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Sample records for shoulder mr-gezielte mr-arthrographie

  1. MR-guided MR arthrography of the shoulder; MR-gezielte MR-Arthrographie der Schulter

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    Tratting, S. [Abt. Magnetresonanztomographie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Breitenseher, M. [Abt. Magnetresonanztomographie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Pretterklieber, M. [Inst. fuer Anatomie, Univ. Wien (Austria); Kontaxis, G. [Ludwig Boltzmann-Institut fuer Physikalische und Radiologische Tumordiagnostik, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Rand, T. [Abt. Magnetresonanztomographie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria); Imhof, H. [Abt. Magnetresonanztomographie, Universitaetsklinik fuer Radiodiagnostik, Wien (Austria)

    1996-09-01

    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.) [Deutsch] Fuer die MR-Arthrographie der Schulter wurde eine MR-gezielte Punktionstechnik entwickelt und an 3 nicht fixierten menschlichen Schulterpraeparaten getestet. MR-kompatible Marker an der Hautoberflaeche erlaubten eine Bestimmung der Punktionsstelle und

  2. MR arthrography of the shoulder: possible indications for clinical use; Einsatzmoeglichkeiten der MR-Arthrographie bei Erkrankungen des Schultergelenkes

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    Kreitner, K.F. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie; Grebe, P. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie; Kersjes, W. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie; Runkel, M. [Mainz Univ. (Germany). Klinik fuer Unfallchirurgie; Kirschner, P. [Elisabeth-Hospital, Mainz (Germany). Abt. fuer Unfall- und Wiederherstellungschirurgie St. Vincenz; Schild, H.H. [Mainz Univ. (Germany). Klinik mit Poliklinik fuer Radiologie

    1994-02-01

    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.) [Deutsch] In einer prospektiven Studie sollten Einsatzmoeglichkeiten der MR-Arthrographie bei Erkrankungen des Schultergelenkes herausgearbeitet werden. 37 Patienten wurden sowohl nativ als auch nach intraartikulaerer Gabe einer 2mmolaren Gd-DTPA-Loesung untersucht. Voraussetzungen fuer die KM-Gabe waren ein fehlender Gelenkerguss und/oder ein unklarer Befund des Labrum-Kapsel-Komplexes oder der Rotatorenmanschette in der Nativuntersuchung. Durch die MR-Arthrographie wurde bei 11/22 Patienten eine verbesserte Darstellung der Labrumpathologie erzielt; in 20/22 Faellen ergabe sich eine zuverlaessige Beurteilung der Gelenkkapsel. Bei 9/15 Patienten mit Erkrankungen der Rotatorenmanschette konnten Tendinitiden von partiellen und kleinen kompletten Rotatorenmanschettenrupturen sicher differenziert werden. Die MR-Arthrographie des Schultergelenkes fuehrt bei nicht eindeutigen Befunden in der Nativuntersuchung zu einer verbesserten Treffsicherheit der MR-Diagnostik. (orig.)

  3. CT-guided puncture for direct MR-arthrography of the shoulder: Description of possible techniques

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    Hauth E

    2016-07-01

    Full Text Available The following report describes the possible techniques of CT-guided puncture for direct magnetic resonance (MR arthrography of the shoulder. CT-guided puncture can be regarded as an alternative technique to fluoroscopic- or ultrasound-guided puncture for MR-arthrography of the shoulder with high efficiency, low dose and extremely low complication rate.

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

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

    2000-08-01

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

  5. Diagnostic value of US, MR and MR arthrography in shoulder instability.

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    Pavic, Roman; Margetic, Petra; Bensic, Mirta; Brnadic, Renata Letica

    2013-09-01

    The aim of our study was to compare US, conventional MRI and MR arthrography findings in patients with anterior shoulder instability and with a clinical diagnosis of labral capsular ligamentous complex lesion. At the same time we evaluated the accuracy of MR arthrography in the diagnosis of this lesion. After approval of the local Ethics Committee, our department's Trauma Registry from July 2008 up to February 2012 was retrospectively reviewed to identify all eligible patients. Eligibility criteria included: 1)history of acute or chronic shoulder instability (more than three dislocations over a period of more than two months); 2) diagnosis of labroligamentous lesion. All patients were investigated with plain radiographs, Ultrasound Scans (US), Magnetic Resonance Imaging (MRI) and MR arthrography. Finally, all patients underwent an arthroscopy that confirmed the diagnosis. A total of 200 consecutive patients who met the inclusion criteria were included in this study. The mean age was 39 years (range 15 to 83); 147 were male and 133 involved the right shoulder. Chronic instability was documented in 133 patients, whereas acute instability was documented in 67 patients. We detected a statistically significant difference between US and MR arthrography in SLAP (Superior Labrum Anterior to Posterior) lesions (TypeII, III and IV), in Bankart lesions, in glenohumeral ligament lesions (superior, middle, anterior-inferior and anterior inferior glenohumeral ligament) in Hill-Sachs lesions, in diagnosing internal subacromial impingement and in normal findings. MR arthrography was superior to the US. A statistically significant difference was evident between MRI and MR arthrography findings in SLAP lesions (III and IV Type lesions), in glenohumeral ligament lesions (anterior inferior and posterior inferior glenohumeral ligament), in partial rotator cuff ruptures and in normal findings. MR arthrography diagnosed this lesion better than MRI without contrast. We also found a

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

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    Kreitner, K.-F.; Thelen, M. [Department of Radiology, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz (Germany); Loew, R. [Department of Radiology, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz (Germany); Department of Radiology, University Hospital, 1201 Basel (Switzerland); Runkel, M. [Department of Traumatology, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz (Germany); Department of Traumatology and Hand Surgery, Klinikum Konstanz, Konstanz (Germany); Zoellner, J. [Department of Orthopedic Surgery, Johannes Gutenberg University, Langenbeckstrasse 1, 55131 Mainz (Germany)

    2003-02-01

    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.)

  7. Diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior lesions of the shoulder.

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    Waldt, Simone; Burkart, Andreas; Lange, Peter; Imhoff, Andreas B; Rummeny, Ernst J; Woertler, Klaus

    2004-05-01

    The purpose of this study was to evaluate the diagnostic performance of MR arthrography in the assessment of superior labral anteroposterior (SLAP) lesions of the shoulder with emphasis on the classification of SLAP lesions. Two hundred sixty-five MR arthrograms including 68 MR arthrograms of patients with arthroscopically proven SLAP lesions of the shoulder and 197 MR arthrograms of patients with an intact superior labrum and biceps anchor were retrospectively reviewed in random order. MR arthrography was performed using triplanar T1-weighted spin-echo sequences and a coronal oblique T2-weighted fast spin-echo sequence. MR arthrograms were evaluated by two radiologists with agreement by consensus, and the results were compared with arthroscopic findings. Of 68 SLAP lesions, seven (10%) were arthroscopically classified as type I, 41 (60%) as type II (including 20 type II lesions with coexisting Bankart lesions [29%]), 14 (21%) as type III, and six (9%) as type IV. Compared with arthroscopy as the gold standard, MR arthrography showed a sensitivity of 82% and a specificity of 98% for the overall detection of SLAP lesions. MR arthrographic grading and arthroscopic grading were concurrent in 45 (66%) of 68 arthroscopic diagnoses. Of the surgically confirmed SLAP lesions, involvement of the biceps insertion and SLAP type II lesions with coexisting Bankart lesions were assessed correctly in 75% and 95% of cases, respectively. MR arthrography is a highly effective method for the detection of SLAP lesions, but this technique is limited in the classification of different types of SLAP lesions. However, for preoperative planning MR arthrography provides accurate information about the stability of the biceps insertion and the presence of associated anteroinferior labral injuries.

  8. MR arthrography in calcific tendinitis of the shoulder: diagnostic performance and pitfalls

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    Zubler, Christoph; Mengiardi, Bernard; Schmid, Marius R.; Hodler, Juerg; Pfirrmann, Christian W.A. [University Hospital Balgrist, Radiology, Zurich (Switzerland); Jost, Bernhard [University Hospital Balgrist, Orthopedic Surgery, Zurich (Switzerland)

    2007-06-15

    The purpose was to assess the diagnostic performance of MR arthrography to diagnose calcific tendinitis of the shoulder and to assess the reasons for diagnostic errors. Standard MR arthrograms of 22 patients with calcific tendinitis and 61 controls were retrospectively analyzed by two independent and blinded radiologists. All cases were consecutively collected from a database. Conventional radiographs were available in all cases serving as gold standard. The supraspinatus was involved in 16, the infraspinatus in four and the subscapularis in two patients. All diagnostic errors were analyzed by two additional readers. Reader 1 correctly detected 12 of the 22 shoulders with and 42 of the 61 shoulders without calcific tendinitis (sensitivity 0.55, specificity 0.66). The corresponding values for reader 2 were 13 of 22 and 40 of 61 cases (sensitivity 0.59, specificity 0.69). Inter-rater agreement (kappa-value) was 0.42. Small size of the calcific deposits and isointensity compared to the surrounding tissue were the most important reasons for false negative results. Normal hypointense areas within the supraspinatus tendon substance and attachment were the main reason for false positive results. In conclusion, MR arthrography is insufficient in the diagnosis of calcific tendinitis. Normal hypointense parts of the rotator cuff may mimic calcific deposits and calcifications may not be detected when they are isointense compared to the rotator cuff. Therefore, MR imaging should not be interpreted without corresponding radiographs. (orig.)

  9. MR arthrography of the shoulder: tolerance evaluation of four different injection techniques

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    Perdikakis, Evangelos; Drakonaki, Eleni; Karantanas, Apostolos [University Hospital, Department of Medical Imaging, Heraklion, Crete (Greece); Maris, Thomas [University Hospital, Department of Medical Physics, Heraklion, Crete (Greece)

    2013-01-15

    We sought to prospectively evaluate patients' pain perception and technical success of four different arthrographic techniques for shoulder MR arthrography. A total of 125 consecutive patients were referred for shoulder MR arthrography. The patients were randomly injected under fluoroscopic guidance (n{sub 1} = 37), with CT guidance using an anterior (n{sub 2} = 29) or a posterior approach (n{sub 3} = 32) and with ultrasound guidance (n{sub 4} = 27). For each patient, absolute periprocedural pain on a numerical rating pain scale (0 = ''no pain'', 10 = ''intolerable pain''), technical success of the method used, and reason for referral were recorded. The technical success rate was 100 % for all injection methods. The results regarding absolute periprocedural pain were as follows: fluoroscopic guidance showed a mean pain of 4.05 {+-} 1.24, CT anterior guidance demonstrated a mean pain of 3.87 {+-} 0.95, CT posterior guidance showed a mean pain of 1.59 {+-} 0.81, and ultrasound guidance a mean pain of 3.63 {+-} 1.12. A significant difference (p <.05) was observed for the posterior route under CT guidance. The mean pain level was significantly higher for older (> 51 year) female patients. No differences were found for the technical success rate of the aforementioned techniques. A CT-guided posterior approach seems to be a more comfortable method for the patient. (orig.)

  10. Gradient-recalled echo sequences in direct shoulder MR arthrography for evaluating the labrum

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    Lee, Marc J.; Motamedi, Kambiz; Chow, Kira; Seeger, Leanne L. [David Geffen School of Medicine at UCLA, Department of Radiology, 200 UCLA Medical Plaza, Suite 165-59, Box 956952, Los Angeles, CA (United States)

    2008-01-15

    The purpose of this study was to determine the utility of fat-suppressed gradient-recalled echo (GRE) compared with conventional spin echo T1-weighted (T1W) sequences in direct shoulder MR arthrography for evaluating labral tears. Three musculoskeletal radiologists retrospectively reviewed MR arthrograms performed over a 12-month period for which surgical correlation was available. Of 180 serial arthrograms, 31 patients had surgery with a mean of 48 days following imaging. Paired coronal oblique and axial T1W or GRE sequences were analyzed by consensus for labral tear (coronal oblique two-dimensional multi-echo data image combination, 2D MEDIC; and axial three-dimensional double-echo steady-state, 3D DESS; Siemens MAGNETOM Sonata 1.5-T MR system). Interpretations were correlated with operative reports. Of 31 shoulders, 25 had labral tears at surgery. The GRE sequences depicted labral tears in 22, while T1W images depicted tears in 16 (sensitivity 88% versus 64%; p < 0.05). Subdividing the labrum, GRE was significantly more sensitive for the posterior labrum (75% versus 25%; p < 0.05) with a trend toward greater sensitivity at the anterior labrum (78% versus 56%; p = 0.157) but not significantly different for the superior labrum (50% versus 57%; p > 0.7). Specificities were somewhat lower for GRE. Thin section GRE sequences are more sensitive than T1W for the detection of anterior and posterior labral tears. As the specificity of GRE was lower, it should be considered as an adjunctive imaging sequence that may improve depiction of labral tears, particularly smaller tears, in routine MR arthrography protocols. (orig.)

  11. [Low-field MR arthrography of the shoulder: early results using an open 0.2T MR system].

    Science.gov (United States)

    Löw, R; Kreitner, K F; Runkel, M; Zöllner, J; Thelen, M

    1998-04-01

    To assess the practicability and image quality of doing MR arthrography of the shoulder using a 0.2T system. 60 patients (24 with chronic instability, 36 with impingement syndrome) were examined in an open 0.2T MR apparatus (Magnetom Open, Siemens). After the intra-articular injections of 15-20 ml of a 2 mmol Gd-DTPA solution, coronary STIR, T1-weighted, sagittal and axial T2*-weighted FLASH 2D sequences were performed. 21 patients subsequently underwent surgery. Image quality of the T1- and T2*-weighted FLASH 2D sequences was regarded as good or adequate and movement artifacts were minor or moderate. STIR sequences were statistically significantly worse in respect of image quality and movement artifacts (p < 0.001, p < 0.005). The sensitivity and specificity in the diagnosis of rotator cuff rupture as confirmed by surgery was 100% (labrum lesions 100%, 93%). Agreement in the diagnosis of rupture of the supraspinatus and infraspinatus tendons was 0.93 and 0.65. MR arthrography of the shoulder using an open 0.2 T MR system provides adequate information concerning the intra articular structures of the joint. The disadvantage is the prolonged duration of the examination with the risk of poor image quality resulting from movement artifacts.

  12. MR arthrography of the shoulder: Optimizing pulse sequence protocols for the evaluation of cartilage and labrum

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    Guermazi, Ali, E-mail: Ali.Guermazi@aspetar.com [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Jomaah, Nabil [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Hayashi, Daichi [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Department of Radiology, Bridgeport Hospital, Yale University School of Medicine, 267 Grant Street, Bridgeport, CT 06610 (United States); Jarraya, Mohamed [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Silva, Jose Roberto [Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Niu, Jingbo [Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite 200, Boston, MA 02118 (United States); Almusa, Emad; Landreau, Philippe [ASPETAR – Qatar Orthopaedic and Sports Medicine Hospital, Sport City Street, Near Khalifa Stadium, P.O. Box 29222 (Qatar); and others

    2014-08-15

    Objectives: To compare axial T1weighted fat-saturated (T1w fs) and T1w non-fs sequences, and coronal T1w-fs and T2w-fs sequences, for evaluation of cartilage and labrum using CT arthrography (CTA) as the reference. Methods: Patients had MR arthrography (MRA) and CTA of the shoulder on the same day. Cartilage was assessed for superficial and full thickness focal and diffuse damage. Labral lesions were graded for Bankart variants and SLAP lesions. CTA images were read for the same features. The diagnostic performance of MRA including area under the curve (AUC) was evaluated against CTA. Results: When comparing axial sequences, the diagnostic performance for cartilage lesion detection on T1w non-fs was 61.9% (sensitivity) 93.6% (specificity) and 89.5% (accuracy) with AUC 0.782, while that for T1w fs was 61.9%, 94.0%, 89.8% and 0.783. For labral assessment, it was 89.1%, 93.0%, 91.4% and 0.919 for T1w non-fs, and 89.9%, 94.0%, 92.6% and 0.922 for T1w fs. Comparing coronal sequences, diagnostic performance for cartilage was 42.5%, 97.5%, 89.8% and 0.702 for T1w fs, and 38.4%, 98.7%, 90.2%, and 0.686 for T2w fs. For the labrum it was 85.1%, 87.5%, 86.2%, and 0.868 for T1w fs, and 75.7%, 97.5%, 80.8% and 0.816 for T2w fs. Conclusions: Axial T1w fs and T1w non-fs sequences are comparable in their ability to diagnose cartilage and labral lesions. Coronal T1w fs sequence offers slightly higher sensitivity but slightly lower specificity than T2w fs sequence for diagnosis of cartilage and labral lesions.

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

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

    2014-06-15

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

  14. [A prospective study on the detection of lesions of the labrum glenoidale by indirect MR arthrography of the shoulder].

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    Mäurer, J; Rudolph, J; Lorenz, M; Hidajat, N; Schröder, R; Südkamp, N P; Felix, R

    1999-10-01

    Aim of this prospective study was the evaluation of signal-alterations of anatomic shoulder structures before and after intravenous application of Gd-DTPA. Furthermore the tested clinical value of indirect MR-arthrography in detecting labrum lesions was tested. 52 patients with suspected shoulder injury were examined on a 1.5 T system: Sequences were T1-weighted axial and oblique-coronary, additionally oblique-coronary T2-weighted, PD-weighted- and axial FLASH-2D-Sequences. After intravenous injection of contrast medium T1-weighted sequences were repeated. Signal-intensities (SI) of anatomic structures were measured by ROI-technique, the percentual contrast-enhancement (CE) and alterations in SNR (signal-noise-ratio) and CNR (contrast-noise-ratio) were calculated. Labrum tears were graded by three observers, their results could be confirmed by arthroscopy or open surgery in 24 patients. Contrast-enhancement was shown in all structures, most remarkable in the joint cavity. In pathologic findings of the labrum the SI and CE were significantly higher compared to intact strictures (p < 0.05). Sensitivity and specificity in the detection of labrum tears were 70% and 71.4% without contrast media, respectively 100% and 71.4% with indirect arthrography. The indirect arthrography improves the signal parameters of the structures. The detection of labrum lesions is improved, but still remains difficult.

  15. Posterior Decentering of the Humeral Head on Shoulder MR Arthrography: Significant Association With Posterior Synovial Proliferation.

    Science.gov (United States)

    Yun, Gabin; Kang, Yusuhn; Ahn, Joong Mo; Lee, Eugene; Lee, Joon Woo; Oh, Joo Han; Kang, Heung Sik

    2017-06-01

    The purpose of this study is to analyze MRI findings associated with posterior decentering of the humeral head on shoulder MR arthrogram. A total of 255 MR arthrograms were obtained during a 10-month period. MR arthrograms in patients with posterior decentering of the humeral head (n = 33) were reviewed and compared with those of randomly selected control group without posterior decentering (n = 66). MR arthrograms were retrospectively evaluated by two observers for posterior factors (posterior synovial proliferation, posterior capsular thickening, and posterior labral abnormality), rotator cuff factors related to fatty degeneration, glenoid version, and anterior factors (subcoracoid bursa effusion and rotator interval tear). The chi-square test, Fisher exact test, and linear-by-linear association were used for comparison of categoric data; the t test was used for comparison of the glenoid version; and multivariate stepwise logistic regression analysis was performed. At univariate analysis, posterior synovial proliferation (27.3% [9/33] in the posterior decentering group vs 6.1% [4/66] in the control group; p = 0.003); posterior capsule thickening (21.2% [7/33] vs 0.0% [0/66]; p < 0.001); fatty infiltration of the supraspinatus, infraspinatus, and teres minor (linear-by-linear association values, 7.944, 10.496, and 5.985, respectively; p = 0.005, 0.001, and 0.014, respectively); and rotator interval tear (51.5% [17/33] vs 30.3% [20/66]; p < 0.04) were more frequently found in the posterior decentering group, with a statistically significant difference. At multivariate analysis, only the posterior synovial proliferation was significantly associated with posterior decentering of the humeral head (odds ratio, 7.675; 95% CI, 2.159-27.288). Posterior decentering of the humeral head is most significantly associated with posterior synovial proliferation. In addition, rotator cuff interval abnormalities and rotator cuff atrophy are associated with posterior decentering of

  16. [Direct CT-arthrography versus direct MR-arthrography in chronic shoulder instability: comparison of modalities after the introduction of multidetector-CT technology].

    Science.gov (United States)

    Bitzer, M; Nasko, M; Krackhardt, T; Schick, F; Schöber, W; Wiskirchen, J; Morgalla, M; Weise, K; Claussen, C

    2004-12-01

    To evaluate the diagnostic accuracy of direct multidetector CT arthrography (CTA) and direct MR arthrography (MRA) in patients suffering from chronic shoulder instability. Twenty-nine patients suffering from chronic shoulder instability were included into a prospective study. In all cases, the indication for direct CTA and arthroscopy was set by the orthopedic surgeon. Prior to the imaging procedures, 10 to 20 ml of a special combination of contrast media (including saline, Isovist(R) and Magnevist(R) in a relation of 125 : 125 : 1) was injected into the joint under sterile conditions. First, CTA was performed with a multidetector CT, with images reconstructed in the axial, semi-coronal and semi-sagittal planes. Thereafter, MRA was performed. Axial images were obtained using a T1-weighted, fat-saturated spin echo sequence and semi-coronal images using a T1-weighted FLASH-3D GRE sequence. The results of CTA and MTA were compared with results obtained from arthroscopy or arthrotomy. MRA was superior to CTA in the detection of labral lesions. The sensitivity of MRA was 96 % and the specificity 96 %, compared to a sensitivity of 76 % (p < 0.05) and specificity of 92 % for CTA. Both methods showed the same effectiveness concerning the assessment of capsule distension (sensitivity for both techniques: 91 %). MRA seems to be superior to CTA in the diagnostic workup of chronic shoulder instability even when using a multidetector CT technique.

  17. MR arthrography of traumatic anterior shoulder lesions showed modest reproducibility and accuracy when evaluated under clinical circumstances

    NARCIS (Netherlands)

    van Grinsven, S.; Kesselring, F. O. H. W.; van Wassenaer-van Hall, H. N.; Lindeboom, R.; Lucas, C.; van Loon, C. J. M.

    2007-01-01

    We examined the reproducibility and accuracy of high-field MRA in traumatic anterior shoulder instability under conditions resembling clinical practice and assessed the influence of observer experience. Two radiologists with different experience levels evaluated 61 MRAs. Assessment was independent,

  18. An overview of MR arthrography with emphasis on the current technique and applicational hints and tips

    Energy Technology Data Exchange (ETDEWEB)

    Sahin, Guelden [Department of Radiology, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara (Turkey)]. E-mail: gsahin@medicine.ankara.edu.tr; Demirtas, Mehmet [Department of Hand Surgery, Faculty of Medicine, Ankara University, Samanpazari, 06100 Ankara (Turkey)

    2006-06-15

    Magnetic resonance (MR) arthrography has been investigated in every major peripheral joint of the body, and has been proven to be effective in determining the integrity of intraarticular ligamentous and fibrocartilaginous structures and in the detection or assessment of osteochondral lesions and loose bodies in selected cases. Several methods could be used to create arthrogram effect during MR imaging, however, direct MR arthrography using diluted gadolinium as the contrast agent is the most commonly used technique and is the most reliable of all. MR arthrography is useful for demonstrating labrocapsular-ligamentous abnormalities and distinguishing partial thickness rotator cuff tears from focal full thickness tears in the shoulder, identifying or excluding recurrent tears following meniscal operations in the knee, demonstrating perforations of the triangular fibrocartilage complex (TFCC) and ligaments in the wrist, showing labral tears in the hip, diagnosing ligament tears in the ankle and identifying osteochondral lesions or loose bodies in any of the aforementioned joints. In this article, an overview of techniques of MR arthrography is provided with emphasis on direct MR arthrography using diluted gadolinium as the contrast agent. The current applications of the technique in major peripheral joints are reviewed, with emphasis given to the shoulder joint where the role of this technique has become well established.

  19. Indirect MR arthrography: techniques and applications.

    Science.gov (United States)

    Vahlensieck, M; Sommer, T; Textor, J; Pauleit, D; Lang, P; Genant, H K; Schild, H H

    1998-01-01

    Indirect MR arthrography is a relatively new MR technique improving articular and periarticular contrast. It is achieved by injection of paramagnetic MR contrast media intravenously instead of intra-articular injection as in direct MR arthrography. After the injection exercising the joint results in considerable signal intensity increase within the joint cavity. Fat saturated MR sequences then yield arthrographic images. The method is less invasive than direct MR arthrography and first results showed comparable sensitivities and specificities for rotator cuff and glenoid labrum pathology. In this article the technique, established and potential future indications, drawbacks and limitations of the method are reviewed.

  20. Indirect MR arthrography: techniques and applications

    Energy Technology Data Exchange (ETDEWEB)

    Vahlensieck, M.; Sommer, T.; Textor, J.; Pauleit, D.; Schild, H.H. [Department of Radiology, University of Bonn (Germany); Lang, P.; Genant, H.K. [Department of Radiology, University of California, San Francisco (United States)

    1998-03-01

    Indirect MR arthrography is a relatively new MR technique improving articular and periarticular contrast. It is achieved by injection of paramagnetic MR contrast media intravenously instead of intra-articular injection as in direct MR arthrography. After the injection exercising the joint results in considerable signal intensity increase within the joint cavity. Fat saturated MR sequences then yield arthrographic images. The method is less invasive than direct MR arthrography and first results showed comparable sensitivities and specificities for rotator cuff and glenoid labrum pathology. In this article the technique, established and potential future indications, drawbacks and limitations of the method are reviewed. (orig.) With 7 figs., 10 refs.

  1. [Indirect MR arthrography in the diagnosis of lesions of the labrum glenoidale].

    Science.gov (United States)

    Sommer, T; Vahlensieck, M; Wallny, T; Lutterbey, G; Pauleit, D; Steuer, K; Golombek, V; Kreft, B; Keller, E; Schild, H

    1997-07-01

    It has been shown that intravenous administration of contrast media produces an MR arthrographic effect without the need for intraarticular injection. This is the first study evaluating this new technique of indirect MR arthrography in the diagnosis of glenoid labrum tears. 28 patients with clinically suspected labral injuries were prospectively investigated (1.5 Tesla, flexible surface coil). A plain MR examination of the shoulder (transverse and oblique-coronal orientation, T1-weighted spin- [TE/TR 15/675], proton density- and T2*-weighted gradient echo [TE/TR/Flip 14,32/600/30 degrees] sequences) and indirect MR arthrography (transverse and oblique-coronal orientation, fat-suppressed T1-weighted spin-echo sequences [TE/TR 15/675], intravenous injection of gadopentetate dimeglumine [0.1 mmol/kg], followed by 10-15 min of joint movement) were performed. Results were confirmed by arthroscopy and/or open surgery. Indirect MR arthrography significantly improved delineation of the glenoid labrum and hyaline cartilage (p < 0.05). Sensitivity and specificity of indirect MR arthrography in the diagnosis of labral injuries were 90% and 89%, compared to 79% and 67% of the native MR examination. Indirect MR arthrography is a promising non-invasive technique in the evaluation of the glenoid labrum.

  2. Supraspinatus tendon tears: comparison of US and MR arthrography with surgical correlation

    Energy Technology Data Exchange (ETDEWEB)

    Ferrari, Francesco S.; Governi, Simone; Burresi, Francesca; Vigni, Francesco; Stefani, Paolo [Department of Radiologic and Orthopaedic-Rehabilitative Sciences, University Hospital Siena (Italy)

    2002-05-01

    The aim of this study was to compare the diagnostic reliability of US with MR arthrography in diagnosing supraspinatus tendon tears. Surgical findings were used as the gold standard in detecting tears. A total of 44 patients were assessed with transverse and longitudinal US scans with respect to the long axis of the rotator cuff tendons and then examined with MR arthrography. This technique involved free-hand injection of contrast medium into the shoulder joint. At surgery 20 incomplete and 24 complete tears were observed. Ultrasound offered good results for the large tears, but its sensitivity decreased proportionally with the size of the tears. Magnetic resonance arthrography correctly diagnosed 43 tears, whereas only one false-negative diagnosis of tendinosis was made for a partial tear on the bursal side. Since it improves the diagnosis of small tears, MR arthrography must be performed on all patients for whom surgical repair is necessary in order to restore normal functions. (orig.)

  3. Indirect MR arthrography: optimization and clinical applications.

    Science.gov (United States)

    Vahlensieck, M; Peterfy, C G; Wischer, T; Sommer, T; Lang, P; Schlippert, U; Genant, H K; Schild, H H

    1996-07-01

    To evaluate and optimize a method for producing magnetic resonance (MR) images similar to MR arthrograms of multiple synovial joints with intravenous gadopentetate dimeglumine injection. The authors examined the effects of joint motion, dose of gadopentetate dimeglumine (0.1, 0.2, and 0.4 mmol/kg), and fat saturation on the enhancement rate of the joint cavity and the degree of image contrast generated among articular structures on MR images in 14 healthy volunteers. Shoulder, elbow, wrist, hip, knee, and ankle joints of 10 volunteers were imaged with optimized parameters. Indirect MR arthrographic findings in 17 patients with joint disorders (eg, rotator-cuff tears, meniscal tears, and osteoarthritis) were compared with arthroscopic findings. Fat-saturated images obtained after 10 minutes of exercise and administration of 0.1 mmol/kg gadopentetate dimeglumine were similar to those obtained after intraarticular injection of contrast medium. Exercising the joint yielded the strongest joint-cavity enhancement. Increasing the dose of contrast medium in the unexercised joint did not statistically significantly improve the contrast-to-noise ratio. Rotator cuff tears, meniscal tears, and cartilage defects were better delineated with this method than with unenhanced MR imaging and showed good correlation with arthroscopic results. Indirect MR arthrography of an exercised joint provides homogeneous enhancement and improved delineation of soft-tissue structures.

  4. Indirect MR arthrography in the evaluation of tears of the glenoid labrum; Indirekte MR-Arthrographie in der Diagnostik von Laesionen des Labrum glenoidale

    Energy Technology Data Exchange (ETDEWEB)

    Sommer, T.; Vahlensieck, M.; Lutterbey, G.; Pauleit, D.; Kreft, B.; Keller, E.; Schild, H. [Radiologische Universitaetsklinik Bonn (Germany); Wallny, T. [Orthopaedische Universitaetsklinik Bonn (Germany); Steuer, K.; Golombek, V. [Klinik fuer Unfallchirurgie, Univ. Bonn (Germany)

    1997-07-01

    Purpose: It has been shown that intravenous administration of contrast media produces an MR arthrographic effect without the need for intraarticular injection. This is the first study evaluating this new technique of indirect MR arthrography in the diagnosis of glenoid labrum tears. Methods: 28 patients with clinically suspected labral injuries were prospectively investigated (1.5 Tesla, flexible surface coil). A plain MR examination of the shoulder (transverse and oblique-coronal orientation, T{sub 1}-weighted spin- [T{sub E}/T{sub R} 15/675], proton density- and T{sub 2}*-weighted gradient echo [T{sub E}/T{sub R}/Flip 14,32/600/30 ] sequences) and indirect MR arthrography (transverse and oblique-coronal orientation, fat-suppressed T{sub 1}-weighted spin-echo sequences [T{sub E}/T{sub R} 15/675], intravenous injection of gadopentetate dimeglumine [0.1 mmol/kg], followed by 10-15 min of joint movement) were performed. Results were confirmed by arthroscopy and/or open surgery. Results: Indirect MR arthrography significantly improved delineation of the glenoid labrum and hyaline cartilage (p<0.05). Sensitivity and specificity of indirect MR arthrography in the diagnosis of labral injuries were 90% and 89%, compared to 79% and 67% of the native MR examination. Conclusion: Indirect MR arthrography is a promising non-invasive technique in the evaluation of the glenoid labrum. (orig.) [Deutsch] Ziel: In frueheren Studien wurde gezeigt, dass die intravenoese Injektion gadoliniumhaltiger Kontrastmittel zur Signalintensitaetssteigerung im Gelenkkavum fuehrt. In dieser Studie wurde erstmals diese Technik der indirekten MR-Arthrographie am Schultergelenk in der Diagnostik von Labrumlaesionen evaluiert. Methode: 28 Patienten mit klinischem Verdacht auf eine Verletzung des Labrum glenoidale und/oder der Rotatorenmanschette wurden prospektiv nach folgendem Protokoll an einem 1,5-Tesla-System mit einer Oberflaechen-Ringspule untersucht: 1. Native MR-Standard-Untersuchung mit

  5. MR arthrography of the ankle joint; MR-Arthrographie des Sprunggelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Trattnig, S.; Rand, T.; Breitenseher, M.; Ba-Ssalamah, A.; Schick, S.; Imhof, H. [Universitaetsklinik fuer Radiodiagnostik, AKH-Wien (Austria)

    1999-01-01

    Due to its superior soft tissue contrast conventional MRI is the imaging method of choice in the evaluation of ankle joint disorders. Conventional MR imaging can accurately demonstrate normal or acutely injured ligaments; however, in subacute and chronic injury joint fluid necessary for delineation of injured ligaments is absent and MR arthrography should be performed. MR arthrography uses the intraarticular injection of contrast material to distend the joint, yielding improved discrimination of intraarticular structures. This joint distension with MR arthrography is also helpful in the staging of osteochondritis dissecans, since in cases of unstable lesions tracking of contrast material into the interface can be more easily demonstrated. Finally, high contrast and joint distension by MR arthrography improves the detection of intraarticular loose bodies, which often require surgery. MR artrography, although invasive, may provide additional information in various ankle joint disorders. (orig.) [Deutsch] Aufgrund des ausgezeichneten Weichteilkontrastes ist die konventionelle MRT die bildgebende Methode der Wahl in der Beurteilung von Sprunggelenkserkrankungen. Die konventionelle MRT kann zuverlaessig normale und akut verletzte Ligamente darstellen. Im subakuten und chronischen Stadium der Verletzung fehlt jedoch oft die Gelenksfluessigkeit die fuer eine exakte Abgrenzung der verletzten Ligamente notwendig ist. Die MR-Arthrographie sollte in diesen Faellen durchgefuehrt werden, da die intraartikulaere KM-Applikation den Gelenksraum distendiert mit verbesserter Unterscheidbarkeit intraartikulaerer Strukturen. Diese Gelenksdistension mit der MR-Arthrographie ist auch in der Stadiumbeurteilung der Osteochondritis dissecans hilfreich, da in Faellen von instabilen Laesionen eine KM-Umspuelung des Dissekats leichter dargestellt werden kann. Schliesslich verbessert die MR-Arthrographie aufgrund des hohen Kontrastes und der Gelenksdistension auch den Nachweis von

  6. Efficacy of MR arthrography in the diagnosis of the acetabular labral tear

    Energy Technology Data Exchange (ETDEWEB)

    Chun, Kwang Jin; Kwon, Soon Tae; Hwang, Deuk Soo; Chung, Yon Su; Paek, Chung Ho; Kim, Young Min; Lee, Won Sok [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    1999-08-01

    To determine the accuracy of magnetic resonance (MR) arthrography in the detection and staging of lesions of the acetabular labrum. Fifteen hips of 14 patients with chronic hip pain and clinical suspicion of labral lesions were examined with direct or indirect MR arthrography and underwent subsequent arthroscopic evaluation. The study population consisted of six women and eight men aged between 40 and 59 years. Nine arthrograms were obtained intra-articular administration of gadolinium solution, and six involved articular motion exercise after intravenous administration of gadolinium solution. In 14 cases a phased-array pelvic coil was used, and a shoulder coil in one. Fat-suppressed T1-weighted images were obtained in the coronal, oblique coronal and oblique axial planes, and T1- and T2-weighted images were obtained in the axial plane. Labral lesions were graded according to the Czerny classification and evaluated on the basis of presence or absence of a tear and location (anteroinferior, anterosuperior, superior, posterosuperior, posteroinferior). The findings were than correlated with the arthroscopic findings. After direct and indirect MR arthography, the findings-based on the Czerny classification-were as follows : stage IA:3; IB:1; IIA:8; IIB:1; IIIA:4; IIIB:0. MR arthrography also showed that seven cases were located in the anterosuperior portion of the labrum, seven in the superior portion, and three in the posteroinferior portion. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MR arthrography for diagnosis of the labral tear was 92%, 75%, and 88%, respectively. In this preliminary study, MR arthrography appears to be a promising imaging modality for accurate diagnosis and useful for screening patients with chronic hip pain.

  7. A feedback protocol improves the diagnostic performance of MR arthrography by experienced musculoskeletal radiologists in patients with traumatic anterior shoulder instability

    NARCIS (Netherlands)

    Grinsven, S. van; Loon, C. van; Gorp, M. van; Kints, M. van; Konings, P.; Kampen, A. van

    2015-01-01

    PURPOSE: To prospectively evaluate the diagnostic performance of magnetic-resonance-arthrography (MRA) by experienced musculoskeletal radiologists in patients with traumatic-anterior-shoulder-instability (TASI), after feedback protocol execution. MATERIALS AND METHODS: Forty-five surgically

  8. Fast MR arthrography using VIBE sequences to evaluate the rotator cuff

    Energy Technology Data Exchange (ETDEWEB)

    Vandevenne, Jan E. [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium); Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Vanhoenacker, Filip; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Department of Radiology, Edegem (Belgium); Mahachie John, Jestinah M. [University of Hasselt, Centre for Statistics, Diepenbeek (Belgium); Gelin, Geert [Ziekenhuizen Oost-Limburg, Department of Radiology, Genk (Belgium)

    2009-07-15

    The purpose of this paper was to evaluate if short volumetric interpolated breath-hold examination (VIBE) sequences can be used as a substitute for T1-weighted with fat saturation (T1-FS) sequences when performing magnetic resonance (MR) arthrography to diagnose rotator cuff tears. Eighty-two patients underwent direct MR arthrography of the shoulder joint using VIBE (acquisition time of 13 s) and T1-FS (acquisition time of 5 min) sequences in the axial and paracoronal plane on a 1.0-T MR unit. Two radiologists scored rotator cuff tendons on VIBE and T1-FS images separately as normal, small/large partial thickness and full thickness tears with or without geyser sign. T1-FS sequences were considered the gold standard. Surgical correlation was available in a small sample. Sensitivity, specificity, and positive and negative predictive values of VIBE were greater than 92% for large articular-sided partial thickness and full thickness tears. For detecting fraying and articular-sided small partial thickness tears, these parameters were 55%, 94%, 94%, and 57%, respectively. The simple kappa value was 0.76, and the weighted kappa value was 0.86 for agreement between T1-FS and VIBE scores. All large partial and full thickness tears at surgery were correctly diagnosed using VIBE or T1-FS MR images. Fast MR arthrography of the shoulder joint using VIBE sequences showed good concordance with the classically used T1-FS sequences for the appearance of the rotator cuff, in particular for large articular-sided partial thickness tears and for full thickness tears. Due to its very short acquisition time, VIBE may be especially useful when performing MR arthrography in claustrophobic patients or patients with a painful shoulder. (orig.)

  9. Adhesive capsulitis of the shoulder: MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Hyun Jeong; Han, Tae Il; Lee, Kwang Won; Choi, Youn Seon; Kim, Dae Hong; Han, Hyun Young; Song, Mun Kab [Eulji Univ. School of Medicine, Taejon (Korea, Republic of); Kwon, Soon Tae [Chungnam National Univ. College of Medicine, Taejon (Korea, Republic of)

    2001-07-01

    Adhesive capsulitis is a clinical syndrome involving pain and decreased joint motion caused by thickening and contraction of the joint capsule. The purpose of this study is to describe the MR arthrographic findings of this syndrome. Twenty-nine sets of MR arthrographic images were included in the study. Fourteen patients had adhesive capsulitis diagnosed by physical examination and arthrography, and their MR arthrographic findings were compared with those of 15 subjects in the control group. The images were retrospectively reviewed with specific attention to the thickness of the joint capsule, volume of the axillary pouch (length, width, height(depth)), thinkness of the coracohumeral ligament, presence of extra-articular contrast extravasation, and contrst filling of the subcoracoid bursa. Mean capsular thickness measured at the inferior portion of the axillary pouch was 4.1 mm in patients with adhesive capsulitis and 1.5 mm in the control group. The mean width of the axillary pouch was 2.5 mm in patients and 9.5 mm in controls. In patients, the capsule was significantly thicker and the axillary pouch significantly narrower than in controls (p<0.05). Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch (sensitivity 93%, specificity 80%) and a pouch narrower than 3.5 mm (sensitivity 93%, specificity 100%) were useful criteria for the diagnosis of adhesive capsulitis. In patients with this condition, extra-articular contrast extravasation was noted in six patients (43%) and contrast filling of the subcoracoid bursa in three (21%). The MR arthrographic findings of adhesive capsulitis are capsular thickening, a low-volume axillary pouch, extra-articular contrast extravasation, and contrast filling of the subcoracoid bursa. Capsule thickness greater than 2.5 mm at the inferior portion of the axillary pouch and a pouch width of less than 3.5 mm are useful diagnostic imaging characteristics.

  10. Comparison of three dimensional isotropic and two dimensional conventional indirect MR arthrography for the diagnosis of rotator cuff tears

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Yoon, Young Cheol; Kwon, Jong Won; Yoo, Jae Chul [Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Cha, Jang Kyu [Dept. of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of); Jee, Suk Kyoung [Joeun Madi Hospital, Seoul (Korea, Republic of)

    2014-12-15

    To compare the accuracy between a three-dimensional (3D) indirect isotropic T1-weighted fast spin-echo (FSE) magnetic resonance (MR) arthrography and a conventional two-dimensional (2D) T1-weighted sequences of indirect MR arthrography for diagnosing rotator cuff tears. The study was approved by our Institutional Review Board. In total, 205 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery for 206 shoulders were included in this study. Both conventional 2D T1-weighted FSE sequences and 3D isotropic T1-weighted FSE sequence were performed in all patients. Two radiologists evaluated the images for the presence of full- or partial-thickness tears in the supraspinatus-infraspinatus (SSP-ISP) tendons and tears in the subscapularis (SSC) tendons. Using the arthroscopic findings as the reference standard, the diagnostic performances of both methods were analyzed by the area under the receiver operating characteristic curve (AUC). Arthroscopy confirmed 165 SSP-ISP tendon tears and 103 SSC tendon tears. For diagnosing SSP-ISP tendon tears, the AUC values were 0.964 and 0.989 for the 2D sequences and 3D T1-weighted FSE sequence, respectively, in reader I and 0.947 and 0.963, respectively, in reader II. The AUC values for diagnosing SSC tendon tears were 0.921 and 0.925, respectively, for reader I and 0.856 and 0.860, respectively, for reader II. There was no significant difference between the AUC values of the 2D and 3D sequences in either reader for either type of tear. 3D indirect isotropic MR arthrography with FSE sequence and the conventional 2D arthrography are not significantly different in terms of accuracy for diagnosing rotator cuff tears.

  11. Diagnosis of classification of SLAP lesion with MR arthrography

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    Yamaguchi, Takayuki; Eto, Masao; Tomonaga, Tadashi; Takahara, Kazuhiro; Kushida, Manabu; Inatomi, Kenshiro; Akase, Keisuke; Wake, Satoshi; Shindo, Hiroyuki [Nagasaki Univ. (Japan). School of Medicine

    2003-03-01

    To determine the accuracy of MR Arthrography (MRA) in the classification of super labrum anterior posterior (SLAP) lesions, we investigated 15 patients (15 men, average 27.5 years) who underwent MRA before arthroscopic operation from 1998 to 2001. Based on the Snyder's classification, we defined the diagnostic criteria for classification of SLAP lesion on MRA: Type I shows irregularity of the labrum, without evidence of detachment from the superior glenoid rim. Type II shows complete detachment of the bicipital-labral complex. Type III shows detachment and inferior displacement of the superior labrum. Type IV shows Gd-DTPA dissecting into the biceps tendon. MRA findings correlated with arthroscopic findings. In MRA, 4 patients were diagnosed as type I, 10 type II, and 1 type IV. But in surgical findings, 3 out of the 4 patients diagnosed as type I were type II, and 3 out of the 10 patients (type II) were type I. MRA had a sensitivity of 25%, specificity of 73%, accuracy of 60% in type I, and sensitivity of 70%, specificity of 40%, accuracy of 60% in type II. The MRA classification corresponded with those of arthroscopy in 9 out of 15 patients (60%). MRA is a useful technique in the diagnosis of SLAP lesion, but classification is still difficult. (author)

  12. Accuracy of 3-T MR arthrography versus conventional 3-T MRI of elbow tendons and ligaments compared with surgery.

    Science.gov (United States)

    Magee, Thomas

    2015-01-01

    MR arthrography of the elbow has been found to be useful in the diagnosis of fullversus partial-thickness tears of the collateral ligaments. This article assesses the accuracy of 3-T MR arthrography of the elbow versus conventional 3-T MRI of the elbow, compared with surgery. Seventy-nine consecutive conventional elbow MRI and MR arthrography examinations performed on the same patients who went on to surgery were retrospectively read in consensus by two musculoskeletal radiologists. Full- or partial-thickness tears of the collateral ligaments and full-thickness tears of the extensor and flexor tendons were assessed. In 54 patients, the diagnoses made on MRI and MR arthrogram examinations were the same. In 16 patients, MR arthrogram examinations revealed additional findings that were not clearly seen on conventional MRI examinations. There were six full-thickness extensor tendon tears, seven radial collateral ligament tears, and three partial-thickness ulnar collateral ligament tears seen on MR arthrography that were not well seen on conventional MRI. In nine patients, MR arthrogram showed ligaments and tendons to be intact that appeared torn on conventional MRI. There were six ulnar collateral ligaments and three common flexor tendons found to be intact on MR arthrography examination that appeared to be torn on conventional MRI. All MR arthrography findings were confirmed at surgery. MR arthrography is more accurate than conventional MRI of the elbow at 3 T. In 16 cases, MR arthrography showed tendons and ligaments to be torn that appeared intact on conventional MRI. In nine cases, MR arthrography showed intact tendons and ligaments that appeared to be torn on conventional MRI. These nine cases are most likely the result of the tears healing, with fibrous tissue allowing the tendon and ligament tissues to coapt.

  13. Long head of the biceps brachii tendon: unenhanced MRI versus direct MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Tadros, Anthony S.; Huang, Brady K. [University of California, Department of Radiology, San Diego, CA (United States); Wymore, Lucas; Hoenecke, Heinz; Fronek, Jan [Scripps Clinic, Department of Orthopedic Surgery, La Jolla, CA (United States); Chang, Eric Y. [VA San Diego Healthcare System, Radiology Service, San Diego, CA (United States); University of California, Department of Radiology, San Diego, CA (United States)

    2015-09-15

    We sought to determine the diagnostic accuracy of unenhanced MRI and direct MR arthrography (MRA) for evaluation of the intra-articular long head of the biceps brachii tendon (LHBT) using arthroscopy as the gold standard. A retrospective review of patients who underwent shoulder MRI (n = 132) and MRA (n = 67) within 12 months prior to arthroscopy was performed. MR images were independently reviewed by two blinded musculoskeletal radiologists. Routinely recorded arthroscopic photos/videos were reviewed by an orthopedic surgeon. The LHBT was graded as normal, tendinosis, partial thickness tear less or greater than 50 %, and complete tear. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for tendinosis and tear detection were calculated. MRI correctly diagnosed fewer normal LHBTs compared to MRA (39-54 % versus 74-84 %, respectively; p < 0.005). MRI and MRA did not differ significantly in the diagnosis of tendinosis (18-36 % and 15-38 %, respectively; p > 0.05) and tears (75-83 % and 64-73 %, respectively; p > 0.05). For tendinosis, MRI versus MRA showed 18-36 % and 15-38 % sensitivity, 69-79 % and 83-91 % specificity, 22-28 % and 18-50 % PPV, 74-76 % and 80-86 % NPV, and 61-64 % and 70-81 % accuracy; respectively. For tears, MRI versus MRA showed 75-83 % and 64-73 % sensitivity, 73-75 % and 82-91 % specificity, 66-69 % and 41-62 % PPV, 82-87 % and 92-94 % NPV, and 74-78 % and 79-88 % accuracy; respectively. No significant difference was found between unenhanced MRI and direct MRA for the detection of tendinosis and tears of LHBTs. (orig.)

