%. The evidence for diagnosis of cervical facet joint pain with cervical facet joint nerve blocks is Level II based on a total of 11 controlled diagnostic accuracy studies, with significant variability among the prevalence in a heterogenous population with internal inconsistency. The prevalence rates ranged from 36% to 67% with at least 80% pain relief as the criterion standard and a false-positive rate of 27% to 63%. The level of evidence for the diagnostic accuracy of thoracic facet

  13. Mechanisms of traumatic shoulder injury in elite rugby players

    Science.gov (United States)

    Crichton, James; Jones, Doug R; Funk, Lennard

    2012-01-01

    Background Shoulder injuries in rugby players are common, but the mechanisms of injury are less well understood. This study aims to elucidate common mechanisms of injury and identify the patterns of injury they produce. Materials and methods Twenty-four elite rugby players, referred to the senior author for diagnosis and management of shoulder injuries, were selected. Videos of the injuries were independently reviewed by rugby-medical experts to describe the mechanisms of injury. The mechanisms reported were collated and analysed to determine the level of agreement between reviewers and conclude an overall description of injury mechanisms. Results The authors identified three mechanisms of shoulder injury from the video analysis. These are the ‘Try-Scorer’, characterised by hyperflexion of the outstretched arm such as when scoring a try; the ‘Tackler’, extension of the abducted arm behind the player while tackling; and the ‘Direct Impact’, a direct blow to the arm or shoulder when held by the side in neutral or slight adduction. The Try Scorer and Tackler mechanisms both involve a levering force on the glenohumeral joint (GHJ). These mechanisms predominantly cause GHJ dislocation, with Bankart, reverse Bankart and superior labrum anterior–posterior tears. The Try-Scorer Mechanism also caused the majority (83%) of rotator cuff tears. The Direct Hit mechanism resulted in GHJ dislocation and labral injury in 37.5% of players and was most likely to cause acromioclavicular joint dislocation and scapula fractures, injuries that were not seen with the other mechanisms. Conclusion Greater understanding of the mechanisms involved in rugby shoulder injury is useful in understanding the pathological injuries, guiding treatment and rehabilitation and aiding the development of injury-prevention methods. PMID:22510645

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

    Directory of Open Access Journals (Sweden)

    Sommervold M

    2017-03-01

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

  15. 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.

  16. Impingement syndrome of the shoulder; Schulterimpingement

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-06-01

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

  17. Degree of Contracture Related to Residual Muscle Shoulder Strength in Children with Obstetric Brachial Plexus Lesions.

    Science.gov (United States)

    van Gelein Vitringa, Valerie M; van Noort, Arthur; Ritt, Marco J P F; van Royen, Barend J; van der Sluijs, Johannes A

    2015-12-01

     Little is known about the relation between residual muscle strength and joint contracture formation in neuromuscular disorders. This study aimed to investigate the relation between residual muscle strength and shoulder joint contractures in children with sequelae of obstetric brachial plexus lesion (OBPL). In OBPL a shoulder joint contracture is a frequent finding. We hypothesize that residual internal and external rotator strength and their balance are related to the extent of shoulder joint contracture.  Clinical assessment was performed in 34 children (mean 10.0 years) with unilateral OBPL and Narakas classes I-III. External and internal rotation strengths were measured with the shoulder in neutral position using a handheld dynamometer. Strength on the affected side was given as percentage of the normal side. Contracture was assessed by passive internal and external rotations in degrees (in 0° abduction). Mallet classification was used for active shoulder function.  External and internal rotation strengths on the affected side were approximately 50% of the normal side and on average both equally affected: 56% (SD 18%) respectively 51% (SD 27%); r  = 0.600, p  = 0.000. Residual strengths were not related to passive internal or external rotation ( p  > 0.200). Internal rotation strength ( r  =  - 0.425, p muscle strength influence contracture formation cannot be confirmed in this study. Our results are of interest for the understanding of contracture formation in OBPL.

  18. Ultrasound measurement of rotator cuff thickness and acromio-humeral distance in the diagnosis of subacromial impingement syndrome of the shoulder.

    Science.gov (United States)

    Cholewinski, Jerzy J; Kusz, Damian J; Wojciechowski, Piotr; Cielinski, Lukasz S; Zoladz, Miroslaw P

    2008-04-01

    The usefulness of ultrasound measurements in the diagnosis of the subacromial impingement syndrome of the shoulder was evaluated. Fifty-seven patients with unilateral symptoms of the impingement syndrome underwent ultrasound examination of both shoulder joints, which included assessment of rotator cuff integrity, measurement of rotator cuff thickness and the distance between the infero-lateral edge of acromion and the apex of the greater tuberosity of humerus (AGT distance) in the standard ultrasonographic positions. As a control group, 36 volunteers (72 shoulders) with no history of shoulder pain were examined sonographically. Ultrasonographic assessment of humeral head elevation, measured as the AGT distance, proved to be useful in establishing the diagnosis of the subacromial impingement syndrome of the shoulder. A difference in rotator cuff thickness of more than 1.1 mm and a difference in the AGT distance of more than 2.1 mm between both shoulder joints may reflect dysfunction of rotator cuff muscles.