  14. Feasibility of ultrasound-guided intraarticular contrast injection for MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Soo Jin; Lee, Jong Min; Kang, Duck Sick [Kyungpook National University School of Medicine, Daegu (Korea, Republic of)

    2005-07-15

    To assess the feasibility of ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography. Between June 2002 and October 2004, 132 patients (29 female, 103 male: mean age, 33.6 years) underwent ultrasound-guided intraarticular contrast media injection (40 ml saline + 10 ml 2% lidocaine + 0.2 ml gadopentetate dimeglumine + 0.4 ml epinephrine) for MR arthrography. The patients were classified into four groups, viz. the no leakage group, the minor leakage with successful intraarticular injection group, the major leakage with unsuccessful intraarticular injection group, and the injection failure group. The 'no leakage' and 'minor leakage' groups were considered to be technical successes, while the 'major leakage' and 'injection failure' groups were regarded as technical failures. The technical success rate of ultrasound-guided intraarticular contrast injection using the posterior approach for MR Arthrography was 99.2% (131/132 patients) and one patients 0.7% (1/132 patients) was included in the 'major leakage' group. Ultrasound-guided intraarticular contrast injection using the posterior approach for MR arthrography was feasible with a high success rate.

  15. Ankle ligamints : comparison of MR arthrography with conventional MR imaging in amputated feet

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Jae Sung; Lee, Sang Yong; Lee, Jeong Min; Han, Young Min; Chung, Kyung Ho; Kim, CHong Soo [Chonbuk National Univ. Hospital, Chonju (Korea, Republic of)

    2001-04-01

    To compare magnetic resonance (MR) arthrography with conventional MR imaging in the evaluation of ankle ligaments. Eight freshly amputated human feet underwent conventional MR imaging and MR arthrography. For the former, 1.5-T magnets in the axial, coronal and sagittal planes were used, and T1-weighted sequences were obtained. Following the injection of 6-10 ml of diluted contrast media (Gd-DTPA 1:250), T1-weighted images were obtained in the same positions as conventional MR images. Paired conventional MR imaging and MR arthrography of each ankle ligament were rated on a five-point scale, and to reflect inter-group differences a Wilcoxon singed-rank test was used to compare the different measurements (p<0.05). In two ankles, MR images of the ligaments were correlated with ankle dissection. Anterior and posterior talofibular ligaments were more clearly revealed by MR arthrography than by conventional MR imaging, while calcaneofibular ligaments showed no difference between these two modalities. With regard to deltoid ligaments, visualization of the anterior and posterior tibiotalar ligament was much improved when contrast material was used to outline the ligament's articular aspect. Visualization of the posterior inferior tibiofibular ligament and inferior transverse ligament were also improved when the use of contrast material provided delineation of the articular side of the ligaments and separated them from adjacent bone. In addition, MR arthography was very useful for indentification of the posterior intermalleolar ligament, though its use did not enhance visualization of the calcaneofibular, tibiocalcaneal, spring or tibiospring ligaments. MR arthrography accurately revealed the anatomic details of ankle ligaments, and may therefore be more useful than conventional Mr imaging for evaluation of these structures.

  16. Evaluation of lesions of the internal ligaments of the wrist; conventional magnetic resonance imaging versus MR arthrography (MRA

    Directory of Open Access Journals (Sweden)

    Heba Ahmed Kamal

    2014-09-01

    Conclusion: MR arthrography is a potent additional tool facilitating the diagnosis of different pathologic entities affecting the major internal ligaments of the wrist joint and helps to reduce arthroscopic interventions.

  17. 3.0 T conventional hip MR and hip MR arthrography for the acetabular labral tears confirmed by arthroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Chun-Yan [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Wang, Jian-Quan [Department of Sports Medicine, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191,PR China (China); Zheng, Zhuo-Zhao, E-mail: zzhuozhao@aliyun.com [Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing 100191 (China); Ren, A.-Hong [Department of Radiology, Beijing Daxing Hospital, 26 West Huangcun Road, Daxing District, Beijing 102600 (China)

    2014-10-15

    Highlights: • MR is the preferred imaging modality for diagnosing acetabular labral tears. • The diagnostic performance of MR arthrography are superior than conventional hip MR. • The hip MR arthrography is recommended for diagnosing acetabular labral lesions. - Abstract: Objective: To evaluate the value of hip MR for diagnosing acetabular labrum tears, and to further compare the diagnostic performances of conventional MR with MR arthrography in acetabular labrum tears. Methods: 90 patients undergoing both hip MR examination and subsequent hip arthroscopy were retrospectively evaluated. Of these patients, 34 accepted both conventional MR and MR arthrography; while the other 56 only underwent conventional MR examination. All hip MR images were independently reviewed by two radiologists, and further compared with the results of hip arthroscopy. Results: 59 of 90 patients were confirmed with acetabular labral tears by hip arthroscopy and 31 without tears. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of conventional MR for evaluating the acetabular labral tears were 61.0%, 77.4%, 83.7% and 51.1% (radiologist A), and 66.1%, 74.2%, 82.9% and 53.4% (radiologist B), respectively, with good consistency between the two observers (K = 0.645). The sensitivity, specificity, PPV and NPV of MR arthrography for assessing the acetabular labral tears were 90.5%, 84.6%, 90.5% and 84.6% (radiologist A), and 95.2%, 84.6%, 90.9% and 91.7% (radiologist B), respectively, with excellent good consistency between the two observers (K = 0.810). The sensitivity and NPV of MR arthrography for diagnosing the acetabular labral tears were significantly higher than those of conventional MR (both P < 0.05). Conclusion: Hip MR arthrography is a reliable evaluation modality for diagnosing the acetabular labral tears, and its diagnostic performance is superior to that of conventional MR at 3.0 T.

  18. Comparison of Plain MRI and MR Arthrography in the Evaluation of Lateral Ligamentous Injury of the Ankle Joint

    Directory of Open Access Journals (Sweden)

    Mei-Chun Chou

    2006-01-01

    Conclusion: For evaluating ankle disability, using plain MRI alone is not adequate for correctly detecting lateral collateral ligamentous injury of the ankle joint. MR arthrography improves the sensitivity and the accuracy for ATaF and CF ligament injuries. It also helps in assessing coexisting pathologic lesions of ankle joints, especially impingement syndromes and osteochondral lesions, and provides more information for therapeutic decision making.

  19. Effect of traction on wrist joint space and cartilage visibility with and without MR arthrography.

    Science.gov (United States)

    Lee, Ryan K L; Griffith, James F; Tang, W K; Ng, Alex W H; Yeung, David K W

    2017-04-01

    To compare the effect of traction during non-arthrographic and arthrographic MR examination of the wrist with regard to joint space width, joint fluid dispersion and cartilage surface visibility. Prospective 3-T MRI study of 100 wrists in 96 patients. The first 50 wrists underwent MR arthrography first without traction and then with traction. The following 50 wrists underwent standard MR first without traction and then with traction. On these examinations, two radiologists independently measured (i) joint space width, semi-quantitatively graded (ii) joint fluid dispersion between opposing cartilage surfaces and (iii) articular cartilage surface visibility. The three parameters were compared between the two groups. Traction led to an increase in joint space width at nearly all joints in all patients (p wrist although the effect was not as great as that seen with MR arthography or MR arthrography with traction. Advances in knowledge: This is the first study to show the beneficial effect of traction during standard non-arthrography MRI of the wrist and compare the effect of traction between non-arthrographic and arthrographic MRI of the wrist.

  20. Comparison of Indirect MR Arthrography With Conventional MRI in the Diagnosis of Knee Pathologies in Patients With Knee Pain.

    Science.gov (United States)

    Babaei Jandaghi, Ali; Mardani-Kivi, Mohsen; Mirbolook, Ahmadreza; Emami-Meybodi, Mohammad Kazem; Mohammadzadeh, Solmaz; Farahmand, Maral

    2016-05-01

    Knee pain is a common problem in the general population. In order to determine the extent of the injury and the appropriate treatment, MRI provides the most accurate imaging method. This may be done through conventional MRI techniques or by injecting a contrast material (MR arthrography). The purpose of this study was to compare the diagnostic value of these two methods. The study involved the diagnostic evaluation on 60 patients with knee pain who received treatment over the course of a one-year period. Referred patients were randomly divided into two groups: indirect MR arthrography was performed on one group, and conventional MRI was performed on the other group. Both groups then underwent arthroscopy. The results from both groups were compared with the arthroscopic findings. In all of the pathologies studied, the sensitivity, specificity, and the positive and negative predictive values were evaluated. A high rate of accuracy was found between MR arthrography and arthroscopy (P < 0.05) for all knee injuries, however a similar rate of accuracy between conventional MRI and arthroscopy was only seen in patients with damage to the posterior cruciate ligament (PCL), the tibio-femoral articular cartilage, and patella chondromalacia (P < 0.05). The highest rate of accuracy was seen in cases where indirect MR arthrography was used for the diagnosis of anterior cruciate ligament (ACL) damage (K = 1). Our results have shown that indirect MR arthrography had greater diagnostic accuracy in regards to the sensitivity, specificity, and positive and negative predictive values than conventional MRI in knee pathologies.

  1. Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries

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    Cerezal, Luis; Fernandez-Hernando, Moises [Department of Radiology, Diagnostico Medico Cantabria, Santander, Cantabria (Spain); Perez Carro, Luis [Learnig Trauma Med. Centro de Consultas Medicas CCM, Orthopedic Surgery department, Santander (Spain); Llorca, Javier [University of Cantabria - IDIVAL, Santander (Spain); CIBER Epidemiology and Public Health, Santander (Spain); Llopis, Eva [Alzira Hospital, Department of Radiology, Valencia (Spain); Montero, Juan Antonio [Cantabria University, Anatomy and Cell Biology, Santander (Spain); Canga, Ana [Cantabria University, Anatomy and Cell Biology, Santander (Spain); Department of Radiology Marques de Valdecilla University Hospital, Santander, Cantabria (Spain)

    2015-11-15

    To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries. Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19-53 years) and 76 women (mean age, 38.5 years; range, 18-56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated. At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6 %) patients and had suffered low-grade partial tears in 15 (8.1 %) patients, high-grade partial tears in 10 (5.4 %) patients, and complete ruptures in 7 (3.8 %) patients. MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93 %) and high-grade (66/96 %) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87 % and a specificity of 95 %. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92 %) and specificity (98 %). Articular distraction was significantly increased in patients with complete ruptures of the

  2. Usefulness of MR arthrography of the hip with leg traction in the evaluation of ligamentum teres injuries.

    Science.gov (United States)

    Cerezal, Luis; Carro, Luis Pérez; Llorca, Javier; Fernández-Hernando, Moisés; Llopis, Eva; Montero, Juan Antonio; Canga, Ana

    2015-11-01

    To retrospectively evaluate the diagnostic accuracy of magnetic resonance (MR) arthrography of the hip with leg traction in the evaluation of ligamentum teres lesions and to evaluate whether there is increased articular distraction, possibly indicating secondary instability, in hips with ligamentum teres injuries. Institutional review board approval and informed consent were obtained for this retrospective study. MR arthrograms of the hip with leg traction of 184 consecutive patients, including 108 men (mean age, 32.6 years; range, 19-53 years) and 76 women (mean age, 38.5 years; range, 18-56 years), who underwent hip arthroscopy were assessed for the presence of ligamentum teres lesions. The MR arthrographic findings were independently assessed by two radiologists who were blinded to the arthroscopic results. The inclusion criteria stipulated no previous surgery, arthroscopy within 1 month after MR arthrography, and availability of a detailed surgical report with ligamentum teres findings. The arthroscopy findings served as the reference standard. Sensitivity, specificity, accuracy, and K statistics for interobserver and intraobserver agreement were calculated. At arthroscopy, 32 ligamentum teres injuries were found. The ligamentum teres was normal in 152 (82.6%) patients and had suffered low-grade partial tears in 15 (8.1%) patients, high-grade partial tears in 10 (5.4%) patients, and complete ruptures in 7 (3.8%) patients. MR arthrography with axial traction demonstrated moderate sensitivity and high specificity for both low-grade (62/93%) and high-grade (66/96%) partial tears. Grouping low- and high-grade partial tears increased the diagnostic performance of MR arthrography, yielding a sensitivity of 87% and a specificity of 95%. For complete ligamentum teres tears, MR arthrography with leg traction demonstrated high sensitivity (92%) and specificity (98%). Articular distraction was significantly increased in patients with complete ruptures of the ligamentum

  3. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation

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    Waldt, S.; Bruegel, M.; Mueller, D.; Holzapfel, K.; Rummeny, E.J.; Woertler, K. [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Imhoff, A.B. [Technische Universitaet Muenchen, Department of Sports Orthopedics, Munich (Germany)

    2007-02-15

    We assessed the diagnostic performance of magnetic resonance (MR) arthrography in the diagnosis of articular-sided partial-thickness and full-thickness rotator cuff tears in a large symptomatic population. MR arthrograms obtained in 275 patients including a study group of 139 patients with rotator cuff tears proved by arthroscopy and a control group of 136 patients with arthroscopically intact rotator cuff tendons were reviewed in random order. MR imaging was performed on a 1.0 T system (Magnetom Expert, Siemens). MR arthrograms were analyzed by two radiologists in consensus for articular-sided partial-thickness and full-thickness tears of the supraspinatus, infraspinatus, and subscapularis tendons. At arthroscopy, 197 rotator cuff tears were diagnosed, including 105 partial-thickness (93 supraspinatus, nine infraspinatus, three subscapularis) and 92 full-thickness (43 supraspinatus, 20 infraspinatus, 29 subscapularis) tendon tears. For full-thickness tears, sensitivity, specificity, and accuracy were 96%, 99%, and 98%, respectively, and for partial tears 80%, 97%, and 95%, respectively. False negative and positive assessments in the diagnosis of articular-sided partial-thickness tears were predominantly [78% (35/45)] observed with small articular-sided (Ellman grade1) tendon tears. MR arthrography is highly accurate in the diagnosis of full-thickness rotator cuff tears and is accurate in the diagnosis of articular-sided partial-thickness tears. Limitations in the diagnosis of partial-thickness tears are mainly restricted to small articular-sided tears (Ellman grade 1) due to difficulties in differentiation between fiber tearing, tendinitis, synovitic changes, and superficial fraying at tendon margins. (orig.)

  4. Imaging of shoulder instability

    Science.gov (United States)

    Martínez Martínez, Alberto; Tomás Muñoz, Pablo; Pozo Sánchez, José; Zarza Pérez, Antonio

    2017-01-01

    This extended review tries to cover the imaging findings of the wide range of shoulder injuries secondary to shoulder joint instability. Usefulness of the different imaging methods is stressed, including radiography, computed tomography (CT) and magnetic resonance. The main topics to be covered include traumatic, atraumatic and minor instability syndromes. Radiography may show bone abnormalities associated to instability, including developmental and post-traumatic changes. CT is the best technique depicting and quantifying skeletal changes. MR-arthrography is the main tool in diagnosing the shoulder instability injuries. PMID:28932699

  5. Diagnostic performance of MR arthrography with anterior trans-subscapularis versus posterior injection approach for subscapularis tendon tears at 3.0 T

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    Jung, Joon-Yong; Jee, Won-Hee [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology, Seoul (Korea, Republic of); Chun, Chang-Woo [Uijeongbu St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Department of Radiology, Uijeongbu-si, Gyeonggi-do (Korea, Republic of); Kim, Yang-Soo [Seoul St. Mary' s Hospital, College of Medicine, The Catholic University of Korea, Department of Orthopedic Surgery, Seoul (Korea, Republic of)

    2017-03-15

    To compare the diagnostic performance of shoulder magnetic resonance arthrography (MRA) with the anterior trans-subscapularis versus posterior injection approach to diagnose subscapularis tendon (SCT) tears. One hundred and sixty-seven arthroscopically confirmed patients (84 anterior and 83 posterior approaches) were included. Two readers retrospectively scored SCT tears. Proportions of correctly graded tears between MR arthrography and arthroscopy were calculated. Retrospective error analysis was performed. The sensitivity and specificity were 80 % (24/30) and 72 % (39/54) by reader 1, 73 % (22/30) and 76 % (41/54) by reader 2 in the anterior approach, and 86 % (30/35) and 79 % (38/48) by reader 1, 80 % (28/35) and 88 % (42/48) by reader 2 in the posterior approach, respectively. There were no significant differences in sensitivity and specificity between the two groups. Proportions of correctly graded tears of both readers were 48 % and 36 % in the anterior approach, and 70 % and 68 % in the posterior approach, respectively. The intratendinous collection of contrast material was not statistically significantly different between anterior (n = 8) and posterior (n = 3) approach group. For the MRA diagnosis of SCT tears, there was no significant difference between the anterior trans-subscapularis and the posterior approach. (orig.)

  6. Use of MR arthrography in detecting tears of the ligamentum teres with arthroscopic correlation

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    Chang, Connie Y.; Gill, Corey M.; Huang, Ambrose J.; Simeone, Frank J.; Torriani, Martin; Bredella, Miriam A. [Massachusetts General Hospital, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); McCarthy, Joseph C. [Massachusetts General Hospital, Department of Orthopedics, Boston, MA (United States)

    2014-12-20

    To demonstrate the normal appearance of the ligamentum teres on MR arthrography (MRA) and evaluate the accuracy of MRA in detecting ligamentum teres tears with arthroscopic correlation. Institutional Review Board approval was obtained with a waiver for informed consent because of the retrospective study design. A total of 165 cases in 159 patients (111 females, 48 males; mean age 41 ± 12 years) who underwent both MRA and hip arthroscopy were evaluated for appearance of the ligamentum teres, including the size, number of bundles, and ligamentum teres tears. Marrow edema of the fovea capitis adjacent to the ligamentum teres insertion and the presence of hip plicae were also recorded. The mean thickness and length of the ligamentum teres were 3.5 ± 1.5 mm and 25.2 ± 3.8 mm, respectively. Sensitivity, specificity, positive and negative predictive value, and accuracy of MRA for the detection of ligamentum teres tears were 78, 97, 74, 97, and 95 %, respectively. MRA is an accurate method to evaluate the normal morphology and to detect tears of the ligamentum teres. (orig.)

  7. Imaging Evaluation of Nonacute Shoulder Pain.

    Science.gov (United States)

    Tuite, Michael J; Small, Kirstin M

    2017-09-01

    A variety of radiographic views have been described in the literature for the initial imaging of nonacute shoulder pain. Multiple articles have also discussed the best next imaging test if radiographs do not show the diagnosis, especially the use of unenhanced MRI, MR arthrography, CT arthrography, and ultrasound. The purpose of this article is to examine the evidence for the most helpful radiographic views and the best imaging test after radiographs for different clinical presentations of chronic shoulder pain. The recommended radiographic views and best next imaging test after the radiograph depends on the clinical diagnosis. Ultrasound is generally preferred over MRI for evaluating chronic rotator cuff pain, whereas MR arthrography, preferably with abducted and externally rotated images, is most accurate for imaging chronic symptoms from a suspected labral tear or instability.

  8. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison.

    Science.gov (United States)

    Schmaranzer, Florian; Klauser, Andrea; Kogler, Michael; Henninger, Benjamin; Forstner, Thomas; Reichkendler, Markus; Schmaranzer, Ehrenfried

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. • The used traction technique was well tolerated by most patients. • The used traction technique almost consistently achieved separation of cartilage layers. • Traction MR arthrography enabled accurate detection of chondral and labral lesions.

  9. Assessment of the long head of the biceps tendon of the shoulder with 3T magnetic resonance arthrography and CT arthrography.

    Science.gov (United States)

    De Maeseneer, Michel; Boulet, Cedric; Pouliart, Nicole; Kichouh, Mimoun; Buls, Nico; Verhelle, Filip; De Mey, Johan; Shahabpour, Maryam

    2012-05-01

    We studied the assessment of proximal biceps tendon lesions including degeneration, tendon luxation, and partial and complete tendon tears with 3T MR arthrography and CT arthrography. Thirty-six patients who underwent both studies, as well as arthroscopy were included in the study. The images were randomized and blinded and independently reviewed by two musculoskeletal radiologists. The pooled sensitivity for lesion detection for CT arthrography was 31% and the specificity 95%. The pooled sensitivity for MR arthrography was 27% and the specificity 94%. There were no statistically significant differences between CT and MR. The interobserver agreement calculated with the kappa statistic was poor for CT and for MR. Both CT arthrography and MR arthrography perform poorly in the detection of biceps tendon pathology of the shoulder. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Comparison of ultrasound and fluoroscopic guidance for injection in CT arthrography and MR arthrography of the hip.

    Science.gov (United States)

    Martínez-Martínez, A; García-Espinosa, J; Ruiz-Santiago, F; Guzmán-Álvarez, L; Castellano-García, M M

    To evaluate the usefulness of ultrasound-guided versus fluoroscopy-guided injection in CT arthrography and MR arthrography. We reviewed all CT arthrography and MR arthrography studies done at our center between October 1, 2014 and October 1, 2015. We analyzed 32 studies: 26 with fluoroscopic guidance and 6 with ultrasound guidance. We compared the two techniques on the following parameters: presence of sufficient contrast material in the joint, extravasation or injection of contrast material in the soft tissues (presence of contrast material in the psoas or other soft tissues), and intra-articular gas bubbles. We used SPSS V. 20 to compare the techniques with Pearson's chi-square tests. Contrast material was observed in soft tissues in 56.3% of ultrasound-guided injections, making 6.3% of the procedures invalid for diagnostic purposes. Extravasation of contrast material was observed in 53.8% of fluoroscopy-guided procedures, making 3.8% invalid for diagnostic purposes. Intra-articular gas was observed in 21.9% of ultrasound-guided studies and in 38.5% of fluoroscopy-guided studies. None of the differences between techniques were statistically significant at p<0.05. Our study shows that ultrasound is as useful as fluoroscopy for injecting contrast material for CT arthroscopy and MR arthroscopy; ultrasound has the advantage of not using ionizing radiation. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Diagnostic performance of direct traction MR arthrography of the hip: detection of chondral and labral lesions with arthroscopic comparison

    Energy Technology Data Exchange (ETDEWEB)

    Schmaranzer, Florian; Klauser, Andrea; Henninger, Benjamin [Medical University Innsbruck, Department of Radiology, Innsbruck (Austria); Kogler, Michael; Schmaranzer, Ehrenfried [District Hospital St. Johann in Tyrol, Department of Radiology, St. Johann in Tyrol (Austria); Forstner, Thomas [Johannes Keppler University, Department for Applied Systems Research and Statistics, Linz (Austria); Reichkendler, Markus [District Hospital St. Johann in Tyrol, Department of Orthopedic Surgery, St. Johann in Tyrol (Austria)

    2015-06-01

    To assess diagnostic performance of traction MR arthrography of the hip in detection and grading of chondral and labral lesions with arthroscopic comparison. Seventy-five MR arthrograms obtained ± traction of 73 consecutive patients (mean age, 34.5 years; range, 14-54 years) who underwent arthroscopy were included. Traction technique included weight-adapted traction (15-23 kg), a supporting plate for the contralateral leg, and intra-articular injection of 18-27 ml (local anaesthetic and contrast agent). Patients reported on neuropraxia and on pain. Two blinded readers independently assessed femoroacetabular cartilage and labrum lesions which were correlated with arthroscopy. Interobserver agreement was calculated using κ values. Joint distraction ± traction was evaluated in consensus. No procedure had to be stopped. There were no cases of neuropraxia. Accuracy for detection of labral lesions was 92 %/93 %, 91 %/83 % for acetabular lesions, and 92 %/88 % for femoral cartilage lesions for reader 1/reader 2, respectively. Interobserver agreement was moderate (κ = 0.58) for grading of labrum lesions and substantial (κ = 0.7, κ = 0.68) for grading of acetabular and femoral cartilage lesions. Joint distraction was achieved in 72/75 and 14/75 hips with/without traction, respectively. Traction MR arthrography safely enabled accurate detection and grading of labral and chondral lesions. (orig.)

  12. 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.

  13. Feasibility and preliminary results of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction

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    Strobel, Klaus [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Kantonsspital Luzern, Roentgeninstitut/Nuklearmedizin, Luzern (Switzerland); Steurer-Dober, Isabelle; Huellner, Martin W.; Sol Perez Lago, Maria del; Veit-Haibach, Patrick; Tornquist, Katharina [Lucerne Cantonal Hospital, Department of Nuclear Medicine and Radiology, Lucerne (Switzerland); Silva, Angela J. da [Advanced Molecular Imaging, Philips Healthcare, San Jose, CA (United States); Bodmer, Elvira; Wartburg, Urs von; Hug, Urs [Lucerne Cantonal Hospital, Division of Hand and Plastic Surgery, Lucerne (Switzerland)

    2014-03-15

    To evaluate the feasibility and performance of SPECT/CT arthrography of the wrist in comparison with MR arthrography in patients with suspected ulnocarpal impaction. This prospective study included 28 wrists of 27 patients evaluated with SPECT/CT arthrography and MR arthrography. Iodine contrast medium and gadolinium were injected into the distal radioulnar and midcarpal joints. Late-phase SPECT/CT was performed 3.5 h after intravenous injection of approximately 650 MBq {sup 99m}Tc-DPD. MR and SPECT/CT images were separately reviewed in relation to bone marrow oedema, radionuclide uptake, and tears in the scapholunate (SL) and lunotriquetral (LT) ligaments and triangular fibrocartilage complex (TFCC), and an overall diagnosis of ulnar impaction. MR, CT and SPECT/CT imaging findings were compared with each other, with the surgical findings in 12 patients and with clinical follow-up. The quality of MR arthrography and SPECT/CT arthrography images was fully diagnostic in 23 of 28 wrists (82 %) and 25 of 28 wrists (89 %), respectively. SPECT/CT arthrography was not diagnostic for ligament lesions due to insufficient intraarticular contrast in one wrist. MR and SPECT/CT images showed concordant findings regarding TFCC lesions in 22 of 27 wrists (81 %), SL ligament in 22 of 27 wrists (81 %) and LT ligament in 23 of 27 wrists (85 %). Bone marrow oedema on MR images and scintigraphic uptake were concordant in 21 of 28 wrists (75 %). MR images showed partial TFCC defects in four patients with normal SPECT/CT images. MR images showed bone marrow oedema in 4 of 28 wrists (14 %) without scintigraphic uptake, and scintigraphic uptake was present without MR bone marrow oedema in three wrists (11 %). Regarding diagnosis of ulnar impaction the concordance rate between CT and SPECT/CT was 100 % and reached 96 % (27 of 28) between MR and SPECT/CT arthrography. The sensitivity and specificity of MR, CT and SPECT/CT arthrography were 93 %, 100 % and 100 %, and 93 %, 93 % and 93

  14. MR-imaging of anterior tibiotalar impingement syndrome: Agreement, sensitivity and specificity of MR-imaging and indirect MR-arthrography

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    Haller, Joerg [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Ludwig Boltzmann Institute for Osteology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Bernt, Reinhard [Department of Radiology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria)]. E-mail: reinhard.bernt@wgkk.sozvers.at; Seeger, Thomas [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Weissenbaeck, Alexander [Department of Trauma Surgery, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Tuechler, Heinrich [Ludwig Boltzmann Institute for Hematology, Hanusch Hospital, Heinrich Collin-Strasse 30, A-1140 Vienna (Austria); Resnick, Donald [Department of Radiology, VA Medical Center, UCSD, 3350 La Jolla Village Dr, San Diego, CA 92161 (United States)

    2006-06-15

    Objective: To clarify the role of MR-imaging in the diagnosis of anterior ankle impingement syndromes. Materials and methods: We prospectively examined 51 consecutive patients with chronic ankle pain by MR-imaging. Arthroscopy was performed in 29 patients who previously underwent non-enhanced MR-imaging; in 11 patients, indirect MR-arthrography additionally was performed. MR-examinations were correlated with clinical findings; MR and arthroscopy scores were statistically compared, agreement was measured. Results: Arthroscopy demonstrated granulation tissue in the lateral gutter (38%) and anterior recess (31%), lesions of the anterior tibiofibular (31%) and the anterior talofibular ligament (21%) as well as intraarticular bodies (10%). Stenosing tenosynovitis and a ganglionic cyst were revealed as extraarticular causes for chronic ankle pain by MR-examination (17%). Agreement of MR-imaging and arthroscopy was fair for the anterior talofibular ligament and the anterior joint cavity (kappa 0.40). Major discrepancy was found for non-enhanced MR scans (kappa 0.49) when compared with indirect MR-arthrography (kappa 0.03) in the anterior cavity. The sensitivity for lesions of the anterior talofibular and calcaneofibular ligament and the anterior cavity (0.91-0.87) detected by MR-imaging was superior in comparison to lesions of the anterior tibiofibular ligament and anteromedial cavity (0.50-0.24). Conclusion: MR-imaging provides additional information about the mechanics of chronic ankle impingement rather than an accurate diagnosis of this clinical entity. The method is helpful in differentiating extra- from intra-articular causes of ankle impingement. Indirect MR-arthrography has little or no additional value in patients with ankle impingement syndrome.

  15. 3-T direct MR arthrography of the wrist: Value of finger trap distraction to assess intrinsic ligament and triangular fibrocartilage complex tears

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    Cerny, Milena; Marlois, Romain [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland); Theumann, Nicolas [Institute of Radiology, Clinique Hirslanden Bois-Cerf, Avenue d’Ouchy 31, 1006 Lausanne (Switzerland); Bollmann, Christof; Wehrli, Laurent [Department of Plastic and Hand Surgery, Clinique Longeraie and Centre Hospitalier Universitaire Vaudois, University of Lausanne, Avenue de la Gare 9, 1003 Lausanne (Switzerland); Richarme, Delphine [Institute of Radiology, Clinique Hirslanden Bois-Cerf, Avenue d’Ouchy 31, 1006 Lausanne (Switzerland); Meuli, Reto [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland); Becce, Fabio, E-mail: fabio.becce@chuv.ch [Department of Diagnostic and Interventional Radiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne (Switzerland)

    2013-10-01

    Purpose: To determine the value of applying finger trap distraction during direct MR arthrography of the wrist to assess intrinsic ligament and triangular fibrocartilage complex (TFCC) tears. Materials and methods: Twenty consecutive patients were prospectively investigated by three-compartment wrist MR arthrography. Imaging was performed with 3-T scanners using a three-dimensional isotropic (0.4 mm) T1-weighted gradient-recalled echo sequence, with and without finger trap distraction (4 kg). In a blind and independent fashion, two musculoskeletal radiologists measured the width of the scapholunate (SL), lunotriquetral (LT) and ulna-TFC (UTFC) joint spaces. They evaluated the amount of contrast medium within these spaces using a four-point scale, and assessed SL, LT and TFCC tears, as well as the disruption of Gilula's carpal arcs. Results: With finger trap distraction, both readers found a significant increase in width of the SL space (mean Δ = +0.1 mm, p ≤ 0.040), and noticed more contrast medium therein (p ≤ 0.035). In contrast, the differences in width of the LT (mean Δ = +0.1 mm, p ≥ 0.057) and UTFC (mean Δ = 0 mm, p ≥ 0.728) spaces, as well as the amount of contrast material within these spaces were not statistically significant (p = 0.607 and ≥0.157, respectively). Both readers detected more SL (Δ = +1, p = 0.157) and LT (Δ = +2, p = 0.223) tears, although statistical significance was not reached, and Gilula's carpal arcs were more frequently disrupted during finger trap distraction (Δ = +5, p = 0.025). Conclusion: The application of finger trap distraction during direct wrist MR arthrography may enhance both detection and characterisation of SL and LT ligament tears by widening the SL space and increasing the amount of contrast within the SL and LT joint spaces.

  16. Comparison of MR-arthrography and MDCT-arthrography for detection of labral and articular cartilage hip pathology

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    Perdikakis, Evangelos; Karantanas, Apostolos [University Hospital, University of Crete, Department of Radiology, Heraklion (Greece); Karachalios, Theofilos [University of Thessaly, Department of Orthopaedic Surgery, Larissa (Greece); Katonis, Pavlos [University of Crete, Department of Orthopaedics, Heraklion (Greece)

    2011-11-15

    To compare the diagnostic ability of MR arthrography (MRa) and MDCT arthrography (CTa) in depicting surgically proven hip labral tears and articular cartilage degradation. Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 10 patients. The findings were evaluated by two independent observers (a musculoskeletal fellow and one senior musculoskeletal radiologist). Sensitivity, specificity, accuracy, and positive predictive value were determined using arthroscopic and open surgery findings as the standard of reference. Interobserver agreement was recorded. All images were assessed for the presence of a labral tear (according to Czerny classification) and for cartilage erosion using a 3 point scale for both methods: 1 = complete visualization-sharp edges, 2 = blurred edges fissuring-partial defects, 3 = exposed bone. The same classification was applied surgically. Disagreement between the senior observer and the fellow observer was recorded in three cases of labral tearing with MRa and six with CTa. Disagreement was also found in four cases of cartilage erosion with both MRa and CTa. The percent sensitivity, specificity, accuracy, and positive predictive value for correctly assessing the labral tear were as follows for MRa/CTa, respectively: 100/15, 50/13, 90/14, and 90/13 (P < 0.05). The same values for cartilage assessment were 63/66, 33/40, 50/57 and 55/66 (P > 0.05). Interobserver reproducibility with MRa is very good for labral tearing assessment. MRa is better for assessing labral tears. CTa shows better, but not statistically significant, demonstration of the articular cartilage. (orig.)

  17. Shoulder instability; Schulterinstabilitaeten

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

    2014-06-15

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

  18. Cam-type femoral-acetabular impingement: is the alpha angle the best MR arthrography has to offer?

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    Lohan, Derek G.; Seeger, Leanne L.; Motamedi, Kambiz; Sayre, James [David Geffen School of Medicine at UCLA, Department of Radiology, Los Angeles, CA (United States); Hame, Sharon [David Geffen School of Medicine at UCLA, Department of Orthopedic Surgery, Los Angeles, CA (United States)

    2009-09-15

    In our institutional experience, determination of the alpha ({alpha}) angle at MR arthrography as an indicator of the likelihood of cam-type femoroacetabular impingement (FAI) is fraught with inconsistency. The aims of this study were to quantify the degree of variability in and calculate the diagnostic accuracy of the {alpha} angle in suggesting a diagnosis of cam impingement, to determine the accuracy of a positive clinical impingement test, and to suggest alternative MR arthrographic measures of femoral head-neck overgrowth and determine their diagnostic utilities. We carried out a retrospective analysis of MR arthrographic studies performed during a 4-year period, combined with chart analysis, which allowed identification of 78 patients in whom surgical correlation was also available. The status of a preoperative clinical impingement test was also noted. Patients were designated as having cam-type FAI (Group A, n = 39) if intra-operative femoral head-neck junction bony osteochondroplasty/arthoscopic femoral debridement was performed. Group B (n = 39) acted as controls. Three radiologists independently and blindly performed a series of measurements ({alpha} angle and two newly proposed measurements) in each patient on two separate occasions. An {alpha} angle of greater than 55 was considered indicative of the presence of cam-type FAI. Performance values for {alpha} angle measurement were poor for each observer. There was considerable (up to 30% of the mean value) intra-observer variability between the first and second {alpha} angle measurements for each subject. Binary logistic regression analysis confirmed that the {alpha} angle is of no value in predicting the presence or absence of cam-FAI. A statistically significant difference existed between Groups A and B with regard to the newly proposed anterior femoral distance (AFD; p = 0.004). Using an AFD value of 3.60 mm or greater as being indicative of the presence of cam-FAI yields a 0.67 performance measure (95

  19. Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder.

    Science.gov (United States)

    Yoon, Jong Pil; Chung, Seok Won; Lee, Byung Joo; Kim, Hyung Sup; Yi, Jae Hyuck; Lee, Hyun-Joo; Jeong, Won-Ju; Moon, Sung Gyu; Oh, Kyung-Soo; Yoon, Seok Tae

    2015-11-26

    To evaluate the correlation between indirect magnetic resonance (MR) arthrographic imaging findings and the clinical symptoms and prognosis of patients with frozen shoulder. Indirect MR arthrography was performed for 52 patients with primary frozen shoulder (mean age 55.1 ± 9.0 years) and 52 individuals without frozen shoulder (mean age 53.1 ± 10.7 years); capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were evaluated. Clinical symptom severity was assessed using the Visual Analogue Scale for Pain (VAS Pain), simple shoulder test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). At 6-month follow-up, we evaluated whether MR arthrography findings correlated with the clinical symptoms and prognosis. Capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were significantly greater in the patient group than in the controls (p symptoms or ROM (n.s.); however, capsular enhancement correlated with clinical symptom severity according to VAS Pain (p = 0.005), SST (p = 0.046), and ASES scores (p = 0.009). Soft tissue thickening of the rotator interval did not correlate with clinical symptom severity, but was associated with external rotation limitation (p = 0.002). However, none of the parameters correlated with clinical symptoms at 6-month follow-up. Indirect MR arthrography provided ancillary findings, especially with capsular enhancement, for evaluating clinical symptom severity of frozen shoulder, but did not reflect the prognosis. MR findings in frozen shoulder should not replace clinical judgments regarding further prognosis and treatment decisions. IV.

  20. Systematics of shoulder instability; Systematik der Schulterinstabilitaet

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

    2015-03-01

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

  1. Evaluation of Labral Pathology and Hip Articular Cartilage in Patients with Femoroacetabular Impingement (FAI): Comparison of Multidetector CT Arthrography and MR Arthrography.

    Science.gov (United States)

    Sahin, Murat; Calisir, Cuneyt; Omeroglu, Hakan; Inan, Ulukan; Mutlu, Fezan; Kaya, Tamer

    2014-01-01

    To compare the multidetector computed tomography (MDCT) arthrography (CTa) and magnetic resonance (MR) arthrography (MRa) findings with surgical findings in patients with femoroacetabular impingement (FAI) and to evaluate the diagnostic performance of these methods. Labral pathology and articular cartilage were prospectively evaluated with MRa and CTa in 14 hips of 14 patients. The findings were evaluated by two musculoskeletal radiologists with 10 and 20 years of experience, respectively. Sensitivity, specificity, accuracy, and positive predictive value were determined using surgical findings as the standard of reference. While the disagreement between observers was recorded in two cases of labral tearing with MRa, there was a complete consensus with CTa. Disagreement between observers was found in four cases of femoral cartilage loss with both MRa and CTa. Disagreement was also recorded in only one case of acetabular cartilage loss with both methods. The percent sensitivity, specificity, and accuracy for correctly assessing the labral tearing were as follows for MRa/CTa, respectively: 100/100, 50/100, 86/100 (p0.05) and for femoral cartilage assessment were 100/75, 90/70, 86/71 (p>0.05). Inter-observer reliability value showed excellent agreement for labral tearing with CTa (κ=1.0). Inter-observer agreement was substantial to excellent with regard to acetabular cartilage assessment with MRa and CTa (κ=0.76 for MRa and κ=0.86 for CTa). Inter-observer reliability with CTa is excellent for labral tearing assessment. CTa seems to have an equal sensitivity and a higher specificity than MRa for the detection of labral pathology. MRa is better, but not statistically significantly, in demonstrating acetabular and femoral cartilage pathology.

  2. Shoulder injuries in overhead sports; Schultergelenkverletzungen bei Ueberkopfsportarten

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-05-15

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

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

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    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.)

  4. A new method for measurement of subcoracoid outlet and its relationship to rotator cuff pathology at MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Porter, N.A.; Singh, J.; Tins, B.J.; Lalam, R.K.; Tyrrell, P.N.M.; Cassar-Pullicino, V.N. [Robert Jones and Agnes Hunt Orthopaedic Hospital, Department of Radiology, Oswestry, Shropshire (United Kingdom)

    2015-09-15

    Orthopaedic surgical studies have shown that variations in the vertical distance between the tip of the coracoid process and the supra-glenoid tubercle alter the shape of the subcoracoid outlet. Our objective was to measure the vertical distance between the coracoid tip and the supra-glenoid tubercle (CTGT) on MR and to assess whether this showed better correlation with rotator cuff pathology compared with the axial coraco-humeral distance. A retrospective review was performed of 100 consecutive shoulder MR arthrograms. Vertical distance between the coracoid tip and the supraglenoid tubercle was measured in the sagittal oblique plane. Separate assessment was then made of tendon pathology of the subscapularis, supraspinatus and long head of biceps tendons. Axial coraco-humeral distance was then measured. Correlation between tendon abnormalities and the two measurements was then made. Of the 100 cases, 42 had subscapularis tendon lesions, 21 had lesions of the long head of biceps and 53 had supraspinatus tendon lesions. Mean vertical distance from the coracoid tip to supraglenoid tubercle was greater in those with lesions of any of these tendons and was statistically significant for the supraspinatus group (P = 0.005). Reduced axial coraco-humeral distance was also seen in patients with tendinopathy, although with less statistically significant difference (p = 0.059). Our results support orthopaedic studies that have shown that the vertical distance between the coracoid tip and the supraglenoid tubercle increases the incidence and risk of rotator cuff disease by altering the shape of the subcoracoid outlet. (orig.)

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

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

    2006-12-15

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

  6. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results.

    Science.gov (United States)

    Tudisco, Cosimo; Bisicchia, Salvatore; Savarese, Eugenio; Fiori, Roberto; Bartolucci, Dario A; Masala, Salvatore; Simonetti, Giovanni

    2013-01-27

    Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR) repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR) repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA), showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS), the Simple Shoulder Test (SST) scores, surgical time and implant expense. The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant expense, despite no difference in clinical outcomes. We think that

  7. Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 Tesla MR arthrography results

    Directory of Open Access Journals (Sweden)

    Tudisco Cosimo

    2013-01-01

    Full Text Available Abstract Background Arthroscopic rotator cuff repair has become popular in the last few years because it avoids large skin incisions and deltoid detachment and dysfunction. Earlier arthroscopic single-row (SR repair methods achieved only partial restoration of the original footprint of the tendons of the rotator cuff, while double-row (DR repair methods presented many biomechanical advantages and higher rates of tendon-to-bone healing. However, DR repair failed to demonstrate better clinical results than SR repair in clinical trials. MR imaging at 3 Tesla, especially with intra-articular contrast medium (MRA, showed a better diagnostic performance than 1.5 Tesla in the musculoskeletal setting. The objective of this study was to retrospectively evaluate the clinical and 3 Tesla MRA results in two groups of patients operated on for a medium-sized full-thickness rotator cuff tear with two different techniques. Methods The first group consisted of 20 patients operated on with the SR technique; the second group consisted of 20 patients operated on with the DR technique. All patients were evaluated at a minimum of 3 years after surgery. The primary end point was the re-tear rate at 3 Tesla MRA. The secondary end points were the Constant-Murley Scale (CMS, the Simple Shoulder Test (SST scores, surgical time and implant expense. Results The mean follow-up was 40 months in the SR group and 38.9 months in the DR group. The mean postoperative CMS was 70 in the SR group and 68 in the DR group. The mean SST score was 9.4 in the SR group and 10.1 in the DR group. The re-tear rate was 60% in the SR group and 25% in the DR group. Leakage of the contrast medium was observed in all patients. Conclusions To the best of our knowledge, this is the first report on 3 Tesla MRA in the evaluation of two different techniques of rotator cuff repair. DR repair resulted in a statistically significant lower re-tear rate, with longer surgical time and higher implant

  8. The diagnostic value of magnetic resonance arthrography of the shoulder in detection and grading of SLAP lesions: Comparison with arthroscopic findings

    Energy Technology Data Exchange (ETDEWEB)

    Amin, Mohammed Farghally, E-mail: Mohammed_amin37@yahoo.com [Department of Radiodiagnosis ElMinya University, ElMinya High Road, ElMinya (Egypt); Youssef, Ahmed Omar [Department of Orthropedic Surgery El Minya University, ElMinya (Egypt)

    2012-09-15

    Purpose: The purpose of the study is to determine the usefulness of magnetic resonance arthrography (MRA) in diagnosis and grading of superior labrum anterior to posterior (SLAP) lesions of the Glenoid Labrum Compared with surgery Material and methods: This was a prospective study including fifty nine clinically diagnosed SLAP patients. The study was done during the period from January 2008 to June 2010. All patients were submitted to history taking, clinical examination and conventional MRI examination of the shoulder, MRA was done in patients with negative conventional MRI, all of these patients underwent arthroscopy for diagnosis wither open or arthroscopy for diagnosis and treatment and results were compared with MRA findings. Main outcome measures: Sensitivity, specificity, positive and negative predictive values, and overall accuracy of MR arthrography in detection and grading of SLAP lesions of the gelnoid labrum. Results: Out of fifty nine patients, 25 patients had positive MR findings in conventional MRI, and 34 patients had negative MR findings, who underwent MR arthrography; 10 out of them had normal arthrogram (only 6 of them underwent arthroscopy), 22 had SLAP (superior labrum anterior to posterior) lesions, one had Bankart's lesion and one had internal impingement syndrome. These results were compared with arthroscopy results. The overall sensitivity of MRA in detection of SLAP lesions was 90% while the specificity was 50%, negative predictive value (NPV) was 66.6% and positive predicative value (PPV) was 81.8%. MRA and arthroscopy results were concurrent in 79.3% patients. Conclusion: MR arthrography is a sensitive minimally invasive technique for detection and grading of SLAP lesions, it can help in avoiding patients unnecessary diagnostic arthroscopy.

  9. 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.

  10. Diagnosis of shoulder impingement syndrome; Diagnostik des Schulterimpingementsyndroms

    Energy Technology Data Exchange (ETDEWEB)

    Hodler, J. [Orthopaedische Universitaetsklinik Balgrist, Zuerich (Switzerland)

    1996-12-01

    This article reviews the pathogenesis and clinical and imaging findings in shoulder impingement syndrome. Different stages of impingement syndrome are described. Stage I relates to edema and hemorrhage of the supraspinatus tendon. Stage II is characterized by bursal inflammation and fibrosis, as well as tendinopathy. In stage III there is a tear of the rotator cuff. Clinical signs many overlap. Moreover, calcifying tendinitis, fractures and pain originating from the cervical spine may mimic shoulder impingement syndrome. Imaging is important for the exact diagnosis. Standard radiographs are the basis of imaging in shoulder impingement syndrome. They may demonstrate subchondral sclerosis of the major tuberosity, subacromial spurs, and form anomalies of the acromion. They are also important in the differential diagnosis of shoulder impingement syndrome and demonstrate calcifying tendinitis, fractures and neoplasm. Ultrasonography has found acceptance as a screening tool and even as a final diagnostic method by many authors. However, there is a high interobserver variability in the demonstration of rotator cuff tears. Its usefulness has therefore been questioned. MR imaging is probably the method of choice in the evaluation of the rotator cuff and surrounding structures. Several investigations have demonstrated that differentiation of early findings, such as tendinopathy versus partial tears, may be difficult with MR imaging. However, reproducibility for fullthickness tears appears to be higher than for sonography. Moreover, specificity appears to be superior to sonography. MR arthrography is not universally accepted. However, it allows for more exact differentiation of discrete findings and may be indicated in preoperative planning. Standard arthrography and CT have a limited role in the current assessment of the rotator cuff. (orig.) [Deutsch] Grundlage des Impingementsyndroms ist eine Kompression des Supraspinatus am akromioklavikularen Bogen vor allem bei Flexion

  11. Traumatic Shoulder Dislocation Among Adolescents: Hill-Sachs Lesion Volume and Recurrent Instability.

    Science.gov (United States)

    Kinsella, Stuart D; Chauvin, Nancy A; Diaz, Tomas; Morey, Jose M; Wells, Lawrence

    2015-01-01

    Accurate assessment of Hill-Sachs lesions (HSLs) and their relationship to the glenoid track is essential to optimizing management following traumatic shoulder dislocation. The purpose of this study was to measure the size of HSLs by a novel method with magnetic resonance (MR) arthrography and to investigate the relationship between lesion size and instability history in adolescents (below 19 y of age) with a history of traumatic dislocation. All shoulder MR arthrograms queried to identify HSLs over a 4-year period were retrospectively reviewed and independently evaluated by 2 blinded musculoskeletal radiologists. HSLs were evaluated on axial T1-weighted fat-saturated images. For each consecutive image slice in which the HSL was identified, a freehand region of interest was constructed along the compression fracture cavity. Region of interest sum was multiplied by image slice thickness (and gap between slices if present) to generate a total HSL volume (mm). Subject chart review was then performed to acquire demographic data, including shoulder dislocation history. A total of 30 patients met inclusion criteria and included 22 boys (mean age, 16.3 y) and 8 girls (mean age, 16.4 y). Four patients had a history of 1 traumatic dislocation, 12 had a history of 2, and 14 had a history of ≥3. The average size of the HSL for all patients was 3.8 mm (range, 0.52 to 11 mm). There was no significant difference in HSL volume between the 21 skeletally immature (3.7 mm) and 9 skeletally mature (4.2 mm) patients (P=0.67). Patients with a history of 1, 2, or 3+ dislocations had an average HSL volume of 1.3, 3.7, and 4.7 mm, respectively. The measurement method revealed excellent interreader reliability (P=0.00). There was a statistically significant difference between dislocation history group mean HSL volumes (P=0.019), as well as a statistically significant difference between the number of dislocations and lesion volume (P=0.011). HSLs can be effectively measured in adolescent

  12. International survey and surgeon's preferences in diagnostic work-up towards treatment of anterior shoulder instability.

    Science.gov (United States)

    Weel, Hanneke; Tromp, Wouter; Krekel, Peter R; Randelli, Pietro; van den Bekerom, Michel P J; van Deurzen, Derek F P

    2016-06-01

    Recurrent anterior shoulder instability after surgical treatment can be caused by bony defects. Several diagnostic tools have been designed to measure the extent of these bony lesions. Currently, there is no consensus which measurement tool to use and decide which type of surgery is most appropriate. We therefore performed an evaluation of agreement in surgeons' preference of diagnostic work-up and surgical treatment of anterior shoulder instability. An international survey was conducted amongst orthopaedic shoulder surgeons. The survey contained questions about surgeons' experience, clinical and radiological examination and the subsequent treatment for anterior shoulder instability. Descriptive statistics were used to present the data, and percentages of responding surgeons were calculated. The questionnaire was completed by 197 delegates from 46 countries. 55 % of the respondents think evidence in current literature is sufficient on diagnostic work-up for anterior shoulder instability. Anamnestic, number of dislocations was most frequently asked (by 95 % of respondents), the most frequently used test is the apprehension test (91 %). For imaging, conventional X-ray in various directions was most performed, followed by MR arthrography and plane CT scan respectively. The responding surgeons perform surgery (labrum repair or Latarjet) in 51 % of the patients. A median of 25 % glenoid bone loss was given by the respondents, as cut-off from when to perform a bony repair. Many different diagnostic examinations for assessing shoulder instability are used and a high variety is seen in the use of diagnostic tools. Also no consensus is seen in the use of different surgical options (arthroscopic and open procedures). This implies the need for more research on diagnostic imaging and the correlation with specific subsequent surgical treatment. Survey, level of evidence IV.

  13. Shoulder MRI

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Shoulder Magnetic resonance imaging (MRI) of the shoulder ... limitations of MRI of the shoulder? What is MRI of the shoulder? MRI of the shoulder provides ...

  14. Postprocedural pain in shoulder arthrography: differences between using preservative-free normal saline and normal saline with benzyl alcohol as an intraarticular contrast diluent.

    Science.gov (United States)

    Storey, Troy F; Gilbride, George; Clifford, Kelly

    2014-11-01

    The purpose of this study was to prospectively evaluate the effect of benzyl alcohol, a common preservative in normal saline, on postprocedural pain after intraarticular injection for direct shoulder MR arthrography. From April 2011 through January 2013, 138 patients underwent direct shoulder MR arthrography. Using the Wong-Baker Faces Pain Scale, patients were asked to report their shoulder pain level immediately before and immediately after the procedure and then were contacted by telephone 6, 24, and 48 hours after the procedure. Fourteen patients did not receive the prescribed amount of contrast agent for diagnostic reasons or did not complete follow-up. Sixty-two patients received an intraarticular solution including preservative-free normal saline (control group) and 62 patients received an intraarticular solution including normal saline with 0.9% benzyl alcohol as a contrast diluent (test group). Patients were randomized as to which intraarticular diluent they received. Fluoroscopic and MR images were reviewed for extracapsular contrast agent administration or extravasation, full-thickness rotator cuff tears, and adhesive capsulitis. The effect of preservative versus control on pain level was estimated with multiple regression, which included time after procedure as the covariate and accounted for repeated measures over patients. Pain scale scores were significantly (p = 0.0382) higher (0.79 units; 95% CI, 0.034-1.154) with benzyl alcohol preservative compared with control (saline). In both study arms, the pain scale scores decreased slightly after the procedure, increased by roughly 1 unit over baseline for the test group and 0.3 unit over baseline for the control group by 6 hours after the procedure, were 0.50 unit over baseline for the test group and 0.12 unit over baseline for the control group at 24 hours, then fell to be slightly greater than baseline at 48 hours with benzyl alcohol and slightly less than baseline without benzyl alcohol. These trends

  15. Shoulder arthroscopy

    Science.gov (United States)

    ... inflammation and pain in your shoulder. Surgery for shoulder instability: If you have a torn labrum, the surgeon ... torn or damaged cartilage ring (labrum) or ligaments Shoulder instability, in which the shoulder joint is loose and ...

  16. Tears at the rotator cuff footprint: Prevalence and imaging characteristics in 305 MR arthrograms of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Schaeffeler, Christoph; Mueller, Dirk; Rummeny, Ernst J.; Woertler, Klaus [Technische Universitaet Muenchen, Department of Radiology, Munich (Germany); Kirchhoff, Chlodwig [Technische Universitaet Muenchen, Department of Orthopedics and Traumatology, Munich (Germany); Wolf, Petra [Technische Universitaet Muenchen, Institute of Medical Statistics and Epidemiology, Munich (Germany)

    2011-07-15

    To evaluate the prevalence, imaging characteristics and anatomical distribution of tears at the rotator cuff (RC) footprint with MR arthrography (MR-A) of the shoulder. MR arthrograms obtained in 305 patients were retrospectively reviewed. Partial articular-sided supraspinatus tendon avulsions (PASTA), concealed interstitial delaminations (CID), reverse PASTA lesions and full-thickness tears (FT) at the humeral tendon insertion were depicted. Anatomical locations were determined and depths of tears were classified. 112/305 patients showed RC tears, including 63 patients with 68 footprint tears. 34 PASTA lesions were detected with 20/34 involving the anterior supraspinatus (SSP) tendon and 17/34 PASTA lesions were grade I lesions. Most CID lesions (14/23) occurred at the posterior SSP and 20/23 were classified as grade I or II. 9 FT and 2 reverse PASTA lesions were found. Statistical analysis revealed no difference in anatomical location (p = 0.903) and no correlation with overhead sports activity (p = 0.300) or history of trauma (p=0.928). There were significantly more PASTA lesions in patients <40 years of age (p = 0.029). Most RC tears detected with MR-A involve the SSP footprint and are articular-sided with predominance in younger patients, but concealed lesions are not as uncommon as previously thought. (orig.)

  17. Diagnostic imaging of shoulder impingement; Bildgebende Diagnostik des Schultergelenkes bei Impingement

    Energy Technology Data Exchange (ETDEWEB)

    Merl, T. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Weinhardt, H. [Klinikum Rechts der Isar, Muenchen (Germany). Klinik und Poliklinik fuer Orthopaedie; Oettl, G. [Klinikum Rechts der Isar, Muenchen (Germany). Klinik und Poliklinik fuer Orthopaedie; Lenz, M. [Technische Univ. Muenchen (Germany). Inst. fuer Roentgendiagnostik; Riel, K.A. [Klinikum Rechts der Isar, Muenchen (Germany). Klinik und Poliklinik fuer Orthopaedie

    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. [Deutsch] Die Magnetresonanztomographie hat sich in den letzten Jahren zur Methode der Wahl in der Diagnostik der Gelenke entwickelt, sie erlaubt neben der Abbildung aller knoechernen auch die Abbildung aller Weichteilelemente eines Gelenkes. Auch in der Diagnostik der Schultergelenkserkrankungen besitzt die Magnetresonanztomographie einen festen Stellenwert mit hoher diagnostischer Treffsicherheit in der Beurteilung der Rotatorenmanschette, als MR-Arthrographie auch in der Beurteilung der Instabilitaet bzw von Laesionen des labrokapsulaeren Komplexes. In der Bewertung frueher Stadien des Impingement ist die klassische Magnetresonanztomographie als statische Methode auf indirekte Zeichen angewiesen, die in vielen Faellen nicht ausreichende Sicherheit bieten und dem funktionellen Charakter des Krankheitsbildes nicht ausreichend Rechnung tragen. Hier koennte die funktionelle Magnetresonanztomographie unter Abbildung des Arms in Abduktion und Rotation eine

  18. Dislocated Shoulder

    Science.gov (United States)

    ... and be prone to repeat dislocations. Symptoms Shoulder dislocation Shoulder dislocation A dislocation is an injury to your joint in which ... their normal positions. One common site for a dislocation is your shoulder, which is a ball-and- ...

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

    Directory of Open Access Journals (Sweden)

    Mowinckel Petter

    2010-10-01

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

  20. Shoulder Instability

    Science.gov (United States)

    ... Causes & Risk FactorsIs shoulder instability the same as shoulder dislocation?No. The signs of dislocation and instability might ... the same to you–weakness and pain. However, dislocation occurs when your shoulder goes completely out of place. The shoulder ligaments ...

  1. Imaging of the coracoglenoid ligament: a third ligament in the rotator interval of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Zappia, Marcello [University of Molise, Department of Medicine and Health Sciences, Campobasso (Italy); Varelli Institute, Naples (Italy); Castagna, Alessandro [Humanitas Research Hospital, Rozzano, Milan (Italy); Barile, Antonio [University of L' Aquila, Applied Clinical Science and Biotechnology, L' Aquila (Italy); Chianca, Vito [University ' ' Federico II' ' , Department of Advanced Biomedical Sciences, Naples (Italy); Brunese, Luca [University of Molise, Department of Medicine and Health Sciences, Campobasso (Italy); Pouliart, Nicole [Vrije Universiteit Brussel (VUB), Basic Biomedical Sciences - Human Anatomy, Brussels (Belgium); Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedics and Traumatology - Shoulder and Elbow Unit, Brussels (Belgium)

    2017-08-15

    The coracoglenoid ligament (CGL) forms part of the anterosuperior capsuloligamentous complex of the shoulder. Although it has received attention in the anatomical literature, it has not been investigated on imaging. The purpose of this study is to determine the percentage value and the interobserver agreement of identification and classification of the CGL on MR and MR arthrography (MRA) imaging. Retrospectively, 280 MR and 150 MRA examinations were evaluated for detection of the CGL by two musculoskeletal radiologists. On the MRA examinations the CGL configuration in relation to the superior glenohumeral (SGHL) and coracohumeral ligament (CHL) was classified into five types. Additionally, the percentage of intra-articular appearance of the CGL and its mean thickness value were calculated. Finally, a possible correlation between pathological condition and anatomical type was evaluated on MRA. The CGL could be identified in 56%/54% of MRI and in 76%/77% of MRA examinations. On MRA, the CGL was detected as distinct structures in 37%/35% of cases and it appeared fused (partially or totally) with the SGHL and/or CHL in 39%/42%; it was absent in 12%/12% and it appears undistinguishable in the remaining cases. The interobserver agreement was excellent (κ = 0.98 for detection on MRI; p = 0.927 for classification of anterosuperior anatomy on MRA; κ = 0.873 and 0.978 for identification on sagittal and axial external rotation MRA respectively; κ = 0.943 for classification as intra- or extra-articular on MRA). The CGL can be reliably identified on MRI and MRA. (orig.)

  2. Dislocated Shoulder

    Science.gov (United States)

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

  3. Shoulder Arthroscopy

    Science.gov (United States)

    ... and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other so tissues surrounding the joint. Common arthroscopic procedures ... for recurrent shoulder dislocation Less common procedures such as nerve release, ...

  4. Shoulder instability

    African Journals Online (AJOL)

    2011-09-02

    Sep 2, 2011 ... Honorary Consultant, Shoulder and Elbow Unit, Department of Orthopaedic Surgery, University of Cape Town. Basil Vrettos is a shoulder ... Head, Shoulder and Elbow Unit, Princess Alice Orthopaedic Unit, Groote Schuur Hospital. Steve Roche heads ..... tidirectional instability is physiotherapy. • Surgery for ...

  5. Shoulder pain

    Science.gov (United States)

    ... and ligaments inside the shoulder become stiff, making movement difficult and painful Overuse or injury of nearby tendons, such as the bicep muscles of the arms Tears of the rotator cuff tendons Watch this video about: Shoulder joint dislocation Sometimes, shoulder pain may ...

  6. Shoulder pain.

    Science.gov (United States)

    Ramponi, Denise R

    2011-01-01

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

  7. Shoulder Pain and Common Shoulder Problems

    Science.gov (United States)

    .org Shoulder Pain and Common Shoulder Problems Page ( 1 ) What most people call the shoulder is really several joints that ... article explains some of the common causes of shoulder pain, as well as some general treatment options. Your ...

  8. Rotator cuff tears noncontrast MRI compared to MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Hyun; Yoon, Young Cheol [Sungkyunkwan University, School of Medicine, Department of Radiology, Samsung Medical Center, Gangnam-gu, Seoul (Korea, Republic of); Jung, Jee Young [Chungang University School of Medicine, Department of Radiology, Chungang University Hospital, Seoul (Korea, Republic of); Yoo, Jae Chul [Sungkyunkwan University, School of Medicine, Department of Orthopedic Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2015-12-15

    To compare the accuracy of indirect magnetic resonance arthrography and noncontrast magnetic resonance imaging for diagnosing rotator cuff tears. In total, 333 patients who underwent noncontrast magnetic resonance imaging or indirect magnetic resonance arthrography were included retrospectively. Two musculoskeletal radiologists evaluated the images for the presence of supraspinatus-infraspinatus and subscapularis tendon tears. The overall diagnostic performance was calculated using the arthroscopic findings as the reference standard. Statistical differences between the diagnostic performances of the two methods were analyzed. Ninety-six and 237 patients who underwent noncontrast magnetic resonance imaging and indirect magnetic resonance arthrography were assigned into groups A and B, respectively. Sensitivity for diagnosing articular-surface partial-thickness supraspinatus-infraspinatus tendon tear was slightly higher in group B than in group A. Statistical significance was confirmed by multivariate analysis using the generalized estimating equation (p = 0.046). The specificity for diagnosing subscapularis tendon tear (85 % vs. 68 %, p = 0.012) and grading accuracy (57 % vs. 40 %, p = 0.005) was higher in group B than in group A; the differences were statistically significant for one out of two readers. Univariate analysis using the generalized estimating equation showed that the accuracy for diagnosing subscapularis tendon tear in group B was higher than in group A (p = 0.042). There were no statistically significant differences between the diagnostic performances of both methods for any other parameters. Indirect magnetic resonance arthrography may facilitate more accurate diagnosis and grading of subscapularis tendon tears compared with noncontrast magnetic resonance imaging. (orig.)

  9. Frozen Shoulder

    Science.gov (United States)

    ... surgery is one measure prescribed to prevent frozen shoulder. Symptoms Pain from frozen shoulder is usually dull or aching. It is typically ... disease and when you move your arm. The pain is usually located over the outer ... er discussing your symptoms and medical history, your doctor will examine your ...

  10. 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.

  11. Painful shoulder

    OpenAIRE

    Benno Ejnismann; Gustavo Cará Monteiro; Luis Fernando Uyeda

    2008-01-01

    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.

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

  13. Shoulder replacement

    Science.gov (United States)

    ... problems Bleeding , blood clot , or infection Risks of shoulder replacement surgery are: Allergic reaction to the artificial joint Blood vessel damage during surgery Bone break during surgery Nerve damage during surgery Dislocation of the artificial joint Loosening of the implant ...

  14. Frozen shoulder

    Science.gov (United States)

    ... Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther . 2013; ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

  15. Separated Shoulder

    Science.gov (United States)

    ... an injury to the ligaments that hold your collarbone (clavicle) to your shoulder blade. In a mild separated ... tenderness or pain near the end of your collarbone. Causes The most common cause of a separated ...

  16. Shoulder Fractures

    Science.gov (United States)

    ... arm bone), the scapula (shoulder blade) and the clavicle (collarbone) (Figure 1). The upper end of the humerus ... age. Most fractures in children occur in the clavicle bone. In adults, the most common fracture is ...

  17. 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.

  18. Shoulder Joint Replacement

    Science.gov (United States)

    ... the development of osteoarthritis. It is a common reason people have shoulder replacement surgery. Rheumatoid Arthritis This is ... severe fracture of the shoulder is another common reason people have shoulder replacements. When the head of the ...

  19. Shoulder separation - aftercare

    Science.gov (United States)

    ... to the top of the shoulder where the collarbone (clavicle) meets the top of the shoulder blade (acromion ... a tear in the tissue that connects the collarbone and top of the shoulder blade. These tears ...

  20. Evaluating shoulder instability treatment

    NARCIS (Netherlands)

    van der Linde, J.A.

    2016-01-01

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

  1. Floating shoulder

    OpenAIRE

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

    2014-01-01

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

  2. Milwaukee shoulder syndrome

    OpenAIRE

    Somashekar SA

    2014-01-01

    Milwaukee shoulder syndrome or rapid destructive arthritis of the shoulder is a very rare rheumatological condition characterized by the deposition of hydroxyapatite crystals. The figure 1 shows the shoulder image of a 67-year-old female with a history of bilateral shoulder pain and swelling since 2 years and knee pain since 6 months. Physical examination revealed restriction in shoulder movements. No neurological deficit was reported. X-ray of the right shoulder indicated rotator cuff disrup...

  3. Floating shoulder

    Directory of Open Access Journals (Sweden)

    B. de Pablo Márquez

    2014-09-01

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

  4. Hemiplegic Shoulder Pain.

    Science.gov (United States)

    Wilson, Richard D; Chae, John

    2015-11-01

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

  5. Bilateral anterior shoulder dislocation

    Science.gov (United States)

    Meena, Sanjay; Saini, Pramod; Singh, Vivek; Kumar, Ramakant; Trikha, Vivek

    2013-01-01

    Shoulder dislocations are the most common major joint dislocations encountered in the emergency departments. Bilateral shoulder dislocations are rare and of these, bilateral posterior shoulder dislocations are more prevalent than bilateral anterior shoulder dislocations. Bilateral anterior shoulder dislocation is very rare. We present a case of 24-year-old male who sustained bilateral anterior shoulder dislocation following minor trauma, with associated greater tuberosity fracture on one side. Prompt closed reduction followed by immobilization in arm sling and subsequent rehabilitation ensured a good outcome. PMID:24082765

  6. 9. Painful shoulder complaints.

    Science.gov (United States)

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

    2010-01-01

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

  7. Shoulder Impingement Treatment

    Science.gov (United States)

    ... the rotator cuff or scapular muscles, postural abnormalities, shoulder joint instability, or improper training or technique. The following is information from the American Academy of Pediatrics summarizing treatment phases ... impingement. Phases and Goals of Shoulder Impingement Treatment ...

  8. Statewide shoulders study.

    Science.gov (United States)

    2015-08-01

    With the ultimate purpose of enhancing safety and improving mobility, the Statewide Shoulders Study was initiated to : develop a prioritized list of candidate locations for shoulder improvements. The need for this study stems directly from : ADOTs...

  9. Shoulder pain in primary care: frozen shoulder.

    Science.gov (United States)

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

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

  10. 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.…

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

    Science.gov (United States)

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

    2011-10-01

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

  12. Work related shoulder disorders

    DEFF Research Database (Denmark)

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

    2004-01-01

    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 occu...... between current work with highly elevated arms and clinically verified shoulder disorders. Substantial long term cumulative effects were not shown. A potential for primary prevention was revealed....

  13. Dislocated shoulder - aftercare

    Science.gov (United States)

    ... 47. Reider BC, Davies GJ, Provencher MT. Anterior shoulder instability. In: Reider BC, Davies GJ, Provencher MT, eds. ... SR, Al-Saati Maád F, Litchfield RB. Anterior shoulder instability. In: Miller MD, Thompson SR, eds. DeLee & Drez's ...

  14. Posterior Shoulder Instability.

    Science.gov (United States)

    Antosh, Ivan J; Tokish, John M; Owens, Brett D

    Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior shoulder pathology may be more difficult to accurately diagnose than its anterior counterpart, and commonly, patients present with complaints of pain rather than instability. "Posterior instability" may encompass both dislocation and subluxation, and the most common presentation is recurrent posterior subluxation. Arthroscopic and open treatment techniques have improved as understanding of posterior shoulder instability has evolved. Electronic databases including PubMed and MEDLINE were queried for articles relating to posterior shoulder instability. Clinical review. Level 4. In low-demand patients, nonoperative treatment of posterior shoulder instability should be considered a first line of treatment and is typically successful. Conservative treatment, however, is commonly unsuccessful in active patients, such as military members. Those patients with persistent shoulder pain, instability, or functional limitations after a trial of conservative treatment may be considered surgical candidates. Arthroscopic posterior shoulder stabilization has demonstrated excellent clinical outcomes, high patient satisfaction, and low complication rates. Advanced techniques may be required in select cases to address bone loss, glenoid dysplasia, or revision. Posterior instability represents about 10% of shoulder instability and has become increasingly recognized and treated in military members. Nonoperative treatment is commonly unsuccessful in active patients, and surgical stabilization can be considered in patients who do not respond. Isolated posterior labral repairs constitute up to 24% of operatively treated labral repairs in a military population. Arthroscopic posterior stabilization is typically considered as first-line surgical treatment, while open techniques may be required in complex or revision settings.

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

    OpenAIRE

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

    2011-01-01

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

  16. Frozen shoulder - aftercare

    Science.gov (United States)

    ... Kuhn JE, et al. Shoulder pain and mobility deficits: adhesive capsulitis. J Orthop Sports Phys Ther . 2013; ... 2018, A.D.A.M., Inc. Duplication for commercial use must be authorized in writing by ADAM ...

  17. SHOULDER ARTHROPLASTY RECORDS

    Science.gov (United States)

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

    2015-01-01

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

  18. Milwaukee shoulder syndrome.

    Science.gov (United States)

    Dewachter, L; Aerts, P; Crevits, I; De Man, R

    2012-01-01

    Milwaukee shoulder syndrome or rapid destructive arthropathy of the shoulder is a rare form of arthropathy that mainly affects elderly women. It is characterized by a rapid destruction of the glenohumeral joint and the rotator cuff and by an important noninflammatory joint effusion containing hydroxyapatite crystals. Radiography plays an important role in the evaluation of patients with articular disease. However, magnetic resonance imaging is the method of choice for assessing the full extent of osseous, chondral, and soft-tissue involvement.

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

    Energy Technology Data Exchange (ETDEWEB)

    Rutten, Matthieu J.C.M.; Janssen, Caroline M.M.; Jager, Gerrit J. [Jeroen Bosch Hospital, Department of Radiology, ' s-Hertogenbosch (Netherlands); Collins, James M.P. [Medical Centre Leeuwarden, Department of Radiology, Leeuwarden (Netherlands); Maresch, Bas J. [Hospital Gelderse Vallei, Department of Radiology, Ede (Netherlands); Smeets, Jacques H.J.M. [Slingeland Hospital, Department of Radiology, Doetinchem (Netherlands); Kiemeney, Lambertus A.L.M. [Radboud University Nijmegen Medical Centre, Department of Epidemiology and Biostatistics, Geert Grooteplein Noord 21, P.O. Box 9101, Nijmegen (Netherlands)

    2009-03-15

    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 posterior approach (USp), fluoroscopic-guided anterior (FLa) and posterior (FLp) approach were used. Number of injection attempts, effect of contrast leakage on diagnostic quality, and total room, radiologist and procedure times were measured. Pain was documented with a visual analogue scale (VAS) pain score. Access to the joint was achieved in all patients. A successful first attempt significantly occurred more often with US (94%) than with fluoroscopic guidance (72%). Leakage of contrast medium did not cause interpretative difficulties. With US guidance mean room, procedure and radiologist times were significantly shorter (p < 0.001). The USa approach was rated with the lowest pre- and post-injection VAS scores. The four image-guided injection techniques are successful in injection of contrast material into the glenohumeral joint. US-guided injections and especially the anterior approach are significantly less time consuming, more successful on the first attempt, cause less patient discomfort and obviate the need for radiation and iodine contrast. (orig.)

  20. Shoulder impingement syndrome in relation to shoulder intensive work

    OpenAIRE

    Frost, P; Andersen, J. H.

    1999-01-01

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

  1. [Leading symptom shoulder pain].

    Science.gov (United States)

    Wittke, R

    2003-09-25

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

  2. Strength training and shoulder proprioception

    National Research Council Canada - National Science Library

    Salles, José Inácio; Velasques, Bruna; Cossich, Victor; Nicoliche, Eduardo; Ribeiro, Pedro; Amaral, Marcus Vinicius; Motta, Geraldo

    2015-01-01

    .... To evaluate the result of an 8-week strength-training program on shoulder JPS and to verify whether using training intensities that are the same or divergent for the shoulder's dynamic-stabilizer...

  3. Fabricating a shoulder somatoprosthesis.

    Science.gov (United States)

    Blumenfeld, I; Schortz, R H; Levy, M; Lepley, J B

    1981-05-01

    A technique for the fabrication of a shoulder prosthesis has been described. The prosthesis has proven to be an effective means of rehabilitating a patient following an intrascapulothoracic amputation. The patient may once again wear clothing without having it adjusted to conform to the defect. Such rehabilitation has been of great psychologic value for patients and their families as well. The impression and processing procedures are effective for the fabrication of a shoulder prosthesis. The principles of this technique may be applied to the fabrication of other large somatoprostheses.

  4. SHOULDER DISORDERS AND OCCUPATION

    Science.gov (United States)

    Linaker, CH; Walker-Bone, K

    2016-01-01

    Shoulder pain is very common and causes substantial morbidity. Standardised classification systems based upon presumed patho-anatomical origins have proved poorly reproducible and hampered epidemiological research. Despite this, there is evidence that exposure to combinations of physical workplace strains such as overhead working, heavy lifting and forceful work as well as working in an awkward posture increase the risk of shoulder disorders. Psychosocial risk factors are also associated. There is currently little evidence to suggest that either primary prevention or treatment strategies in the workplace are very effective and more research is required, particularly around the cost-effectiveness of different strategies. PMID:26612238

  5. Robotics in shoulder rehabilitation

    Science.gov (United States)

    Sicuri, Chiara; Porcellini, Giuseppe; Merolla, Giovanni

    2014-01-01

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

  6. Sleep position and shoulder pain.

    Science.gov (United States)

    Zenian, John

    2010-04-01

    The overuse theory for musculoskeletal joint pain cannot explain adequately the occurrence of shoulder pain in those who do not engage in activities that involve repeated and stressful use of the shoulder since the percentage of the painful right shoulders usually does not match the percentage of dominant right arms in such individuals. An alternative hypothesis is presented to propose that shoulder pain is caused by postural immobility in the decubitus or side position during sleep. Prolonged pressure on the shoulder caused by the weight of the thorax can produce enough damage to cause subsequent shoulder pain. In order to test this hypothesis, a preliminary study was carried out to compare the laterality of shoulder pain with the laterality of sleep position. The calculated laterality ratios for sleep position and shoulder pain were found to be strikingly similar, suggesting a causal relationship between the two phenomena. However, the prevalence of shoulder pain in the general population was found to be smaller than the percentage of the time people would spend sleeping in the decubitus position. This discrepancy could be explained by the idea that in order for shoulder pain to develop subjects may have to spend longer times in the same decubitus position before changing to another position than the average person would. Additional evidence from published clinical studies also supports the postural theory of shoulder pain. More studies can be done to test this hypothesis by focusing on the sleep habits of patients with shoulder pain. According to the present hypothesis shoulder pain should for the most part occur on the side that the patient preferred to sleep on before the onset of shoulder pain. The postural theory of shoulder pain provides the possibility for a new and noninvasive method to treat shoulder pain by the modification of posture during sleep. (c) 2009 Elsevier Ltd. All rights reserved.

  7. The Painful Shoulder: Shoulder Impingement Syndrome

    Science.gov (United States)

    Khan, Yousaf; Nagy, Mathias Thomas; Malal, Joby; Waseem, Mohammad

    2013-01-01

    Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care. The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition. Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases. A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible. PMID:24082973

  8. 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...

  9. [Arthritis of the shoulder].

    Science.gov (United States)

    Sibilia, J

    1999-09-01

    Diagnosis of shoulder arthritis should situate the precise location (glenohumeral, acromioclavicular, scapulothoracic) and rapidly determine the cause in order to eliminate the possibility of septic arthritis which requires urgent treatment. Good knowledge of shoulder symptomatology is essential. When there is joint effusion, the fluid should be sampled for rapid analysis (cells, crystals, germs), and the work-up for diagnosis must include clinical and laboratory analyses as well as imaging. Causes are especially microcrystallin arthritis (hydroxyapatite rheumatism, chondrocalcinosis, etc.) and inflammatory rheumatism (rheumatoid arthritis, ankylosis spondylitis, etc.). Septic arthritis is much less common but more rapidly destructive, which justifies their consideration whenever suspected. Treatment should be rapidly initiated in acute, particularly septic forms. In other forms, diagnosis guides treatment. Steps should be taken rapidly, both medically and sometimes surgically, to avoid destructive articular and periarticular lesions (rotator cuff).

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

    Science.gov (United States)

    Matzkin, Elizabeth; Suslavich, Kaytelin; Wes, David

    2016-08-01

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

  11. 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...

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

    OpenAIRE

    Jyoti Rinku Dilip; Vinod Babu. K; Sai Kumar. N; Akshata Akalwadi

    2016-01-01

    Background: Frozen shoulder is a painful condition with gradual restriction of all planes of movement in the shoulder joint. The purpose of the present study is to evaluate the effect of Gong’s Mobilization versus Mulligan’s Mobilization on Shoulder pain and Shoulder Medial Rotation mobility in subjects with Frozen shoulder. Methods: An Experimental study design, 40 subjects with unilateral frozen shoulder were selected and randomized 20 subjects into each of two groups- Gong’s mobilizatio...

  13. Imaging shoulder impingement

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-11-01

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

  14. Shoulder arthrodesis in 14 dogs.

    Science.gov (United States)

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

    2012-08-01

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

  15. 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.)

  16. 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

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

    Science.gov (United States)

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

    2016-03-12

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

  18. Patient perception of magnetic resonance arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Robbins, M.I.; Anzilotti, K.F. Jr.; Katz, L.D.; Lange, R.C. [Dept. of Diagnostic Radiology, Yale University School of Medicine, New Haven, CT (United States)

    2000-05-01

    Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients' perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection.Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including ''pain'', ''needles'', ''complications'', and ''discovery of results that would lead to surgery''. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain.Results. While many patients expressed fear of ''pain'' and ''needles'', after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected.Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort. (orig.)

  19. Shoulder Problems: Symptom Checker Flowchart

    Science.gov (United States)

    ... your upper arm swollen or misshaped?YesNoIs your collarbone tender, or do you have a bump on ... or pain near the shoulder-end of your collarbone, and does lifting your arm with your uninjured ...

  20. 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

  1. Arthroscopic findings after shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Medenica Ivica

    2009-01-01

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

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

    Science.gov (United States)

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

    2014-02-01

    The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and "frozen" shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. Strength training and shoulder proprioception.

    Science.gov (United States)

    Salles, José Inácio; Velasques, Bruna; Cossich, Victor; Nicoliche, Eduardo; Ribeiro, Pedro; Amaral, Marcus Vinicius; Motta, Geraldo

    2015-03-01

    Proprioception is essential to motor control and joint stability during daily and sport activities. Recent studies demonstrated that athletes have better joint position sense (JPS) when compared with controls matched for age, suggesting that physical training could have an effect on proprioception. To evaluate the result of an 8-week strength-training program on shoulder JPS and to verify whether using training intensities that are the same or divergent for the shoulder's dynamic-stabilizer muscles promote different effects on JPS. Randomized controlled clinical trial. We evaluated JPS in a research laboratory and conducted training in a gymnasium. A total of 90 men, right handed and asymptomatic, with no history of any type of injury or shoulder instability. For 8 weeks, the participants performed the strength-training program 3 sessions per week. We used 4 exercises (bench press, lat pull down, shoulder press, and seated row), with 2 sets each. We measured shoulder JPS acuity by calculating the absolute error. We found an interaction between group and time. To examine the interaction, we conducted two 1-way analyses of variance comparing groups at each time. The groups did not differ at pretraining; however, a difference among groups was noted posttraining. Strength training using exercises at the same intensity produced an improvement in JPS compared with exercises of varying intensity, suggesting that the former resulted in improvements in the sensitivity of muscle spindles and, hence, better neuromuscular control in the shoulder.

  4. Soft tissue balancing in total shoulder replacement.

    Science.gov (United States)

    Mueller, Maike; Hoy, Gregory

    2014-03-01

    Total shoulder arthroplasty is now capable of recreating near anatomic reproduction of native bony shoulder anatomy, but the function and longevity of anatomic shoulder replacement is dependent on a competent soft tissue envelope and adequate motoring of all musculo-tendinous units about the shoulder. Balancing the soft tissues requires understanding of the anatomy and pathology, as well as technical skills. The advent of reverse shoulder biomechanics has brought with it special requirements of understanding of the soft tissue elements still left in the shoulder despite major rotator cuff deficiency.

  5. Shoulder Injuries in US Astronauts Related to EVA Suit Design

    Science.gov (United States)

    Scheuring, Rick; McCulloch, Pat; Van Baalen, Mary; Watson, Richard; Bowen, Steve; Blatt, Terri

    2012-01-01

    There are multiple factors associated with the mechanism of injury that leads to shoulder injury requiring surgical repair. Despite the injury prevention measures taken from the 2003 Shoulder Tiger Team recommendations, shoulder injuries and subsequent shoulder surgeries remain relatively unchanged.

  6. Clinical Evaluation of the TITAN™ Total Shoulder System

    Science.gov (United States)

    2018-02-14

    Arthritis; Arthritis, Degenerative; Rheumatoid Arthritis; Post-traumatic Arthrosis of Other Joints, Shoulder Region; Rotator Cuff Syndrome of Shoulder and Allied Disorders; Fracture; Avascular Necrosis; Joint Instability; Joint Trauma; Dislocation, Shoulder; Pain, Shoulder

  7. Simultaneous shoulder and elbow dislocation.

    Science.gov (United States)

    Cobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih

    2014-05-23

    Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice. 2014 BMJ Publishing Group Ltd.

  8. Painful Shoulder in Swimmers: A Diagnostic Challenge.

    Science.gov (United States)

    McMaster, William C.

    1986-01-01

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

  9. Use of soil stabilizers on highway shoulders.

    Science.gov (United States)

    2005-01-01

    This study evaluated soil additives as stabilizers for aggregate and topsoil shoulders. Its purpose was to determine (1) the effect soil stabilizers have on the strength and stability of soil shoulders, and (2) the costs and benefits of using stabili...

  10. 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....

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  12. Neurovascular injuries to the shoulder.

    Science.gov (United States)

    Baker, C L; Liu, S H

    1993-07-01

    The throwing athlete is at risk for neurovascular injuries of the shoulder because of the excessive demands placed upon the shoulder by repetitive throwing motions. The most commonly recognized neurovascular compression syndromes are axillary artery occlusion, effort thrombosis, quadrilateral space syndrome, and thoracic outlet syndrome. Diagnosis is aided by the use of the Adson's test, costoclavicular maneuver, and hyperabduction maneuver. Initial treatment usually is nonoperative. Anticoagulation or thrombolytic therapy can be used for vascular occlusion. Surgery usually is reserved for patients suffering acute or chronic symptoms despite nonoperative treatment. With proper treatment, most patients are able to resume their previous athletic activities in a timely manner with minimal disability.

  13. Arthroscopic Findings in Anterior Shoulder Instability

    OpenAIRE

    Hantes, Michael; Raoulis, Vasilios

    2017-01-01

    Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthros...

  14. Gimbaled-shoulder friction stir welding tool

    Science.gov (United States)

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

    2010-01-01

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

  15. Shoulder fusion for paralyzed upper limb

    NARCIS (Netherlands)

    Emmelot, CH; Nielsen, HKL; Eisma, WH

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

  16. Frozen shoulder and risk of cancer

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  17. 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)

  18. 49 CFR 572.184 - Shoulder assembly.

    Science.gov (United States)

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Shoulder assembly. 572.184 Section 572.184... Dummy, 50th Percentile Adult Male § 572.184 Shoulder assembly. (a) The shoulder (175-3000) is part of the body assembly shown in drawing 175-0000. When subjected to impact tests specified in paragraph (b...

  19. Labral and cartilage abnormalities in young patients with hip pain: accuracy of 3-Tesla indirect MR arthrography

    Energy Technology Data Exchange (ETDEWEB)

    Petchprapa, Catherine N.; Rybak, Leon D. [NYU Langone Medical Center-Hospital for Joint Diseases, Department of Radiology, New York, NY (United States); Dunham, Kevin S.; Recht, Michael P. [NYU Langone Medical Center, Department of Radiology, New York, NY (United States); Lattanzi, Riccardo [NYU Langone Medical Center, The Bernard and Irene Schwartz Center for Biomedical Imaging, New York, NY (United States)

    2015-01-15

    Assess the diagnostic accuracy of 3-T indirect magnetic resonance arthrography (iMRA) for hip cartilage and labral pathology detection using arthroscopy as the reference standard and compare it to the published performance of direct magnetic resonance arthrography (dMRA). Between 2009 and 2011, 290 patients suspected of having femoroacetabular impingement underwent iMRA. Our study group consisted of 41 of these patients (17 males, mean age 35 years; 24 females, mean age 33 years) who did not have a prior history of hip surgery and who subsequently underwent arthroscopy. Two experienced musculoskeletal radiologists separately evaluated the randomized and anonymized studies for the presence and quadrant location of labral and cartilage pathology. These recorded data were compared to arthroscopic reports. Forty-one patients had labral pathology, 34 patients had acetabular and 5 patients had femoral cartilage pathology at arthroscopy. Sensitivity, specificity, accuracy, negative- and positive-predictive values for labral lesion detection were respectively 98, 99, 99, 99 and 98 %; for acetabular cartilage lesion detection they were 69, 98, 89, 87 and 95 %; for femoral cartilage lesion detection they were 69, 95, 93 and 39 %. Sensitivities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum were 100.0, 95.0, NA and 85.7 %, for acetabular cartilage were NA, 58.8, NA and 39.5 % and for femoral cartilage were 50.0, 33.3, 75.0 and 75.0 %. NA indicates results not available because of the absence of findings in those quadrants. Specificities of iMRA by quadrant (anteroinferior, anterosuperior, posteroinferior, posterosuperior) for the labrum (95.0, 100.0, 95.1, 67.5 %), acetabular (100.0, 85.7, 92.6, 79.5 %) and femoral cartilage (100.0, 94.7, 96.2, 85.9 %). iMRA at 3 T is accurate in detecting labral pathology suggesting that it is a viable alternative to dMRA. (orig.)

  20. [Shoulder dystocia: an obstetrical emergency].

    Science.gov (United States)

    Marques, Joana Borges; Reynolds, Ana

    2011-01-01

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

  1. History of shoulder instability surgery.

    Science.gov (United States)

    Randelli, Pietro; Cucchi, Davide; Butt, Usman

    2016-02-01

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

  2. Throwing Injuries of the Shoulder.

    Science.gov (United States)

    McCue, Frank C., III; and Others

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

  3. EAMJ April Shoulders.indd

    African Journals Online (AJOL)

    2009-04-04

    Apr 4, 2009 ... common condition while septic arthritis and avascular necrosis were least diagnosed. 22.7% of the subjects .... Physical therapy was also initiated. ... around the joint. Table 4. Treatment modalities in patients with shoulder pain syndrome. Treatment modality. No. (%). Intra articular steroids+NSAIDs. 43 65.1.

  4. Using your shoulder after surgery

    Science.gov (United States)

    ... Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 45. Wilk KE, Macrina LC, Arrigo C. Shoulder rehabilitation. In: Andrews JR, Harrelson GL, Wilk KE, eds. ...

  5. Management of the frozen shoulder

    Directory of Open Access Journals (Sweden)

    van de Laar SM

    2014-10-01

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

  6. Acute Shoulder Injuries in Adults.

    Science.gov (United States)

    Monica, James; Vredenburgh, Zachary; Korsh, Jeremy; Gatt, Charles

    2016-07-15

    Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary.

  7. Shoulder pain syndrome among Nigerians.

    Science.gov (United States)

    Adelowo, O O; Oguntona, S; Ojo, O

    2009-04-01

    To identify aetiological causes of shoulder pain syndrome among patients attending a rheumatology clinic, and to highlight the therapeutic options. Retrospective study. A private rheumatology clinic in Lagos, Nigeria fromJanuary 2002 to December 2006. Forty female adult patients and 26 male adult patients aged 24-79 years. Patient reported outcome in terms of pain relief and increased mobility. Sixty six subjects were seen during the study period. Females were more commonly affected and were mostly middle aged. Adhesive capsulitis was the most common condition while septic arthritis and avascular necrosis were least diagnosed 22.7% of the subjects could not, however, be categorised. Shoulder pain syndrome is common among Nigerians. Diagnosis and management are mostly based on the clinical presentations, especially considering the lack of sensitivity of plain radiographs and the high cost of more sensitive MRI. The treatment of these conditions are standard.

  8. The nerves around the shoulder

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-01-15

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

  9. The nerves around the shoulder.

    Science.gov (United States)

    Blum, Alain; Lecocq, Sophie; Louis, Matthias; Wassel, Johnny; Moisei, Andreea; Teixeira, Pedro

    2013-01-01

    Neuropathies of the shoulder are considered to be entrapment syndromes. They are relatively common, accounting for about 2% of cases of sport-related shoulder pain. Many instances involve suprascapular neuropathy, but the clinical diagnosis is often delayed because of nonspecific symptoms. Classically, EMG is the gold standard investigation but MRI currently reveals muscular abnormality in 50% of cases. Muscle edema, the most characteristic symptom, is nonspecific. In general, the topography of edema, the presence of a lesion compressing the nerve and clinical history contribute to the diagnosis. Although atrophy and fatty degeneration may persist after the disappearance of edema, they are rarely symptomatic. The main differential diagnosis is Parsonage-Turner syndrome. Evidence of a cyst pressing on a nerve may prompt puncture-infiltration guided by ultrasonography or CT-scan. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  10. Central Hypersensitivity in Chronic Hemiplegic Shoulder Pain

    Science.gov (United States)

    Hoo, Jennifer Soo; Paul, Tracy; Chae, John; Wilson, Richard

    2013-01-01

    Objective This study aimed to examine the association of hemiplegic shoulder pain with central hypersensitivity through pressure-pain thresholds (PPT) at healthy, distant tissues. Design This study is a cross-sectional study. A total of 40 patients (n=20 hemiplegic shoulder pain (HSP), n=20 stroke without HSP) were enrolled in this study. Pressure-pain thresholds were measured at the affected deltoid and contralateral deltoid and tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs. Results Subjects with hemiplegic shoulder pain had lower local PPTs than stroke control subjects when comparing the painful to dominant shoulders and comparing the non-painful shoulder and tibialis anterior to the non-dominant side controls. Similarly, those with hemiplegic shoulder pain had lower PPTs when comparing to controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. Conclusions Subjects with hemiplegic shoulder pain have lower local and distal PPTs than subjects without hemiplegic shoulder pain. Our study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this hemiplegic shoulder pain. PMID:23255268

  11. Shoulder injuries from attacking motion

    Science.gov (United States)

    Yanagi, Shigeru; Nishimura, Tetsu; Itoh, Masaru; Wada, Yuhei; Watanabe, Naoki

    1997-03-01

    Sports injuries have bothered professional players. Although many medical doctors try to treat injured players, to prevent sports injuries is more important. Hence, it is required to clear a kinematic mechanism of the sport injuries. A shoulder of volleyball attacker or baseball pitcher is often inured by playing motion. The injuries are mainly caused at the end of long head tendon, which is located in the upper side of scapula. Generally, a muscle and tendon have enough strength against tensile force, however, it seems that they are sometimes defeated by the lateral force. It is imagined that the effect of the lateral force has a possibility of injuring the tendon. If we find the influence of the lateral force on the injured portion, the mechanism of injuries must be cleared. In our research, volleyball attacking motion is taken by high speed video cameras. We analyze the motion as links system and obtain an acceleration of an arm and a shoulder from video image data. The generated force at a shoulder joint is calculated and resolved into the lateral and longitudinal forces. Our final goal is to discuss a possibility that the lateral force causes the injuries.

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  13. Gimballed Shoulders for Friction Stir Welding

    Science.gov (United States)

    Carter, Robert; Lawless, Kirby

    2008-01-01

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

  14. Problem of painful shoulder in hemiparetics patients

    OpenAIRE

    Daumann, Pavla

    2013-01-01

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

  15. Arthroscopic Findings in Anterior Shoulder Instability.

    Science.gov (United States)

    Hantes, Michael; Raoulis, Vasilios

    2017-01-01

    In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly ( e.g . anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of clinical and functional outcomes to the

  16. 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.

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2011-11-01

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

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

    OpenAIRE

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

    2008-01-01

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

  20. Optimal management of shoulder impingement syndrome

    National Research Council Canada - National Science Library

    Escamilla, Rafael; Hooks, Todd; Wilk, Kevin

    2014-01-01

    ...; 4Champion Sports Medicine, Birmingham, AL, USA Abstract: Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities...

  1. Emergency department management of shoulder dystocia.

    Science.gov (United States)

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

    2014-03-01

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

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

    Science.gov (United States)

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

    2017-06-15

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

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  4. [Adhesive capsulitis of the shoulder].

    Science.gov (United States)

    Revel, M; Ghanem, N

    1999-09-01

    Adhesive capsulitis is a painful stiff shoulder due to the thickening of the capsule and synovium. The main observed changes are hyperhaemia of the synovium and a capsular fibrosis similar to that of Dupuytren's disease. Stiffness involves mainly flexion, lateral rotation and abduction. In most cases, a spontaneous healing is observed within 12 to 30 months. When the capsulitis is disabling and pain still present, a joint distension followed by rehabilitation can be indicated. When the disability is important and mainly due to stiffness, a manipulation under anesthesia with or without arthroscopic release of soft tissues can be indicated.

  5. Radiographic evaluation of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Goud, Ajay [Division of Musculoskeletal Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: mskrads@gmail.com; Segal, Dmitri [Division of Musculoskeletal Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: dsegal1@partners.org; Hedayati, Pejman [Division of Musculoskeletal Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: phedayati@partners.org; Pan, John J. [Division of Musculoskeletal Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: jjpan@partners.org; Weissman, Barbara N. [Harvard Medical School, Department of Radiology, Brigham and Women' s Hospital, 75 Francis Street, Boston, MA 02115 (United States)], E-mail: bweissman@partners.org

    2008-10-15

    Imaging evaluation of shoulder disorders should begin with radiographs. Several radiographic projections have been developed to best show areas affected by particular clinical disorders. This paper reviews the radiographic examinations that are used at our hospital for evaluating arthritis, impingement, trauma and instability. The techniques used to obtain each of these radiographs are briefly described to better understand the resulting images. An organized approach to assessment of these radiographs is delineated including evaluation of the ABCs (alignment, bone density, cartilage spaces and soft tissues). The expected radiographic findings in normal individuals and in patients with common abnormal conditions are reviewed.

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

    Directory of Open Access Journals (Sweden)

    Jyoti Rinku Dilip

    2016-02-01

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

  7. Rheumatoid shoulder assessed by ultrasonography: prevalence of ...

    African Journals Online (AJOL)

    Introduction: The shoulder involvement in rheumatoid arthritis (RA) is common. It can be subclinical and compromise the function of the upper limb. Musculoskeletal ultrasonography can detect subclinical abnormalities in rheumatoid shoulder. Our aim was to assess the prevalence of ultrasound abnormalities in rheumatoid ...

  8. 14 CFR 91.521 - Shoulder harness.

    Science.gov (United States)

    2010-01-01

    ... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Shoulder harness. 91.521 Section 91.521 Aeronautics and Space FEDERAL AVIATION ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) AIR TRAFFIC... Airplanes and Fractional Ownership Program Aircraft § 91.521 Shoulder harness. (a) No person may operate a...

  9. [Classification and diagnostics of unstable shoulders].

    Science.gov (United States)

    Greiner, S; Herrmann, S; Gerhardt, C; Scheibel, M

    2009-01-01

    Shoulder instability includes a vast spectrum of different manifestations ranging from painful hyperlaxity to chronic locked shoulder dislocations. A correct diagnosis and classification is essential to establish an adequate treatment strategy. The correct use of different clinical tests and signs in combination with the corresponding imaging diagnostics allows an explicit classification and therefore the correct choice of treatment regimes in the majority of cases.