  19. A concise evidence-based physical examination for diagnosis of acromioclavicular joint pathology: a systematic review.

    Science.gov (United States)

    Krill, Michael K; Rosas, Samuel; Kwon, KiHyun; Dakkak, Andrew; Nwachukwu, Benedict U; McCormick, Frank

    2018-02-01

    The clinical examination of the shoulder joint is an undervalued diagnostic tool for evaluating acromioclavicular (AC) joint pathology. Applying evidence-based clinical tests enables providers to make an accurate diagnosis and minimize costly imaging procedures and potential delays in care. The purpose of this study was to create a decision tree analysis enabling simple and accurate diagnosis of AC joint pathology. A systematic review of the Medline, Ovid and Cochrane Review databases was performed to identify level one and two diagnostic studies evaluating clinical tests for AC joint pathology. Individual test characteristics were combined in series and in parallel to improve sensitivities and specificities. A secondary analysis utilized subjective pre-test probabilities to create a clinical decision tree algorithm with post-test probabilities. The optimal special test combination to screen and confirm AC joint pathology combined Paxinos sign and O'Brien's Test, with a specificity of 95.8% when performed in series; whereas, Paxinos sign and Hawkins-Kennedy Test demonstrated a sensitivity of 93.7% when performed in parallel. Paxinos sign and O'Brien's Test demonstrated the greatest positive likelihood ratio (2.71); whereas, Paxinos sign and Hawkins-Kennedy Test reported the lowest negative likelihood ratio (0.35). No combination of special tests performed in series or in parallel creates more than a small impact on post-test probabilities to screen or confirm AC joint pathology. Paxinos sign and O'Brien's Test is the only special test combination that has a small and sometimes important impact when used both in series and in parallel. Physical examination testing is not beneficial for diagnosis of AC joint pathology when pretest probability is unequivocal. In these instances, it is of benefit to proceed with procedural tests to evaluate AC joint pathology. Ultrasound-guided corticosteroid injections are diagnostic and therapeutic. An ultrasound-guided AC joint

  20. Technical concept and evaluation of a novel shoulder simulator with adaptive muscle force generation and free motion

    Directory of Open Access Journals (Sweden)

    Verjans Mark

    2016-09-01

    Full Text Available The human shoulder is one of the most complex joints of the human body, and due to the high range of motion and the complex soft tissue apparatus prone to injuries. Surgical therapies and joint replacements often lead to unsatisfactory results. To improve the understanding of the complex biomechanics of the shoulder, experimental investigations have to be conducted. For this purpose a new shoulder simulator with an innovative muscle force generation was developed. On the basis of a modular concept six artificial pneumatic muscles were integrated to represent the functionally most important muscles of the shoulder joint, whereby a free and controlled movement of the humerus can be conducted. For each muscle individual setpoints for muscle length control based on a user defined shoulder movement for any artificial or cadaver specimen are created by manual motion “Teach-In”. Additional to muscle forces and lengths, optical tracking and a joint force measurement is used to enable different biomechanical studies of the shoulder joint. This paper describes the technical setup as well as the control strategy and first results of its experimental functional validation.

  1. Conservative treatment and rehabilitation of shoulder problems; Konservative Therapie und Rehabilitation von Schulterbeschwerden

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    Paternostro-Sluga, T.; Zoech, C. [Klinik fuer Physikalische Medizin und Rehabilitation, Allgemeines Krankenhaus der Medizinischen Universitaet Wien (Austria)

    2004-06-01

    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.) [German] Aufgrund der zentralen Rolle des Schultergelenks fuer die Arm- und Handfunktion koennen Erkrankungen des Schultergelenks zu einer erheblichen Beeintraechtigung in Alltag, Beruf und Freizeit fuehren. Muskulaere Dysbalancen und Fehlhaltungen sind haeufige Ursachen fuer Schulterbeschwerden. Es besteht eine enge Beziehung zwischen Schulterfunktion und Koerperhaltung. Therapieziele in der konservativen Behandlung und Rehabilitation sind neben der Verbesserung der lokalen Situation das Wiedererlangen der Funktion und sozialen Partizipation. Zu den konservativen Therapiemassnahmen zaehlen medikamentoese, Bewegungs-, Ergo-, Elektro-, Ultraschall- und Stosswellentherapie, Massage, Thermo- und Magnetfeldtherapie. Muskulaere Dysbalancen und Fehlhaltungen sind durch bewegungstherapeutische Massnahmen gut