  10. Return to sports after shoulder arthroplasty

    Science.gov (United States)

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

    2016-01-01

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

  11. Eponymous terms in anterior shoulder stabilization surgery

    NARCIS (Netherlands)

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

    2017-01-01

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

  12. Frozen shoulder or missed posterior dislocation?

    African Journals Online (AJOL)

    posterior shoulder dislocation or adhesive capsulitis. Discussion. PSD is a rare entity. Incidence is approximately 2 - 5% of all shoulder dislocations.[1] Most often PSD is the result of an epileptic seizure. Less frequent causes are seizures due to alcoholic withdrawal or other metabolic disorders, electrocution or during a ...

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

    DEFF Research Database (Denmark)

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

    2002-01-01

    BACKGROUND: Few studies relate the occurrence of shoulder disorders to quantified ergonomic exposures. This study evaluates the hypothesis that shoulder loads in repetitive work might contribute to the occurrence of shoulder tendinitis. METHODS: This is a cross-sectional study of 1961 workers...... in repetitive work and 782 referents. Shoulder loads were quantified at task level and measures of exposures were assigned based on task distribution. Symptoms in combination with clinical criteria defined shoulder tendinitis. RESULTS: The prevalence of shoulder tendinitis was higher among exposed workers...... risk slightly (OR 1.6, 95% CI 1.0-2.6 per unit). CONCLUSIONS: The results indicate that workers with repetitive tasks have increased risk of shoulder tendinitis, which partially can be attributed to force requirements...

  14. 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.

  15. Head kinematics and shoulder biomechanics in shoulder impacts similar to pedestrian crashes--a THUMS study.

    Science.gov (United States)

    Paas, Ruth; Davidsson, Johan; Brolin, Karin

    2015-01-01

    Head injuries account for the largest percentage of fatalities among pedestrians in car crashes. To prevent or mitigate such injuries, safety systems that reduce head linear and rotational acceleration should be introduced. Human body models (HBMs) are valuable safety system evaluation tools for assessing both head injury risk and head kinematics prior to head contact. This article aims to evaluate the suitability of the Total Human Model for Safety (THUMS) version 4.0 for studying shoulder impacts, similar to pedestrian crashes, investigating head, spine, and shoulder kinematics as well as shoulder biomechanics. Shoulder impact experiments including volunteers and postmortem human subjects (PMHSs) were simulated with THUMS. Head linear and angular and vertebral linear displacements of THUMS were compared with volunteers and shoulder deflections with both volunteers and PMHSs. A parameter variation study was conducted to assess head response to shoulder impacts, by varying shoulder posture and impact directions mimicking shoulder-to-vehicle contacts. Functional biomechanics literature was compared with THUMS responses in view of pedestrian-like shoulder impacts. THUMS head linear displacement compared better with tensed than with relaxed volunteers. Head lateral rotation was comparable with volunteer responses up to 120 ms; head twist was greater in THUMS than in the volunteers. The THUMS spine appeared to be stiffer than in the volunteers. Shoulder deflections were smaller than in the relaxed volunteers but matched the PMHSs. Raised shoulder postures decreased the THUMS shoulder deflections and increased head lateral displacements. When the impactor surface orientation or the impact velocity angle was changed from lateral to superolateral, THUMS head lateral displacement decreased. THUMS scapula and clavicle kinematics compared well with previous experimental studies. The shoulder impact conditions influenced the scapula motion over the thorax, which had

  16. Shoulder posture and median nerve sliding

    Directory of Open Access Journals (Sweden)

    Dilley Andrew

    2004-07-01

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

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

    Science.gov (United States)

    Marcondes, Freddy B; de Jesus, Julio F; Bryk, Flavio F; de Vasconcelos, Rodrigo A; Fukuda, Thiago Y

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Freddy B. Marcondes

    2013-04-01

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

  19. Competency based clinical shoulder examination training improves physical exam, confidence, and knowledge in common shoulder conditions.

    Science.gov (United States)

    Hose, Michal Kalli; Fontanesi, John; Woytowitz, Manjulika; Jarrin, Diego; Quan, Anna

    2017-11-01

    Deficiencies in musculoskeletal knowledge are reported at every stage of learning. Medical programs are looking for effective ways to incorporate competency-based training into musculoskeletal education. To evaluate the impact of bedside feedback on learner's shoulder examination skills, confidence, and knowledge of common shoulder conditions. Four-week musculoskeletal clinic rotation. UCSD third year medical students and internal medicine residents. Learners completed three baseline evaluations: videotaped shoulder examination, attitude survey, and knowledge test. During the 4-week intervention learners received bedside observation and feedback from musculoskeletal experts while evaluating patients with shoulder conditions. Post-intervention learners repeated the three assessments. Eighty-nine learners participated. In the primary outcome measure evaluating the pre/post videotaped shoulder examination, significant improvement was seen in 21 of 23 shoulder examination maneuvers. Secondary outcomes include changes in learner confidence and knowledge. Greatest gains in learner confidence were seen in performing the shoulder examination (61.5% improvement) and performing injections (97.1% improvement). Knowledge improved significantly in all categories including anatomy/examination interpretation, diagnosis, and procedures. Direct observation and feedback during clinical evaluation of patients with shoulder pain improves shoulder examination competency, provider confidence, and knowledge of common shoulder conditions.

  20. An entropy-assisted musculoskeletal shoulder model.

    Science.gov (United States)

    Xu, Xu; Lin, Jia-Hua; McGorry, Raymond W

    2017-04-01

    Optimization combined with a musculoskeletal shoulder model has been used to estimate mechanical loading of musculoskeletal elements around the shoulder. Traditionally, the objective function is to minimize the summation of the total activities of the muscles with forces, moments, and stability constraints. Such an objective function, however, tends to neglect the antagonist muscle co-contraction. In this study, an objective function including an entropy term is proposed to address muscle co-contractions. A musculoskeletal shoulder model is developed to apply the proposed objective function. To find the optimal weight for the entropy term, an experiment was conducted. In the experiment, participants generated various 3-D shoulder moments in six shoulder postures. The surface EMG of 8 shoulder muscles was measured and compared with the predicted muscle activities based on the proposed objective function using Bhattacharyya distance and concordance ratio under different weight of the entropy term. The results show that a small weight of the entropy term can improve the predictability of the model in terms of muscle activities. Such a result suggests that the concept of entropy could be helpful for further understanding the mechanism of muscle co-contractions as well as developing a shoulder biomechanical model with greater validity. Copyright © 2017 Elsevier Ltd. All rights reserved.

  1. [Shoulder disability questionnaires: a systematic review].

    Science.gov (United States)

    Fayad, F; Mace, Y; Lefevre-Colau, M M

    2005-07-01

    To identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality. We used the Medline database and the "Guide des outils de mesure de l'évaluation en médecine physique et de réadaptation" textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health. Thirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires. Numerous shoulder outcome measure instruments are available. There is no "gold standard" for assessing shoulder function outcome in the general population.

  2. Shoulder stiffness and rotator cuff repair.

    Science.gov (United States)

    Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Gallo, Andrea; Maffulli, Nicola; Denaro, Vincenzo

    2012-01-01

    Shoulder stiffness is a frequent complication of surgical repair of rotator cuff tears. Post-operative stiffness negatively affects surgical outcomes leading to a substantial comorbidity and to the failure of surgical treatment. Also, a stiff shoulder could commonly be concomitant with an rotator cuff tear (RCT). We performed a comprehensive search of CINAHL, Embase, Medline and the Cochrane Central Registry of Controlled Trials, from inception of the database to 31 July 2011. Sixteen articles published in peer-reviewed journals were included in this comprehensive review. The management of shoulder stiffness is still controversial. The role of rehabilitation programs (standard versus early passive mobilization) after RCT repair on the development of stiffness is not clear, while the role of arthroscopic capsular release for post-operative stiffness is better defined, although a threshold of decreased the range of movement for which capsular release is advised has not been identified. Several factors have been identified to predispose the development of shoulder stiffness. There is also evidence in favor of surgical management of RCTs even when accompanied by shoulder stiffness, and there are strong evidences that arthroscopic capsular release is reliable and effective in managing shoulder stiffness. The post-operative rehabilitation protocol remains controversial. We are still far from definitive guidelines for the management of pre- and post-operative stiffness, and prospective double-blinded randomized clinical trials are needed to obtain evidence allowing to establish a reliable and effective management plan for shoulder stiffness.

  3. Bleeding in primary shoulder arthroplasty.

    Science.gov (United States)

    Malcherczyk, Dominik; Abdelmoula, Asma; Heyse, Thomas J; Peterlein, Christian D; Greene, Brandon; El-Zayat, Bilal F

    2017-12-06

    The aim of this investigation was to analyse "total blood loss" (TBL), "blood transfusion rate" (BT) and the "amount of transfused blood units" (BU) between the different primary shoulder arthroplasty (SA) types: reverse, anatomical and stemless. Only primary SA was included. Further goal was to identify risk factors for TBL, amount of BU and BT rate. A retrospective charts analysis of patients who received primary SA for degenerative shoulder pathology in our institution between 2004 and 2016 was performed. The demographic data, co-morbidities, haemoglobin and hematocrit level, BT rate, amount of transfused BU etc. were collected. TBL was estimated. Linear regression, log-linear poisson regression and logistic regression were used to compare the outcomes TBL, amount of transfused BU and BT rate, respectively, between different prosthesis types. Of 278 patients included in this study 209 received reverse, 57 anatomical and 12 stemless SA. Mean TBL was 392.7 ml in reverse, 394.6 ml in anatomical and 298.3 ml in stemless SA. The BT rate and mean amount of BU were, respectively, 14.4% and 0.32 in reverse and 8.77% and 0.23 in anatomical SA. None of the patients with stemless arthroplasty received BT. Significant risk factors for elevated TBL are operation time, higher BMI, male sex. Significant risk parameters for BT and higher amount of transfused BU are low BMI, cemented arthroplasty, coronary heart disease, ASA score > 2 and previous therapy with vitamin K antagonists. Although there were little differences between the blood transfusion rates in reverse vs. anatomical arthroplasty, there was no difference in total blood loss between these different prosthesis types. None of the patients with stemless arthroplasty received blood transfusion. There are various risk factors affecting total blood loss and blood transfusion rate. However, risk parameters influencing blood transfusion may be different to them affecting total blood loss.

  4. Imaging of bursae around the shoulder joint

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-08-01

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

  5. Anatomy and Biomechanics of the Unstable Shoulder.

    Science.gov (United States)

    Cuéllar, Ricardo; Ruiz-Ibán, Miguel Angel; Cuéllar, Adrián

    2017-01-01

    To review the anatomy of the shoulder joint and of the physiology of glenohumeral stability is essential to manage correctly shoulder instability. It was reviewed a large number of recently published research studies related to the shoulder instability that received a higher Level of Evidence grade. It is reviewed the bony anatomy, the anatomy and function of the ligaments that act on this joint, the physiology and physiopathology of glenohumeral instability and the therapeutic implications of the injured structures. This knowledge allows the surgeon to evaluate the possible causes of instability, to assess which are the structures that must be reconstructed and to decide which surgical technique must be performed.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    OpenAIRE

    Wensing Michel; Stegenga Boudewijn; Dommerholt Jan; Bron Carel; Oostendorp Rob AB

    2011-01-01

    Abstract Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment target...

  8. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders.

    Science.gov (United States)

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

    2015-02-01

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

  9. Unrecognized shoulder disorders in treatment of cervical spondylosis presenting neck and shoulder pain.

    Science.gov (United States)

    Jo, Hyun-Jin; Shin, Myung-Hoon; Hur, Jung-Woo; Kim, Jin-Sung; Ryu, Kyeong-Sik; Park, Chun-Kun

    2012-09-01

    Cervical spondylosis and shoulder disorders share with neck and shoulder pain. Differentiating between the two can be challenging and patient with combined pathologies is less likely to have pain improvement even after successful cervical operation. We investigated clinical characteristics of the patients who were diagnosed as cervical spondylosis however, were turned out to have shoulder disorders or the patients whose pain was solely originated from shoulder. Between January 2008 and October 2009, the patients presenting neck and shoulder pain with diagnosis of cervical spondylosis were enrolled. Among them, the patients who met following inclusion criteria were grouped into shoulder disorder group and the others were into cervical spondylosis group. Inclusion criteria were as follows. (1) To have residual or unresponsive neck and shoulder pain despite of optimal surgical treatment due to concomitant shoulder disorders. (2) When the operation was cancelled for the reason that shoulder and neck pain was proved to be related with unrecognized shoulder disorders. The authors retrospectively reviewed and compared clinical characteristics, level of pathology, diagnosis of cervical spondylosis and shoulder disorders. A total of 96 patients were enrolled in this study. Shoulder disorder group was composed of 15 patients (15.8%) and needed additional orthopedic treatment. Cervical spondylosis group was composed of 81 patients (84.2%). There was no significant differences in mean age, sex ratio and major diagnosis in both shoulder disorder and cervical spondylosis group (p=0.33, 0.78, and 0.68 respectively). However, the distribution of pathologic levels was found to be significantly different (p=0.03). In shoulder disorder group, the majority of lesions (15 of 19 levels, 78.9%) were located at the level of C4-5 (36.8%) and C5-6 (42.1%). On the other hand, in cervical spondylosis group, C5-6 (39.0%) and C6-7 (37.1%) were the most frequently observed level of lesions (80

  10. Handball load and shoulder injury rate

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  11. MRI findings in the painful hemiplegic shoulder

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-10-15

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

  12. Subacromial shoulder disorders among baggage handlers

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  13. [Neonatal complications related to shoulder dystocia].

    Science.gov (United States)

    Lopez, E; de Courtivron, B; Saliba, E

    2015-12-01

    To describe neonatal complications related to shoulder dystocia. This systematic evidence review is based on PubMed search, Cochrane library and experts' recommendations. The risks of brachial plexus birth injury, clavicle and humeral fracture, perinatal asphyxia, hypoxic-ischemic encephalopathy and perinatal mortality are increased after shoulder dystocia. The medical team should be able to provide neonatal resuscitation in the delivery room in case of perinatal asphyxia following shoulder dystocia, according to national and international guidelines. The initial clinical examination should search for complications such as brachial plexus birth injury or clavicle fracture. The risk of perinatal complications is increased in newborn after shoulder dystocia. The medical team should be able to manage these complications. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. Pseudotumors of the shoulder invited review

    Energy Technology Data Exchange (ETDEWEB)

    Anderson, Suzanne E. [Department of Radiology, Royal Melbourne Hospital and University of Melbourne, Grattan Street, Parkville 3050, Melbourne, Victoria (Australia); Department of Diagnostic, Pediatric, and Interventional Radiology, University Hospital of Bern, Inselspital, Freiburg Str. 10, 3005 Bern (Switzerland)], E-mail: andersonsembach@yahoo.com.au; Johnston, James O. [Department of Radiology, Bone Section, University of California, San Francisco (United States); Tumour Oncology, Orthopedic Surgery, Kaiser Health, Bay Area, San Francisco (United States); Steinbach, Lynne S. [Department of Radiology, Bone Section, University of California, San Francisco (United States)

    2008-10-15

    This paper discusses the main types of MRI pseudotumors in and around the shoulder region. Some unusual types of pseudotumor will also be mentioned. Suggestions on how to improve awareness and diagnosis are also given.

  15. Shoulder Impingement/Rotator Cuff Tendinitis

    Science.gov (United States)

    ... by the American Academy of Orthopaedic Surgeons. .org Shoulder Impingement/Rotator Cuff Tendinitis cont. Page ( 2 ) Symptoms Rotator cuff pain commonly causes local swelling and tenderness in the ...

  16. Total shoulder replacement in rheumatoid arthritis

    DEFF Research Database (Denmark)

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

    1996-01-01

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

  17. MRI findings in the painful hemiplegic shoulder.

    Science.gov (United States)

    Távora, D G F; Gama, R L; Bomfim, R C; Nakayama, M; Silva, C E P

    2010-10-01

    To evaluate the magnetic resonance imaging (MRI) findings in painful hemiplegic shoulder (PHS) in hemiplegic post-stroke patients. Patients with hemiplegia following their first cerebrovascular accident who were admitted to the Sarah Network of Hospitals for Rehabilitation were studied. Forty-five patients with pain in the hemiplegic shoulder and 23 post-stroke patients without shoulder pain were investigated. MRI and radiographic findings of the hemiplegic and contralateral asymptomatic shoulders were evaluated. Some MRI findings were more frequent in PHS group, including synovial capsule thickening, synovial capsule enhancement, and enhancement in the rotator cuff interval. Adhesive capsulitis was found to be a possible cause of PHS. Copyright (c) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  18. Using your shoulder after replacement surgery

    Science.gov (United States)

    ... FM, Beaty JH, Canale ST, eds. Campbell's Operative Orthopaedics . 13th ed. Philadelphia, PA: Elsevier; 2017:chap 12. Wilk KE, Macrina LC, Arrigo C. Shoulder rehabilitation. In: Andrews JR, Harrelson GL, Wilk KE, eds. ...

  19. Severe shoulder tendinopathy associated with levofloxacin

    National Research Council Canada - National Science Library

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

    2012-01-01

    .... The case of a 63-year-old previously asymptomatic female patient who developed severe left shoulder tendinopathy after surreptitiously doubling the prescribed dose of levofloxacin for the treatment...

  20. Questions and Answers About Shoulder Problems

    Science.gov (United States)

    ... https://www.rheumatology.org American Orthopaedic Society for Sports Medicine Website: https://www.sportsmed.org American Physical Therapy Association Website: https://www.apta.org American Shoulder ...

  1. 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.

  2. Sports activity after anatomical total shoulder arthroplasty.

    Science.gov (United States)

    Schumann, Katrin; Flury, Matthias P; Schwyzer, Hans-Kaspar; Simmen, Beat R; Drerup, Susann; Goldhahn, Joerg

    2010-10-01

    Implant functionality has clearly increased over the past decades because of improvements in total shoulder arthroplasty systems. This means that prostheses are now being implanted in younger patients with high sports activity. The implantation of the total shoulder arthroplasty does not mainly influence the sports activity. Case series; Level of evidence, 4. One hundred consecutive patients with unilateral total shoulder arthroplasty, followed for at least 1 year, were included in the study. Assessment preoperatively and 1 year and 2 years after operation included clinical examination and a validated questionnaire (Constant, Shoulder Pain and Disability Index [SPADI], and Disabilities of the Arm, Shoulder and Hand [DASH] scores, and the Short Form 36 [SF-36]). In addition, all patients received a sports questionnaire developed in house. Of the 55 patients who took part in sports before having shoulder disease, 49 (89%) were still able to participate after a mean follow-up of 2.8 years (range, 1.3-4.6 years). Seventeen patients had given up sports before total shoulder arthroplasty; 11 of them resumed activities after joint replacement but 6 did not start again. No patient had to stop sports because of the total shoulder arthroplasty. The sports most commonly mentioned were swimming (10 patients [20.4%]), golf (8 patients [16.3%]), cycling (8 patients [16.3%]), and fitness training (8 patients [16.3%]). Strength and range of motion, as well as the physical component summary (PCS) of the SF-36 and the Constant score (CS) after total shoulder arthroplasty, were significantly better in the sports group (49 of 100; PCS = 46, CS = 77) than in the nonsports group (45 of 100; PCS = 41,CS = 71). Eighteen patients (36.7%) stated that even after joint replacement, they still suffered restrictions on their sports activities because of shoulder problems. Whereas the overall mean age at follow-up was 68.9 years (range, 26-92 years), the mean age of patients participating in

  3. Impingement syndrome and pain of shoulder joint

    OpenAIRE

    Švingrová, Eva

    2014-01-01

    Name: Eva Švingrová Supervisor: Mgr. Bc. Milena Valenová Opponent: Title of bachelor thesis: Impingement syndrom and pain of shoulder joint ABSTRACT The topic of this thesis was focused on the characteristics, course and the treatment of the impingement syndrome and the other kinds of shoulder joint pain. The aim was to objectify the data from the therapy using goniometric measurements and demonstrate the possitive effect of the physiotherapy on the increased range of movement and decreased p...

  4. 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...... lesion also showed poor agreement. Pain during muscle contraction showed moderate agreement. The agreement of clinical diagnoses was poor and the accuracy was low in comparison with arthroscopy. Ultrasonography was accurate in full thickness supraspinatus tendon tears, but inaccurate for partial tears...

  5. Arthroscopic management of native shoulder septic arthritis.

    Science.gov (United States)

    Abdel, Matthew P; Perry, Kevin I; Morrey, Mark E; Steinmann, Scott P; Sperling, John W; Cass, Joseph R

    2013-03-01

    There is little information on the results of arthroscopic treatment of native shoulder sepsis. Therefore, the purpose of this study was to determine the presentation, preoperative indices, intraoperative findings, and outcomes related to native shoulder sepsis treated with arthroscopy. We retrospectively reviewed 50 consecutive native shoulders with septic arthritis between 1994 and 2008. Patients (75% male) were an average age of 66 years. Four patients had bilateral involvement. All underwent arthroscopic irrigation and debridement. The mean follow-up was 31 months (range, 1-185 months). Patients were immunocompromised in 57% of cases. The mean preoperative values (normal reference ranges) included white blood cell count, 13 × 10(9)/L (3.5-10.5 × 10(9)/L); erythrocyte sedimentation rate, 66 mm/h (0-29 mm/h), and C-creative protein, 83 mg/L (0-10 mg/L). The average aspiration cell count was 110,988, with a mean differential of 87% neutrophils. The most common organisms were methicillin-susceptible Staphylococcus aureus (44%). Repeat irrigation and debridement was required within the first month in 16 of 50 shoulders (32%). Within 1 year, 17% of patients had died. Final Gächter staging was I or II for 32 shoulders and III or IV for 18 shoulders. Most patients with native shoulder sepsis are elderly and immunocompromised and present with increased inflammatory markers and a supporting aspiration cell count. Patients and surgeons must be aware that after initial arthroscopy, 1 in 3 patients will require additional surgical intervention, whether anticipated or not. Level IV, Case Series, Treatment Study. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  6. Concept of healing of recurrent shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Donato D'Angelo

    2014-08-01

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

  7. Evaluation and Management of Posterior Shoulder Instability

    Science.gov (United States)

    Tannenbaum, Eric; Sekiya, Jon K.

    2011-01-01

    Context: Posterior shoulder instability is a commonly misdiagnosed disorder in many competitive athletes. Type of Study: Clinical review. Evidence Acquisition: Relevant studies on posterior shoulder instability from 1950 to 2010 in PubMed and Cochrane databases were reviewed. Results: A total of 107 studies were reviewed. Conclusion: Patients who have undergone at least 6 months of physical therapy and still experience instability symptoms should be considered for surgical stabilization directed at their underlying pathology. PMID:23016015

  8. Serum Cartilage Biomarkers and Shoulder Instability.

    Science.gov (United States)

    Owens, Brett D; Cameron, Kenneth L; Bokshan, Steven L; Clifton, Kari B; Svoboda, Steven J; Wolf, Jennifer Moriatis

    2017-01-01

    Differences in cartilage biomarkers have been noted in patients with anterior cruciate ligament tears, but little is known about any similar relationship with shoulder instability. This study evaluated the relationship between serum cartilage biomarkers and shoulder instability. The authors present a prospective cohort study of young athletes followed from 2006 to 2010. A nested case-control analysis was conducted within this cohort to evaluate the association between preinjury collagen type II cleavage (a marker for type II collagen cleavage) and procollagen II carboxy propeptide (a marker of cartilage synthesis) and the subsequent likelihood of shoulder instability during the 4-year follow-up period. Preinjury collagen type II cleavage and procollagen II carboxy propeptide levels in 51 subjects who had shoulder instability were compared with levels in 210 subjects without documented anterior cruciate ligament or shoulder instability (control group) with commercially available enzyme-linked immunosorbent assay kits. Mean preinjury collagen type II cleavage levels in patients who subsequently had shoulder instability were significantly lower than those in the control group (73.91 vs 79.24 pg/mL, P=.03). No significant difference was found in preinjury procollagen II carboxy propeptide levels compared with the control group (359.94 vs 396.37, P=.24). This study is the first to examine the relationship between baseline collagen biomarkers and subsequent shoulder instability. The finding of lower baseline collagen type II cleavage levels in patients with subsequent shoulder instability may represent a genetic predisposition or a compensatory mechanism by which cartilage degradation is decreased in those who are more likely to have instability. [Orthopedics. 2017; 40(1):34-36.]. Copyright 2016, SLACK Incorporated.

  9. Traumatic anterior instability of the shoulder

    Directory of Open Access Journals (Sweden)

    João Roberto Polydoro Rosa

    Full Text Available ABSTRACT The shoulder is the most unstable joint in the human body. Traumatic anterior instability of the shoulder is a common condition, which, especially in young patients, is associated with high recurrence rates. The effectiveness of non-surgical treatments when compared to surgical ones is still controversial. The purpose of this study was to review the literature for current concepts and updates regarding the treatment of this condition.

  10. Little Leaguer's shoulder

    Energy Technology Data Exchange (ETDEWEB)

    Fleming, J.L.; Hollingsworth, C.L.; Bisset, G.S. [Department of Radiology, Duke University Medical Center, Durham, NC (United States); Squire, D.L. [Department of Pediatrics, Duke University Medical Center, Durham, NC (United States)

    2004-06-01

    A case of Little Leaguer's shoulder in a skeletally immature patient is described with a review of the English literature. This entity manifests as widening of the proximal humeral physis and is well known to our orthopedic colleagues. To our knowledge, however, there is little in the current radiologic literature describing Little Leaguer's shoulder. We describe such a case. (orig.)

  11. The evaluation of the failed shoulder arthroplasty.

    Science.gov (United States)

    Wiater, Brett P; Moravek, James E; Wiater, J Michael

    2014-05-01

    As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  12. Rugby and Shoulder Trauma: A Systematic Review

    Science.gov (United States)

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

    2015-01-01

    Rugby is a popular contact sport worldwide. Collisions and tackles during matches and practices often lead to traumatic injuries of the shoulder. This review reports on the epidemiology of injuries, type of lesions and treatment of shoulder injuries, risk factors, such as player position, and return to sport activities. Electronic searches through PubMed (Medline), EMBASE, and Cochrane Library retrieved studies concerning shoulder injuries in rugby players. Data regarding incidence, type and mechanisms of lesion, risk factors and return to sport were extracted and analyzed. The main reported data were incidence, mechanism of injury and type of lesion. Most of the studies report tackle as the main event responsible for shoulder trauma (between 50% and 85%), while the main lesions reported were Bankart lesions, Superior Labral tear from Anterior to Posterior (SLAP tears), anterior dislocation and rotator cuff tears. Open or arthroscopic repair improve clinical outcomes. Shoulder lesions are common injuries in rugby players. Surgical treatment seems to be effective in for rotator cuff tears and shoulder instability. More and better designed studies are needed for a higher Level of Evidence analysis of this topic. PMID:26535182

  13. Anterior Shoulder Instability in the Military Athlete.

    Science.gov (United States)

    Waterman, Brian; Owens, Brett D; Tokish, John M

    Given its young, predominately male demographics and intense physical demands, the US military remains an ideal cohort for the study of anterior shoulder instability. A literature search of PubMed, MEDLINE, and the Cochrane Database was performed to identify all peer-reviewed publications from 1950 to 2016 from US military orthopaedic surgeons focusing on the management of anterior shoulder instability. Clinical review. Level 4. The incidence of anterior shoulder instability events in the military occurs at an order of magnitude greater than in civilian populations, with rates as high as 3% per year among high-risk groups. With more than 90% risk of a Bankart lesion and high risk for instability recurrence, the military has advocated for early intervention of first-time shoulder instability while documenting up to 76% relative risk reduction versus nonoperative treatment. Preoperative evaluation with advanced radiographic imaging should be used to evaluate for attritional bone loss or "off-track" engaging defects to guide comprehensive surgical management. With complex recurrent shoulder instability and/or cases of clinically significant osseous lesions, potential options such as remplissage, anterior open capsular procedures, or bone augmentation procedures may be preferentially considered. Careful risk stratification, clinical evaluation, and selective surgical management for at-risk military patients with anterior shoulder instability can optimize the recurrence risk and functional outcome in this population.

  14. Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease

    Science.gov (United States)

    Sheehan, Scott E.; Orwin, John F.; Lee, Kenneth S.

    2016-01-01

    Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial soft-tissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases—with select MR imaging and arthroscopic correlation. Online supplemental material is available for this article. ©RSNA, 2016 PMID:27726738

  15. Use of shoulder pacemaker for treatment of functional shoulder instability: Proof of concept.

    Science.gov (United States)

    Moroder, Philipp; Minkus, Marvin; Böhm, Elisabeth; Danzinger, Victor; Gerhardt, Christian; Scheibel, Markus

    2017-01-01

    Functional shoulder instability (polar type III) is caused by underactivity of rotator cuff and periscapular muscles, which leads to subluxation or dislocation during shoulder movement. While surgical treatment has shown no benefits, aggravates pain, and frequently diminishes function even further, conservative treatment is often ineffective as well. The aim was to investigate the effectiveness of a "shoulder pacemaker" device that stimulates underactive muscles in patients with functional instability during shoulder movement in order to re-establish glenohumeral stability. Three patients with unsuccessfully treated functional shoulder instability causing pain, emotional stress, as well as limitations during daily activities and sports participation were enrolled in this pilot project. The device was used to stimulate the external rotators of the shoulder and retractors of the scapula. Pain level, subjective shoulder instability, range of motion, visible aberrant muscle activation, and signs of dislocation were compared when the device was switched on and off. No changes were observed when the device was attached but switched off. When the device was switched on, all patients were able to move their arms freely without pain, discomfort, or subjective or objective signs of instability. All patients rated this as an excellent experience and volunteered to train further with the device. No complications were observed. The electric stimulation of hypoactive rotator cuff and periscapular muscles by means of the shoulder pacemaker successfully re-establishes stability in patients with functional shoulder instability during the time of application. The online version of this article (doi: 10.1007/s11678-017-0399-z) contains the video: "The Shoulder-Pacemaker: treatment of functional shoulder instability with pathological muscle activation pattern". Video by courtesy of P. Moroder, M. Minkus, E. Böhm, V. Danzinger, C. Gerhardt and M. Scheibel, Charité Universit

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

    DEFF Research Database (Denmark)

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul

    2009-01-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven...... healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees...... -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles...

  17. 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

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven...... healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0A degrees......-105A degrees) at a speed of approximately 120A degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder...

  18. Septic shoulder presenting as a shoulder dislocation in the pediatric patient: a case report.

    Science.gov (United States)

    Maguire, Kathleen J; Otsuka, Norman Y

    2017-05-01

    Shoulder dislocation is relatively uncommon in the younger pediatric population. Because of the relative strength of the surrounding soft tissue structures of the shoulder compared with the proximal humeral physis, subluxation or dislocation resulting from a traumatic event or application of force is rare and instead a proximal humeral physeal injury occurs. Case presentation - We present a 5-year-old male who presented to the office with post-traumatic left shoulder pain for about 1 week. Radiographs of the left shoulder indicated inferior subluxation of the humeral head. He was ultimately diagnosed and treated for a septic shoulder. Septic arthritis of the glenohumeral joint accounts for about 3% of all septic arthritis cases. About half of the pediatric patients with a septic arthritis will present with a concomitant osteomyelitis about the joint involved. Widening of the glenohumeral joint and subluxation clinically as well as radiographically have been described in cases of large joint effusions because of an increase in intra-articular fluid in adults. This inferior subluxation is often noted without a frank dislocation. The case described in this report is unique in that this is the first to describe a pediatric septic shoulder presenting as a shoulder subluxation. Given the rarity of pediatric shoulder dislocations and subluxations, the pediatric orthopaedist and pediatrician should maintain a suspicion for a septic joint. Level V.

  19. Reducing Shoulder by Vertical Traction: A One-Man Method for Shoulder Reduction

    Directory of Open Access Journals (Sweden)

    Hayat Ahmad Khan

    2016-01-01

    Full Text Available Fifty percent of joint dislocations reported to the emergency department are of shoulder joint. Various techniques are used to reduce the shoulder and Spaso technique is the least known to the orthopaedic residents which is a simple one-man vertical traction method of shoulder reduction. We evaluated the effectiveness of vertical traction method for anterior shoulder dislocation by orthopaedic residents. Sixty consecutive patients of anterior glenohumeral dislocation attending the emergency department of our hospital were taken up for the study. The reduction was done using Spaso technique. Right shoulder was dislocated in 40 patients and 31 patients had recurrent shoulder dislocation. In 55 patients, shoulder was reduced without the use of any anaesthesia. In patients where no anaesthesia was used, the time of traction ranged from 45 seconds to 5 minutes, while under anaesthesia the time of traction ranged from 1 to 4 minutes. Twenty-one patients had associated greater tuberosity fracture which did not affect the method of reduction and all of them were reducible. No complication was reported, and all the patients were satisfied with the method. In conclusion vertical traction method is a good technique for reducing anterior shoulder dislocation with an easy learning curve among the residents and no complication has been reported so far.

  20. Measurement properties of the Western Ontario Shoulder Instability Index in Dutch patients with shoulder instability

    NARCIS (Netherlands)

    van der Linde, J.A.; Willems, W.J.; van Kampen, D.A.; van Beers, L.W.A.H.; van Deurzen, D.F.P.; Terwee, C.B.

    2014-01-01

    Background: The Western Ontario Shoulder Instability index (WOSI) is a patient-reported outcome measure for patients with shoulder instability. The purpose of this study was to validate the WOSI in a Dutch population by evaluating its structural validity, internal consistency, measurement error,

  1. [Evolution of the isokinetic torque of shoulder rotators before and after 3 months of shoulder stabilization by the Latarjet technique].

    Science.gov (United States)

    Dauty, M; Dominique, H; Héléna, A; Charles, D

    2007-05-01

    To compare prospectively isokinetic shoulder strength before and 3 months after shoulder stabilization by the Latarjet procedure indicated for the treatment of recurrent dislocation. Twenty-five subjects, 23+/-6 years old, with anterior unidirectional recurrent shoulder dislocation, underwent isokinetic concentric (con) and eccentric (ecc) measurement of lateral rotators (LR) and medial rotators (MR) of both shoulders at the angular speed of 60 and 120 degrees par second. Evaluation was carried out in the scapular plane with the patient in a sitting position one month before and 3 months after shoulder stabilization by the Latarjet technique. We calculated the concentric ratio LR/MR and mixed ratios LR(ecc)/MR(con) and LR(con)/MR(ecc). Before surgery, the rotator peak torque for the operated shoulder side was similar to that of the healthy shoulder side. The concentric ratio for the healthy shoulder side was higher because the lateral rotators were slightly weaker on the recurrent-dislocated shoulder side. Three months after shoulder stabilization by the Latarjet technique, for the operated shoulder side, the isokinetic concentric torque of rotators was similar to that before surgery. For the operated shoulder side, only the eccentric torque of medial rotators was significantly lower after surgery than before surgery and lower than that for the healthy shoulder side (9 to 15%). Ratios did not differ before and after surgery. Three months after surgery with Latarjet technique for recurrent dislocated shoulder, operated shoulders showed a slight strength deficit as compared with healthy shoulders. The concentric deficit after surgery was not significantly different from that before surgery. This result could be explained by strengthening exercises performed during the shoulder rehabilitation program. However, the eccentric strength deficit of medial rotators of the operated shoulder is certainly associated with the opening and stitching of the sub-scapular muscle

  2. Clinical outcomes following revision anterior shoulder arthroscopic capsulolabral stabilization.

    Science.gov (United States)

    Shin, Jason J; Mascarenhas, Randy; Patel, Anish V; Yanke, Adam B; Nicholson, Gregory P; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

    2015-11-01

    Traditionally surgeons have treated failed shoulder instability with open capsulolabral repair. Despite improved instrumentation, technique and familiarity in shoulder arthroscopy, few studies have reported the outcomes of arthroscopic revision shoulder instability repair. The purpose of this study was to assess clinical outcomes in patients following revision shoulder arthroscopic anterior capsulolabral stabilization. Sixty-two patients (63 shoulders) with failure of primary instability repairs were treated with revision arthroscopic anterior shoulder stabilization at a mean follow-up of 46.9 ± 16.8 months (range 18-78). Clinical outcomes were evaluated using validated patient-reported outcome questionnaires including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog pain scale and Western Ontario Shoulder Instability Index. In addition, patients were queried for recurrent instability events (subluxation or dislocation) or revision surgery. At final follow-up, the mean postoperative Western Ontario Shoulder Instability normalized score was 80.1 ± 18.7 (range 15.0-100). There were clinically significant improvements in American Shoulder and Elbow Surgeons scores, Simple Shoulder Test scores and ten-point visual analog scale for pain (P instability occurred in 12 shoulders (19.0 %), with number of prior surgeries and hyperlaxity found to be significant risk factor for failure (P shoulder can result in satisfactory outcomes in appropriately selected patients who have failed previous capsulolabral repair. An increased number of prior surgeries and hyperlaxity are predictive of poor outcome. Case series, LOE IV.

  3. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS.

    Science.gov (United States)

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2011-01-01

    To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Misericórdia, São Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. 14 of the 55 players evaluated were pitchers, and 20 reported pain during the pitching motion. The mean values for lateral and medial rotation and range of motion (ROM) in the dominant shoulder were, respectively, 110 °, 61 ° and 171 °, with a statistically significant difference in relation to the non-dominant limb. Pitchers had greater gains in lateral rotation and deficits in medial rotation than did non-pitchers. Pain presented a statistically significant correlation with diminished ROM, greater length of time playing the sport and situations of "shoulder at risk". Statistically significant differences in dominant shoulder mobility were found, with increased lateral rotation, diminished medial rotation and smaller ROM, in relation to the contralateral limb. There was a statistically significant relationship between the pitcher's position and greater gain in lateral rotation and diminished medial rotation. There were statistically significant correlations between pain and diminished ROM, greater length of time playing the sport and situations of "shoulder at risk". There was a statistical tendency suggesting that players with diminished medial rotation of the dominant shoulder presented a relationship with pain.

  4. Incidence of Posttraumatic Shoulder Dislocation in Poland.

    Science.gov (United States)

    Szyluk, Karol J; Jasiński, Andrzej; Mielnik, Michał; Koczy, Bogdan

    2016-10-25

    BACKGROUND The incidence of shoulder joint dislocation has been estimated at 11-26 per 100 000 population per year. In our opinion, basic epidemiological data need to be continually updated in studies of large populations. To study the incidence of posttraumatic dislocation of the shoulder joint in the Polish population. MATERIAL AND METHODS We retrospectively investigated the entire Polish population between 1 January 2010 and 1 January 2015. To identify the study group, data collected in the electronic database of the National Health Fund were used. The study group was divided into subgroups to detect possible differences in the incidence of shoulder dislocation with regard to age, sex, and season of the year (month) when the dislocation occurred. RESULTS The cumulative size of the study sample was 192.72 million over the 5 years of the study. We identified 51 409 patients with first posttraumatic shoulder dislocation, at a mean age of 50.83 years (SD 21.12), from 0 to 104 years. The incidence of traumatic shoulder dislocations for the entire study group ranged from 24.75/100 000/year (number of posttraumatic shoulder dislocations per 100 000 persons per year) to 29.09/100 000/year, for a mean of 26.69/100 000/year. CONCLUSIONS In this study, the overall incidence of first-time posttraumatic shoulder dislocations in the Polish general population was 26.69 per 100 000 persons per year. These results are higher than estimates presented by other authors. It is necessary to study, regularly update, and monitor this problem in the general population.

  5. Clinical Outcomes Following Revision Anterior Shoulder Stabilization

    Science.gov (United States)

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

    2015-01-01

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

  6. Effect of isokinetic training on shoulder impingement.

    Science.gov (United States)

    Wang, T L; Fu, B M; Ngai, G; Yung, P

    2014-01-31

    The aim of this study was to review the literature evaluating the effect of isokinetic training in patients suffering from shoulder impingement syndrome (SIS). Studies published up to March 2011 were located from the Pubmed, Scopus, Lilacs, Physiotherapy Evidence Database, and Cochrane Library databases using "isokinetic", "shoulder", and "impingement" as key words. Referenced studies were also checked. Studies were included if isokinetic training was employed as at least one of the treatments in the therapeutic program to treat shoulder impingement or other shoulder pathologies leading to impingement-related pain. All eligible studies described the level of evidence, patient characteristics, interventions, outcome evaluation, results, complications, and return to work. There were 2 randomized control trials (RCTs) and 4 studies with level 4 evidence that met the inclusion criteria. All of the studies included showed a statistically or clinically significant outcome after isokinetic training. However, most of the studies could not identify the isolated effect of isokinetic training. There was not enough evidence to support or refute the effectiveness of isokinetic training for SIS. This result does not reflect a true lack of effect, but rather a lack of RCTs. A consensus definition of the different types and stages of SIS is urgently needed. More RCTs are also essential to clarify the value of this technique. The homogeneity of treatment interventions, study populations, and outcome measures should be prioritized. Further studies are also needed to clarify the differences in isokinetic data across different types and stages of shoulder impingement.

  7. The evidenced-based shoulder evaluation.

    Science.gov (United States)

    O'Kane, John W; Toresdahl, Brett G

    2014-01-01

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

  8. Biomechanical Considerations in the Competitive Swimmer's Shoulder.

    Science.gov (United States)

    Heinlein, Scott A; Cosgarea, Andrew J

    2010-11-01

    Competitive swimming has become an increasingly popular sport in the United States. In 2007, more than 250 000 competitive swimmers were registered with USA Swimming, the national governing body. The average competitive swimmer swims approximately 60 000 to 80 000 m per week. With a typical count of 8 to 10 strokes per 25-m lap, each shoulder performs 30 000 rotations each week. This places tremendous stress on the shoulder girdle musculature and glenohumeral joint, and it is why shoulder pain is the most frequent musculoskeletal complaint among competitive swimmers. Articles were obtained through a variety of medical search sources, including Medline, Google Scholar, and review articles from 1980 through January 2010. The most common cause of shoulder pain in swimmers is supraspinatus tendinopathy. Glenohumeral instability and labral tears have also been reported, but a paucity of information remains regarding prevalence and treatment in swimmers. Because of the great number of stroke repetitions and force generated through the upper extremity, the shoulder is uniquely vulnerable to injury in the competitive swimmer. Comprehensive evaluation should include the entire kinetic chain, including trunk strength and core stability.

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

    Directory of Open Access Journals (Sweden)

    Ejnisman B

    2016-08-01

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

  10. Effects of shoulder stabilization exercise on pain and functional recovery of shoulder impingement syndrome patients.

    Science.gov (United States)

    Park, Sang-In; Choi, Yong-Kyu; Lee, Jung-Ho; Kim, Young-Min

    2013-11-01

    [Purpose] This study examined the effects of scapular stabilization exercises immediately after surgery on pain and function in patients diagnosed with shoulder impingement syndrome. [Subjects] The subjects were assigned by random sampling to an experimental group (n=15) to which stabilization exercise was applied and a control group (n=15) to which ordinary physical treatment was applied. [Methods] To evaluate the degree of pain, a 100 mm visual analogue scale (VAS) was used. The Constant-Murley Scale (CMS) was used to evaluate the functions of the shoulder joints. To determine the range of motion, a goniometer was used to measure range of shoulder motion. The simple shoulder test (SST) was used to determine the condition of the shoulder joints of the subjects. [Results] There were significant differences in all the items of the experimental group. The results of comparison of the therapeutic effect in the experimental and control groups revealed significant differences in active abduction, passive abduction, VAS, SST, and the CMS, except for pain. [Conclusion] The results suggest that shoulder stabilization exercise positively affects pain alleviation and functional recovery in shoulder impingement patients.

  11. 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.

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

    Directory of Open Access Journals (Sweden)

    Naoya Iida

    2011-10-01

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

  13. [Triple fracture of the shoulder suspensory complex].

    Science.gov (United States)

    Tamimi Mariño, I; Martin Rodríguez, I; Mora Villadeamigo, J

    2013-01-01

    The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Management of painful reverse shoulder arthroplasty.

    Science.gov (United States)

    Ekelund, Anders L

    2017-07-01

    Even though reverse shoulder arthroplasty is a very successful procedure, painful complications occur. During the initial postoperative years, the most common reasons for pain are instability, postoperative fracture of the acromion or spine, and periprosthetic infection. Later, aseptic loosening, with humeral loosening being more frequent that glenoid loosening, can be a source of pain and reduction in function. A careful patient history, clinical examination, plain radiographs, computed tomography and blood tests give an explanation for the pain in most cases. The majority of these complications can be successfully treated, maintaining a functional reverse shoulder arthroplasty. However, if all examinations are normal, it is important to remember that nonshoulder conditions such as tumour of the lung or degenerative changes of the cervical spine can give shoulder pain.

  15. Cost Analysis in Shoulder Arthroplasty Surgery

    Directory of Open Access Journals (Sweden)

    Matthew J. Teusink

    2012-01-01

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

  16. Rehabilitation for Shoulder Instability - Current Approaches.

    Science.gov (United States)

    Jaggi, Anju; Alexander, Susan

    2017-01-01

    The shoulder relies predominantly on dynamic muscular control to provide stability. Successful treatment is highly dependent upon the correct clinical diagnosis, identification of anatomical structural defects and abnormal movement patterns so that rehabilitation programs can be designed accordingly and individualised to the patient. A systematic outline is provided to guide the clinician on how to identify muscular insufficiencies both local to the shoulder joint and global muscles that can influence shoulder instability. Management is based on expert experience and current literature. The Stanmore classification helps to correctly diagnose the type of instability and prioritise management. Symptom modification tests can help to guide management, however assessing individual muscle groups local to glenohumeral control is also recommended. Physical and psychosocial factors can influence motor control in the presence of pain and injury. A multi-disciplinary approach is required to avoid recurrence of symptoms with rehabilitation focusing on kinetic chain, scapular and gleno-humeral control.

  17. Evaluation and treatment of shoulder pain.

    Science.gov (United States)

    Greenberg, Deborah L

    2014-05-01

    Shoulder pain is a common symptom in the adult population. The most common cause of shoulder pain is SIS, reflecting a problem with the rotator cuff or subacromial bursa. Determining the cause of a patient’s pain is usually a clinical diagnosis based on careful history taking and physical examination. Limited use of imaging studies will be needed in the setting of trauma, possible glenohumeral arthritis, or when a complete tendon tear is suspected. Therapy is based on pain control and therapeutic exercises in almost all cases. Despite the prevalence of shoulder pain, there is no consensus on the best way to achieve pain control or on the type of exercise most likely to achieve speedy recovery. Copyright © 2014 Elsevier Inc. All rights reserved.

  18. Rehabilitation for Shoulder Instability – Current Approaches

    Science.gov (United States)

    Jaggi, Anju; Alexander, Susan

    2017-01-01

    Background: The shoulder relies predominantly on dynamic muscular control to provide stability. Successful treatment is highly dependent upon the correct clinical diagnosis, identification of anatomical structural defects and abnormal movement patterns so that rehabilitation programs can be designed accordingly and individualised to the patient. Method: A systematic outline is provided to guide the clinician on how to identify muscular insufficiencies both local to the shoulder joint and global muscles that can influence shoulder instability. Management is based on expert experience and current literature. Results: The Stanmore classification helps to correctly diagnose the type of instability and prioritise management. Symptom modification tests can help to guide management, however assessing individual muscle groups local to glenohumeral control is also recommended. Conclusion: Physical and psychosocial factors can influence motor control in the presence of pain and injury. A multi-disciplinary approach is required to avoid recurrence of symptoms with rehabilitation focusing on kinetic chain, scapular and gleno-humeral control. PMID:28979601

  19. Patient assistive system for the shoulder joint

    Directory of Open Access Journals (Sweden)

    Scheuner Erika

    2016-09-01

    Full Text Available The mobility of the upper extremity is essential for everyday activities and for independent living. Shoulder disorders affect the range of motion, therefore a patient assistive system (PAS for the shoulder joint can be used to compensate the restrictions. The developed PAS supports up to 120° of flexion and abduction. The portable dynamic orthotic consists of two levers and is attached to a hip belt. The upper arm of the patient is connected to the device using a brace. The prototype is driven by one motor and controlled by surface electromyography (EMG. The functionality of the system was successfully verified by tests with healthy subjects. For further development, a study with shoulder patients will be performed and health professionals will evaluate the PAS.

  20. Resuscitating the Baby after Shoulder Dystocia

    Directory of Open Access Journals (Sweden)

    Savas Menticoglou

    2016-01-01

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

  1. Effect of Kinesiotaping and Stretching Exercise on Forward Shoulder Angle in Females with Rounded Shoulder Posture

    Directory of Open Access Journals (Sweden)

    Arghavan Hajibashi

    2014-12-01

    Full Text Available Background: Rounded shoulder posture is a common abnormal posture in upper quarter. Kinesiotape is a new intervention that recently used in rehabilitation. There are no studies have examined the effect of kinesiotape on rounded shoulder posture. Therefore the purpose of this study was to determine the effect of scapular kinesiotaping and pectoralis minor stretching exercise on forward shoulder angle in female subjects with rounded shoulder posture. Methods: Twenty female students aged between 18 to 25 years old with rounded shoulder posture participated in this study. Then, the subjects were randomly and equally assigned to two groups: the stretch group and the stretch plus kinesiotape group. Both groups were trained for doing home exercise to stretch Pectoralis minor bilaterally for two weeks. Kinesiotape group received kinesiotape on scapular area additionally. Forward shoulder angle was measured in four sessions including pre-intervention (first session, immediately after the first intervention (second session, fourth day (third session and at the end of two weeks (fourth session. Two-way repeated measures ANOVA (4×2 was used for data analysis. Results: kinesiotape group showed significant within-group decrease in forward shoulder angle between first session with three other sessions (P≤0.05.There was no significant within-group difference in stretch group and between groups (P=0.20 forward shoulder angle-by-group interaction in measurement sessions was significantly different (P=0.02 Conclusion: scapular kinesiotaping along with pectoralis minor stretching exercise improved rounded shoulder posture in subjects of the present study. kinesiotape is suggested as a complem

  2. Treatments for Shoulder Impingement Syndrome

    Science.gov (United States)

    Dong, Wei; Goost, Hans; Lin, Xiang-Bo; Burger, Christof; Paul, Christian; Wang, Zeng-Li; Zhang, Tian-Yi; Jiang, Zhi-Chao; Welle, Kristian; Kabir, Koroush

    2015-01-01

    Abstract Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking. Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant–Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities. Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses. Exercise and other exercise-based therapies, such as kinesio taping

  3. Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study

    Science.gov (United States)

    Hatchett, Patricia; Eberly, Valerie J.; Lighthall Haubert, Lisa; Conners, Sandy; Requejo, Philip S.

    2015-01-01

    Background Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI). Objective The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia. Methods/Design A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. Results Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility. Limitations Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall. Conclusions Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset. PMID:25721123

  4. Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study.

    Science.gov (United States)

    Mulroy, Sara J; Hatchett, Patricia; Eberly, Valerie J; Haubert, Lisa Lighthall; Conners, Sandy; Requejo, Philip S

    2015-07-01

    Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI). The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia. A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility. Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall. Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset. © 2015 American Physical Therapy Association.

  5. Numerical modelling of the shoulder for clinical applications

    National Research Council Canada - National Science Library

    Philippe Favre; Jess G. Snedeker; Christian Gerber

    2009-01-01

    Research activity involving numerical models of the shoulder is dramatically increasing, driven by growing rates of injury and the need to better understand shoulder joint pathologies to develop therapeutic strategies...

  6. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS

    OpenAIRE

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2011-01-01

    Objective: To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Methods: Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Miseric?rdia, S?o Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. Results: 14 of...

  7. Influence of Bony Defects on Preoperative Shoulder Function in Recurrent Anteroinferior Shoulder Instability.

    Science.gov (United States)

    Wolke, Julia; Herrmann, Diem Anh; Krannich, Alexander; Scheibel, Markus

    2016-05-01

    Recurrent anteroinferior shoulder dislocations are often associated with bony glenoid and humeral defects. The influence of those bony lesions on the postoperative outcomes after arthroscopic shoulder stabilization procedures has been the subject of many studies. Little is known about the influence of those lesions on preoperative function. To evaluate the influence of glenoid and humeral bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. Cross-sectional study; Level of evidence, 3. Included in the study were 90 patients (70 men, 20 women; mean age, 27.1 years; 24 patients with prior failed stabilization) with posttraumatic recurrent anteroinferior shoulder instability who underwent preoperative computed tomography (CT) of both shoulders. The glenoid index was used to measure glenoid defect on a 3-dimensional CT. Humeral head defect was measured on a 2-dimensional CT with evaluation of the Hill-Sachs quotient, product, sum, and difference. Preoperative evaluation also included the Rowe score, Constant score, Walch-Duplay score, Melbourne Instability Shoulder Score (MISS), Western Ontario Shoulder Instability Index (WOSI), and Subjective Shoulder Value (SSV). There was a weak but significant correlation of the Hill-Sachs quotient and the glenoid index with the Rowe score (P = .03, r = -0.22 and P = .03, r = 0.23, respectively). Furthermore, the Hill-Sachs product significantly correlated with the WOSI (P = .02); in particular, the physical symptoms subscore showed a significant correlation (P = .04). The glenoid index showed a significant correlation with the SSV (P shoulder instability and associated bony defects. It is recommended that clinicians use the Rowe score, WOSI, and SSV for the clinical evaluation of patients with recurrent anteroinferior shoulder instability and associated bony defects. These evaluation systems may provide an early clinical indication of bony defects. Furthermore, very poor results on these

  8. Evaluation and management of shoulder pain in skeletally immature athletes

    OpenAIRE

    Patel, Dilip R.; Breisach, Stephen

    2017-01-01

    Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in youn...

  9. Outcome evaluation in shoulder surgery using 3D kinematics sensors

    OpenAIRE

    Coley, B.; Jolles, B.; Farron, A.; Bourgeois, A.; Nussbaumer, F.; Pichonnaz, C.; Aminian, K.

    2007-01-01

    A new method of scoring systems for the functional assessment of the shoulder is presented. 3D accelerometers and gyroscopes attached on the humerus were used to differentiate a healthy from a painful shoulder. The method was first tested on 10 healthy volunteer subjects without any shoulder pathologies. Then, the system was tested on 10 patients with unilateral shoulder pathology (rotator cuff disease, osteoarthritis) before and after surgery (3, 6 months). To evalua...

  10. Frozen shoulder and the Big Five personality traits.

    Science.gov (United States)

    Debeer, Philippe; Franssens, Fien; Roosen, Isabelle; Dankaerts, Wim; Claes, Laurence

    2014-02-01

    In the past, several studies have suggested the existence of a "periarthritic personality" in patients with frozen shoulder. We conducted a study to determine differences in personality traits in patients with primary and secondary frozen shoulders. We prospectively evaluated 118 patients (84 women and 34 men; mean age, 53.8 years; SD 7.56) with a frozen shoulder. Of these patients, 48 had an idiopathic frozen shoulder and 70 had a secondary frozen shoulder. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale. This questionnaire measures the 5 major personality traits and is based on the norms determined in a neutral test situation for 2415 controls. Compared with healthy controls, no differences in personality traits were found in patients with primary and secondary frozen shoulder, except for Conscientiousness and Extraversion, for which patients with secondary frozen shoulder scored significantly higher than healthy controls. Patients with primary frozen shoulder scored significantly higher on Openness to Experience than did patients with secondary frozen shoulder; on the other 4 Big Five personality traits, no significant differences were found between patients with primary and secondary frozen shoulder. More specifically, patients with idiopathic frozen shoulder did not score higher on the trait Neuroticism as would be expected from previous publications. Our study results do not indicate that patients with an idiopathic frozen shoulder have a specific personality compared with healthy controls. Only a few differences were found in personality traits when the entire frozen shoulder group was compared with healthy controls and between patients with primary and secondary frozen shoulders. The results of this study suggest that these differences are not sufficient to speak about a specific "frozen shoulder personality." Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights

  11. Relation between shoulder proprioception, kinematics and pain after stroke

    NARCIS (Netherlands)

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

    2010-01-01

    Purpose: To identify a possible relationship between chronic Post-Stroke Shoulder Pain (PSSP), scapular resting pose and shoulder proprioception. Methods: A total of 21 inpatients with stroke and 10 healthy control subjects were included and kinematics and proprioception of both shoulders were

  12. Shoulder dystocia: An update and review of new techniques | Cluver ...

    African Journals Online (AJOL)

    In cases of fetal death associated with undelivered shoulder dystocia, one can consider the trans-abdominal performance or facilitation of traditional vaginal manoeuvres. We suggest a simplified mnemonic, 'MAPS' – M: McRoberts, A: anterior shoulder, P: posterior shoulder, and S: salvage. A video teaching programme will ...

  13. Is shoulder arthroplasty an option for charcot arthropathy?

    Science.gov (United States)

    Schoch, Bradley; Werthel, Jean-David; Sperling, John W; Cofield, Robert H; Sanchez-Sotelo, Joaquin

    2016-12-01

    Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control. The purpose of this study is to review the outcomes, complications, and survivorship of shoulder arthroplasty for Charcot arthropathy. Between January 2000 and December 2011, ten shoulders with Charcot arthropathy were treated with shoulder arthroplasty at our Institution (six hemiarthroplasty, one total shoulder arthroplasty, three reverse shoulder arthroplasty). Shoulders were followed for a minimum of two years or until re-operation. Outcomes measures included pain, range of motion, complications, and reoperation. Shoulder arthroplasty improved pain to a mean score of 2.6 at follow up. However, gains in range of motion were not as substantial, with mean elevation of only 105°. External rotation improved from 20 to 43°. Subjectively, six of the ten patients rated the result as much better or better. Two shoulders underwent revision surgery at an average of five months after index arthroplasty. Shoulder arthroplasty for the treatment of the sequelae of a Charcot joint is a reasonable treatment option to provide substantial pain relief and improved motion. The relative indications of hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty for this particular condition continue to evolve.

  14. SHOULDER JOINT PAIN: APPROACHES TO DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    N. A. Shostak

    2014-07-01

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

  15. Frozen shoulder or missed posterior dislocation? | Leijnen | South ...

    African Journals Online (AJOL)

    The clinical presentation of a missed posterior shoulder dislocation has similarities with an idiopathic frozen shoulder masking proper diagnosis at the time of injury. We report a case of a 48-year-old woman with shoulder pain which demonstrates the importance of correct initial diagnosis and management.

  16. Incidence of shoulder injuries and related risk factors among master ...

    African Journals Online (AJOL)

    Swimmers engaging in strength training (OR = 0.78) showed a reduced incidence of shoulder pain. The calculated incidence of shoulder pain over the three-year period among the master swimmers was 62.4%. Significant statistical associations between shoulder pain and the risk factors of osteoporosis, volume of training ...

  17. Interobserver reliability of physical examination of shoulder girdle

    NARCIS (Netherlands)

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

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

  18. Shoulder injuries in competitive swimmers in KwaZulu- | Puckree ...

    African Journals Online (AJOL)

    of overuse injury. Results. Seventy-one per cent of the swimmers had shoulder pain and 64% reported injury to the shoulder. Forty-six per cent of the swimmers with pain complained of anterior shoulder pain, while 65% of all injuries were due to overuse. The commonest diagnoses included tendonitis (35%), muscle ...

  19. Criteria for implementing full-width/depth shoulders to accommodate hard shoulder running.

    Science.gov (United States)

    2011-08-22

    "WisDOT is considering constructing full-width/depth shoulders along certain freeway segments to carry traffic : during future freeway resurfacing or construction projects. The goal of this measure is to minimize lane closures and : congestion. WisDO...

  20. ultrasound-guided shoulder arthrogram injection

    African Journals Online (AJOL)

    2008-10-15

    Oct 15, 2008 ... Anterior approach ultrasound-guided arthrogram injections are a quick and reliable way of injecting contrast medium prior to a shoulder. MRI scan. A retrospective study on patients who we had previously injected and scanned at our clinic was undertaken, to compare the more documented posterior ...

  1. Looking over the shoulders of researchers

    DEFF Research Database (Denmark)

    Nielsen, Kristian Hvidtfelt; Autzen, Charlotte

    2011-01-01

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

  2. Clavicular eosinophilic granuloma causing adult shoulder pain

    Directory of Open Access Journals (Sweden)

    Lawrence R. Menendez

    2013-02-01

    Full Text Available Though rarely reported, neoplasms of the clavicle occur, and their symptoms can be mistaken for more common shoulder conditions. We present the case of a benign clavicular neoplasm, rarely seen in adults, presenting with pain, and eventual pathologic fracture in a 49 year-old. A 49 year-old male firefighter underwent arthroscopic rotator cuff repair for shoulder pain after magnetic resonance imaging revealed supraspinatus tendon tear. The patient’s pain persisted after surgery, and was described as routine until he developed severe pain after minor blunt trauma. A local Emergency Room performed the first x-rays, which revealed a pathologic fracture of the distal clavicle through a destructive lesion. The patient was referred to an orthopedic oncologist, who performed incisional biopsy, which initially diagnosed osteomyelitis. The patient was subsequently taken to surgery for debridement. Pathology then yielded the diagnosis of eosinophilic granuloma. The patient was taken back to surgery for formal curettage with open reduction and internal fixation. The patient’s pain resolved, the pathologic fracture fully healed, and the patient returned to full time work as a firefighter. Though workup for common shoulder conditions often identifies incidental benign lesions of bone, the converse can be true. Persistent pain despite intervention should raise concern for further investigation. An x-ray alone can reveal a destructive bone lesion as the source of shoulder pain.

  3. Relationship Between Stretch Duration And Shoulder Musculature ...

    African Journals Online (AJOL)

    To date, studies focussing on the effect of stretching on flexibility have focused almost solely on the effect of chronic stretching rather than the effects of acute stretching performed immediately prior to physical activity. The effects of different static stretches were assessed on passive shoulder range of motion (ROM).

  4. Reading on the Shoulders of Giants

    Science.gov (United States)

    Ben-Chaim, Michael; Riendeau, Michael

    2012-01-01

    Reflecting on his successful scientific career, Isaac Newton highlighted his intellectual debt to his predecessors. "If I have seen further," he wrote, "it was "only" by standing on the shoulders of giants." The authors have chosen the title of their article as a token of recognition of their debt to the teachings of…

  5. Shoulder complaints : the occurence, course and diagnosis

    NARCIS (Netherlands)

    J.J. Luime (Jolanda)

    2004-01-01

    textabstractShoulder complaints are expressed in a variety of symptoms. In many cases, the prominent symptom is pain. In some cases, pain is present most of the day and frequently also at night. In other cases, it is provoked primarily by physical activities. Often it is accompanied by restricted

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

    Directory of Open Access Journals (Sweden)

    Mortensen Ole S

    2011-01-01

    Full Text Available Abstract Background Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct training of the painful area. Our study investigates the effect of the latter approach. Methods/Design A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training with training supervision or to a reference group receiving advice to stay physically active. Shoulder function training primarily focuses on the serratus anterior and lower trapezius muscle with only minimal activation the upper trapezius. An announcement was sent to the administrative section of the university including jobs characterized by intensive computer work. The first 100 positive replies entered the study. Among these inclusion criteria were pain intensity in the neck/shoulder of at least 3 on a 0-9 scale. Exclusion criteria were cardiovascular disease, trauma, hypertension, or serious chronic disease. Before and after the intervention period the participants replied to a questionnaire about musculoskeletal disorders and work disability, and underwent a standardized clinical examination of the neck and shoulder girdle. Further, on a weekly basis the participants log pain intensity of the neck and shoulder during the previous week. The primary outcome measure is pain in the neck and shoulders at week 10 based on the weekly pain registration and results

  7. Does shoulder impingement syndrome affect the shoulder kinematics and associated muscle activity in archers?

    Science.gov (United States)

    Shinohara, H; Urabe, Y; Maeda, N; Xie, D; Sasadai, J; Fujii, E

    2014-12-01

    Archery related injuries, such as shoulder impingement syndrome are caused by repeated motion of the shoulder. The aim of this study was to analyze differences in the shoulder kinematics and the associated muscle activity between archers with shoulder impingement and uninjured archery players. Thirty male archers, who were divided into an impingement group and an uninjured group, were included in this study. The angle of scapular elevation, shoulder joint abduction, horizontal extension, and elbow joint flexion as well as the electromyographic activity of the upper trapezius, lower trapezius, deltoid middle, deltoid posterior, biceps brachii, and triceps brachii muscles at the point of stabilization during shooting were measured. Variables differing between impingement and uninjured groups were identified, and a stepwise regression analysis was performed to identify a combination of variables that effectively impingement syndrome. The results indicated that the angle of scapular elevation was significantly greater than that uninjured group (Psyndrome showed that UT/LT ratio was significantly related impingement syndrome (Pshoulder impingement syndrome exhibit different kinematics and muscle activity compared to uninjured archers. Therefore, in order to prevent shoulder joint impingement during archery, training is necessary what can make lower trapezius muscle activity increased to decrease the UT/LT ratio.

  8. Evaluation and management of shoulder pain in skeletally immature athletes

    Science.gov (United States)

    Breisach, Stephen

    2017-01-01

    Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies. PMID:28795009

  9. Evaluation and management of shoulder pain in skeletally immature athletes.

    Science.gov (United States)

    Patel, Dilip R; Breisach, Stephen

    2017-07-01

    Shoulder pain in young athletes generally is a result of poor sports technique and overuse. A number intrinsic causes of shoulder pain have been identified. Pain may also be referred to shoulder area from cervical spine, neck and chest pathology. Overuse stress injury of the proximal humeral physis is important to recognize early in order to prevent later complications. Shoulder impingement syndrome is a general term used to describe multiple underlying lesions and relatively uncommon in young athletes. In adolescent athletes, glenohumeral instability is an important underlying pathomechanical basis for shoulder pain. Other less frequent causes reviewed here include atraumatic osteolysis of the distal clavicle, long thoracic and suprascapular neuropathies.

  10. Painful shoulder. Introduction into fundamental facts and problems

    Energy Technology Data Exchange (ETDEWEB)

    Hartl, P.W.

    1987-10-19

    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.

  11. Decreased shoulder function and pain common in recreational badminton players.

    Science.gov (United States)

    Fahlström, M; Söderman, K

    2007-06-01

    The aim of this study was to describe the prevalence and consequences of painful conditions in the shoulder region in recreational badminton players. A questionnaire study was performed on 99 players, of whom 57 were also assessed with Constant score. Previous or present pain in the dominant shoulder was reported by 52% of the players. Sixteen percent of the players had on-going shoulder pain associated with badminton play. A majority of these players reported that their training habits were affected by the pain. Total Constant score was lower in the painful shoulders. Furthermore, range of active pain-free shoulder abduction was decreased. However, isometric shoulder strength test showed no differences when compared with pain-free shoulders. Even though the pain caused functional problems, the players were still playing with on-going symptoms. The diagnoses were mostly unknown, although history and clinical tests indicate problems resembling subacromial impingement.

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

    Directory of Open Access Journals (Sweden)

    S. K. Mustafa

    2006-01-01

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

  13. Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability.

    Science.gov (United States)

    Ma, Richard; Brimmo, Olubusola A; Li, Xinning; Colbert, Lindsey

    2017-12-01

    The objectives of this review are to evaluate the current evidence-based literature and concepts surrounding rehabilitation in patients with anterior shoulder instability injuries and surgical repair. The current literature evidence for shoulder rehabilitation for anterior shoulder instability and labral repair is limited. As a result, there are variations among surgeons and physical therapists in rehabilitation protocols after anterior shoulder instability injuries and repair. While general consensus on certain rehabilitation parameters exists, the evidence for the importance of rehabilitation and functional performance test for return to sport in future injury prevention is still lacking in literature. Rehabilitation after anterior shoulder instability injury and anterior labral repair is paramount in the injured or post-operative shoulder. Restoration of soft tissue mobility, dynamic glenohumeral joint stability, and balance and strength around the shoulder not only protect healing of injured or repaired soft tissues but also potentially minimizes future re-injury or recurrence risk.

  14. Strength asymmetry of the shoulders in elite volleyball players.

    Science.gov (United States)

    Hadzic, Vedran; Sattler, Tine; Veselko, Matjaž; Markovic, Goran; Dervisevic, Edvin

    2014-01-01

    Volleyball players are reported to have shoulder strength imbalances. Previous authors have primarily investigated small samples of male players at a single skill level, without considering playing position, and with inconsistent findings. To evaluate shoulder strength asymmetry and a history of shoulder injury in a large sample of professional volleyball players of both sexes across different playing positions and skill levels. Descriptive laboratory study. A sample of 183 volleyball players (99 men, 84 women). We assessed shoulder internal-rotator and external-rotator concentric strength at 60°/s using an isokinetic dynamometer and dominant-nondominant differences in shoulder strength and strength ratios using repeated-measures analyses of variance. Peak torque was normalized for body mass and external-rotation/internal-rotation concentric strength. Internal-rotation strength was asymmetric in favor of the dominant side in both sexes, regardless of previous shoulder injury status. Male volleyball players had a lower shoulder strength ratio on the dominant side, regardless of previous shoulder injury status. However, this finding was valid only when hand dominance was taken into account. Female volleyball players playing at a higher level (ie, first versus second division) were 3.43 times more likely to have an abnormal strength ratio. Playing position was not associated with an abnormal shoulder strength ratio or strength asymmetry. In male volleyball players, the external-rotation/internal-rotation strength ratio of the dominant shoulder was lower, regardless of playing position, skill level, or a previous shoulder injury. In female players, the ratio was less only in those at a higher skill level. Although speculative, these findings generally suggest that female volleyball players could have a lower risk of developing shoulder-related problems than male volleyball players. Isokinetic shoulder testing may reveal important information about the possible risk

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

    Directory of Open Access Journals (Sweden)

    Yashavantha Kumar C

    2013-01-01

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

  16. Effect of a worktable position on head and shoulder posture and shoulder muscles in manual material handling.

    Science.gov (United States)

    Kim, Min-Hee; Yoo, Won-Gyu

    2015-06-05

    According to a recent research, manual working with high levels of static contraction, repetitive loads, or extreme working postures involving the neck and shoulder muscles causes an increased risk of neck and shoulder musculoskeletal disorders. We investigated the effects of the forwardly worktable position on head and shoulder angles and shoulder muscle activity in manual material handling tasks. The forward head and shoulder angles and the activity of upper trapezius, levator scapulae, and middle deltoid muscle activities of 15 workers were measured during performing of manual material handling in two tasks that required different forward head and shoulder angles. The second manual material task required a significantly increased forward head and shoulder angle. The upper trapezius and levator scapulae muscle activity in second manual material task was increased significantly compared with first manual material task. The middle deltoid muscle activity in second manual material task was not significantly different compared with first manual material task. Based on this result, the forward head and shoulder angles while performing manual work need to be considered in selection of the forward distance of a worktable form the body. The high level contractions of the neck and shoulder muscles correlated with neck and shoulder pain. Therefore, the forward distance of a worktable can be an important factor in preventing neck and shoulder pain in manual material handling workers.

  17. 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.

  18. Functional Analysis of the Primate Shoulder.

    Science.gov (United States)

    Preuschoft, Holger; Hohn, Bianca; Scherf, Heike; Schmidt, Manuela; Krause, Cornelia; Witzel, Ulrich

    2010-04-01

    Studies of the shoulder girdle are in most cases restricted to morphological comparisons and rarely aim at elucidating function in a strictly biomechanical sense. To fill this gap, we investigated the basic functional conditions that occur in the shoulder joint and shoulder girdle of primates by means of mechanics. Because most of nonhuman primate locomotion is essentially quadrupedal walking-although on very variable substrates-our analysis started with quadrupedal postures. We identified the mechanical situation at the beginning, middle, and end of the load-bearing stance phase by constructing force parallelograms in the shoulder joint and the scapulo-thoracal connection. The resulting postulates concerning muscle activities are in agreement with electromyographical data in the literature. We determined the magnitude and directions of the internal forces and explored mechanically optimal shapes of proximal humerus, scapula, and clavicula using the Finite Element Method. Next we considered mechanical functions other than quadrupedal walking, such as suspension and brachiation. Quadrupedal walking entails muscle activities and joint forces that require a long scapula, the cranial margin of which has about the same length as the axillary margin. Loading of the hand in positions above the head and suspensory behaviors lead to force flows along the axillary margin and so necessitate a scapula with an extended axillary and a shorter cranial margin. In all cases, the facies glenoidalis is nearly normal to the calculated joint forces. In anterior view, terrestrial monkeys chose a direction of the ground reaction force requiring (moderate) activity of the abductors of the shoulder joint, whereas more arboreal monkeys prefer postures that necessitate activity of the adductors of the forelimb even when walking along branches. The same adducting and retracting muscles are recruited in various forms of suspension. As a mechanical consequence, the scapula is in a more frontal

  19. Trends in Surgical Management of Shoulder Instability

    Science.gov (United States)

    Bonazza, Nicholas A.; Liu, Guodong; Leslie, Douglas L.; Dhawan, Aman

    2017-01-01

    Background: Optimal surgical management of anterior shoulder instability remains controversial. There is a need to assess the most recent trends for primary and revision shoulder stabilization surgery using a national database significantly larger than those previously utilized. Hypothesis: Most shoulder stabilization procedures are performed arthroscopically. Examining revision procedures, we hypothesized that open procedures would result in decreased revision stabilizations compared with arthroscopic procedures and that most revision procedures would be open Bankart or bone transfer procedures regardless of the index procedure technique. Study Design: Descriptive epidemiology study. Methods: The MarketScan Database was searched using International Classification of Diseases–Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) codes to identify patients who underwent any shoulder stabilization procedure between 2008 and 2012. Regression analysis was used to evaluate trends between patient groups. The Cochran-Armitage trend test was used to identify differences in trends seen yearly. Odds ratios (ORs) were calculated to compare the likelihood of undergoing a revision stabilization procedure. Results: A total of 66,564 shoulder stabilization procedures were identified from 2008 through 2012: 60,248 arthroscopic stabilization procedures (90.5%) and 6316 open stabilization procedures (9.5%), including 1623 bone block procedures. Arthroscopic stabilization procedures increased in total number and percentage of all procedures in each year of the study. Bone block procedures increased in number each year, although other open procedures decreased during the study period. Males underwent more stabilization procedures, while patients between the ages of 10 and 19 years were most likely to undergo any procedure. Patients who underwent bone block stabilization were significantly less likely to undergo a second stabilization procedure during the study period when

  20. Functional internal rotation after shoulder arthroplasty: a comparison of anatomic and reverse shoulder arthroplasty.

    Science.gov (United States)

    Triplet, Jacob J; Everding, Nathan G; Levy, Jonathan C; Moor, Molly A

    2015-06-01

    Recovery of functional internal rotation after primary shoulder arthroplasty is essential to perform many important activities of daily living. Functional internal rotation is typically reported as it relates to clinical examination findings of motion (posterior reach) and lift-off or belly-press tests. A more detailed evaluation of functional recovery of internal rotation after primary anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) is needed. A retrospective review of patients treated with primary TSA (n = 132) and RSA (n = 91) with a minimum 2-year follow-up was performed. Subanalysis of revision RSA (n = 24) and primary RSA was performed. Active range of motion, subjective internal rotation motion, manual internal rotation strength, and specific questions related to internal rotation function isolated from the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) functional questionnaires were reviewed. Compared with RSA, TSA patients could more likely reach the small of the back (SST) and wash the back/fasten bra (ASES). Active internal rotation motion, SST score, ASES score, and subjective internal rotation were greater after TSA. No significant difference was observed with respect to managing toileting between cohorts. Revision RSA patients were less likely to be able to wash the back/fasten bra (ASES) and easily manage toileting (ASES) compared with primary RSA patients. Primary anatomic shoulder arthroplasty yields greater functional internal rotation than does primary RSA, with either procedure being effective at managing toileting. Patient education regarding activities of daily living related to internal rotation can be predicted. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. EMG analysis of shoulder muscle fatigue during resisted isometric shoulder elevation.

    Science.gov (United States)

    Minning, Stephen; Eliot, Colin A; Uhl, Tim L; Malone, Terry R

    2007-04-01

    The purpose of this study was to determine if a difference existed in the rate of fatigue of select shoulder muscles during isometric shoulder elevation and if the measured rate of fatigue was consistent from day to day. Shoulder muscle fatigue has been associated with alterations in joint mechanics and possibly contributes to shoulder dysfunction. While research exists, there is limited information on an objective and reliable measure of shoulder fatigue. Sixteen asymptomatic subjects were evaluated. The subjects held a weight equivalent to 60% of his/her Maximum Voluntary Isometric Contraction (MVIC) while elevating in the scapular plane. Surface electrodes were applied to collect electromyographic activity from the upper trapezius, middle deltoid, serratus anterior, and lower trapezius muscles while the arm was held at 90 degrees elevation. Data collection ceased when the subject was no longer able to maintain 90 degrees of elevation. The subject then rested and a second trial performed. One week later, the two-trial procedure was repeated. A significant interaction of trial x day x muscle was found for the rate of fatigue. Post hoc analysis revealed that the rate of fatigue of the middle deltoid was significantly greater than the other muscles tested. The intraday reliability was good for all muscles but interday reliability was poor except for the middle deltoid. This study suggests that the middle deltoid appears to fatigue faster than the other shoulder muscles tested at the selected level of shoulder elevation. This should be considered in designing a rehabilitation program to develop a sequence that does not overly fatigue the middle deltoid.

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

    Science.gov (United States)

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

    2011-03-01

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

  3. 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

    2017-04-13

    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 stabilisation 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 (Pshoulders (P>0.22). 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.

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

    Science.gov (United States)

    2011-01-01

    Background Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. Methods An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables. Results MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTr

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

    Science.gov (United States)

    Bron, Carel; Dommerholt, Jan; Stegenga, Boudewijn; Wensing, Michel; Oostendorp, Rob A B

    2011-06-28

    Shoulder pain is reported to be highly prevalent and tends to be recurrent or persistent despite medical treatment. The pathophysiological mechanisms of shoulder pain are poorly understood. Furthermore, there is little evidence supporting the effectiveness of current treatment protocols. Although myofascial trigger points (MTrPs) are rarely mentioned in relation to shoulder pain, they may present an alternative underlying mechanism, which would provide new treatment targets through MTrP inactivation. While previous research has demonstrated that trained physiotherapists can reliably identify MTrPs in patients with shoulder pain, the percentage of patients who actually have MTrPs remains unclear. The aim of this observational study was to assess the prevalence of muscles with MTrPs and the association between MTrPs and the severity of pain and functioning in patients with chronic non-traumatic unilateral shoulder pain. An observational study was conducted. Subjects were recruited from patients participating in a controlled trial studying the effectiveness of physical therapy on patients with unilateral non-traumatic shoulder pain. Sociodemographic and patient-reported symptom scores, including the Disabilities of the Arm, Shoulder, and Hand (DASH) Questionnaire, and Visual Analogue Scales for Pain were compared with other studies. To test for differences in age, gender distribution, and education level between the current study population and the populations from Dutch shoulder studies, the one sample T-test was used. One observer examined all subjects (n = 72) for the presence of MTrPs. Frequency distributions, means, medians, standard deviations, and 95% confidence intervals were calculated for descriptive purposes. The Spearman's rank-order correlation (ρ) was used to test for association between variables. MTrPs were identified in all subjects. The median number of muscles with MTrPs per subject was 6 (active MTrPs) and 4 (latent MTrPs). Active MTrPs were most

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

    Directory of Open Access Journals (Sweden)

    Wensing Michel

    2011-06-01

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

  7. Shoulder MRI after impingement test injection

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    Bergman, A.G. [Department of Radiology, Stanford University Medical Center, CA (United States); Fredericson, M. [Department of Functional Restoration, Division of Physical Medicine and Rehabilitation, Stanford University Medical Center, CA (United States)

    1998-07-01

    Objective. To determine how long injected fluid from an impingement test remains in the bursa or adjacent soft tissues after an injection. Design and patients. Six patients prospectively underwent MRI of the shoulder immediately before and after an impingement test injection, and at 3 days, 2 weeks and 4 weeks later. MR images were evaluated and graded for fluid distribution within the bursa and adjacent soft tissues. The rotator cuff was evaluated for signal abnormalities related to the injection. Results and conclusion. Three days after the injection, the soft tissue fluid had returned to pre-injection levels or less in five of the six patients. No patients showed rotator cuff signal abnormalities related to the impingement test injection. We recommend a delay of 3 days before a shoulder MR examination after an injection has been performed, to avoid misinterpretations. (orig.) With 3 figs., 1 tab., 7 refs.

  8. Common Shoulder Injuries in American Football Athletes.

    Science.gov (United States)

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

    2015-01-01

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

  9. Dexamethasone for pain after outpatient shoulder surgery

    DEFF Research Database (Denmark)

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

    2014-01-01

    Background Dexamethasone has analgesic properties when given intravenously before surgery, but the optimal dose has not been determined. We hypothesised that a dose of 40 mg dexamethasone would improve analgesia after outpatient shoulder surgery compared with 8 mg. Methods A randomised, double......-blind, placebo-controlled clinical trial was conducted at Horsens Regional Hospital, Denmark. Patients scheduled for arthroscopic subacromial decompression and/or acromioclavicular joint resection as an outpatient procedure (n = 101) were randomised to receive intravenous dexamethasone 40 mg (D40), 8 mg (D8...... a dose–response relationship, increasing the dexamethasone dose from 8 to 40 mg did not improve analgesia significantly after outpatient shoulder surgery....

  10. Posterior Shoulder Dislocation Due to an Atypical Trauma Mechanism

    Science.gov (United States)

    Güzel, Şevket Ergun; Baysal, Özgür; Eceviz, Engin; Elmalı, Nurzat

    2014-01-01

    Objectives: A 32 year old man who was admitted to the emergency department with serious pain and absent movement of the right upper extremity due to passing the ball in a basketball game. He had no shoulder dislocation in his medical history. The right shoulder position was flexion and adduction. The shoulder range of motion was restricted and the neurovascular examination was intact. Posterior shoulder dislocation was diagnosed in radiographs.The aim of the study is pointed out an unusual mechanism of the posterior shoulder dislocations which is related microtrauma. The main problem in treatment of this kind of dislocation is correct and timely diagnosis. Methods: After diagnosing the posterior shoulder dislocation, we reducted the shoulder joint immediately and immobilized in abduction and external rotation with Velpeau bandage. We took radiographs and computerized tomography to confirm the reduction of the joint and diagnose the additional bone pathology. Reverse Hill Sacks lesion was diagnosed. Two weeks later after diagnosing passive range of movement exercises were applied. Magnetic resonance imaging was done to diagnose the additional pathology. Results: There was no spesific finding in radiographs and reverse Hill Sachs lesion and anterior labral tear were determined in magnetic images finding. Conclusion: Shoulder joint dislocations are the most seen pathology in the emergency department. On the other hand posterior shoulder dislocations are less common than anterior dislocations, but more commonly missed. Posterior shoulder dislocations are caused by high energy trauma, seizures, electric shocks and microtrauma.

  11. Shoulder kinematics and mobility adaptations in water-polo players.

    Science.gov (United States)

    Turgut, Elif; Yildiz, Taha I; Demirci, Serdar; Eraslan, Leyla; Ulusoy, Burak; Tok, Damla; Harput, Gulcan; Kara, Dilara; Duzgun, Irem; Tunay, Volga B; Ergun, Nevin

    2017-09-29

    There is limited research to demonstrate how scapular kinematics and shoulder-related physical characteristics are affected in water-polo players, who undertake swimming and repetitive throwing activity. The aim of this study was to investigate possible adaptations in the three- dimensional scapular kinematics and in glenohumeral internal rotation, external rotation range of motion and shoulder posterior-capsule tightness in water-polo players. Fourteen water-polo players and 14 asymptomatic volunteers participated in the study. The scapular kinematics were recorded using an electromagnetic tracking device during the scapular plane shoulder elevation. Additionally, shoulder range of motion and posterior-capsule tightness were evaluated. Analysis of variance models were used to make comparisons between groups. Although there was a trend toward increased scapular internal rotation and downward rotation in the throwing shoulders of water-polo players, comparisons revealed there was no significant differences in kinematics, shoulder internal-external range of motion and posterior-capsule tightness between the throwing shoulders of the players and dominant shoulders of the control participants. The throwing shoulders of water-polo players did not demonstrate alterations in shoulder kinematics and mobility parameters.

  12. The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties.

    Science.gov (United States)

    Dillon, Mark T; Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

    2015-06-01

    Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases.

  13. Adaptation of the AnyBody™ Musculoskeletal Shoulder Model to the Nonconforming Total Shoulder Arthroplasty Context.

    Science.gov (United States)

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

    2015-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Melissa M. B. Morrow

    2014-01-01

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

  15. Early dislocation after reverse total shoulder arthroplasty.

    Science.gov (United States)

    Chalmers, Peter N; Rahman, Zain; Romeo, Anthony A; Nicholson, Gregory P

    2014-05-01

    Although instability can occur after reverse total shoulder arthroplasty (RTSA), the risk factors, the treatment, and ultimate fate of the implant in these patients remains poorly understood. Demographics, acute treatment, and the need for revision were evaluated in all patients with RTSAs who sustained a subsequent dislocation within the first 3 months. Standardized outcome scores were collected preoperatively and at the final follow-up. Atraumatic instability occurred in 11 patients (incidence, 2.9%) treated with RTSA early (before 3 months postsurgery). The mean time to dislocation was 3.4 weeks. These patients tended to be previously operated-on (64%), male (82%), overweight (mean body mass index (BMI) of 32.2 kg/m(2), with 82% having a BMI ≥30 kg/m(2)), and without a satisfactory subscapularis repair at initial RTSA (64%). Initial treatment included closed reduction in 9 patients, open reduction in 1, and open reduction with a thicker polyethylene insert in 1. Four experienced recurrent instability requiring a thicker polyethylene insert. Two additional patients were converted to hemiarthroplasty due to persistent instability. Visual analog pain scores (P = .014) and American Shoulder and Elbow Surgeons scores (P = .018) were significantly improved. Simple Shoulder Test scores trended towards improvement (P = .073). Early dislocations of the RTSA prosthesis were uncommon. The most common associated factors were a BMI >30 kg/m(2), male gender, subscapularis deficiency, and previous surgery; in these patients, we now use an abduction orthosis. Closed reduction alone was successful in 4 of the 9 closed reductions (44%). Five of 11 RTSAs (45%) required polyethylene exchange. The RTSA was retained in 82%, 36% with the original implant. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  16. Severe shoulder tendinopathy associated with levofloxacin

    Directory of Open Access Journals (Sweden)

    Walter de Araujo Eyer-Silva

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

  17. Cine-MR imaging of the shoulder

    Energy Technology Data Exchange (ETDEWEB)

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

    1997-11-01

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

  18. 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.)

  19. 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.

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

    DEFF Research Database (Denmark)

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

    2011-01-01

    ABSTRACT: BACKGROUND: Neck and shoulder complaints are common among employees in sedentary occupations characterized by intensive computer use. Such musculoskeletal pain - which is often associated with restricted range of motion and loss of muscle strength - is one of the most common conditions...... treated by physical therapists. The exact mechanism of neck pain is rarely revealed by clinical examination and the treatment has varied from passive rest to active treatments. Active treatments have often been divided into either training of the painful area or the surrounding musculature avoiding direct...... training of the painful area. Our study investigates the effect of the latter approach. METHODS/DESIGN: A randomized controlled trial of 10 weeks duration is currently being conducted. Employed office workers with severe neck-shoulder pain are randomized to 3 × 20 min shoulder function training...

  1. Shoulder Impingement Syndromes: Implications on Physical Therapy Examination and Intervention

    Science.gov (United States)

    2005-01-01

    A painful shoulder presents challenges in examination, diagnosis and intervention for the physical therapist because of the complexity of the structures involved. A common cause of shoulder pain is shoulder impingement syndrome. This was first described as a condition in which the soft tissues of the subacromial space were chronically entrapped and compressed between the humeral head and the subacromial arch. This definition does not account for the myriad potential causes of shoulder impingement conditions, as forms of impingement other than subacromial soft tissue compression may explain different symptomatic shoulder injuries. This paper describes shoulder impingement syndromes that have been hypothesized, identified and analyzed in the literature. Physical Therapy examination and intervention for these syndromes are also discussed. PMID:25792938

  2. Evaluation and management of shoulder pain in primary care clinics.

    Science.gov (United States)

    House, Jeff; Mooradian, Arshag

    2010-11-01

    Shoulder pain is a frequent clinical problem facing primary care physicians. Despite its common occurrence, many clinicians are unfamiliar with the diagnosis and treatment of many common shoulder ailments. Because therapy for most shoulder disorders can be made at the initial consultation, a good history and physical remain paramount. The purpose of this paper is to review the basic approach to diagnosis and management of shoulder pain. It will summarize a pragmatic approach to the initial history, with particular attention to differentiating extrinsic and intrinsic etiologies. Physical exam techniques for evaluating shoulder pain will be reviewed, including provocation testing for specific disorders. Specific disorders covered include supraspinatus tendonitis, subdeltoid bursitis, frozen shoulder, biceps tendonitis, and acromioclavicular (AC) joint arthritis.

  3. Reoperation for failed shoulder reconstruction following brachial plexus birth injury

    Science.gov (United States)

    2013-01-01

    Background Various approaches have been developed to treat the progressive shoulder deformity in patients with brachial plexus birth palsy. Reconstructive surgery for this condition consists of complex procedures with a risk for failure. Case presentations This is a retrospective case review of the outcome in eight cases referred to us for reoperation for failed shoulder reconstructions. In each case, we describe the initial attempt(s) at surgical correction, the underlying causes of failure, and the procedures performed to rectify the problem. Results were assessed using pre- and post-operative Mallet shoulder scores. All eight patients realized improvement in shoulder function from reoperation. Conclusions This case review identifies several aspects of reconstructive shoulder surgery for brachial plexus birth injury that may cause failure of the index procedure(s) and outlines critical steps in the evaluation and execution of shoulder reconstruction. PMID:23883413

  4. The critical shoulder angle is associated with osteoarthritis in the shoulder but not rotator cuff tears

    DEFF Research Database (Denmark)

    Bjarnison, Arnar O; Sørensen, Thomas J; Kallemose, Thomas

    2017-01-01

    BACKGROUND: In 2013 Moor et al introduced the concept of the critical shoulder angle (CSA) and suggested that an abnormal CSA was a leading factor in development of rotator cuff tear (RCT) and osteoarthritis (OA) of the shoulder. This study assessed whether the CSA was associated with RCT and OA...... of the acromion to make the CSA smaller because it might increase the risk of developing OA without decreasing the risk of developing RCT. The CSA measurements showed excellent intra- and inter-rater reliability....

  5. Management of shoulder hemiarthroplasty in a patient with rheumatoid arthritis.

    Science.gov (United States)

    Marsh, Darrin W

    2006-08-01

    Case report. Rehabilitation after shoulder hemiarthroplasty for rotator cuff tear arthropathy (RCTA) represents a significant challenge to physical therapists. Limited goals have been defined for this patient population and include no pain or slight pain at rest, moderate pain with vigorous activity, shoulder external rotation active range of motion (AROM) greater than 20 degrees, and shoulder abduction AROM greater than 90 degrees. The patient was a 60-year-old female elementary school teacher with functional class III adult-onset rheumatoid arthritis, who came to physical therapy 2 weeks after undergoing a hemiarthroplasty for RCTA of the right shoulder. Physical therapy included 33 treatment sessions involving 4 to 11 exercises each session. All sessions were performed under the direct supervision of a physical therapist utilizing specially designed equipment. Physical therapy emphasized early active assisted elevation range of motion (ROM), graded progressive exercise, and functional training. All exercises were performed in a pain-free ROM or a ROM that did not increase shoulder pain. Following physical therapy, subjective pain scale at rest was 0/10 and during vigorous activity 1/10 to 2/10. Shoulder AROM was normal and shoulder rotation and elevation strength was good. There was a significant improvement in shoulder proprioception and the patient demonstrated a negative belly press test for subscapularis muscle integrity. Additionally, the patient's score on the self-report section of the American Shoulder and Elbow Surgeons Assessment Form increased from 0% at the initial examination to 70% at discharge. Despite limited expectations, this patient achieved normal shoulder ROM and near normal shoulder strength after 14 weeks of physical therapy. Overall, an early, aggressive, progressively graded exercise program appears to be a safe and effective form of treatment after shoulder hemiarthroplasty for RCTA.

  6. Shoulder disorders in an outpatient clinic: an epidemiological study

    OpenAIRE

    Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; Assunção, Jorge Henrique; Pinto, Gustavo de Mello Ribeiro; Silveira, Arthur Zorzi Freire da; Ferreira Neto,Arnaldo Amado

    2017-01-01

    ABSTRACT OBJECTIVE: To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. METHODS: This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. RESULTS: We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64...

  7. Normal anatomy, variants and pitfalls on shoulder MRI

    Energy Technology Data Exchange (ETDEWEB)

    Rudez, Jasna [University Hospital Balgrist, Radiology, University of Zurich Switzerland, Forchstrasse 340, CH-8008 Zurich (Switzerland); Zanetti, Marco [University Hospital Balgrist, Radiology, University of Zurich Switzerland, Forchstrasse 340, CH-8008 Zurich (Switzerland)], E-mail: marco.zanetti@balgrist.ch

    2008-10-15

    MR imaging of the shoulder is widely used for assessment of impingement and instability-related clinical conditions. The following review article demonstrates the normal anatomy, variations and classical pitfalls. In addition to classical pitfalls (sublabral hole, sublabral recess, Buford complex) the authors focus on a number of normal, bony, cartilaginous, ligamentous and tendinous structures that can simulate disease at the shoulder. In addition, ways to distinguish these pitfalls from true shoulder abnormalities are shown.

  8. Muscle activation patterns in patients with recurrent shoulder instability

    Science.gov (United States)

    Jaggi, Anju; Noorani, Ali; Malone, Alex; Cowan, Joseph; Lambert, Simon; Bayley, Ian

    2012-01-01

    Purpose: The aim of this study is to present muscle patterns observed with the direction of instability in a series of patients presenting with recurrent shoulder instability. Materials and Methods: A retrospective review was carried out on shoulder instability cases referred for fine wire dynamic electromyography (DEMG) studies at a specialist upper limb centre between 1981 and 2003. An experienced consultant clinical neurophysiologist performed dual needle insertion into four muscles (pectoralis major (PM), latissimus dorsi (LD), anterior deltoid (AD) and infraspinatus (IS)) in shoulders that were suspected to have increased or suppressed activation of muscles that could be contributing to the instability. Raw EMG signals were obtained while subjects performed simple uniplanar movements of the shoulder. The presence or absence of muscle activation was noted and compared to clinical diagnosis and direction of instability. Results: A total of 140 (26.6%) shoulders were referred for fine wire EMG, and 131 studies were completed. Of the shoulders tested, 122 shoulders (93%) were identified as having abnormal patterns and nine had normal patterns. PM was found to be more active in 60% of shoulders presenting with anterior instability. LD was found to be more active in 81% of shoulders with anterior instability and 80% with posterior instability. AD was found to be more active in 22% of shoulders with anterior instability and 18% with posterior instability. IS was found to be inappropriately inactive in only 3% of shoulders with anterior instability but in 25% with posterior instability. Clinical assessment identified 93% of cases suspected to have muscle patterning, but the specificity of the clinical assessment was only correct in 11% of cases. Conclusion: The DEMG results suggest that increased activation of LD may play a role in both anterior and posterior shoulder instability; increased activation of PM may play a role in anterior instability. PMID:23493512

  9. ANALYSIS OF LEVEL OF BOTH SHOULDERS IN PHYSICAL THERAPY STUDENTS

    Directory of Open Access Journals (Sweden)

    Ghazala Noor Nizami

    2017-09-01

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

  10. Intertester reliability of a classification system for shoulder pain.

    Science.gov (United States)

    Carter, Tom; Hall, Hamilton; McIntosh, Greg; Murphy, John; MacDougall, Janice; Boyle, Christina

    2012-03-01

    To describe and determine the intertester reliability of a newly developed classification system of shoulder syndrome recognition. Intertester reliability study. Fourteen primary care physiotherapy clinics. Two hundred and fifty-five patients with shoulder pain. Inclusion criterion: presence of shoulder pain aring within the glenohumeral or associated joints and structures. previous shoulder surgery, surgical candidates, recognised malignancy, systemic illness, or concurrent cervical pain and/or radiculopathy. Examiners were 55 physiotherapists who were arranged in pairs; each patient received two independent and blinded assessments, one by each of the paired physiotherapists. This shoulder classification approach contains three main clinical syndromes: Pattern 1 (impingement pain), Pattern 2 (acromioclavicular joint pain) and Pattern 3 (shoulder pain: frozen shoulder, glenohumeral arthritis, massive cuff tear, subscapularis tear, painful laxity, post-traumatic instability, internal derangement). Percentage agreement and Cohen's kappa coefficient. The mean age of patients was 46.6 years (standard deviation 16.3, range 16 to 86), and 57% were male. Physiotherapists agreed on the pattern of shoulder pain for 205 of the 255 shoulders assessed (agreement rate 80%); the kappa coefficient was 0.664 (95% confidence interval 0.622 to 0.706; Pshoulder pain. The kappa coefficient denotes good reproducibility. Copyright © 2011 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  11. [Implementation of preoperative physiotherapy and recovery after shoulder impingement surgery].