  2. Endobutton technique for the treatment of acute acromioclavicular joint dislocations

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    Raif Özden

    2014-06-01

    Full Text Available Objective: Acromioclavicular (AC joint dislocation is a common injury frequently affecting young athletes. The aim of this study is to evaluate postoperative functional results in cases diagnosed with acute AC joint dislocation stabilized with endobutton system. Methods: This fixation procedure has been applied on 10 patients. Indications of the technique included: a grade V AC joint dislocation (7 patients, and grade III AC joint dislocation (3 patient according to Rockwood classification. The coracoclavicular (CC interval and AC joint were reduced using two endobuttons. One endobutton was fitted on the clavicle and the second was placed at the undersurface of the coracoid. Outcomes were assessed with the Constant shoulder score and visual analog pain scale. Results: All the patients had powerful intraoperative fixation. Immediately after surgery, and 6 weeks, and 1 year postoperative radiographs showed adequate reduction of the CC distance and the AC joint. The mean Constant shoulder score was 89 (88–92 in the injured shoulder and 90 (88–93 in the uninjured shoulder. There was no statically significant difference between the injured and normal shoulder in terms of Constant shoulder score and there was no complication during the process. Conclusion: This technique is a safe and effective method for providing fixation for the AC joint.

  3. Frozen shoulder : long-term outcome following arthrographic distension.

    Science.gov (United States)

    Clement, Rhys G E; Ray, Andrew G; Davidson, Colin; Robinson, C Mike; Perks, Fergus J

    2013-08-01

    Arthrographic distension of the glenohumeral joint was adopted as a mainstream treatment for frozen shoulder before any randomised controlled trials were performed. Interpretation of the effectiveness of this procedure rests mostly on data from cohort studies of which there are few of high quality. Papers reporting long-term results have either excluded diabetic patients or failed to report patient orientated outcomes. The authors present a long-term prospective cohort study of 51 patients (12 diabetics and 39 non-diabetics), with 53 frozen shoulders, who had an arthrographic distension performed by a single radiologist as a primary intervention. Oxford shoulder score (OSS), visual analogue pain score (VAS), and range of movement (ROM) were recorded pre-distension, at 2 days and 1 month post-distension. OSS and VAS were recorded again at a mean of 14 months post distension (range : 8-26 months). OSS improved from a pre-distension mean of 22.3 by 16.9 points at final follow-up (p diabetic patients was the same as in non-diabetic patients. Arthrographic distension is a safe and effective treatment for frozen shoulder; it is also effective in diabetic patients. It gives long-term improvement. The authors believe that the low number of patients requiring a secondary procedure makes arthrographic distension preferable to manipulation under anaesthesia.

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

    Science.gov (United States)

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

    2014-03-01

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

  5. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    Directory of Open Access Journals (Sweden)

    Siwei Sun

    2016-01-01

    Full Text Available Purpose. To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. Methods. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients’ shoulder function to judge if it has been affected by subacromial osteolysis. Results. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients and group B (33 patients in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38±3.56 versus 94.24±3.60, P>0.05. Conclusion. The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function.

  6. A novel ultrasound-guided shoulder arthroscopic surgery

    Science.gov (United States)

    Tyryshkin, K.; Mousavi, P.; Beek, M.; Chen, T.; Pichora, D.; Abolmaesumi, P.

    2006-03-01

    This paper presents a novel ultrasound-guided computer system for arthroscopic surgery of the shoulder joint. Intraoperatively, the system tracks and displays the surgical instruments, such as arthroscope and arthroscopic burrs, relative to the anatomy of the patient. The purpose of this system is to improve the surgeon's perception of the three-dimensional space within the anatomy of the patient in which the instruments are manipulated and to provide guidance towards the targeted anatomy. Pre-operatively, computed tomography images of the patient are acquired to construct virtual threedimensional surface models of the shoulder bone structure. Intra-operatively, live ultrasound images of pre-selected regions of the shoulder are captured using an ultrasound probe whose three-dimensional position is tracked by an optical camera. These images are used to register the surface model to the anatomy of the patient in the operating room. An initial alignment is obtained by matching at least three points manually selected on the model to their corresponding points identified on the ultrasound images. The registration is then improved with an iterative closest point or a sequential least squares estimation technique. In the present study the registration results of these techniques are compared. After the registration, surgical instruments are displayed relative to the surface model of the patient on a graphical screen visible to the surgeon. Results of laboratory experiments on a shoulder phantom indicate acc