    Science.gov (United States)

    Vuorenmaa, Mirja; Häkkinen, Arja; Paloneva, Juha; Kiviranta, Ilkka; Kautiainen, Hannu; Marjo, Oikari; Ylinen, Jari

    2011-01-01

    Subacromial impingement syndrome is a common orthopedic condition. Patients operated due to shoulder impingement (n=104) were sent a questionnaire inquiring rehabilitation procedures before and after surgery, pain and shoulder function. Response rate was 68%, mean age of the patients was 53 years. Before surgery, 50% of the patients had received physiotherapy. The symptoms disappeared after surgery in the majority of the patients. However, 13% of the patients had significant shoulder pain (VAS over 30 mm) one year postoperatively and 15% had considerable functional deficit. To avoid unnecessary operations for shoulder impingement proper conservative treatment must be provided before surgery.

  12. Role of radiographs in shoulder pathology: a clinical review

    Directory of Open Access Journals (Sweden)

    Hershkovich O

    2014-07-01

    Full Text Available Oded Hershkovich,1–3,* Shachar Shapira,1–3,* Yaron Sela,1,3 Itamar B Botser1,31Department of Orthopedic Surgery, Chaim Sheba Medical Center, 2Medical Corps, Israeli Defense Forces, Tel Hashomer, 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel*SS and OH contributed equally to this workAbstract: Shoulder pain is a very common complaint, and affects as many as 20% of all people at some point during their lives. Despite the availability of more advanced imaging modalities, X-ray remains the first imaging test to be performed in the investigation of any shoulder pain. However, with their increasing availability, ultrasound and magnetic resonance imaging have in recent years become first-line techniques for the diagnostic imaging of the shoulder. Moreover, ultrasound of the shoulder is increasingly performed in lieu of radiography. Nevertheless, many patients who visit a shoulder specialist for their pain are referred by a family physician or community orthopedist without an X-ray having ever been performed. Shoulder pain can be caused by many conditions, including rotator cuff tears, calcification within the tendons of the rotator cuff, stiff shoulder, subacromial impingement, space-occupying lesions, degenerative changes, and rheumatoid arthritis. This paper reviews various types of shoulder injury and the radiographic symptomatology of each, with the goal of encouraging the use of radiography by demonstrating the importance of this basic tool in the diagnostic process for these injuries.Keywords: shoulder, pain, pathology, imaging, radiographs

  13. An unusual case of bilateral anterior shoulder dislocations

    Directory of Open Access Journals (Sweden)

    Tennessee D. Park, BA

    2018-02-01

    Full Text Available A 23-year-old man was transported to a trauma center after injuring himself while snowboarding. He presented with bilateral shoulder pain and associated deformity to both shoulders. His exam was otherwise unremarkable, and his x-rays confirmed bilateral shoulder dislocations. Cunningham and external rotation without sedation and analgesia techniques were unsuccessful even with local anesthesia to the joint. Subsequent bilateral reduction was successful with moderate sedation using the Milch technique. Simultaneous anterior bilateral shoulder dislocations are rare and providers may need to adjust their techniques to accommodate this unusual presentation.

  14. Shoulder Duplication in Constriction Band Syndrome: a Case Report

    Directory of Open Access Journals (Sweden)

    Davod Jafari

    2011-11-01

    Full Text Available A 2.5 year old girl is presented with both hands constriction bands leading to distal amputations and the rare deformity of shoulder duplication in the right side accompanying constriction skin marking over the affected shoulder. The cephalomedial scapula articulated with the clavicle and the caudolateral scapula articulated with humeral head. The most important physical finding which could explain the pathophysiology of this rare anomaly, was constriction band marking over the right shoulder. Shoulder range of motion was limited but still functional and no surgical intervention was required for the scapular duplication.

  15. Chronic shoulder pain: part I. Evaluation and diagnosis.

    Science.gov (United States)

    Burbank, Kelton M; Stevenson, J Herbert; Czarnecki, Gregory R; Dorfman, Justin

    2008-02-15

    Shoulder pain is defined as chronic when it has been present for longer than six months. Common conditions that can result in chronic shoulder pain include rotator cuff disorders, adhesive capsulitis, shoulder instability, and shoulder arthritis. Rotator cuff disorders include tendinopathy, partial tears, and complete tears. A clinical decision rule that is helpful in the diagnosis of rotator cuff tears includes pain with overhead activity, weakness on empty can and external rotation tests, and a positive impingement sign. Adhesive capsulitis can be associated with diabetes and thyroid disorders. Clinical presentation includes diffuse shoulder pain with restricted passive range of motion on examination. Acromioclavicular osteoarthritis presents with superior shoulder pain, acromioclavicular joint tenderness, and a painful cross-body adduction test. In patients who are older than 50 years, glenohumeral osteoarthritis usually presents as gradual pain and loss of motion. In patients younger than 40 years, glenohumeral instability generally presents with a history of dislocation or subluxation events. Positive apprehension and relocation are consistent with the diagnosis. Imaging studies, indicated when diagnosis remains unclear or management would be altered, include plain radiographs, magnetic resonance imaging, ultrasonography, and computed tomography scans. Plain radiographs may help diagnose massive rotator cuff tears, shoulder instability, and shoulder arthritis. Magnetic resonance imaging and ultrasonography are preferred for rotator cuff disorders. For shoulder instability, magnetic resonance imaging arthrogram is preferred over magnetic resonance imaging.

  16. Risk factors for volleyball-related shoulder pain and dysfunction.

    Science.gov (United States)

    Reeser, Jonathan C; Joy, Elizabeth A; Porucznik, Christina A; Berg, Richard L; Colliver, Ethan B; Willick, Stuart E

    2010-01-01

    To identify risk factors for volleyball-related shoulder pain and dysfunction. Cross-sectional, observational. National championship sporting event. Competitors at the 2006 National Intramural & Recreational Sports Association Collegiate Club Volleyball Championship competition were invited to volunteer for the study. A total of 422 athletes returned questionnaires, of whom 276 also underwent a structured physical examination. Study participants provided information on any history of volleyball-related shoulder pain or dysfunction. The simple shoulder test (SST) and a visual analog scale permitted subjects to quantify the extent of their perceived functional limitation. Subjects also were invited to undergo a physical examination in which dynamic scapular positioning, glenohumeral range of motion, shoulder girdle strength, and core stability were assessed. Standard statistical methods of comparison and tests of association were used to identify risk factors for shoulder pain among participating volleyball athletes. Approximately 60% of participants reported a history of shoulder problems. Attackers and "jump" servers were more likely to have shoulder problems than setters, defensive specialists, and "float" servers. Nearly half of the athletes who reported shoulder problems perceived some associated functional limitation, with female athletes providing lower SST scores than male athletes (9.0 versus 10.1, P = .001). Athletes reporting shoulder pain and dysfunction were more likely to have SICK scapula scores of 3 or greater (P = .010). Participants who demonstrated core instability also had greater SICK scapula scores (3.9 versus 2.9, P = .038), and were more likely to report a history of shoulder problems (chi2 = 8.83, P = .032). Although the authors observed a significant mean left-right difference of 8.9 degrees in available glenohumeral internal rotation among participating athletes, this deficit was not associated with shoulder problems. However, there was an

  17. A Case of Simultaneous Bilateral Anterior Shoulder Dislocation

    Directory of Open Access Journals (Sweden)

    Mallanagouda N Patil

    2013-04-01

    Full Text Available Introduction: Anterior dislocation of shoulder is commonest dislocation one encounters in day to day Orthopaedic practice. But bilateral shoulder dislocations are relatively uncommon frequently posterior and secondary to violent muscle contraction. Simultaneous bilateral anterior dislocations of shoulder following trauma is rare occurrence. Case Report: 35 year old male presented to emergency department with history fall by tripping on a stone (fall on outstretched hand. He complained of pain and difficulty in moving both the shoulders. On clinical examination, patient’s both upper limbs were abducted and externally rotated. Bilaterally shoulder contour was lost with flattening. Other classical signs of shoulder dislocation viz, Bryants test, Callway sign, Hamilton’s ruler test were positive. Diagnosis was confirmed on X rays. Both shoulders were reduced in emergency operation theater under general anaesthesia by Kocher’s method and were immobilised in sling. Conclusion: Though bilateral shoulder dislocations are commonly posterior, usually either secondary to convulsions or electric shock, anterior dislocation has to be kept in mind , especially in post traumatic injuries. This bilateral dislocation also presents with practical problems immobilization and day to day care of patients. Keywords: Simultaneous, bilateral, shoulder dislocation, traumatic.

  18. Bone mineral density measurement over the shoulder region

    DEFF Research Database (Denmark)

    Doetsch, A M; Faber, J; Lynnerup, N

    2002-01-01

    The purpose of this study was to (1). establish a method for measuring bone mineral density (BMD) over the shoulder region; (2). compare the relationship between shoulder BMD levels with hip BMD and body mass index (BMI); and (3). discuss the relevance of the shoulder scan as an early indicator...... to the least relative influence of weight and stress loading because of migration of calcium to weight and stress-bearing areas. Since the effect of this migration could mask local osteoporotic bone loss, shoulder BMD measurement is likely to minimize false indicators of healthy bone in women with high BMI...

  19. Managing anterior shoulder instability with bracing: an expanded update.

    Science.gov (United States)

    Reuss, Bryan L; Harding, Warren G; Nowicki, Kevin D

    2004-06-01

    This article provides an updated report on functional bracing for anterior shoulder instability. A classification of shoulder braces is reintroduced into three separate types. Type A braces limit shoulder motion to a "safe zone," whereas types B and C apply indirect and direct stabilizing forces to the joint, respectively. Thirteen of the most widely available braces were surveyed and the parameters of comfort, convenience, construction, cost, potential sport use, and special features were analyzed. Problem areas included poor fit and range of motion restriction. The system of classifying sports based on shoulder demands is reintroduced.

  20. Management of recurrent shoulder instability in patients with epilepsy.

    Science.gov (United States)

    Thangarajah, Tanujan; Lambert, Simon M

    2016-08-01

    Epileptic seizures can cause dislocation of the shoulder. Recurrent instability is common and occurs soon after the first dislocation. Significant bone loss from the humeral head and glenoid is thought to be responsible for this, and therefore the majority of surgical approaches focus on bone augmentation of the glenohumeral joint. Understanding of the current management strategies and the anatomic lesions associated with seizure-related shoulder instability will guide clinical decision-making. The purpose of this article was to review the pathoanatomy, treatment options, and clinical outcomes of seizure-related shoulder instability. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  1. 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.

  2. 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.

  3. Painful shoulder? Remote clinical management of a Field Guide with shoulder pain and loss of shoulder function in Antarctica

    Directory of Open Access Journals (Sweden)

    Gareth Jones

    2017-06-01

    Full Text Available We report the case of a female Field Guide based at the British Antarctic Survey’s Rothera Science Research Station on Adelaide Island, Antarctica who independently contacted a physiotherapist specialising in climbing related injuries (GJ located in the UK. for a second opinion. The Field Guide was experiencing significant work difficulties due to shoulder pain and subsequent loss of function particularly in overhead activities. The case raises important issues about the medical management of Field Guides operating in extreme environments and remote locations

  4. Comparison of shoulder rotation range of motion in professional tennis players with and without history of shoulder pain.

    Science.gov (United States)

    Moreno-Pérez, Victor; Moreside, Janice; Barbado, David; Vera-Garcia, Francisco J

    2015-04-01

    A glenohumeral internal rotation deficit of the dominant shoulder relative to the non-dominant shoulder (GIRD) is considered a risk factor for shoulder injury in overhead athletes. The aim of this study was to investigate whether professional tennis players with a history of self-reported shoulder pain show differences in rotation range of motion (ROM) of the dominant and non-dominant shoulder compared to asymptomatic controls. Forty-seven professional tennis players belonging to the Association of Tennis Professionals World Tour took part in the study: 19 with shoulder pain history and 28 without. Passive shoulder ROM was measured using a process of photography and software calculation of angles. The dominant shoulder had reduced internal rotation (IR) ROM and total rotation ROM, and increased external rotation (ER) ROM compared to the non-dominant side. These differences did not correlate significantly with years of tennis practice, years of professional play, nor the players' age. However, glenohumeral rotation ROMs correlated negatively with the duration of tennis practice and players' age. Although tennis players with shoulder pain history showed less IR ROM in both shoulders compared with the no-pain group, no significant differences between groups were found for ER ROM, side-to-side ROM asymmetries, years of tennis practice or years of professional play. In professional tennis players, limited IR ROM rather than a GIRD, seems to be associated with shoulder pain history, duration of tennis practice and the players' age, when compared to a similar cohort with no history of shoulder pain. Copyright © 2014 Elsevier Ltd. All rights reserved.

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

    NARCIS (Netherlands)

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

    2012-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

  7. The Effect of the Modified Lateral Suprascapular Block on Shoulder Function in Patients With Chronic Shoulder Pain.

    Science.gov (United States)

    Dorn, Christian; Rumpold-Seitlinger, Gudrun; Farzi, Sylvia; Auer, Johann; Bornemann-Cimenti, Helmar

    2015-12-01

    Suprascapular nerve block (SSNB) is commonly used in pain therapy for patients with chronic shoulder pain. The effect of SSNB on shoulder function has, however, not been investigated so far. If in shoulder function, i.e. the range of motion is increased after application of the nerve block, it can be expected that subsequent physiotherapy, besides being less painful, is also more effective in terms of restoring shoulder mobility. Our aim was to evaluate the effect of SSNB on shoulder function, in patients with chronic shoulder pain. Patients were evaluated using the Constant-Murley Score (CMS) and number rating scale values for pain. The SSN was blocked using the Feigl approach, with 5 ml ropivacaine 0.5%. Shoulder function and pain were assessed 60 minutes and 24 hours after the block. Totally, 20 patients completed the study. The CMS and pain scores significantly improved after the block. The use of the modified lateral SSNB of Feigl significantly reduces pain and increases shoulder function, in chronic shoulder pain.

  8. Validity of an Alternate Hand Behind Back Shoulder Range of Motion Measurement in Patients With Shoulder Pain and Movement Dysfunction.

    Science.gov (United States)

    Satpute, Kiran H; Hall, Toby; Adanani, Aditi

    2018-02-23

    The purpose of this study was to determine the criterion-related validity of a novel method of measuring hand behind back (HBB) shoulder range of motion (ROM) for evaluating pain and disability in people with shoulder pain and movement impairment. This cross-sectional study design evaluated shoulder ROM, pain, fear-avoidance beliefs, and disability in 60 people (aged 35-70 years, 31 male) with chronic unilateral shoulder dysfunction (mean duration 15.73 weeks). Shoulder HBB ROM was measured with a bubble inclinometer in a manner that did not require the patient to disrobe. Correlations were sought between HBB ROM and other shoulder movements, as well as scores recorded on the Shoulder Pain and Disability Index (SPADI), visual analogue scale for pain, Fear Avoidance Beliefs Questionnaire (FABQ), and duration of symptoms. Restriction of HBB movement was significantly correlated with SPADI total disability score (r = 0.39, P shoulder movements. These findings suggest that this novel method of measuring HBB ROM could be used as a functional outcome measure in the evaluation of patients with shoulder disorders. This method could be considered as an additional or alternative where there are challenges in measuring HBB because of restrictions in undressing a patient, such as for cultural reasons. Copyright © 2018. Published by Elsevier Inc.

  9. Return to Sports After Shoulder Stabilization Surgery for Anterior Shoulder Instability.

    Science.gov (United States)

    Elsenbeck, Michael J; Dickens, Jonathan F

    2017-10-26

    Young athletes continue to experience traumatic shoulder instability and are often plagued by recurrent instability, limiting their return to sport. The purpose of this paper was to review return to sport in athletes after shoulder stabilization surgery for anterior shoulder instability. Athletes managed nonoperatively demonstrate unacceptably high rates of recurrent instability and are less likely to successfully return to sport. Operative management includes capsuloligamentous repair (arthroscopic versus open) and bone augmentation techniques. While modern arthroscopic techniques have provided favorable outcomes, open techniques have demonstrated lower recurrence rates among young collision athletes. A subset of athletes continue to experience recurrent instability, leading to further investigation of concomitant pathologies, which may put patients at risk of failure following Bankart repair. Bony augmentation procedures remain favorable for patients with glenoid bone loss; however, what constitutes critical bone loss in the decision between anterior labral repair versus bone augmentation has recently been questioned. Operative management of anterior shoulder instability provides superior results, including lower recurrent instability and return to sport. Future research on patient-specific risk factors may aid surgical decision-making and optimization of outcomes.

  10. Inter-rater reliability of the Shoulder Symptom Modification Procedure in people with shoulder pain.

    Science.gov (United States)

    Lewis, Jeremy S; McCreesh, Karen; Barratt, Eva; Hegedus, Eric J; Sim, Julius

    2016-01-01

    Musculoskeletal conditions involving the shoulder are common and, because of the importance of the upper limb and hand in daily function, symptoms in this region are commonly associated with functional impairment in athletic and non-athletic populations. Deriving a definitive diagnosis as to the cause of shoulder symptoms is fraught with difficulty. Limitations have been recognised for imaging and for orthopaedic special tests. 1 solution is to partially base management on the response to tests aimed at reducing the severity of the patient's perception of symptoms. 1 (of many) such tests is the Shoulder Symptom Modification Procedure (SSMP). The reliability of this procedure is unknown. 37 clinician participants independently watched the videos of 11 patient participants undergoing the SSMP and recorded each patient's response as improved (partially or completely), no change or worse. Inter-rater reliability was assessed by Krippendorff's α, which ranges from 0 to 1. Krippendorff's α was found to range from 0.762 to 1.000, indicating moderate to substantial reliability. In addition, short (3-hour) and longer (1-day) durations of training were associated with similar levels of reliability across the techniques. Deriving a definitive structural diagnosis for a person presenting with a musculoskeletal condition involving the shoulder is difficult. The findings of the present study suggest that the SSMP demonstrates a high level of reliability. More research is needed to better understand the relevance of such procedures. ISRCTN95412360.

  11. Neurologic complications of shoulder joint replacement.

    Science.gov (United States)

    Ball, Craig M

    2017-07-05

    Little attention has been given to neurologic complications after shoulder joint replacement (SJR). Previously thought to occur infrequently, it is likely that many are not clinically recognized, and they can result in postoperative morbidity and impair the patient's recovery. The purpose of this study was to document the prevalence of nerve complications after SJR, to identify the nerves involved, and to define patient outcomes. This was a retrospective review of 211 SJRs in 202 patients during a 5-year period were included, with 89 male and 122 female patients at an average age of 70 years. All patients underwent a comprehensive analysis of any postoperative nerve complication, including onset, duration, investigation, treatment, and symptom resolution. Of the 211 SJR procedures, 44 were identified as having sustained a nerve complication (20.9%), with 36 female (81.8%) and 8 male patients (18.2%). Reverse SJR was associated with the highest number of nerve complications. The median nerve (25 patients) and musculocutaneous nerve (8 patients) were most commonly involved. Most nerve complications were transient and resolved within 6 months. Permanent sequelae and injuries that required secondary surgical intervention were rare. The occurrence of nerve complications after SJR is common, but almost all will fully recover. Most are transient neurapraxias involving the lateral cord of the brachial plexus. Women are more likely to be affected, as are patients who have undergone prior surgery to the affected shoulder. Most are likely to be the result of excessive traction or direct injury to the nerves during glenoid exposure. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. Propensity for obtaining alcohol through shoulder tapping.

    Science.gov (United States)

    Toomey, Traci L; Fabian, Lindsey E A; Erickson, Darin J; Lenk, Kathleen M

    2007-07-01

    Underage youth often obtain alcohol from adults who illegally provide the alcohol. One method for obtaining alcohol from adults is shoulder tapping, where youth approach an adult outside an alcohol establishment and ask the adult to purchase alcohol for them. The goal of this study was to assess what percentage of the general and youth-targeted adult population approached outside of a convenience/liquor store will agree to purchase and then provide alcohol to individuals who appear under age 21. We conducted 2 waves of pseudo-underage shoulder tap request attempts, using requesters who were age 21 or older but appeared 18 to 20 years old. In both waves, requests were conducted at randomly selected liquor and convenience stores, requesters explained that the reason they were asking the adult was because they did not have their identification with them, and requesters asked the adults to purchase a 6-pack of beer. During wave 1, we conducted 102 attempts, with the requester approaching the first adult entering the store alone. During wave 2, we conducted 102 attempts where the requester approached the first casually dressed male entering the store alone who appeared to be 21 to 30 years old. During wave 1, 8% of the general sample of approached adults provided alcohol to the pseudo-underage requesters. The odds of adults providing alcohol in urban areas were 9.4 times greater than in suburban areas. During wave 2, 19% of the approached young men provided alcohol to the requesters. No requester, request attempt, establishment, or community characteristics were associated with request attempt outcomes during wave 2. A small percentage of the general population of adults will agree to provide alcohol to underage youth when approached outside an alcohol establishment. The likelihood of underage youth obtaining alcohol through shoulder tapping increases substantially if the youth approach young men.

  13. Subacromial lipoma causing shoulder impingement syndrome.

    Science.gov (United States)

    Sucuoglu, Hamza; Akgun, Kenan

    2017-01-01

    Subacromial lipoma represents a rare cause of subacromial impingement syndrome (SIS). A 49-year-old male patient presented to clinic with progressive right shoulder pain and limited movement, ongoing for approximately 1 month. Magnetic resonance imaging (MRI) revealed a lesion, compatible with lipoma, extending through subacromial space and pressing on supraspinatus muscle. After histopathological verification of lipoma, mass was excised. Postoperatively, patient completed 1 month physical therapy and rehabilitation program. Patient was free of pain at 4-month follow-up. Subacromial lipoma should be included in differential diagnosis of SIS for patients unresponsive to conservative treatment; MRI is very useful to determine precise etiology and inform surgical treatment.

  14. Optimal management of shoulder impingement syndrome

    Science.gov (United States)

    Escamilla, Rafael F; Hooks, Todd R; Wilk, Kevin E

    2014-01-01

    Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities. An effective nonoperative treatment for impingement syndrome is aimed at addressing the underlying causative factor or factors that are identified after a complete and thorough evaluation. The clinician devises an effective rehabilitation program to regain full glenohumeral range of motion, reestablish dynamic rotator cuff stability, and implement a progression of resistive exercises to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers. The clinician can introduce stresses and forces via sport-specific drills and functional activities to allow a return to activity. PMID:24648778

  15. Shoulder-elbow exoskeleton as rehabilitation exerciser

    Science.gov (United States)

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

    2016-08-01

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

  16. Pain Management Strategies in Shoulder Arthroplasty.

    Science.gov (United States)

    Codding, Jason L; Getz, Charles L

    2018-01-01

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

  17. Humeral shaft fracture with ipsilateral shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Behera Prateek

    2014-02-01

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

  18. The clinical utility of ultrasonography for rotator cuff disease, shoulder impingement syndrome and subacromial bursitis.

    Science.gov (United States)

    Awerbuch, Mark S

    2008-01-07

    Periarticular shoulder disorders are common in clinical practice, and diagnosis is often difficult. Medicare statistics indicate that between 2001 and 2006 the use of diagnostic shoulder ultrasonography increased significantly. Rotator cuff disease, shoulder impingement syndrome and subacromial bursitis are among the most common diagnoses reported on shoulder ultrasonography. Shoulder ultrasonography is useful in the diagnosis of full thickness tears, but its utility for other rotator cuff disorders, shoulder impingement syndrome and subacromial bursitis is less well established.

  19. Changes with time in skin temperature of the shoulders in healthy controls and a patient with shoulder-hand syndrome.

    Science.gov (United States)

    Koike, Yoichi; Sano, Hirotaka; Imamura, Itaru; Goto, Masako; Ooyama, Masamizu; Kita, Atushi

    2010-11-01

    Abnormal skin temperature in the shoulder is caused by various diseases. A thermography is unable to capture temperature changes over time. In contrast, a Thermocron is an effective measuring device to monitor temperature changes over time. The purposes of this study employing a Thermocron were to measure shoulder skin temperature over time in healthy subjects and to detect shoulder skin temperature abnormalities in a patient with shoulder-hand syndrome. Subjects comprised 10 healthy volunteers (20 shoulders; 4 men and 6 women, mean age 54 years). For measurements, a Thermocron was attached on both shoulders. Measurements were made from 21.00 to 07.00 the following morning at 15-minute intervals. Gradual difference in right and left shoulder skin temperature was observed with the timing of measurements but no significant difference was apparent, i.e. dominant side 34.9 ± 0.8°C, non-dominant side 34.9 ± 0.9°C (P = 0.28). Presentation of a case with shoulder-hand syndrome. A 54-year-old woman with the diagnosis of rotator cuff tear underwent surgical treatment of rotator cuff repair, but the pain of the operated shoulder persisted due to phase 1 shoulder-hand syndrome. In postoperative week 3, skin temperature measurement using Thermocrons demonstrated a significant decrease in temperature on the operated side (affected side 34.3 ± 0.4°C, healthy side 35.2 ± 0.3°C; P shoulder-hand syndrome using a Thermocron.

  20. mri evaluation of patients with shoulder pain at three imaging ...

    African Journals Online (AJOL)

    Background: Shoulder pain is a common reason for visiting a physician. It is the third most common cause of musculoskeletal complaint after low back pain and cervical pain in the USA. No data is available on MRI findings among our local population with shoulder pain despite having an MRI machine in our country since ...

  1. Seat belts and shoulder harnesses : smart protection in small airplanes.

    Science.gov (United States)

    2004-05-01

    Seat belts alone will protect you only in minor impacts. : Using shoulder belts in small aircraft would reduce major injuries by 88% and fatalities by 20%. Shoulder belt kits are now available for most airplanes. : Proper use and installation of chil...

  2. Adhesive capsulitis of the shoulder: pain intensity and distribution.

    Science.gov (United States)

    Candela, V; Giannicola, G; Passaretti, D; Venditto, T; Gumina, S

    2017-12-01

    Papers regarding adhesive capsulitis (AC) of the shoulder focused on etiology, epidemiology, diagnosis, and treatment; until now, information on shoulder pain characteristics is still scarce. Our aim was to analyze pain intensity and distribution in patients with AC. The study group was composed of 278 (133M-145F) consecutive patients with AC. After diagnosis, shoulder pain distribution was assessed through an upper limb pain map and pain intensity through a visual analog scale. Patients were distinguished on the basis of gender, age, time elapsed from onset of symptoms, and severity of functional limitation. Data were submitted to statistical analysis. Intensity of shoulder pain caused by AC was higher in females (p pain arose from more than 3 months suffered a lower intensity of shoulder pain. Furthermore, pain intensity was higher in the most severe form of AC (active forward flexion Pain was localized predominantly on the anterior aspect of the shoulder (dermatomes C5-C6) and rarely extended beyond the distal third of the arm. No differences were found in pain distribution between male and female, between patients with pain from less or more than 3 months and between different levels of AC severity (p > 0.05). Shoulder pain due to AC may be influenced by gender and severity of functional limitation. AC pain distribution principally involves anterior aspect of the shoulder with downward extension of the arm until its distal third. Level IV.

  3. Does scapular positioning predict shoulder pain in recreational overhead athletes?

    Science.gov (United States)

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

    2014-01-01

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

  4. Myofascial origin of shoulder pain: a literature review.

    Science.gov (United States)

    Sergienko, Stanislav; Kalichman, Leonid

    2015-01-01

    Shoulder pain is a common problem imposing a considerable burden on the affected person and society. Since interventions targeting traditional musculoskeletal conditions are usually only moderately effective, myofascial origin can be suggested as an alternative possible source of shoulder pain. To examine current evidence associated with myofascial origin of shoulder pain, with emphasis on diagnosis, prevalence and treatment efficacy. PubMed, Google Scholar and PEDro databases were searched from inception until December 2013 for terms relating to myofascial pain in the shoulder area. Two studies showed a high reliability of the following diagnostic characteristics during palpation: presence or absence of the taut band, spot tenderness, jump sign, pain recognition and referred pain sensation. Three prevalence studies showed a significant greater number of active myofascial trigger points (MTrPs) on the painful shoulder side. Reduced muscle strength, accelerated muscle fatigue, inconsistent muscle activation pattern under load and reduced antagonist reciprocal inhibition were found in subjects with latent MTrPs in four observational studies. Six interventional studies demonstrated the effectiveness of dry needling, myofascial manipulation, ischemic compression, laser therapy and multimodal treatment. MTrPs in shoulder muscles is a common condition among patients with shoulder complaints and can be reliably diagnosed by palpation. The reviewed interventions seem to be effective in reducing pain, increasing range of motion and improving function of the painful shoulder. Copyright © 2014 Elsevier Ltd. All rights reserved.

  5. A Case of Simultaneous Bilateral Anterior Shoulder Dislocation

    Science.gov (United States)

    Patil, Mallanagouda N

    2013-01-01

    Introduction: Anterior dislocation of shoulder is commonest dislocation one encounters in day to day Orthopaedic practice. But bilateral shoulder dislocations are relatively uncommon frequently posterior and secondary to violent muscle contraction. Simultaneous bilateral anterior dislocations of shoulder following trauma is rare occurrence. Case Report: 35 year old male presented to emergency department with history fall by tripping on a stone (fall on outstretched hand). He complained of pain and difficulty in moving both the shoulders. On clinical examination, patient's both upper limbs were abducted and externally rotated. Bilaterally shoulder contour was lost with flattening. Other classical signs of shoulder dislocation viz, Bryants test, Callway sign, Hamilton's ruler test were positive. Diagnosis was confirmed on X rays. Both shoulders were reduced in emergency operation theater under general anaesthesia by Kocher's method and were immobilised in sling. Conclusion: Though bilateral shoulder dislocations are commonly posterior, usually either secondary to convulsions or electric shock, anterior dislocation has to be kept in mind , especially in post traumatic injuries. This bilateral dislocation also presents with practical problems immobilization and day to day care of patients. PMID:27298905

  6. 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

  7. Ipsilateral dislocation of the shoulder and elbow: A case report

    African Journals Online (AJOL)

    Pr KODO

    Abstract. Ipsilateral dislocation of the shoulder and elbow is uncommon. Shoulder dislocation is often misdiagnosed on admission. We report the case of an 31-year old male whose dislocations were both recognised at the initial examination. Diagnosis pitfalls, mechanism, and management of this rare injury are reviewed.

  8. Ipsilateral dislocation of the shoulder and elbow: A case report ...

    African Journals Online (AJOL)

    Ipsilateral dislocation of the shoulder and elbow is uncommon. Shoulder dislocation is often misdiagnosed on admission. We report the case of an 31-year old male whose dislocations were both recognised at the initial examination. Diagnosis pitfalls, mechanism, and management of this rare injury are reviewed. Keywords: ...

  9. Delayed Axillary Artery Occlusion after Reverse Total Shoulder Arthroplasty

    Directory of Open Access Journals (Sweden)

    Omar M. Ghanem

    2016-01-01

    Full Text Available Axillary artery injury has been associated with shoulder dislocation and surgery. We describe a case of delayed axillary artery occlusion after reverse total shoulder arthroplasty. The injury was confirmed by Doppler and angiography and was treated with angioplasty and stenting. Early recognition and treatment of this injury are mandatory for patients’ recovery.

  10. Infantile dystocia fibrosarcoma presentIng as shoulder

    African Journals Online (AJOL)

    fibrosarcoma. •. presentIng as shoulder. M. S. PUZEY, D. F. INNES, C. W. VAN DER ELST. Summary. Congenital (infantile) fibrosarcomas are soft-tissue tumours that usually present after birth. In the case described a large tumour of the right arm caused shoulder dystocia and death of the fetus. S Atr Med J 1989; 76: 73-74.

  11. Posture and isokinetic shoulder strength in female water polo players

    African Journals Online (AJOL)

    Background: Being overhead athletes, water polo players can present with muscular imbalances of the shoulder, between the internal rotators (IR) and external rotators (ER), leading to changes in posture and an increased risk of injury. Objectives: To assess posture and isokinetic shoulder strength of female club-level ...

  12. Risk of subacromial shoulder disorder in airport baggage handlers

    DEFF Research Database (Denmark)

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

    2017-01-01

    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...

  13. Radiographic Evaluation of Patients with Anterior Shoulder Instability.

    Science.gov (United States)

    Kompel, Andrew J; Li, Xinning; Guermazi, Ali; Murakami, Akira M

    2017-12-01

    Injuries to the labrum, joint capsule (in particular the inferior glenohumeral ligament), cartilage, and glenoid periosteum are associated with anterior shoulder instability. The goal of this review is to provide common radiographic images and findings in patients with anterior shoulder instability. Furthermore, we will demonstrate the best methods for measuring anterior glenoid bone loss. Magnetic resonance (MR) imaging is highly relied upon for evaluating anterior shoulder instability and can diagnose soft tissue injuries with high sensitivity. While 3D computed tomography (CT) scan has been considered the optimal tool for evaluating osseous defects, certain MR imaging sequences have been shown to have similar diagnostic accuracy. Repair of Bankart lesions is critical to stabilizing the shoulder, and in the recent years, there has been an increasing focus on imaging to accurately characterize and measure glenoid bone loss to properly indicate patients for either arthroscopic repair or anterior bony reconstruction. Furthermore, Hill-Sachs lesions are commonly seen with shoulder instability, and importance must be placed on measuring the size and depth of these lesions along with possible engagement, as these factors will dictate management. The labral-ligamentous complex and rotator cuff are primary stabilizers of the shoulder. With anterior shoulder instability, the labrum is frequently injured. MRI with an arthrogram or provocative maneuvers is the gold standard for diagnosis. Various imaging modalities and methods can be performed to identify and measure Bankart and Hill-Sachs lesions, which can then be used for surgical planning and treating shoulder instability.

  14. Open capsular shift for multi directional shoulder instability.

    NARCIS (Netherlands)

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

    2002-01-01

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

  15. Thoracic posture, shoulder muscle activation patterns and isokinetic ...

    African Journals Online (AJOL)

    Methods. Using the hand-behind-the-neck and -back methods, we manually tested the range of motion (ROM) of the shoulder joints of 91 uninjured ... of a relationship between postural deviation and incorrect shoulder kinematics.[5] .... The participants started the required movement with their arms resting next to their sides.

  16. Association of fetal cranial shape with shoulder dystocia

    NARCIS (Netherlands)

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

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

  17. Shouldering the blame for impingement: the rotator cuff continuum ...

    African Journals Online (AJOL)

    ... research on shoulder impingement and rotator cuff pathology. A continuum model of rotator cuff pathology is described, and the challenges of accurate clinical diagnosis, imaging and best management discussed. Keywords: shoulder impingement syndrome, subacromial impingement syndrome, rotator cuff, tendinopathy, ...

  18. shoulder injuries in competitive swimmers in KwaZulu- natal

    African Journals Online (AJOL)

    athletes. The shoulder joint is the most vulnerable to injury, as has been shown in many reports.3,6,8-11 To date very little research on the epidemiology of shoulder or other injuries in. South African ... breaststroke.14 Athletes, who use the arm for propelling, strain at the ... Fatigue of the supraspinatus muscle predisposes ...

  19. Shoulder injuries in provincial male fast bowlers - predisposing factors

    African Journals Online (AJOL)

    Absolute and relative peak torque measures were obtained at isokinetic speeds of 90°/s and 180°/s, with both concentric and eccentric contractions performed. Shoulder flexibility was tested using a Leighton Flexometer in both internal and external shoulder rotation. The players were classified into a front-on (N = 7), semi ...

  20. Safety zone for posterosuperior shoulder access: study on cadavers

    Directory of Open Access Journals (Sweden)

    Miguel Pereira Costa

    2016-08-01

    Full Text Available ABSTRACT OBJECTIVE: The posterosuperior shoulder access used in surgical treatment for acromioclavicular dislocation was constructed through dissection of 20 shoulders from 10 recently chilled adult cadavers, and the distances from this route to the nearby neurovascular structures were analyzed. METHODS: A Kirschner wire was introduced into the top of the base of the coracoid process through the posterosuperior shoulder access, in the area of the origin of the conoid and trapezoid ligaments, thus reproducing the path for inserting two anchors for anatomical reconstruction of the coracoclavicular ligaments. The smallest distance from the insertion point of the Kirschner wire to the suprascapular nerve and artery/vein was measured. RESULTS: The mean distance from the suprascapular nerve to the origin of the coracoclavicular ligaments at the top of the base of the coracoid process was 18.10 mm (range: 13.77-22.80 in the right shoulder and 18.19 mm (range: 12.59-23.75 in the left shoulder. The mean distance from the suprascapular artery/vein to the origin of the coracoclavicular ligaments was 13.10 mm (range: 9.28-15.44 in the right shoulder and 14.11 mm (range: 8.83-18.89 in the left shoulder. Comparison between the contralateral sides did not show any statistical difference. CONCLUSION: The posterosuperior shoulder access route for anatomical reconstruction of the coracoclavicular ligaments in treating acromioclavicular dislocation should be performed respecting the minimum limit of 8.83 mm medially.

  1. ANALYSIS OF LONG-TERM RESULTS OF SHOULDER ARTHROPLASTY

    Directory of Open Access Journals (Sweden)

    D. V. Nenashev

    2012-01-01

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

  2. Cervical epidural anaesthesia for shoulder arthroscopy and effective ...

    African Journals Online (AJOL)

    Shoulder arthroscopy is used to treat various diseases of the shoulder, including refractory adhesive capsulitis. Effective postoperative pain relief is critical for these patients, as the success of surgery largely depends on early and regular physiotherapy. Although traditionally, various methods of postoperative analgesia have ...

  3. Optimal management of shoulder impingement syndrome

    Directory of Open Access Journals (Sweden)

    Escamilla RF

    2014-02-01

    Full Text Available Rafael F Escamilla,1,2 Todd R Hooks,3 Kevin E Wilk4 1Department of Physical Therapy, California State University, Sacramento, CA, USA; 2Andrews Research and Education Institute, Gulf Breeze, FL, USA; 3Drayer Physical Therapy Institute, Columbus, MS, USA; 4Champion Sports Medicine, Birmingham, AL, USA Abstract: Shoulder impingement is a progressive orthopedic condition that occurs as a result of altered biomechanics and/or structural abnormalities. An effective nonoperative treatment for impingement syndrome is aimed at addressing the underlying causative factor or factors that are identified after a complete and thorough evaluation. The clinician devises an effective rehabilitation program to regain full glenohumeral range of motion, reestablish dynamic rotator cuff stability, and implement a progression of resistive exercises to fully restore strength and local muscular endurance in the rotator cuff and scapular stabilizers. The clinician can introduce stresses and forces via sport-specific drills and functional activities to allow a return to activity. Keywords: rotator cuff impingement, internal impingement, overhead athlete, shoulder, rehabilitation

  4. Diagnostic imaging of shoulder rotator cuff lesions

    Directory of Open Access Journals (Sweden)

    Nogueira-Barbosa Marcello Henrique

    2002-01-01

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

  5. Gorham-Stout syndrome of the shoulder

    Science.gov (United States)

    Brunner, Ulrich; Rückl, Kilian; Konrads, Christian; Rudert, Maximilian; Plumhoff, Piet

    2016-01-01

    Introduction: Gorham-Stout syndrome (GSS) is a rare but severe subtype of idiopathic osteolysis. There are no guidelines for the treatment of GSS. We analysed different diagnostic and therapeutic regimes and we describe the sucessful treatment of GSS considering individual patient factors. Methods: We diagnosed three patients with shoulder-specific GSS using clinical, radiological and histopathological examinations. Two out of three patients with similar clinical appearances were treated non-operatively. One patient was treated by reverse shoulder arthroplasty. All patients were analysed retrospectively using clinical and radiological evaluation with a mean follow-up of 42 (range 30–50) months. Results: Two patients had few symptoms of GSS and were treated conservatively. One patient underwent arthroplasty, with a good clinical result. No additional therapy, such as radiation or anti-resorptive medications, was needed for the stable fixation of the prosthesis and the termination of osteolysis. In all patients we found good clinical outcomes with high patient satisfaction. Discussion: GSS is diagnosed after exclusion of infectious, malignant, and systemic disorders. The diagnosis should be supported by clinical, radiological, and histopathological characteristics of patients. Different humoral and cellular changes have been reported in GSS, but lack sufficient supporting evidence. GSS is associated with angiomatous and lymphatic malformations. The changes in GSS and the theories of its pathophysiology may reveal. PMID:27194110

  6. EMU Shoulder Injury Tiger Team Report

    Science.gov (United States)

    Williams, David R.; Johnson, Brian J.

    2003-01-01

    The number and complexity of extravehicular activities required for the completion and maintenance of the International Space Station is unprecedented. It is not surprising that training to perform these space walks presents a risk of overuse musculoskeletal injuries. The goal of this tiger team, created in December 2002, was to identify the different factors contributing to the risk of EVA training-related shoulder injury in the Neutral Buoyancy Lab at the Sonny Carter Training Facility and to make recommendations that would either significantly reduce or eliminate those risks. Since 1999, concerns have been expressed about the risk of shoulder injury associated with EVA training at the NBL, particularly in inverted body positions (McMonigal, 1999). A survey was developed and administered to 42 astronauts and astronaut candidates; the results suggest a causal relationship between EVA training at the NBL and the observed injuries. Also, during the tiger team review, it became evident that training in the extravehicular mobility unit may also result in other types of injuries, including fingernail delamination, elbow pain, knee pain, foot pain, and nerve compression leading to transient loss of sensation in certain areas of the upper or lower extremity. A multi-directorate team to detect, evaluate and respond to the medical issues associated with EVA training should be implemented immediately and given the appropriate resources and authority to reduce the risk of injury to crew during training to a level as low as reasonably achievable.

  7. Recurrent Shoulder Instability After Primary Bankart Repair.

    Science.gov (United States)

    Donohue, Michael A; Mauntel, Timothy C; Dickens, Jonathan F

    2017-09-01

    The glenohumeral joint is one of the most frequently dislocated joints and occurs with increasing frequency in collision and contact athletes, especially those in sports that repeatedly place the glenohumeral joint in a position of vulnerability. Nonoperative management of shoulder instability especially in young contact athletes results in unacceptably high recurrence rates; thus, early surgical stabilization has become commonplace. Surgical stabilization typically yields acceptable outcomes. However, recurrent anterior instability may occur following a previous stabilization procedure at rates of 7% to 12%. Recurrent glenohumeral instability represents a treatment challenge for orthopedic surgeons as it not only has the potential to result in subsequent surgery, therapy, and missed activity time, but also has been associated with long-term degenerative joint changes. Thus, recurrent instability requires close examination to determine underlying pathology leading to failure. Evaluation of underlying pathology requires consideration of patient activity-related factors, hyperlaxity and multidirectional instability, glenoid bone loss, glenoid track lesions, and other pathologic lesions. Revision surgical stabilization approaches include arthroscopic and open stabilization, as well as glenoid osseous augmentation procedures. Postoperative rehabilitation and release to sports and activity must be tailored to protect the shoulder from continued instability. Understanding that risk of recurrent glenohumeral instability and the risk factors associated with it are essential so that these factors may be mitigated and recurrent instability prevented.

  8. Isolated Pulmonary Embolism following Shoulder Arthroscopy

    Directory of Open Access Journals (Sweden)

    Nicole H. Goldhaber

    2014-01-01

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

  9. Shoulder replacement for osteoarthritis: A review of surgical management.

    Science.gov (United States)

    Pandya, Jay; Johnson, Tamara; Low, Adrian K

    2018-02-01

    Osteoarthritis of the shoulder is caused by progressive cartilage wear of the glenohumeral joint. Its prevalence is increasing due to our ageing population and it may affect up to one-third of people over 60 years of age. Patients usually complain of pain with restricted shoulder movement and function. Initial treatment should be non-operative, such as activity modification, oral analgesics (e.g. non-steroidal anti-inflammatories) and possibly physical therapy or corticosteroid injections. Patients with ongoing severe pain and functional restriction despite non-operative treatment would be candidates for surgery, usually a shoulder replacement. There are various forms of shoulder replacements and the aim of this review is to discuss the types available, the indications for using one over another and recent worldwide trends in the use of shoulder replacements. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. Glenoid Dysplasia in the Recurrent Shoulder Dislocation: A Case Report

    Directory of Open Access Journals (Sweden)

    Hamza Sucuoglu

    2016-02-01

    Full Text Available Glenoid dysplasia, which is often ignored, is a rare developmental anomaly. In most cases the patients remain asymptomatic. Although glenoid dysplasia has been diagnosed by incidentally on chest radiograph, also it has been described because of the developing instability of shoulder joint. Our young male patient who has recurrent dislocation of the shoulder-joint 4-5 times a year for last 5 years, dislocation has been reduced in the emergency department and he has been discharged from hospital with shoulder strap and rest. Finally when he admitted to our outpatient clinic with recurrent shoulder dislocation, the diagnosis of glenoid dysplasia is revealed by X-ray examination. We present the diagnose of glenoid dysplasia with clinical and radiological findings which should be kept in mind in patients with recurrent dislocations of shoulder as in our case.

  11. Revision to Reverse Total Shoulder Arthroplasty Restores Stability for Patients With Unstable Shoulder Prostheses.

    Science.gov (United States)

    Hernandez, Nicholas M; Chalmers, Brian P; Wagner, Eric R; Sperling, John W; Cofield, Robert H; Sanchez-Sotelo, Joaquin

    2017-11-01

    Instability after shoulder arthroplasty remains a complication with limited salvage options. Reoperation for instability with anatomic designs has led to high rates of persistent instability, therefore we aimed to evaluate the use of RSA for treatment of prosthetic instability. (1) After revision shoulder arthroplasty to a reverse prosthesis (RSA), what is the survivorship free from dislocations at 2 and 5 years? (2) What factors are associated with dislocations? (3) What is the survivorship free from revision after revision to RSA? (4) From preoperation to postrevision to RSA, what are the clinical outcomes-the proportion of patients with moderate to severe pain, shoulder elevation and external rotation ROM, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores? All shoulder arthroplasties revised for prosthetic instability using RSA components between January 2004 and July 2014 were retrospectively studied. During the period in question, we performed 82 revisions for instability of an anatomic total shoulder arthroplasty (TSA) (n = 62), hemiarthroplasty (n = 13), or reverse TSA (n = 7). We typically used a reverse TSA to treat this problem, but we identified 12 treated in other ways, including revision of a TSA to hemiarthroplasty (n = 3), revision of a reverse TSA to hemiarthroplasty (n = 2), revision of hemiarthroplasty to a hemiarthroplasty (n = 1), and revision of an anatomic TSA to another anatomic TSA (n = 6). This left 70 patients for evaluation; of those, 65 (93%) were available for analysis at a mean of 3 years (range, 2-10 years). A total of seven patients died. Eight of the 65 shoulders were not evaluated during the last 5 years, including three in patients who died earlier. The mean age of the patients at the time of revision RSA was 65 years (range, 40-89 years). Data were obtained from a longitudinally maintained institutional joint registry. Instability was defined as severe subluxation confirmed on clinical and radiographic

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

    Science.gov (United States)

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

    2009-04-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load

  13. Evaluation of a Shoulder Injury Prevention Program in Wheelchair Basketball.

    Science.gov (United States)

    Wilroy, Jereme; Hibberd, Elizabeth

    2017-11-15

    Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics. To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury. Pre and post-test. Home-based and controlled laboratory. Seven collegiate wheelchair athletes. Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a post-intervention screening was performed. Internal/external rotation ROM, retraction strength, and internal/external rotation strength. Participants experienced a significant improvement in dominant limb shoulder internal rotation ROM (t6=3.56,p=0.012) with an average increase of 11.4° of IR ROM, and a significant improvement in dominant limb shoulder external rotation (ER) ROM (t6=2.79,p=0.032) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (p>0.05). Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair athletics.

  14. Secondary shoulder reconstruction in patients with brachial plexus injuries.

    Science.gov (United States)

    Terzis, Julia K; Barmpitsioti, Antonia

    2011-07-01

    Restoration of shoulder stability in post-traumatic plexopathy patients is very important because more distal functions depend on a stable and functioning shoulder. The purpose of this study is to present our experience with secondary surgeries in patients with devastating paralysis. Functional outcomes were analyzed in relation to age, severity score and type of reconstruction. The medical records of 55 post-traumatic plexopathy patients who underwent secondary shoulder reconstruction, by a single surgeon, between 1978 and 2006, were reviewed. 55 patients had 73 procedures, 44 for shoulder abduction and 29 for external rotation. 38 patients underwent secondary surgery to augment shoulder abduction. Trapezius advancement was performed in 14 patients, double free muscle transfer in 18, free latissimus dorsi in 4 and triceps muscle transfer in 2 patients. 26 patients had secondary procedures for enhancement of shoulder external rotation. Dynamic rerouting of latissimus dorsi and teres major was carried out in 18 patients and rotational humerus osteotomy in 11 patients. All patients had improvement of shoulder stability and function. Shoulder abduction reached 40.80 ± 15.93 and external rotation at 24.28 ± 17.90°. Trapezius advancement yielded 41.81 ± 9.02° of abduction. Latissimus dorsi yielded stronger shoulder abduction than adductor longus. Rerouting of latissimus dorsi and teres major attained 22.33 ± 20.31° of dynamic external rotation while humerus osteotomy produced 26.87 ± 10.32 of external rotation. Secondary procedures such as pedicle and free muscles transfers, tendon transfers, and rotational humerus osteotomy augment shoulder stability and function in patients with irreparable paralysis. Copyright © 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Performance of PROMIS Instruments in Patients With Shoulder Instability.

    Science.gov (United States)

    Anthony, Chris A; Glass, Natalie A; Hancock, Kyle; Bollier, Matt; Wolf, Brian R; Hettrich, Carolyn M

    2017-02-01

    Shoulder instability is a relatively common condition occurring in 2% of the population. PROMIS (Patient-Reported Outcome Measurement Information System) was developed by the National Institutes of Health in an effort to advance patient-reported outcome (PRO) instruments by developing question banks for major health domains. To compare PROMIS instruments to current PRO instruments in patients who would be undergoing operative intervention for recurrent shoulder instability. Cohort study (diagnosis); Level of evidence, 2. A total of 74 patients with a primary diagnosis of shoulder instability who would be undergoing surgery were asked to fill out the American Shoulder and Elbow Surgeons shoulder assessment form (ASES), Marx shoulder activity scale (Marx), Short Form-36 Health Survey Physical Function subscale (SF-36 PF), Western Ontario Shoulder Instability Index (WOSI), PROMIS physical function computer adaptive test (PF CAT), and PROMIS upper extremity item bank (UE). Correlation between PRO instruments was defined as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), and poor (0.2-0.3). Utilization of the PROMIS UE demonstrated excellent correlation with the SF-36 PF ( r = 0.78, P shoulder and upper extremity PRO instruments as well as the SF-36 PF in patients with shoulder instability. In patients aged ≤21 years, there were significant ceiling effects utilizing the PROMIS UE. While the PROMIS PF CAT appears appropriate for use in adults of any age, our findings demonstrate that the PROMIS UE has significant ceiling effects in patients with shoulder instability who are ≤21 years old, and we do not recommend use of the PROMIS UE in this population.

  16. Corticospinal excitability of the biceps brachii is shoulder position dependent.

    Science.gov (United States)

    Collins, Brandon Wayne; Cadigan, Edward W J; Stefanelli, Lucas; Button, Duane C

    2017-12-01

    The purpose of this study was to examine the effect of shoulder position on corticospinal excitability (CSE) of the biceps brachii during rest and a 10% maximal voluntary contraction (MVC). Participants ( n = 9) completed two experimental sessions with four conditions: 1 ) rest, 0° shoulder flexion; 2 ) 10% MVC, 0° shoulder flexion; 3 ) rest, 90° shoulder flexion; and 4 ) 10% MVC, 90° shoulder flexion. Transcranial magnetic, transmastoid electrical, and Erb's point stimulation were used to induce motor-evoked potentials (MEPs), cervicomedullary MEPs (CMEPs), and maximal muscle compound potentials (M max ), respectively, in the biceps brachii in each condition. At rest, MEP, CMEP, and M max amplitudes increased ( P rest and decreased ( P rest but decreased ( P rest and decreased ( P shoulder position, and the pattern of change was altered within the state in which it was measured. The position-dependent changes in M max amplitude, EMG, and CSE itself all contribute to the overall change in CSE of the biceps brachii. NEW & NOTEWORTHY We demonstrate that when the shoulder is placed into two common positions for determining elbow flexor force and activation, corticospinal excitability (CSE) of the biceps brachii is both shoulder position and state dependent. At rest, when the shoulder is flexed from 0° to 90°, supraspinal factors predominantly alter CSE, whereas during a slight contraction, spinal factors predominantly alter CSE. Finally, the normalization techniques frequently used by researchers to investigate CSE may under- and overestimate CSE when shoulder position is changed. Copyright © 2017 the American Physiological Society.

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

    NARCIS (Netherlands)

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

    2015-01-01

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

  18. Identification of shoulder-specific patient acceptable symptom state in patients with rheumatic diseases undergoing shoulder surgery.

    Science.gov (United States)

    Christie, Anne; Dagfinrud, Hanne; Garratt, Andrew M; Ringen Osnes, Hanne; Hagen, Kåre Birger

    2011-01-01

    Clinical measurement study with a longitudinal design. Estimate Patient Acceptable Symptom State (PASS) thresholds in six shoulder outcome measures and two pain scales. Patients with rheumatic diseases undergoing shoulder surgery were assessed at baseline and one-year follow-up (with Bostrom Shoulder Movement Impairment Scale, Constant, Disability of the Arm, Shoulder and Hand [DASH], Oxford Shoulder Score [Oxford], Shoulder Function Assessment Scale, Shoulder Pain and Disability Index [Spadi], and two visual analog pain scales [VAS]). PASS thresholds were estimated using the 75th percentile and the receiver operating characteristic curve approach. One hundred patients were included; 74 (74%) patients considered their shoulder function to be acceptable (PASS+), which was significantly associated with being female, odds ratio (OR) 4.54, and having better functional status (Health Assessment Questionnaire), OR 0.17 (ppain (VAS), the Oxford, and the Spadi showed best discriminative accuracy for PASS. All measures estimated changes exceeding the minimal clinical important difference. The Oxford and the Spadi showed better discriminant ability for PASS than the more commonly used Constant score and the DASH. The PASS thresholds for pain showed that patients accepted less pain at rest than during activity, underlining the importance of assessing both aspects of pain. 3. Diagnostic study. Copyright © 2011 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  19. Unusual variation of the rotator interval: insertional abnormality of the pectoralis minor tendon and absence of the coracohumeral ligament

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Shin Jae; Ha, Doo Hoe; Lee, Sang Min [CHA University, Department of Radiology, CHA Bundang Medical Center, Seongnam-si, Gyeonggi-do (Korea, Republic of)

    2010-12-15

    To evaluate the anomalous insertion of the pectoralis minor tendon with absence of the coracohumeral ligament on MR arthrography and to demonstrate the associated findings seen with this anatomical variation. We retrospectively reviewed the 335 MR arthrograms of the shoulder joint (mean age 37.8 years) performed from March 2000 to February 2008. Images were evaluated with attention to anomalous insertion of the pectoralis minor tendon and the coracohumeral ligament. Anomalous insertion of the pectoralis minor tendon was demonstrated in 5 out of 335 shoulders (1.5%). The pectoralis minor tendons crossed over the coracoid process and attached directly to a glenohumeral joint capsule, and the coracohumeral ligament was absent in these 5 patients. In these patients, injected contrast material was noted to extend over the coracoid process along the course of the pectoralis minor tendon. Among 5 patients, 3 patients (60%) were diagnosed with SLAP (superior labrum anterior to posterior) lesions. Anomalous insertion of the pectoralis minor tendon to the glenohumeral joint capsule and associated absence of the coracohumeral ligament is well demonstrated on MR arthrography. It is an unusual variant of the pectoralis minor muscle insertion, and may be a possible contributing factor in the development of a SLAP lesion. (orig.)

  20. Constrained fixed-fulcrum reverse shoulder arthroplasty improves functional outcome in epileptic patients with recurrent shoulder instability.

    Science.gov (United States)

    Thangarajah, Tanujan; Higgs, Deborah; Bayley, J I L; Lambert, Simon M

    2016-07-18

    To report the results of fixed-fulcrum fully constrained reverse shoulder arthroplasty for the treatment of recurrent shoulder instability in patients with epilepsy. A retrospective review was conducted at a single facility. Cases were identified using a computerized database and all clinic notes and operative reports were reviewed. All patients with epilepsy and recurrent shoulder instability were included for study. Between July 2003 and August 2011 five shoulders in five consecutive patients with epilepsy underwent fixed-fulcrum fully constrained reverse shoulder arthroplasty for recurrent anterior shoulder instability. The mean duration of epilepsy in the cohort was 21 years (range, 5-51) and all patients suffered from grand mal seizures. Mean age at the time of surgery was 47 years (range, 32-64). The cohort consisted of four males and one female. Mean follow-up was 4.7 years (range, 4.3-5 years). There were no further episodes of instability, and no further stabilisation or revision procedures were performed. The mean Oxford shoulder instability score improved from 8 preoperatively (range, 5-15) to 30 postoperatively (range, 16-37) (P = 0.015) and the mean subjective shoulder value improved from 20 (range, 0-50) preoperatively to 60 (range, 50-70) postoperatively (P = 0.016). Mean active forward elevation improved from 71° preoperatively (range, 45°-130°) to 100° postoperatively (range, 80°-90°) and mean active external rotation improved from 15° preoperatively (range, 0°-30°) to 40° (20°-70°) postoperatively. No cases of scapular notching or loosening were noted. Fixed-fulcrum fully constrained reverse shoulder arthroplasty should be considered for the treatment of recurrent shoulder instability in patients with epilepsy.

  1. Simple shoulder test and Oxford Shoulder Score: Persian translation and cross-cultural validation.

    Science.gov (United States)

    Naghdi, Soofia; Nakhostin Ansari, Noureddin; Rustaie, Nilufar; Akbari, Mohammad; Ebadi, Safoora; Senobari, Maryam; Hasson, Scott

    2015-12-01

    To translate, culturally adapt, and validate the simple shoulder test (SST) and Oxford Shoulder Score (OSS) into Persian language using a cross-sectional and prospective cohort design. A standard forward and backward translation was followed to culturally adapt the SST and the OSS into Persian language. Psychometric properties of floor and ceiling effects, construct convergent validity, discriminant validity, internal consistency reliability, test-retest reliability, standard error of the measurement (SEM), smallest detectable change (SDC), and factor structure were determined. One hundred patients with shoulder disorders and 50 healthy subjects participated in the study. The PSST and the POSS showed no missing responses. No floor or ceiling effects were observed. Both the PSST and POSS detected differences between patients and healthy subjects supporting their discriminant validity. Construct convergent validity was confirmed by a very good correlation between the PSST and POSS (r = 0.68). There was high internal consistency for both the PSST (α = 0.73) and the POSS (α = 0.91 and 0.92). Test-retest reliability with 1-week interval was excellent (ICCagreement = 0.94 for PSST and 0.90 for POSS). Factor analyses demonstrated a three-factor solution for the PSST (49.7 % of variance) and a two-factor solution for the POSS (61.6 % of variance). The SEM/SDC was satisfactory for PSST (5.5/15.3) and POSS (6.8/18.8). The PSST and POSS are valid and reliable outcome measures for assessing functional limitations in Persian-speaking patients with shoulder disorders.

  2. Shoulder orthoses for the prevention and reduction of hemiplegic shoulder pain and subluxation: systematic review.

    Science.gov (United States)

    Nadler, M; Pauls, Mmh

    2017-04-01

    To determine whether shoulder orthoses prevent or reduce gleno-humeral subluxation and hemiplegic shoulder pain. OVID SP, MEDLINE, AMED, CINAHL, PEDro and the Cochrane Central Register of Controlled Trials. We included: randomised or quasi-randomised controlled trials, controlled before and after studies and observational studies. Two reviewers independently screened, critically appraised papers using the PEDro tool, and extracted data. A descriptive synthesis was performed as there were insufficient data for meta-analysis. Eight studies were included, totalling 186 participants: One randomised controlled trial with 41 participants, one quasi-randomised with 14 participants, one before and after controlled study with 40 participants and five observational studies with 91 participants met the inclusion criteria. Findings suggest that applying an orthosis to an already subluxed shoulder immediately reduced vertical subluxation on X-ray but improvements were not maintained when orthosis was removed. Orthoses with both proximal and distal attachments improved shoulder pain in the majority of stroke patients when worn for four weeks (starting several days or weeks post-stroke). There was no increase in adverse effects of contracture, spasticity or hand oedema when compared to no orthosis. Orthoses were generally well-tolerated and most patients rated the orthosis as comfortable to wear. Observational studies suggest that orthoses reduce vertical subluxation whilst in-situ. Available evidence from heterogeneous studies after stroke suggests that orthoses may reduce pain and are well-tolerated with prolonged use. No studies have tested whether subluxation and pain can be prevented by immediate post-stroke application of orthoses.

  3. Shoulder functionality after manual therapy in subjects with shoulder impingement syndrome: a case series.

    Science.gov (United States)

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

    2013-04-01

    The aim of the study was to identify the differences in functionality of the upper limb in subjects suffering from shoulder impingement syndrome after intervention by two manual therapy protocols. Randomized, single-blind study with a sample of 22 subjects (58 ± 10.86 years old) divided into two groups. The conventional-group (n = 11) received mobilizations of the shoulder and the experimental-group (n = 11) was treated with soft tissue techniques in the cervical and upper thoracic regions. These two groups received electrotherapy and postural advices. The treatment lasted three weeks (15 daily sessions of 1 h and 30 min). Both active and passive range of motion (ROM) and self-perceived functionality of the upper limb (DASH questionnaire) were measured. The experimental group showed a significant improvement in the DASH scores and both groups improved mobility in the intra-group comparison pre-intervention versus post-intervention (p .05). Our results suggest that a combined treatment with electrotherapy, postural hygiene and manual therapy, regardless of the protocol, improves shoulder mobility and functionality. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. [Painful hemiplegic shoulder in stroke patients: causes and management].

    Science.gov (United States)

    Murie-Fernández, M; Carmona Iragui, M; Gnanakumar, V; Meyer, M; Foley, N; Teasell, R

    2012-05-01

    The hemiplegic shoulder pain is common after a stroke. Its appearance brings pain and limits daily living activities as well as participation in specific Neuro-rehabilitation programs. All this leads to a worse functional outcome. Good management of patients can reduce both the frequency and intensity of shoulder pain, improving functional outcome. We conducted a literature search of various databases between 1980 and 2008. The articles were evaluated using the PEDro scoring system. Five evidence levels were established for the conclusions. Shoulder subluxation, occurs at an early stage after stroke and is associated with subluxation of the shoulder joint and spasticity (mainly subscapularis and pectoralis). Slings prevent subluxation of the shoulder. It is preferable to move within a lower range of motion and without aggression to prevent the occurrence of shoulder pain. The injection of corticosteroids does not improve pain and range of motion in hemiplegic patients, while botulinum toxin combined with physical therapy appears to reduce hemiplegic shoulder pain. Copyright © 2011 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  5. Effect of reverse shoulder design philosophy on muscle moment arms.

    Science.gov (United States)

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

    2015-04-01

    This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  6. Humeral retroversion and shoulder rotational mobility in young handball practitioners.

    Science.gov (United States)

    Quadros, Gustavo Aguiar; Döhnert, Marcelo Baptista

    2015-01-01

    : To evaluate the prevalence of humeral retroversion and rotational mobility (RHH) in young handball practitioners and non-practitioners. : This is a cross-sectional study performed with two groups: the handball group, with 14 female students practicing handball and the control group, with 13 young participants non-practicing pitch sports. : The handball group presented full rotational movement (FRM) hi-gher than the control group in both the dominant shoulder (p=0.001) and the non-dominant shoulder (p=0.0001). The mobility of active and passive internal rotation was significantly higher in handball players in both shoulders. The handball group presented lower internal rotation range of motion for the dominant shoulder as compared to the non-dominant shoul-der (p=0.001). : Young handball practitioners, des-pite skeletally immature, showed a higher MRT than the control group. The handball group showed loss of internal rotation (medial) on the dominant shoulder as compared to the non--dominant shoulder. Level of Evidence II, Prospective Study.

  7. Psychosocial factors and shoulder symptom development among workers.

    Science.gov (United States)

    Smith, Caroline K; Silverstein, Barbara A; Fan, Z Joyce; Bao, Stephen; Johnson, Peter W

    2009-01-01

    Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand-control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand-control model and the incidence of shoulder symptoms in a working population. After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand-control model quadrants. Cases were more likely to be female and report other upper extremity symptoms at baseline (P shoulder symptoms. Hazard ratios were 2.17, 95% CI 1.02-4.66 and 2.19, 95% CI 1.08-4.42, respectively. Using self-reporting to determine demand-control quadrants was successful in identifying subjects at risk of developing work-related shoulder symptoms. Research is needed to determine if this relationship holds with clinically diagnosed shoulder and other upper extremity musculoskeletal disorders. This may be part of a simple tool for assessing risk of developing these UEMSDs. (c) 2008 Wiley-Liss, Inc.

  8. Deficient Pain Modulation in Patients with Chronic Hemiplegic Shoulder Pain.

    Science.gov (United States)

    Kashi, Yafit; Ratmansky, Motti; Defrin, Ruth

    2017-11-14

    Hemiplegic shoulder pain (HSP) following stroke significantly affects the individual's function and quality of life. The mechanism of HSP is not clearly understood; hence, it is unclear why HSP resolves spontaneously or following routine care in some patients, while in others it becomes persistent. The aim was therefore to study whether HSP is associated with deficient pain modulation. Thirty post-stroke patients-16 with HSP and 14 without HSP-and 20 matched controls participated. Pain adaptation and conditioned pain modulation (CPM) were measured as indicators of pain modulation, in the affected (hemiplegic) and contralateral shoulder as well as in the affected shin among post-stroke patients, and in comparable body regions among controls. Post-stroke patients also underwent functional and physical evaluation of the shoulder. Pain adaptation was absent among HSP patients, in both the painful shoulder and the affected shin, but existed in the 2 control groups. In addition, the affected shoulder and shin among the HSP group had reduced thermal sensibility compared to the contralateral regions. CPM was similar across groups. Shoulder functional status and physical status were similar for the 2 post-stroke groups. The results suggest that HSP is associated with a lack of pain adaptation, characteristic not only of the painful shoulder but also of the affected side. Although we cannot determine whether lack of pain adaptation precedes the HSP or results from it, interventions that enhance descending pain inhibition may improve management and prevent HSP chronification. © 2017 World Institute of Pain.

  9. Ultrasound-guided interventional procedures around the shoulder.

    Science.gov (United States)

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

    2016-01-01

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

  10. Bilateral, locked, recurrent anterior shoulder dislocation: case report.

    Science.gov (United States)

    Şanel, Selim; Şencan, Savaş; Öçgüder, Ali; Solakoğlu, Can

    2015-01-01

    Bilateral anterior dislocation of the shoulder is a rare condition. Most of the cases are seen as posterior dislocations which generally occur during diffuse tonic-clonic contractions of epileptic seizures or after being exposed to strong electric shock. In this article, we report a 21-year-old epileptic patient who had severe bilateral shoulder pain and joint restriction. Diagnoses of bilateral, locked, anterior shoulder dislocation and Hill-Sachs lesions were made with shoulder X-rays and computed tomography. Arthroscopic Bankart repair and remplissage technique were applied in surgical treatment of both shoulders. Posterior dislocations of shoulder usually occur during epileptic seizures but anterior dislocations are rare in the literature. This may lead to delay in diagnosis. Computed tomography scan may be helpful in making diagnosis in uncertain patients. It should not be forgotten that recurrent anterior dislocations may be seen in epileptic patients. Such dislocations should be followed up regularly and instability must be treated to prevent excessive damage to the shoulder.

  11. [Clinical factors associate with shoulder subluxation in stroke patients].

    Science.gov (United States)

    Daviet, J C; Salle, J Y; Borie, M J; Munoz, M; Rebeyrotte, I; Dudognon, P

    2002-11-01

    This study explores whether shoulder subluxation after stroke is related to age, hemiplegic side motor impairment, spasticity, sensory deficit, depression, unilateral neglect and length of stay in acute ward. This prospective study included 57 patients with hemiplegia. The shoulder subluxation was systematically detected by radiography and quantified according to de Bats score. The complete clinical assessment of the upper limb on day 15 analyzed motricity (motricity index), spasticity of shoulder adductors and biceps (Ashworth), sensory deficit, unilateral neglect and depression (MADRS). Age, side of hemiplegia and the aetiology were also noted. We researched relations between shoulder subluxation and these clinical factors. Means were compared using Mann Whitney and chi(2) tests. Coefficients of correlation were estimated between two quantitative variables. A multiple regression analysis was also conducted including all significant parameters, the dependent variable being the shoulder subluxation. Shoulder subluxation was observed in 32% of hemiplegic patients. After multiple regression analysis, the main clinical factors related to subluxation were motor (p shoulder adductors (p = 0.028) and age (p = 0.036). Statistically, the risk of subluxation was divided by 1.62 (1.07, 2.43) for every five years age growth and by two (1.33, 2.94) when the motricity index went up by ten points. This study shows that the age could play an independent part. The loss of elasticity of the periarticular tissues when ageing could have a protective role.

  12. Lipidic characterization of Santa Inês lamb shoulder

    Directory of Open Access Journals (Sweden)

    Christian Albert Carvalho da Cruz

    2011-06-01

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

  13. 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.

  14. [Hypoglossal nerve neuropraxia after shoulder hemiarthroplasty].

    Science.gov (United States)

    Pariente, L; Camarena, P; Koo, M; Sabaté, A; Armengol, J

    2014-05-01

    We report a case of hypoglossal nerve damage after shoulder hemiarthroplasty with the patient in "beach chair" position, performed with general anesthesia with orotracheal intubation, and without complications. An ultrasound-guided interscalene block was previously performed in an alert patient. After the intervention, the patient showed clinical symptomatology compatible with paralysis of the right hypoglossal nerve that completely disappeared after 4 weeks. Mechanisms such as hyperextension of the neck during intubation, endotracheal tube cuff pressure, excessive hyperextension, or head lateralization during surgery have been described as causes of this neurological damage. We discuss the causes, the associated factors and suggest preventive measures. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  15. An Unusual Complication after Shoulder Hemiarthroplasty

    Directory of Open Access Journals (Sweden)

    Oliver D. Stone

    2013-01-01

    Full Text Available Hemiarthroplasty of the shoulder can be a safe and an effective treatment for pain in patients with rheumatoid arthritis. Many complications have been previously described in the literature; the most common of which are dislocation, loosening, periprosthetic fractures, and infection. We report a patient who presented with a discharging sinus over the tip of the acromium which was created by the displacement of the prosthesis and erosion of the AC joint and distal clavicle. The erosion of the distal clavicle and AC joint caused the remaining proximal clavicle to become mobile and displaced posteriorly; this spike of clavicle was then able to penetrate the trapezius muscle and eventually the skin causing an aseptic sinus. This was successfully treated with the exploration and excision of the distal 2 cm of the clavicle.

  16. Septic Arthritis of the Shoulder Complicating Pregnancy

    Directory of Open Access Journals (Sweden)

    Sara Raiser

    2014-01-01

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

  17. 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

  18. Surgical management of periprosthetic shoulder infections.

    Science.gov (United States)

    Stone, Geoffrey P; Clark, Rachel E; O'Brien, Kathleen C; Vaccaro, Lisa; Simon, Peter; Lorenzetti, Adam J; Stephens, Brent C; Frankle, Mark A

    2017-07-01

    The treatment of periprosthetic joint infection is a difficult challenge in shoulder arthroplasty. This study investigated 1-stage modular component exchange vs. 1-stage complete removal and reimplantation (CRR) vs. 2-stage revision arthroplasty for periprosthetic joint infection. Between January 1, 2004, and December 31, 2012, 79 patients received a component exchange (n = 15), CRR (n = 45), or a 2-stage (n = 19) revision for infection. A binary logistic regression analysis was performed to determine factors presenting the greatest risk of reinfection. Complications and functional outcomes were also evaluated. Overall, 4 of 15 (27%) component exchanges, 2 of 45 (4%) CRRs, and 4 of 19 (21%) 2-stage procedures required a reoperation for infection with a minimum of 1 year of follow-up. The difference between the CRR group and exchange group was significant (P = .030); however, the difference between the CRR group and 2-stage group did not reach statistical significance (P = .059). No preoperative and intraoperative selection bias between the groups was found. Binary logistic regression predicted that reinfection was highest in patients whose cultures grew Staphylococcus aureus (P = .004) or coagulase-negative Staphylococcus species (P = .041) or those treated with a component exchange (P = .015). The difference between groups for noninfection-related complications was not significant (P = .703). All procedures provided improved functional outcomes and pain relief. Patients with infection caused by Staphylococcus aureus or coagulase-negative Staphylococcus species may require additional operations to treat the infection. Although effective in some cases, component exchange presents an increased risk for reinfection. A 1-stage CRR procedure had similar reinfection rates as a 2-stage procedure in our patient population. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  19. Shoulder proprioception in patients with subacromial impingement syndrome.

    Science.gov (United States)

    Sahin, Ebru; Dilek, Banu; Baydar, Meltem; Gundogdu, Mehtap; Ergin, Burcu; Manisali, Metin; Akalin, Elif; Gulbahar, Selmin

    2017-01-01

    Recently, proprioception deficits of the rotator cuff and the deltoid muscles have been suggested to play a pivotal role in the subacromial impingement syndrome (SIS). To date, there are no study has been found where the kinesthesia and joint position senses have been evaluated together in SIS. To investigate the shoulder proprioception in patients with SIS. Sixty-one patients with SIS and 30 healthy controls, aging between 25 and 65 years, were included in the study. Main outcome measure was proprioception, assessed with an isokinetic dynamometer. Kinesthesia, active and passive joint repositioning senses were tested at 0° and 10° external rotation. All tests were repeated 4 times and the mean of angular errors were obtained. The mean age was 49.14 ± 10.27 and 48.80 ± 11.09 years in patient group and in control group respectively. No significant difference was found between two groups in terms of age, gender and dominance. When involved and uninvolved shoulders of the patient group were compared, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders at all angles (P shoulders of the patient group were compared to the control group, kinesthesia, active and passive joint position senses were significantly impaired in involved shoulders in patient group at all angles (P shoulders of the patient group were compared to the control group, kinesthesia at 10° was significantly impaired (P shoulder proprioception was impaired in patients with SIS. This proprioceptive impairment was found not only in involved shoulders but also in uninvolved shoulders in patients with SIS.

  20. POINT CLOUD ORIENTED SHOULDER LINE EXTRACTION IN LOESS HILLY AREA

    Directory of Open Access Journals (Sweden)

    L. Min

    2016-06-01

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

  1. Should Patients With Frozen Shoulder Be Screened for Diabetes Mellitus?

    Science.gov (United States)

    Safran, Ori; El-Haj, Madi; Leibowitz, Gil; Beyth, Shaul; Furman, Zohar; Milgrom, Charles; Kandel, Leonid

    2017-07-01

    Idiopathic frozen shoulder (nontraumatic) is commonly encountered in patients between the ages of 35 and 60 years in general orthopaedic practice. While the prevalence of frozen shoulder among the general population is estimated to be between 2% and 4%, a significantly higher prevalence of 10% to 22% has been reported in patients with diabetes mellitus. Since diabetic patients are more prone to develop frozen shoulder than nondiabetics, the question arises as to whether patients diagnosed as having idiopathic frozen shoulder are at greater risk to develop diabetes mellitus and should be routinely screened for this condition. To compare the prevalence of diabetes mellitus and prediabetes among patients diagnosed with idiopathic frozen shoulder who are not known to have either diabetes mellitus or prediabetic conditions with that of an age-matched group from the general population. Case series; Level of evidence, 4. Patients at a shoulder clinic with a diagnosis of idiopathic frozen shoulder were asked to participate in the study if they were aged between 35 to 60 years and had no known previous diagnosis of diabetes mellitus or prediabetic conditions. These patients underwent a 2-hour oral glucose tolerance test. According to their fasting and 2-hour plasma glucose levels, patients were diagnosed as normal glucose tolerance, prediabetic, or diabetic. Findings were matched with the prevalence in an age-matched general population. Fifty patients completed the test. Four patients with idiopathic frozen shoulder (8%) were found to be prediabetic. No patient was found to be diabetic. All 4 patients reported a history of diabetes in their parents or siblings. Patients diagnosed with idiopathic frozen shoulder who are 60 years or younger and are not known diabetics have a similar probability of having diabetes or prediabetes to an age-matched population. No routine diabetic workup is warranted specifically for these patients.

  2. Risk factors associated with intraoperative complications in primary shoulder arthroplasty.

    Science.gov (United States)

    Cowling, Paul D; Holland, Philip; Kottam, Lucksy; Baker, Paul; Rangan, Amar

    2017-12-01

    Background and purpose - Increasing numbers of shoulder arthroplasty are performed internationally. The predictors of intraoperative complications when implanting primary shoulder replacements are unknown. We determined the incidence of intraoperative complications during primary shoulder arthroplasty using the National Joint Registry of England, Wales, Northern Ireland and the Isle of Man (NJR), and analyzed the associated risk factors for complications. Patients and methods - NJR data on primary shoulder arthroplasty were scrutinized for intraoperative complications. 2 analyses were performed: the first examined the incidence and predictors of any recorded complication; the second examined the incidence and predictors for intraoperative fractures specifically. Analysis of risk factors was performed using multivariable binary logistic regression modeling. Results - 12,559 primary shoulder arthroplasties were recorded, with an intraoperative complication rate of 2.5%, the majority being fractures (1.6% overall). The incidence of all complications was lower in men (RR vs. women =0.63 (95% CI 0.47-0.84)). Patients undergoing surgery for avascular necrosis (RR =2.3 (1.3-4.2)) or trauma sequelae (RR =1.6 (1.2-2.7)) had a higher risk of complications compared with OA. Patients undergoing a stemmed hemiarthroplasty (RR =1.8 (1.2-2.5)) and reverse shoulder arthroplasty (RR 1.6 (1.1-2.5)) had a higher risk of complications compared with total shoulder arthroplasty. The incidence of all complications was less in patients undergoing resurfacing arthroplasty (vs. total shoulder arthroplasty (RR 0.42 (0.24-0.73)) and when performing the superior approach (vs. deltopectoral (RR 0.56 (0.39-0.80)). Interpretation - This is the first study to use a national data set to examine risk factors for intraoperative complications during all types of primary shoulder arthroplasty, and identifies several previously unrecognized risk factors, such as surgical approach.

  3. The 50 Most Cited Articles in Shoulder Arthroplasty

    Directory of Open Access Journals (Sweden)

    Karim Sabeh

    2016-08-01

    Full Text Available AIM: Citation analyses are often used as a measurement of an article’s impact in a specific field of study. Clinically, shoulder arthroplasty has been a rapidly growing field, and there has been ample research done on it in the past few decades. The purpose of this study is to determine the 50 most cited articles in shoulder arthroplasty and their characteristics. METHODS: The Science Citation Index Expanded was searched for citations of articles related to shoulder arthroplasty (including total shoulder, reverse shoulder arthroplasty, and hemiarthroplasty published in the 72 journals in the category “Orthopedics”. The 50 most cited articles were determined and the following characteristics were analyzed in each article: authors, journal, year of publication, country of origin, number of citations, citation density (total number of citations/years since publication, article type (clinical or basic science, article subtype via study design and level of evidence. RESULTS: The number of citations ranged from 594 to 104, with citation density ranging from 28.8 to 4.1. The 50 most cited articles in shoulder arthroplasty were published in 6 of the 72 journals, most from 1970s to 2010s and represented by 10 countries. The articles were composed of 7 study designs with the most common being case series and 7 topics within shoulder arthroplasty. The most common level of evidence was IV (35 out of 50 studies. CONCLUSION: Articles with the highest citation density were those discussing reverse shoulder arthroplasty. The top 50 list provides residents, fellows and researchers with a comprehensive list of the major academic contributions to shoulder arthroplasty.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1998-02-01

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

  5. MRI findings in little leaguer's shoulder

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    Song, James C.; Lazarus, Martin L. [Northwestern University and Evanston Northwestern Healthcare, Department of Radiology, Evanston, IL (United States); Song, Alexandra Pae [Health Department, Evanston, IL (United States)

    2006-02-15

    Little leaguer's shoulder, a stress injury of the proximal humeral physis, should be considered in the differential diagnosis for an adolescent baseball player with shoulder pain, especially if the player is pitching regularly in a competitive environment. While roentgenographs may or may not be helpful, depending on the duration and severity of the injury, we report the MRI appearance of a case of little leaguer's shoulder. We found MRI helpful in diagnosing injury to the growth plate that was radiographically occult; furthermore, we were able to document the patient's progress with a follow-up MRI examination, which showed improvement with treatment. (orig.)

  6. 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

    2017-01-01

    Background: Characteristics of rugby tackles that lead to primary anterior shoulder dislocation remain unclear. Purpose: 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. Study Design: Case series; Level of evidence, 4. Methods: 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. Results: 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. Conclusion: 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

  7. MRI of the shoulder. IRM de l'epaule

    Energy Technology Data Exchange (ETDEWEB)

    Lucas, C.; Duvauferrier, R.; Korvin, B. de; Lelievre, N.; Ramee, A.; Thomazeau, H. (Hopital Sud, 35 Rennes (FR))

    1991-01-01

    The affections of the shoulder are frequent and highly disabling. The MRI study of painful shoulders allows differentiating between tendon inflammation and rupture, produces information on the location and extent of the lesion, as well as on the regional trophic condition, all these being essential data for treatment. The sensitivity and specificity of MRI are higher than those of ultrasound and arthrography in ruptures of the cuff. For the study of unstable shoulders, MRI currently is less effective than arthrographic CT to study the articular capsule and the glenoid ligament. However, the recent studies on surface coils, arthrographic MRI and radial fast imaging are very promising.

  8. Spectrum of shoulder injuries in the baseball pitcher

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-06-15

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

  9. POSTTRAUMATIC SHOULDER INSTABILITY IN CHILDREN: CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT

    Directory of Open Access Journals (Sweden)

    Ярослав Николаевич Прощенко

    2014-09-01

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

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

    DEFF Research Database (Denmark)

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

    2015-01-01

    with adjustment for age, sex, and previous surgery. RESULTS: During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were...... treated with reverse shoulder arthroplasty (rTSA). 130 patients returned a completed questionnaire, and the total mean WOOS score was 63. The cumulative 5-year revision rate was 7%. Most revisions occurred after RHA, with a revision rate of 14%. Mean WOOS score was similar for RHA and for SHA...

  11. Physical exam of the adolescent shoulder: tips for evaluating and diagnosing common shoulder disorders in the adolescent athlete.

    Science.gov (United States)

    Lazaro, Lionel E; Cordasco, Frank A

    2017-02-01

    In the young athlete, the shoulder is one of the most frequently injured joints during sports activities. The injuries are either from an acute traumatic event or overuse. Shoulder examination can present some challenges; given the multiple joints involved, the difficulty palpating the underlying structures, and the potential to have both intra- and/or extra-articular problems. Many of the shoulder examination tests can be positive in multiple problems. They usually have high sensitivity but low specificity and therefore low predictive value. The medical history coupled with a detailed physical exam can usually provide the information necessary to obtain an accurate diagnosis. A proficient shoulder examination and the development of an adequate differential diagnosis are important before considering advanced imaging. The shoulder complex relies upon the integrity of multiple structures for normal function. A detailed history is of paramount importance when evaluating young athletes with shoulder problems. A systematic physical examination is extremely important to guiding an accurate diagnosis. The patient's age and activity level are very important when considering the differential diagnosis. Findings obtain through history and physical examination should dictate the decision to obtain advanced imaging of the shoulder.

  12. Shoulder muscle strength and fatigability in patients with frozen shoulder syndrome: the effect of 4-week individualized rehabilitation.

    Science.gov (United States)

    Sokk, J; Gapeyeva, H; Ereline, J; Kolts, I; Pääsuke, M

    2007-07-01

    The effect of 4-week individualized rehabilitation on shoulder muscle strength and fatigability was evaluated in 10 patients with frozen shoulder syndrome (FSS) in comparison of 10 age- and gender-matched healthy control subjects. Isometric maximal voluntary contraction (MVC) force of the shoulder flexors was measured by hand-held dynamometer. Isometric endurance of the shoulder muscles was characterized by endurance time and net impulse (NI) assessed during weight (30% MVC) holding in hand until exhaustion. Fatigability of deltoideus, infraspinatus and trapezius muscles during isometric endurance test was assessed by electromyogram (EMG) power spectrum median frequency (MF) slope per minute. Rehabilitation in patients with FSS consisted of exercise therapy in swimming pool and gymnasium, electrical therapy and massage. Before rehabilitation, patients with FSS had less (p force and NI during endurance test compared to the control. MF slope in patients with FSS for involved extremity was higher (p muscle and less for the infraspinatus muscle before rehabilitation compared to the controls. Shoulder pain was decreased (p force and NI in endurance test in patients for involved extremity were increased after rehabilitation. No significant changes in endurance time and MF slope for infraspinatus and trapezius muscles in patients for involved extremity were observed after rehabilitation, whereas MF slope for deltoideus muscle was increased. It was concluded that in patients with FSS, 4-week rehabilitation decreased shoulder pain and improved MVC force of the shoulder flexors and isometric working capacity of these muscles during endurance test.

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

    Science.gov (United States)

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

    2018-03-03

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

  14. Prevalence of shoulder pain in Swedish flatwater kayakers and its relation to range of motion and scapula stability of the shoulder joint.

    Science.gov (United States)

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

    2016-01-01

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

  15. 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

  16. 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.

  17. Shoulder arthroplasty with the Neer Mark-II prosthesis

    DEFF Research Database (Denmark)

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

    1988-01-01

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

  18. Is shoulder arthroplasty an option for charcot arthropathy?

    National Research Council Canada - National Science Library

    Schoch, Bradley; Werthel, Jean-David; Sperling, John W; Cofield, Robert H; Sanchez-Sotelo, Joaquin

    2016-01-01

    Charcot arthropathy is a rare cause of debilitating joint destruction. Shoulder arthroplasty for Charcot arthropathy is challenging secondary to local bone and soft tissue loss, lack of protective sensation, and altered muscle control...

  19. Sprengels Shoulder at the Kenyatta National Hospital: A Case Report

    African Journals Online (AJOL)

    ang'o, P Wabomba. Abstract. Sprengel's deformity is a rare complex congenital deformity of the shoulder girdle. It raises cosmetic conerns and occassions functional disability. Management is challenging at whatever age treatment is sought.

  20. Missed posterior shoulder dislocation with malunited proximal humerus fracture

    Directory of Open Access Journals (Sweden)

    Kumar Sunil

    2013-12-01

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

  1. Simple self-reduction method for anterior shoulder dislocation

    Directory of Open Access Journals (Sweden)

    Reiner Wirbel

    2014-01-01

    Conclusion: The presented Boss-Holzach-Matter method for reduction of anterior shoulder dislocation is a simple method without the need of anaesthesia, but cooperation from patients is crucial. The successful rate is comparable with other established methods.

  2. Hierarchy of stability factors in reverse shoulder arthroplasty.

    Science.gov (United States)

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

    2008-03-01

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

  3. Structure and internal consistency of a shoulder model.

    Science.gov (United States)

    Högfors, C; Karlsson, D; Peterson, B

    1995-07-01

    A three-dimensional biomechanical model of the shoulder is developed for force predictions in 46 shoulder structures. The model is directed towards the analysis of static working situations where the load is low or moderate. Arbitrary static arm postures in the natural shoulder range may be considered, as well as different kinds of external loads including different force and moment directions. The model can predict internal forces for the shoulder muscles, for the glenohumeral, the acromioclavicular and the sternoclavicular joint as well as for the coracohumeral ligament. A solution to the statistically indeterminate force system is obtained by minimising an objective function. The default function chosen for this is the sum of the squared muscle stresses, but other objective functions may be used as well. The structure of the model is described and its ingredients discussed. The internal consistency of the model, its structural stability and the compatibility of the elements that go into it, is investigated.

  4. Strength asymmetry of the shoulders in elite volleyball players

    National Research Council Canada - National Science Library

    Hadzic, Vedran; Sattler, Tine; Veselko, Matjaž; Markovic, Goran; Dervisevic, Edvin

    2014-01-01

    Volleyball players are reported to have shoulder strength imbalances. Previous authors have primarily investigated small samples of male players at a single skill level, without considering playing position, and with inconsistent findings...

  5. Infantile fibrosarcoma presenting as shoulder dystocia A case report ...

    African Journals Online (AJOL)

    Abstract. Congenital (infantile) fibrosarcomas are soft-tissue tumours that usually present after birth. In the case described a large tumour of the right arm caused shoulder dystocia and death of the fetus.

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

    Directory of Open Access Journals (Sweden)

    Martin Mikek

    2005-04-01

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

  7. Comparative study of total shoulder arthroplasty versus total shoulder surface replacement for glenohumeral osteoarthritis with minimum 2-year follow-up

    NARCIS (Netherlands)

    Kooistra, B.W.; Willems, W.J.H.; Lemmens, E.; Hartel, B.P.; Bekerom, M.P. van den; Deurzen, D.F.P. van

    2017-01-01

    BACKGROUND: Compared with total shoulder arthroplasty (TSA), total shoulder surface replacement (TSSR) may offer the advantage of preservation of bone stock and shorter surgical time, possibly at the expense of glenoid component positioning and increasing lateral glenohumeral offset. We hypothesized

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

    Science.gov (United States)

    Mercier, Numa; Saragaglia, Dominique

    2011-01-01

    Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure. PMID:22191039

  9. Shoulder arthroplasty following gastric bypass, do complications follow?

    Science.gov (United States)

    Schoch, Bradley S; Aibinder, William R; Werthel, Jean-David; Sperling, John W; Sanchez-Sotelo, Joaquin; Cofield, Robert H

    2018-02-01

    Previous reports have shown an increased risk of complications after arthroplasty in the obese population. It remains unclear if gastric bypass surgery prior to shoulder arthroplasty modifies the complication and failure rate. The purpose of this study is to assess the complication and re-operation rates following shoulder arthroplasty in this population. Between 2002 and 2012, 39 shoulders with prior gastric bypass underwent shoulder arthroplasty (3 HA, 16 TSA, 20 RSA). The mean time from the gastric bypass to arthroplasty was 13 years (range, 0.7-32). Shoulders were followed for a minimum of two years (mean, 3.8 years) or until re-operation. Outcome measures included pain, range of motion, satisfaction, modified Neer ratings, and ASES scores. Complications occurred in seven shoulders (18%), with five requiring re-operation. There was no common failure mechanism. Re-operations occurred for aseptic glenoid loosening, periprosthetic fracture, and unexplained pain. Those shoulders with complications were similar to those without in regard to age, sex, and BMI. Complications were more common following anatomic arthroplasty compared to reverse arthroplasty (5 vs 1, p = 0.06); however, complications were not improved compared to historical controls with morbid obesity. Overall, pain improved significantly from 4.8 pre-operatively to 2.3 postoperatively (p bypass surgery prior to shoulder arthroplasty leads to clinical improvement in both pain and range of motion. Prior gastric bypass surgery does not result in a lower surgical complication rate compared to previously published reports in the morbidly obese population. Level 4, case series.

  10. Bilateral Neuropathic Osteoarthropathy of the Shoulder Due to Syringomyelia.

    Science.gov (United States)

    Adiyeke, Levent; Durakbaşa, Mehmet Oǧuz; Duymuş, Tahir Mutlu

    2017-04-06

    Neuropathic osteoarthropathy, which is known as Charcot osteoarthropathy, is a degenerative arthritis that develops as a result of proprioceptive and sensory innervation loss. A 47-year-old man was admitted to the emergency department of the hospital with left shoulder pain, which was ongoing and exacerbating for 5 days. Examination of the cervical region takes a crucial part in determining shoulder pathology. Palliative therapy is the prior treatment of choice as surgical therapy has potential risks in Charcot osteoarthropathy.

  11. Bilateral neuropathic osteoarthropathy of the shoulder due to syringomyelia

    Directory of Open Access Journals (Sweden)

    Levent Adiyeke

    2017-04-01

    Full Text Available Neuropathic osteoarthropathy, which is known as Charcot osteoarthropathy, is a degenerative arthritis that develops as a result of proprioceptive and sensory innervation loss. A 47-year-old man was admitted to the emergency department of the hospital with left shoulder pain, which was ongoing and exacerbating for 5 days. Examination of the cervical region takes a crucial part in determining shoulder pathology. Palliative therapy is the prior treatment of choice as surgical therapy has potential risks in Charcot osteoarthropathy.

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

    Directory of Open Access Journals (Sweden)

    Numa Mercier

    2011-01-01

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

  13. 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.)

  14. Surgical techniques to minimize shoulder pain after laparoscopic cholecystectomy

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  15. Ultrasound-guided interventional procedures around the shoulder

    OpenAIRE

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

    2015-01-01

    Ultrasound is an established modality for shoulder evaluation, being accurate, low cost and radiation free. Different pathological conditions can be diagnosed using ultrasound and can be treated using ultrasound guidance, such as degenerative, traumatic or inflammatory diseases. Subacromial–subdeltoid bursitis is the most common finding on ultrasound evaluation for painful shoulder. Therapeutic injections of corticosteroids are helpful to reduce inflammation and pain. Calcific tendinopathy of...

  16. Experiences of returning to elite beach volleyball after shoulder injury

    OpenAIRE

    Bele, Sofie; ?stenberg, Anna Hafsteinsson; Sj?str?m, Rita; Alricsson, Marie

    2015-01-01

    The purpose of this study was to examine beach volleyball players? experience regarding shoulder injury and how it affects their return to play. To achieve the research aims a qualitative design with semi-structured interviews had been conducted, five elite beach volleyball players, four men and one woman aged 27?42 participated in the study. All participants had suffered a severe shoulder injury, with absence from training and competing for at least 28 days. The findings of this study indica...

  17. Intrauterine fetal death and risk of shoulder dystocia at delivery.

    Science.gov (United States)

    Larsen, Sandra; Dobbin, Joanna; McCallion, Oliver; Eskild, Anne

    2016-12-01

    Vaginal delivery is recommended after intrauterine fetal death. However, little is known about the risk of shoulder dystocia in these deliveries. We studied whether intrauterine fetal death increases the risk of shoulder dystocia at delivery. In this population-based register study using the Medical Birth Registry of Norway, we included all singleton pregnancies with vaginal delivery of offspring in cephalic presentation in Norway during the period 1967-2012 (n = 2 266 118). Risk of shoulder dystocia was estimated as absolute risk (%) and odds ratio with 95% confidence interval. Adjustment was made for offspring birthweight (in grams). We performed sub-analyses within categories of birthweight (<4000 and ≥4000 g) and in pregnancies with maternal diabetes. Shoulder dystocia occurred in 1.1% of pregnancies with intrauterine fetal death and in 0.8% of pregnancies without intrauterine fetal death (p < 0.0001) (crude odds ratio 1.5, 95% confidence interval 1.2-4.9). After adjustment for birthweight, the odds ratio was 5.9 (95% confidence interval 4.7-7.4). In pregnancies with birthweight ≥4000 g, shoulder dystocia occurred in 14.6% of pregnancies with intrauterine fetal death and in 2.8% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 5.9, 95% confidence interval 4.5-7.9). In pregnancies with birthweight ≥4000 g and concurrent maternal diabetes, shoulder dystocia occurred in 57.1% of pregnancies with intrauterine fetal death and 9.6% of pregnancies without intrauterine fetal death (p < 0.001) (crude odds ratio 12.6, 95% confidence interval 5.9-26.9). Intrauterine fetal death increased the risk of shoulder dystocia at delivery, and the absolute risk of shoulder dystocia was particularly high if offspring birthweight was high and the mother had diabetes. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  18. Shoulder abduction and external rotation restoration with nerve transfer.

    Science.gov (United States)

    Kostas-Agnantis, Ioannis; Korompilias, Anastasios; Vekris, Marios; Lykissas, Marios; Gkiatas, Ioannis; Mitsionis, Gregory; Beris, Alexander

    2013-03-01

    In upper brachial plexus palsy patients, loss of shoulder function and elbow flexion is obvious as the result of paralysed muscles innervated by the suprascapular, axillary and musculocutaneus nerve. Shoulder stabilisation, restoration of abduction and external rotation are important as more distal functions will be affected by the shoulder situation. Between 2005 and 2011, eleven patients with upper type brachial plexus palsy were operated on with triceps nerve branch transfer to anterior axillary nerve branch and spinal accessory nerve transfer to the suprascapular nerve for shoulder abduction and external rotation restoration. Nine patients met the inclusion criteria for the study. All patients were men with ages ranged from 21 to 35 years (average, 27.4 years). The interval between injury and surgery ranged from 4 to 11 months (average, 7.2 months). Atrophy of the supraspinatus, infraspinatus and deltoid muscle and subluxation at the glenohumeral joint was obvious in all patients preoperatively. During the pre-op examination all patients had at least muscle grading 4 on the triceps muscle. The mean post-operative value of shoulder abduction was 112.2° (range: 60-170°) while preoperatively none of the patients was able for abduction (pshoulder external rotation was 66° (range: 35-110°) while preoperatively none of them was able for external rotation (pshoulder abduction were significantly better that those of external rotation (p=0.0004). The postoperative average muscle grading for shoulder abduction according the MRC scale was 3.6±0.5 and for the shoulder external rotation was 3.2±0.4. Combined nerve transfer by using the spinal accessory nerve for suprascapular nerve neurotisation and one of the triceps nerve branches for axillary nerve and teres minor branch neurotisation is an excellent choice for shoulder abduction and external rotation restoration. Copyright © 2013 Elsevier Ltd. All rights reserved.

  19. [Measurement of shoulder disability in the athlete: a systematic review].

    Science.gov (United States)

    Fayad, F; Mace, Y; Lefevre-Colau, M M; Poiraudeau, S; Rannou, F; Revel, M

    2004-08-01

    To identify all available shoulder disability questionnaires and to examine those that could be used for athlete. We systematically reviewed the literature in Medline using the keywords shoulder, function, scale, index, score, questionnaire, disability, quality of life, assessment, and evaluation. We searched for scales used for athletes with the keywords scale name AND (sport OR athlete). Data were completed by using the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation" textbook. Analysis took into account the clinimetric quality of the instruments and the number of items specifically related to sports. A total of 37 instruments have been developed to measure disease-, shoulder-specific or upper extremity specific outcome. Older instruments were developed before the advent of modern measurement methods. They usually combined objective and subjective measures. Recent instruments were designed with use of more advanced methods. Most are self-administered questionnaires. Fourteen scales included items assessing sport activity. Four of these scales have been used to assess shoulder disability in athlete. Six scales have been used to assess such disability but do not have specific items related to sports. There is no gold standard for assessing shoulder outcome in the general population and no validated outcome instruments specifically for athletes. We suggest the use of ASES, WOSI and WORC scales for evaluating shoulder function in the recreational athletes. The DASH scale should be evaluated in this population. The principal criterion in evaluating shoulder function in the high level athlete is a return to the same level of sport performance. Further studies are required to identify measurement tools for shoulder disability that have a high predictive value for return to sport.

  20. Trapezius transfer to treat flail shoulder after brachial plexus palsy

    Directory of Open Access Journals (Sweden)

    Diaz Humberto

    2007-01-01

    Full Text Available Abstract Background After severe brachial palsy involving the shoulder, many different muscle transfers have been advocated to restore movement and stability of the shoulder. Paralysis of the deltoid and supraspinatus muscles can be treated by transfer of the trapezius. Methods We treated 10 patients, 8 males and 2 females, by transfer of the trapezius to the proximal humerus. In 6 patients the C5 and C6 roots had been injuried; in one C5, C6 and C7 roots; and 3 there were complete brachial plexus injuries. Eight of the 10 had had neurosurgical repairs before muscle transfer. Their average age was 28.3 years (range 17 to 41, the mean delay between injury and transfer was 3.1 years (range 14 months to 6.3 years and the average follow-up was 17.5 months (range 6 to 52, reporting the clinical and radiological results. Evaluation included physical and radiographic examinations. A modification of Mayer's transfer of the trapezius muscle was performed. The principal goal of this work was to evaluate the results of the trapezius transfer for flail shoulder after brachial plexus injury. Results All 10 patients had improved function with a decrease in instability of the shoulder. The average gain in shoulder abduction was 46.2°; the gain in shoulder flexion average 37.4°. All patients had stable shoulder (no subluxation of the humeral head on radiographs. Conclusion Trapezius transfer for a flail shoulder after brachial plexus palsy can provide satisfactory function and stability.

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

    OpenAIRE

    Numa Mercier; Dominique Saragaglia

    2011-01-01

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

  2. Double level arterial injury with neuropraxia following anterior shoulder dislocation.

    Science.gov (United States)

    Zaraa, Mourad; Sehli, Heithem; Mahjoub, Sabri; Dridi, Moez; Mbarek, Mondher

    2015-12-01

    Vascular and nervous complications are rare after shoulder dislocation. We report the case of a double level arterial injury with neuropraxia following anterior shoulder dislocation that was diagnosed by MultiDetector-row Computed Tomographic (MDCT) angiography and treated by surgical bypass graft and embolectomy. Our case is original, not only because of the rarity of these complications, but also because of the thromboembolism of brachial artery which could be undiagnosed and could compromise prognosis.

  3. Effects of manual therapy on shoulder pain in office workers

    OpenAIRE

    Go, Seong-Uk; Lee, Byoung-Hee

    2016-01-01

    [Purpose] The purpose of this study was to determine the effects of manual therapy on shoulder pain in office workers. [Subjects and Methods] Subjects included 38 office workers who were randomly divided into two groups: a manual therapy group of 19 subjects and a shoulder stabilization exercise group of 19 subjects. All subjects underwent evaluation of the pressure pain threshold in the splenius capitis and upper, middle, and lower trapezius muscles on both sides. The manual therapy used in ...

  4. Safety and efficacy of hyperosmolar irrigation solution in shoulder arthroscopy.

    Science.gov (United States)

    Capito, Nicholas M; Cook, James L; Yahuaca, Bernardo; Capito, Marie D; Sherman, Seth L; Smith, Matthew J

    2017-05-01

    A hyperosmolar irrigation solution has been reported to be safe and have potential benefits for use during shoulder arthroscopy in an animal model study. In this study, the clinical effects of a hyperosmolar solution were compared with a standard isotonic solution when used for shoulder arthroscopy. A prospective, double-blind, randomized controlled trial was performed to compare isotonic (273 mOsm/L) and hyperosmolar (593 mOsm/L) irrigation solutions used for arthroscopic rotator cuff repair. Primary outcomes focused on the amount of periarticular fluid retention based on net weight gain, change in shoulder girth, and pain. All patients were tracked through standard postsurgical follow-up to ensure no additional complications arose. Patients were contacted at 1 year to assess American Shoulder and Elbow Surgeon score, visual analog scale pain score, and the Single Assessment Numeric Evaluation shoulder scores RESULTS: Fifty patients (n = 25/group) were enrolled and completed the study. No statistically significant differences were noted between cohorts in demographics or surgical variables. The hyperosmolar group experienced significantly less mean weight gain (1.6 ± 0.82 kg vs. 2.25 ± 0.77 kg; P = .005), significantly less change in shoulder girth (P  .2). A hyperosmolar irrigation solution provides a safe and effective way to decrease periarticular fluid retention associated with arthroscopic rotator cuff surgery without any adverse long-term effects. Use of a hyperosmolar irrigation solution for shoulder arthroscopy has potential clinical benefits to surgeons and patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Proprioception and Throwing Accuracy in the Dominant Shoulder After Cryotherapy

    Science.gov (United States)

    Wassinger, Craig A; Myers, Joseph B; Gatti, Joseph M; Conley, Kevin M; Lephart, Scott M

    2007-01-01

    Context: Application of cryotherapy modalities is common after acute shoulder injury and as part of rehabilitation. During athletic events, athletes may return to play after this treatment. The effects of cryotherapy on dominant shoulder proprioception have been assessed, yet the effects on throwing performance are unknown. Objective: To determine the effects of a cryotherapy application on shoulder proprioception and throwing accuracy. Design: Single-group, pretest-posttest control session design. Setting: University-based biomechanics laboratory. Patients or Other Participants: Healthy college-aged subjects (n = 22). Intervention(s): Twenty-minute ice pack application to the dominant shoulder. Main Outcome Measure(s): Active joint position replication, path of joint motion replication, and the Functional Throwing Performance Index. Results: Subjects demonstrated significant increases in deviation for path of joint motion replication when moving from 90° of abduction with 90° of external rotation to 20° of flexion with neutral shoulder rotation after ice pack application. Also, subjects exhibited a decrease in Functional Throwing Performance Index after cryotherapy application. No differences were found in subjects for active joint position replication after cryotherapy application. Conclusions: Proprioception and throwing accuracy were decreased after ice pack application to the shoulder. It is important that clinicians understand the deficits that occur after cryotherapy, as this modality is commonly used following acute injury and during rehabilitation. This information should also be considered when attempting to return an athlete to play after treatment. PMID:17597948

  6. Osteoporosis and shoulder osteoarthritis: incidence, risk factors, and surgical implications.

    Science.gov (United States)

    Pervaiz, Khurram; Cabezas, Andres; Downes, Katheryne; Santoni, Brandon G; Frankle, Mark A

    2013-03-01

    Patients with osteoarthritis undergoing shoulder arthroplasty may suffer from osteoporosis. The purpose of this study was to determine whether computed tomography (CT)-derived Hounsfield unit (HU) measurements correlate with bone mineral density (BMD) and whether these data could predict implant size and fixation choice. The study analyzed preoperative dual energy x-ray absorptiometry and shoulder CT scans for 230 patients who underwent total shoulder arthroplasty. Hip BMD and T scores and HU attenuation in the humerus were correlated. HU cutoff values were developed to aid in differentiating patients whose BMD values were within normal reference ranges from patients with osteopenia or osteoporosis. Risk factors associated with low BMD were correlated, and the effect of BMD on humeral stem size, and fixation method was investigated. Significant correlations between HU and hip BMD and T score were identified (P risk factors. Age at time of surgery was a predictor of cemented stem fixation (P = .024). Patients with a lower BMD were statistically more likely to receive a larger-diameter humeral stem (P = .016). Orthopedic surgeons may be able to use data obtained from shoulder CT scans to predict the need for larger stem size or cement fixation during shoulder arthroplasty. In combination with the risk factor profile, these data may be useful in predicting the need for an osteoporosis workup and treatment. Level III, Study of Nonconsecutive Patients, Diagnostic Study. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

  7. Psychosocial work factors and shoulder pain in hotel room cleaners.

    Science.gov (United States)

    Burgel, Barbara J; White, Mary C; Gillen, Marion; Krause, Niklas

    2010-07-01

    Hotel room cleaners have physically demanding jobs that place them at high risk for shoulder pain. Psychosocial work factors may also play a role in shoulder pain, but their independent role has not been studied in this group. Seventy-four percent (941 of 1,276) of hotel room cleaners from five Las Vegas hotels completed a 29-page survey assessing health status, working conditions, and psychosocial work factors. For this study, 493 of the 941 (52%) with complete data for 21 variables were included in multivariate logistic regression analyses. Fifty-six percent reported shoulder pain in the prior four weeks. Room cleaners with effort-reward imbalance (ERI) were three times as likely to report shoulder pain (OR 2.99, 95% CI 1.95-4.59, P = 0.000) even after adjustment for physical workload and other factors. After adjustment for physical workload, job strain and iso-strain were not significantly associated with shoulder pain. ERI is independently associated with shoulder pain in hotel room cleaners even after adjustment for physical workload and other risk factors. 2010 Wiley-Liss, Inc.

  8. Correlations between three patient-assessed shoulder instability scales.

    Science.gov (United States)

    Taylor, David; Garewal, Devinder; Evans, Matthew C

    2015-08-01

    To evaluate the correlations between three patient-assessed shoulder instability scales before and after Latarjet stabilisation for traumatic anteroinferior glenohumeral instability. Records of 30 men and 2 women (mean age, 26.7 years) who had not undergone surgery for antero-inferior shoulder instability and records of 31 men and one woman (mean age, 27 years) who had undergone Latarjet stabilisation for anteroinferior shoulder instability and had been followed up for a mean period of 21.3 months were reviewed. Correlations between the Western Ontario Shoulder Instability Index (WOSI), the Melbourne Instability Shoulder Score (MISS), and the L'Insalata Shoulder Questionnaire (L'Insalata) were assessed. The mean score of each scale was significantly greater in the postoperative than preoperative group (p0.01, post-hoc analysis). Correlations of all scale pairs were significant (p<0.001). The WOSIMISS correlations in the pre- and post-operative groups were moderate. The L'Insalata-WOSI correlations in the pre- and post-operative groups were moderate and high, respectively. The L'Insalata-MISS correlations in the pre- and post-operative groups were high and moderate, respectively. The MISS and WOSI scales are moderately correlated. Correlation of the L'Insalata scale with other scales depends on the operative status of the patient. The use of the L'Insalata scale alone is not recommended.

  9. Shoulder Dysfunction after Selective Neck Dissection in Recurrent Nasopharyngeal Carcinoma.

    Science.gov (United States)

    Chan, Jimmy Yu Wai; Wong, Stanley Thian Sze; Chan, Richie Chiu Lung; Wei, William Ignace

    2015-09-01

    To investigate the incidence of occult nodal metastasis and severity of shoulder dysfunction after selective neck dissection (SND) for recurrent nasopharyngeal carcinoma (NPC) with N0 status. Prospective, single-group, pre/post test design. Academic medical center. Between 1998 and 2012, 46 patients who had recurrent NPC and N0 status were recruited. They subsequently received salvage nasopharyngectomy and SND, removing ipsilateral level I to III and V lymphatics. The incidence of occult nodal metastasis was noted. All patients underwent standardized physiotherapy after surgery. Postoperative shoulder function was measured using the Disability of Arm, Shoulder, and Hand (DASH) questionnaire. The incidence of microscopic nodal metastasis was 15.2%. For first year posttreatment, the mean DASH score was 44.2. With time, there was no improvement in shoulder function despite targeted physiotherapy (P = .09), and the second postoperative year mean DASH score was 46.3. The degree of daily activity affected was rated as moderate to very limited, and 30% of the patients had at least moderate shoulder pain at rest. Shoulder dysfunction after SND for recurrent NPC is significant and persistent. Given the low incidence of microscopic nodal metastasis in such circumstances, routine SND is not recommended. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  10. Outcomes Study of the TM Reverse Shoulder System Used in Primary or Revision Reverse Total Shoulder Arthroplasty

    Science.gov (United States)

    2017-01-10

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

  11. The responsiveness and minimal important change of the western Ontario shoulder instability index and oxford shoulder instability score

    NARCIS (Netherlands)

    Van Der Linde, Just A.; Van Kampen, Derk A.; Van Beers, Loes W.A.H.; Van Deurzen, Derek F.P.; Saris, Daniël B.F.; Terwee, Caroline B.

    2017-01-01

    BACKGROUND: Patient-reported outcome measurements (PROMs) are widely used to evaluate functional limitations. Considering PROMs for shoulder instability, information is lacking with regard to what constitutes a relevant change from baseline scores. OBJECTIVES: To evaluate the responsiveness of the

  12. [Isokinetic dynamometer measurement of shoulder rotational strength in healthy elite athletes (swimming, volley-ball, tennis): comparison between dominant and nondominant shoulder].

    Science.gov (United States)

    Gozlan, G; Bensoussan, L; Coudreuse, J-M; Fondarai, J; Gremeaux, V; Viton, J-M; Delarque, A

    2006-02-01

    To compare lateral rotator (LR) and medial rotator (MR) muscle strength of both shoulders in a sport involving asymmetrical movements (tennis), symmetrical movements (swimming), and symmetrical and asymmetrical movements (volley-ball). Retrospective study of 42 healthy elite athletes (18 women: 14 tennis players, 19 swimmers and 9 volleyball players. We evaluated the strength of LR and MR of both shoulders by Cybex Norm isokinetic dynamometer, in the concentric mode, in the modified Davies position, at 2 different speeds (60 degrees and 180 degrees s(-1)) and analysed peak torque of LR and MR and LR/MR ratios. TENNIS: The MR peak torque of the dominant shoulder was significantly higher than that of the non-dominant shoulder. The LR/MR ratio of the dominant shoulder was significantly lower than the non dominant shoulder in women. SWIMMING: The LR strength and LR/MR ratio of the dominant shoulder was higher than the non dominant side in men at 60 degrees/second. Both shoulders showed comparable strength in women. VOLLEYBALL: Shoulder muscular strength was symmetrical. The higher strength of MR muscles in the dominant shoulder of tennis players (asymmetrical movements) has been reported in the literature. Athletes show asymmetrical shoulder strength in swimming, a symmetrical sport and similar LR and MR strength in both shoulders in volleyball, a sport with asymmetrical movements. To our knowledge, these results have never been reported before.

  13. FORWARD HEAD POSTURE CORRECTION VERSUS SHOULDER STABILIZATION EXERCISES EFFECT ON SCAPULAR DYSKINESIA AND SHOULDER PROPRIOCEPTION IN ATHLETES AN EXPERIMENTAL STUDY

    Directory of Open Access Journals (Sweden)

    Deepmala Thakur

    2016-04-01

    Full Text Available Background: Forward head posture (FHP, the most common deviation from the normal curvature in cervical spine. Craniocervical flexor muscle strengthening is frequently used treatment for FHP. Scapular dykinesia (SD is the alteration in the normal static or dynamic motion of the scapula during coupled scapulohumeral movements. Shoulder stabilization exercises are an effective treatment for SD. As both FHP and SD are related to each other, the objective of the study was to find and compare the effect of FHP correction and shoulder stabilization exercises on SD and shoulder proprioception. Methods: 40 athletes (18-30yrs were recruited. Subjects were randomly allocated into two groups. Group A received deep neck flexor strengthening and anterior scalene stretch, group B received shoulder stabilizing exercises. Paired t test and chi-square test were used to judge the statistical significant difference. The level of significance was set at p <0.05. All data was analyzed using SPSS program version 12. Result: No statistical significant difference was found between the groups for the 4 outcome variables, but significant improvement was seen within the groups. Shoulder proprioception was found to be significant between the groups where group B (p =<0.001 showed better improvement than group A (p = <0.017. Conclusion: Both FHP correction as well as shoulder stabilization exercises were equally effective in correction of scapular dyskinesia and shoulder proprioception. Shoulder stabilization exercises showed slightly better improvement than FHP correction group in reducing proprioception errors. Also neck strength values were found to be clinically significant for deep neck strengthening group.

  14. Posterior bone block of chronic locked posterior shoulder dislocations with glenoid augmentation: a retrospective evaluation of ten shoulders.

    Science.gov (United States)

    Aksekili, Mehmet Atıf Erol; Uğurlu, Mahmut; Işık, Çetin; Yüksel, Kağan; Biçici, Vedat; Bozkurt, Murat

    2016-04-01

    The aim of this study, which is the most extensive series to date on this subject, was to present the results of ten shoulders of seven patients treated with the posterior bone block augmentation method with autograft taken from the iliac wing for a chronic locked posterior shoulder dislocation and to evaluate the results in the light of the relevant literature. A retrospective examination was made of patients who underwent iliac autograft with glenoid augmentation for chronic posterior shoulder dislocation in our clinic between 2004 and 2011. All of the patients had been initially treated at another centre and referred to our hospital because of continuing or relapsing posterior shoulder dislocation. Assessment was made by physical examination X-ray, computed tomography (CT), and the Constant-Murley score. All the patients were male with a mean age at the time of surgery of 42.4 years (range, 23-53 years), with a mean follow-up period of 40.6 months (range, 24-55 months). On presentation, all the patients had locked posterior shoulder dislocation. Radiological union was evaluated from the CT images taken 24 months postoperatively. The graft was observed to have been incorporated in all cases. The mean postoperative Constant-Murley score was 81.25/100 ± 17.8. In seven of the shoulders, arthropathy findings increased by varying degrees. A functional and stable shoulder can be obtained with glenoid augmentation in patients with chronic locked posterior shoulder dislocation. When other treatment alternatives are considered for a young patient group, this is a safe and applicable treatment method.

  15. Rodeo athletes: management of shoulder instability.

    Science.gov (United States)

    Figueiredo, Eduardo A; Belangero, Paulo S; Cohen, Carina; Louchard, Rafael L; Terra, Bernardo B; Pochini, Alberto C; Andreoli, Carlos V; Cohen, Moisés; Ejnisman, Benno

    2016-05-01

    The aim of this study was to describe epidemiological data and evaluate the clinical results of traumatic anterior glenohumeral instability in rodeo athletes. Thirteen patients, all male, with a mean age of 23.2 (18-31) years old, with anterior glenohumeral instability were include in this study. In 9 patients, the right side was affected. The mean time elapsed between injury and undergoing surgery was 56 months (24-120 months). The surgical technique used (arthroscopic or open bone block procedure) was chosen based on the ISIS (Instability Severity Index Score). Only professional athletes who had been in the sport for at least 60 months were included. Functional evaluation was conducted using the UCLA scale, after a 24-month follow-up period. The number of dislocation episodes varied from 10 to 100 (mean 27 episodes). All of the patients were submitted a surgical treatment open bone block procedure, due to their degree of sport participation, type of sport (forced overhead and collision) and the presence of associated bone defect lesions. According to UCLA criteria, the results were excellent in 12 patients and good in one. The mean time elapsed before returning to the sport was five months, varying between two and ten months. Complications included one patient developing axillary neuropraxia, which was completely resolved six months after the operation, and another patient developed a superficial skin infection. The rodeo athletes with anterior shoulder instability had serious associated bony lesions and has good outcome after bone block procedure.

  16. Electrotherapy modalities for adhesive capsulitis (frozen shoulder).

    Science.gov (United States)

    Page, Matthew J; Green, Sally; Kramer, Sharon; Johnston, Renea V; McBain, Brodwen; Buchbinder, Rachelle

    2014-10-01

    Adhesive capsulitis (also termed frozen shoulder) is a common condition characterised by spontaneous onset of pain, progressive restriction of movement of the shoulder and disability that restricts activities of daily living, work and leisure. Electrotherapy modalities, which aim to reduce pain and improve function via an increase in energy (electrical, sound, light, thermal) into the body, are often delivered as components of a physical therapy intervention. This review is one in a series of reviews which form an update of the Cochrane review 'Physiotherapy interventions for shoulder pain'. To synthesise the available evidence regarding the benefits and harms of electrotherapy modalities, delivered alone or in combination with other interventions, for the treatment of adhesive capsulitis. We searched CENTRAL, MEDLINE, EMBASE, CINAHL Plus and the ClinicalTrials.gov and World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) clinical trials registries up to May 2014, unrestricted by language, and reviewed the reference lists of review articles and retrieved trials to identify any other potentially relevant trials. We included randomised controlled trials (RCTs) and controlled clinical trials using a quasi-randomised method of allocation that included adults with adhesive capsulitis and compared any electrotherapy modality to placebo, no treatment, a different electrotherapy modality, or any other intervention. The two main questions of the review focused on whether electrotherapy modalities are effective compared to placebo or no treatment, or if they are an effective adjunct to manual therapy or exercise (or both). The main outcomes of interest were participant-reported pain relief of 30% or greater, overall pain, function, global assessment of treatment success, active shoulder abduction, quality of life, and the number of participants experiencing any adverse event. Two review authors independently selected trials for inclusion

  17. Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 2: Glenohumeral Joint

    Science.gov (United States)

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

    2015-01-01

    STUDY DESIGN Cross-sectional. OBJECTIVES To compare differences in glenohumeral joint angular motion and linear translations between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Numerous clinical theories have linked abnormal glenohumeral kinematics, including decreased glenohumeral external rotation and increased superior translation, to individuals with shoulder pain and impingement diagnoses. However, relatively few studies have investigated glenohumeral joint angular motion and linear translations in this population. METHODS Transcortical bone pins were inserted into the scapula and humerus of 12 a symptomatic and 10 symptomatic participants for direct bone-fixed tracking using electromagnetic sensors. Glenohumeral joint angular positions and linear translations were calculated during active shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups in angular positions were limited to glenohumeral elevation, coinciding with a reduction in scapulothoracic upward rotation. Symptomatic participants demonstrated 1.4 mm more anterior glenohumeral translation between 90° and 120° of shoulder flexion and an average of 1 mm more inferior glenohumeral translation throughout shoulder abduction. CONCLUSION Differences in glenohumeral kinematics exist between symptomatic and a symptomatic individuals. The clinical implications of these differences are not yet understood, and more research is needed to understand the relationship between abnormal kinematics, shoulder pain, and pathoanatomy. PMID:25103132

  18. The Role of Acromioplasty in the Treatment of Shoulder Impingement Syndrome Acromioplasty in the Treatment of Shoulder Impingement

    Directory of Open Access Journals (Sweden)

    Rüştü Nuran

    2011-12-01

    Full Text Available Aim: The results of open acromioplasty procedures were investigated for shoulder impingement syndrome in patients who did not respond to conservative treatment. Methods: Twenty cases of shoulder impingement syndrome who did not respond to conservative treatment were investigated prospectively. The shoulder abduction and flexion range of motion and muscle power were measured preoperatively and postoperatively. Anteroposterior, neutral, axillary and impingement radiographs were taken. Shoulder magnetic resonance imaging (MRI was performed. Clinical assessment was performed by the Constant shoulder score. Results: Results of MRI revealed that 20 cases had type 1, 2 and 3 acromion in 3, 9 and 8 patients, respectively. The mean followup time was 16 months. Compared to preoperative conditions, the results in 80% of cases were rated as perfect (p<0.000, since all cases had gained both significantly more range of motion (p<0.000 and muscle power (p<0.000, in addition to decreased pain in all cases (p<0.000. Four cases who had been rated as good had common features as advance age, traumatic etiology and inadequate rehabilitation. Conclusion: Open acromioplasty surgery reduces pain, increases range of motion and is an effective treatment option in cases of shoulder impingement syndrome not responding to conservative treatment. (The Me di cal Bul le tin of Ha se ki 2011; 49: 141-4

  19. Shoulder muscle isometric strength and active range of motion in patients with frozen shoulder syndrome after manipulation under anesthesia.

    Science.gov (United States)

    Sokk, Jelena; Gapeyeva, Helena; Ereline, Jaan; Merila, Mati; Pääsuke, Mati

    2012-01-01

    Frozen shoulder syndrome (FSS) causes pain and restriction of movement in the shoulder. The aim was to assess changes in shoulder muscle isometric maximal voluntary contraction (MVC) force and active range of motion (AROM) in patients with frozen shoulder syndrome (FSS) after manipulation under general anesthesia (MUA). In total, 18 patients with FSS (9 women and 9 men) with a mean age of 53.6 years (SD, 9.7) participated in this study. MVC force of shoulder flexors, adductors, and internal and external rotators was measured by a handheld dynamometer. AROM in the same directions was measured goniometrically. The patients were screened according to the intensity of pain by day and at night. The data were collected before MUA and 1 and 6 months after MUA. A significant reduction in MVC force and AROM was noted before MUA in the involved extremity as compared with the uninvolved extremity (P0.05), whereas AROM of flexion and external rotation remained significantly reduced (Pshoulder pain by day and at night was recorded 1 and 6 months after MUA (Pshoulder muscle MVC force for the involved extremity did not differ significantly as compared with the uninvolved extremity, whereas the shoulder AROM in flexion and external rotation remained lower.

  20. Eccentric training for shoulder abductors improves pain, function and isokinetic performance in subjects with shoulder impingement syndrome: a case series.

    Science.gov (United States)

    Camargo, Paula R; Avila, Mariana A; Alburquerque-Sendín, Francisco; Asso, Naoe A; Hashimoto, Larissa H; Salvini, Tania F

    2012-01-01

    Conservative treatments have been proposed for people with shoulder impingement syndrome (SIS), such as strengthening of the rotator cuff and scapular muscles and stretching of the soft tissues of the shoulder. However, there is a lack of studies analyzing the effectiveness of eccentric training in the treatment of SIS. To evaluate the effects of eccentric training for shoulder abductors on pain, function, and isokinetic performance during concentric and eccentric abduction of the shoulder in subjects with SIS. Twenty subjects (7 females, 34.2 SD 10.2 years, 1.7 SD 0.1 m, 78.0 SD 16.3 kg) with unilateral SIS completed the study protocol. Bilateral isokinetic eccentric training at 60º/s for shoulder abductors was performed for six consecutive weeks, twice a week, on alternate days. For each training day, three sets of 10 repetitions were performed with a 3-minute rest period between the sets for each side. The range of motion trained was 60° (ranging from 80° to 20°). The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used to evaluate functional status and symptoms of the upper limbs. Peak torque, total work and acceleration time were measured during concentric and eccentric abduction of the arm at 60º/s and 180º/s using an isokinetic dynamometer. DASH scores, peak torque, total work and acceleration time improved (pshoulder abductors improves physical function of the upper limbs in subjects with SIS.

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

    Directory of Open Access Journals (Sweden)

    Kyle A. R. Kemp

    2012-01-01

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

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

    Science.gov (United States)

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

    2014-07-01

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

  3. Injuries about the shoulder in skiing and snowboarding.

    Science.gov (United States)

    McCall, D; Safran, M R

    2009-12-01

    There has been a decrease in the overall injury rate, particularly the rate of lower-extremity injuries, for alpine skiing, with a resultant increase in the ratio of upper-extremity to lower-extremity injuries. The upper extremity is injured nearly twice as often during snowboarding than alpine skiing, with approximately half of all snowboarding injuries involving the upper extremity. Shoulder injuries are likely under-reported, as many patients seek evaluation for minor shoulder injuries with their local physicians, and not at the ski medical clinic, where most epidemiology studies obtain their data. Shoulder injuries account for 4 to 11% of all alpine skiing injuries and 22 to 41% of upper-extremity injuries. During snowboarding, shoulder injuries account for 8 to 16% of all injuries and 20 to 34% of upper-extremity injuries. Falls are the most common mechanism of shoulder injury, in addition to pole planting during skiing and aerial manoeuvres during snowboarding. Common shoulder injuries during skiing and snowboarding are rotator cuff strains, glenohumeral dislocations, acromioclavicular separations and clavicle fractures. It is still unclear, when comparing snowboarding and skiing injury data, which sport has the higher incidence of shoulder injuries. Stratifying shoulder injuries by type allows better delineation as to which sport has an increased incidence of certain injury patterns. The differing mechanisms of injury combined with distinct equipment for each sport plays a role in the type and frequency of shoulder injuries seen in these two subgroups. With the increased ratio of upper- to lower-extremity injuries during alpine skiing and the boom in popularity of snowboarding, shoulder injuries are seen with increasing frequency by those who care for alpine sport injuries. According to recent epidemiological data, only clavicle and humerus fractures have shown increased rates of incidence among alpine skiers. Over the past 30 years, there has been a general

  4. Association Between Serum Relaxin and Subsequent Shoulder Instability.

    Science.gov (United States)

    Owens, Brett D; Cameron, Kenneth L; Clifton, Kari B; Svoboda, Steven J; Wolf, Jennifer Moriatis

    2016-07-01

    Ligamentous laxity correlates with shoulder instability. Relaxin is a hormone that has been linked to laxity in the knee and has been shown to be a risk factor for anterior cruciate ligament (ACL) injury. This study prospectively evaluated the association between relaxin and acute shoulder instability. A prospective cohort study of 1050 young athletes was performed between 2006 and 2010. The authors conducted a nested case-control analysis within this cohort to evaluate the association between preinjury serum relaxin concentration and the likelihood of subsequent shoulder instability. The study compared 53 patients who had shoulder instability and 53 control subjects who were matched for sex, age, height, and weight. The serum relaxin concentration in preinjury baseline samples was tested with enzyme-linked immunosorbent assay analysis in duplicate. Independent t tests were performed to identify differences in mean serum relaxin concentration between patients with shoulder instability and uninjured control subjects. Logistic regression was used to evaluate whether preinjury baseline serum relaxin concentration was associated with the subsequent likelihood of shoulder instability. Of the 53 patients with instability, 13 (25%) had a detectable serum relaxin concentration compared with 9 (17%) of uninjured control subjects (P=.34). Mean serum relaxin concentration in the injury group was 3.69±1.78 pg/mL and 2.20±0.97 pg/mL in uninjured control subjects (P=.02). Increased serum relaxin concentration was associated with the subsequent likelihood of acute shoulder instability. Subjects were 2.18 times (odds ratio, 2.18; 95% confidence interval, 1.01-4.76) more likely to have acute shoulder instability during the follow-up period for every 1-pg/mL increase in serum relaxin concentration at baseline. The findings suggest that serum relaxin concentration is associated with a risk of subsequent shoulder instability in young athletes. Further research on the role of relaxin

  5. Shoulder mechanism design of an exoskeleton robot for stroke patient rehabilitation.

    Science.gov (United States)

    Koo, Donghan; Chang, Pyung Hun; Sohn, Min Kyun; Shin, Ji-hyeon

    2011-01-01

    Shoulder girdle movement is critical for stabilizing and orientating the arm during daily activities. During robotic arm rehabilitation with stroke patients, the robot must assist movements of the shoulder girdle. Shoulder girdle movement is characterized by a highly nonlinear function of the humeral orientation, which is different for each person. Hence it is improper to use pre-calculated shoulder girdle movement. If an exoskeleton robot cannot mimic the patient's shoulder girdle movement well, the robot axes will not coincide with the patient's, which brings reduced range of motion (ROM) and discomfort to the patients. A number of exoskeleton robots have been developed to assist shoulder girdle movement. The shoulder mechanism of these robots, along with the advantages and disadvantages, are introduced. In this paper, a novel shoulder mechanism design of exoskeleton robot is proposed, which can fully mimic the patient's shoulder girdle movement in real time. © 2011 IEEE

  6. What Change in American Shoulder and Elbow Surgeons Score Represents a Clinically Important Change After Shoulder Arthroplasty?

    Science.gov (United States)

    Werner, Brian C; Chang, Brenda; Nguyen, Joseph T; Dines, David M; Gulotta, Lawrence V

    2016-12-01

    The American Shoulder and Elbow Surgeons (ASES) questionnaire was developed to provide a standardized method for evaluating shoulder function. Previous studies have determined the clinical responsiveness of this outcome measure for heterogenous populations or patients with nonoperatively treated rotator cuff disease. Currently, to our knowledge, no studies exist that establish the clinically relevant change in the ASES score after shoulder arthroplasty. We asked: (1) What are the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) for the ASES score after primary and reverse shoulder arthroplasties? (2) Are the MCID and SCB for the ASES score different between primary and reverse shoulder arthroplasties? (3) What patient-related factors are associated with achieving the MCID and SCB after total shoulder arthroplasty and reverse shoulder arthroplasty? A longitudinally maintained institutional shoulder arthroplasty registry was retrospectively queried for patients who underwent primary shoulder arthroplasty, including anatomic or reverse total shoulder arthroplasty from 2007 to 2013, with a minimum 2-year followup. Seven hundred ninety-four patients were identified and eligible; 304 of these patients did not have 2 years of followup or complete datasets, resulting in a study cohort of 490 patients (62% of the 794 potentially eligible). The MCID and SCB of the ASES score for these patients was calculated using an anchor-based method, using four different anchors measuring satisfaction with work, activities, overall, and activity from the SF-36. The MCID (anchored to somewhat satisfied) and SCB (very satisfied) of the ASES score were calculated for the entire cohort and stratified by arthroplasty type. Multivariate logistic regression of patient-related factors that influence the MCID and SCB achievement was performed. The MCID for all patients combined ranged from 6.3 to 13.5; for the overall satisfaction anchor, the MCID was 13.5

  7. Instability of the long head of the biceps tendon in patients with rotator cuff tear: evaluation on magnetic resonance arthrography of the shoulder with arthroscopic correlation

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    Kang, Yusuhn; Lee, Joon Woo; Ahn, Joong Mo; Lee, Eugene; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seongnam-si, Gyeonggi-do (Korea, Republic of)

    2017-10-15

    To evaluate the diagnostic value of MR arthrography (MRA) in diagnosing instability of the LHBT in patients with rotator cuff tendon tear. The MR arthrograms of 101 patients were retrospectively reviewed and correlated with arthroscopic findings as the standard reference. Images were evaluated for (1) the integrity of the LHBT, (2) the position of the LHBT (subluxation/dislocation on axial images, inferior displacement on oblique sagittal image) and (3) the integrity of the biceps pulley (SGHL, supraspinatus and subscapularis tendon adjacent to the rotator interval). The integrity of the LHBT was correctly classified in 74.3% (75/101) and 66.3% (67/101) by readers 1 and 2, respectively. The diagnosis of LHBT instability could be made on axial images with a sensitivity of 82.6% and 73.9% and specificity of 69.9% and 87.7%, whereas the displacement sign on sagittal images had a sensitivity of 73.9% and 78.3% and a specificity of 64.4% and 61.6%, respectively. Assessing the integrity of the SGHL had a sensitivity of 60.9 and 93.3% and a specificity of 70.4 and 75.0%, respectively. By combining the different image findings, the accuracy in assessing LHBT instability was 80.9 and 90.5% with a sensitivity of 60.9 and 86.7% and specificity of 83.1 and 91.8%, respectively. Individual image findings may have a limited role in diagnosing LHBT instability in patients with rotator cuff tendon tear. The accuracy of MRA may be improved by assessing the integrity of the biceps pulley structures along with the position of the LHBT on both axial and sagittal images. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Arno Celliers

    2017-01-01

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

  9. Inflammatory genes and psychological factors predict induced shoulder pain phenotype.

    Science.gov (United States)

    George, Steven Z; Parr, Jeffrey J; Wallace, Margaret R; Wu, Samuel S; Borsa, Paul A; Dai, Yunfeng; Fillingim, Roger B

    2014-10-01

    The pain experience has multiple influences, but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several preclinical shoulder pain phenotypes. An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, and IL6 single nucleotide polymorphisms (SNP)) and psychological (anxiety, depression symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-d average and peak reported on numerical rating scale), upper extremity disability (5-d average and peak reported on the Quick Disabilities of the Arm, Shoulder and Hand instrument), and duration of shoulder pain (d). After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depression symptoms for average pain intensity and duration and 2) IL1B two SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B. These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts to determine their involvement in the transition from acute to chronic pain conditions.

  10. Ultrasound-guided interventional procedures around the shoulder

    Science.gov (United States)

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

    2016-01-01

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

  11. Epidemiologic aspects of shoulder dystocia-related neurological birth injuries.

    Science.gov (United States)

    Iffy, Leslie; Varadi, Valeria; Papp, Zoltan

    2015-04-01

    The first part of the study involved data collection for the detection of geographic variations and chronologic fluctuations in the rates of shoulder dystocia. The second part of the research evaluated head-to-body delivery times in cases of arrest of the shoulders at birth that had resulted in fetal damage during the last four decades in the USA. The study of geographic and chronologic changes in the rates of shoulder dystocia rested on reported statistics coming from the USA and 11 other countries. These data were obtained by computer search. Evaluation of head-to-body delivery times rested on 104 well-documented cases that resulted in permanent neonatal damage. Literary reports of shoulder dystocia indicate that the incidence of shoulder dystocia has increased in the USA about fourfold since the middle of the twentieth century. No comparable trend has been reported from most other countries. Study of head-to-body delivery times revealed that more than two-thirds of all injured fetuses had been extracted from the birth canal within 2 minutes. Incidents of shoulder dystocia began to escalate in the USA during the 1980s, shortly after the introduction of "active management" of the birthing process. This new technique replaced a conservative philosophy which had recommended abstinence from intervention on the part of the accoucheur. The authors consider the interventionist approach largely responsible for the exponential increase in the rates of shoulder dystocia in the USA. They recommend adherence to the traditional method of delivery on the part of obstetricians in Europe and elsewhere.

  12. Coracoid syndrome: a neglected cause of anterior shoulder pain.

    Science.gov (United States)

    Gigante, Antonio; Bottegoni, Carlo; Barbadoro, Pamela

    2016-01-01

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

  13. Correlation of Patient-Reported Outcome Measurement Information System Physical Function Upper Extremity Computer Adaptive Testing, With the American Shoulder and Elbow Surgeons Shoulder Assessment Form and Simple Shoulder Test in Patients With Shoulder Pain.

    Science.gov (United States)

    Minoughan, Chelsea E; Schumaier, Adam P; Fritch, John L; Grawe, Brian M

    2018-02-13

    To evaluate the Patient-Reported Outcome Measurement Information System Physical Function Upper Extremity Computer Adaptive Testing (PROMIS PFUE CAT) measurement tool against the already validated American Shoulder and Elbow Surgeons Shoulder Assessment Form (ASES) and the Simple Shoulder Test (SST) in patients presenting with shoulder pain and determine the responder burden for each of the 3 surveys. Ninety patients presenting with shoulder pain were asked to fill out the ASES, SST, and PROMIS PFUE CAT. The time for completion of each survey was measured to determine responder burden, and the Pearson correlation between the 3 instruments was defined as excellent (r > 0.7), excellent-good (0.61 ≤ r ≤ 0.7), good (0.31 ≤ r ≤ 0.6), and poor (0.2 ≤ r ≤ 0.3). The PROMIS PFUE CAT showed an excellent correlation with the SST (r = 0.82, P shoulder pain. The time saving of the PROMIS PFUE CAT was found to be smaller than that of the ASES and SST but shows that moving forward, using the PROMIS PFUE CAT would not place any additional burden on the patient filling out the survey. The lack of ceiling or floor effects with the PROMIS PFUE CAT indicates its ability to differentiate both high and low functioning patients. All of these findings indicate that the PROMIS PFUE CAT is an adequate tool for the evaluation of patients with shoulder pain and should be used in these patients going forward. Level II, diagnostic study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  14. Kinesio Tape and Shoulder-Joint Position Sense.

    Science.gov (United States)

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

    2015-08-01

    Joint position sense (JPS) is a key neuromuscular factor for developing and maintaining control of muscles around a joint. It is important when performing specialized tasks, especially at the shoulder. No researchers have studied how Kinesio Tape (KT) application affects JPS. To investigate the effects of KT application and no tape on shoulder JPS at increasing shoulder elevations in athletes. Cross-sectional study. University laboratory. A total of 27 healthy athletes who did not participate in overhead sports (age = 20.44 ± 1.05 years, height = 175.02 ± 11.67 cm, mass = 70.74 ± 9.65 kg) with no previous pathologic shoulder conditions volunteered for the study. All participants were from 1 university. Shoulder JPS was assessed at increasing elevations with and without KT application. Participants attempted to actively replicate 3 target positions with and without the KT and without visual guidance. We examined absolute and variable repositioning errors at increasing shoulder-elevation levels with and without KT application. Data revealed an interaction between tape and position for absolute error (F2,52 = 4.07, P = .02); simple effects revealed an increase in error, with KT demonstrating a 2.65° increase in error at 90° of elevation compared with no tape (t26 = 2.65, P = .01). The effect size was medium (ω(2) = .135). Variable error showed no interaction of tape and position (F2,52 = .709, P = .50). Further analysis of simple effects was not needed. However, we still calculated the effect size and observed small effect sizes for tape (ω(2) = .002), position (ω(2) = .072), and tape by position (ω(2) = .027). At 90° of elevation, shoulder JPS was impaired by the application of KT.

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

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    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

  16. Shoulder Activity Level is Associated With Type of Employment and Income in the Normative Population Without Shoulder Disorders.

    Science.gov (United States)

    Brophy, Robert H; Lin, Kenneth M; Skillington, S Andrew; Hepper, C Tate; Smith, Matthew V

    2016-10-01

    Socioeconomic variables influence various healthcare issues in different ways. The effect of socioeconomic variables on the shoulder has not been well studied. Because activity level, defined by how much a patient actually does, is an important patient outcome measure and prognostic factor for the shoulder, studying its association with occupation and income will advance our understanding of how these variables relate to shoulder disorders, treatments, and outcomes. We asked: (1) Does shoulder activity score correlate with income level, stratified by gender? (2) Do different employment groups-heavy, moderate, light, student, retired-have different shoulder activity scores, as stratified by gender? (3) Is type of sports participation (contact or overhead) associated with income level, employment type, race, or household size? A survey collected the Brophy and Marx shoulder activity score and demographic information, such as age, gender, race, income, type of employment, and household size from 1625 individuals 18 years and older with no current or previous shoulder pain or injury who are members of a research panel matched to the United States population by age, gender, household income and size, race/ethnicity, and geography. Men and women were analyzed separately. Activity level was controlled for age. Shoulder activity correlated with income level among men (R = 0.03; p student (8.8 ± 5.1; mean difference, 3.3; 95% CI, 3.0-3.7; p = 0.007), retired (8.0 ± 4.6; mean difference, 4.1; 95% CI, 3.6-4.7; p = 0.0001), and not working (7.5 ± 5.3; mean difference, 4.6; 95% CI, 4.6-4.6; p sports (25.2% vs 14.2%; p sports. Independent of the underlying cause, these patients probably are more likely to seek treatment for shoulder disorders and may be more challenging to treat because of their elevated activity level. Future research should focus on how elevated activity level in these populations affects their risk for shoulder disorders, and their use of and outcomes from

  17. The Responsiveness and Minimal Important Change of the Western Ontario Shoulder Instability Index and Oxford Shoulder Instability Score.

    Science.gov (United States)

    van der Linde, Just A; van Kampen, Derk A; van Beers, Loes W A H; van Deurzen, Derek F P; Saris, Daniël B F; Terwee, Caroline B

    2017-06-01

    Study Design Prospective cohort study. Background Patient-reported outcome measurements (PROMs) are widely used to evaluate functional limitations. Considering PROMs for shoulder instability, information is lacking with regard to what constitutes a relevant change from baseline scores. Objectives To evaluate the responsiveness of the Western Ontario Shoulder Instability Index (WOSI) and the Oxford Shoulder Instability Score (OSIS) and estimate their minimal important change (MIC). Methods One hundred five consecutive patients with shoulder instability completed 5 PROMs at baseline and at 6-month follow-up. The PROMs included the WOSI and OSIS, the Simple Shoulder Test, the Oxford Shoulder Score, and the Disabilities of the Arm, Shoulder and Hand assessment. Patients also rated their functional change on an anchor question at follow-up. Responsiveness was evaluated by testing 9 hypotheses regarding predefined correlations between the changes in PROM scores, by calculating the area under the receiver operating characteristic curve and by calculating the standardized response mean and effect size statistics. The MIC was determined by identifying the optimal cutoff on the receiver operating characteristic curve. Results Seven out of 9 hypotheses (78%) were confirmed; as expected, a high correlation (0.77) was found between change scores of the WOSI and OSIS, whereas the correlations of the change scores of the WOSI and OSIS with those of general shoulder PROMs were slightly lower (0.61-0.75). The area under the curve was 0.83 (95% confidence interval: 0.75, 0.91) for the OSIS and 0.82 (95% confidence interval: 0.74, 0.90) for the WOSI. The MIC was about 6 points for the OSIS and about 14 points for the WOSI. Conclusion Both the WOSI and OSIS are able to measure change in shoulder function in patients with shoulder instability. The estimated MIC is 6 points for the OSIS (on a scale from 0 to 48) and 14 points for the WOSI (on a scale from 0 to 100). J Orthop Sports Phys

  18. A clinical and radiological observation of shoulder arthrography

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    Jang, Hwee Yul; Hur, Won Joo; Kim, Byung Soo [Busan National University College of Medicine, Busan (Korea, Republic of); Han, Sang Suk [Inje Medical College Paik Hospital, Busan (Korea, Republic of)

    1984-09-15

    The authors analyzed 23 cases of shoulder arthrography performed at Busan National University Hospital and Inje Medical College Paik Hospital for about 2.5 years from March 1981 to September 1983, both clinically and radiologically. The results obtained were as follows: 1. Of the 23 cases, 20 cases (87.0%) were male and 3 cases (13.0%) were female, and the most prevalent age group was second decade. 2. Right shoulder arthrography was performed in 16 cases (69.6%), and left in 7 cases (30.4%). 3. The number of cases which had had certain history of trauma was 13 (56.5%), and remainder of 10 cases (43.5%) had no history of trauma. 4. Frequent symptoms and signs were pain in shoulder region in 16 cases (69.6%) and limitation of motion in 14 cases (60.9%). 5. On plain film findings, 18 cases (78.3%) were normal, and 5 cases (21.7%) were abnormal. 6. On shoulder arthrographic findings, 16 cases (69.6%) were normal, and 7 cases (30.4%) were abnormal. Those abnormal cases were consisted of 2 cases (8.7%) of adhesive capsulitis, 2 cases (8.7%) of chronic shoulder dislocation, 1 case (4.3%) of rotator cuff tear, 1 case (4.3%) of loose bodies in joint cavity, and 1 case (4.3%) of rupture of biceps tendon sheath. 7. Among routine views of shoulder arthrography of normal cases, the external rotation view revealed axillary recess and biceps tendon more distincity, and the internal rotation view revealed subscapular bursa more clearly. In case of double contrast shoulder arthrography, the contour and thickness of the medial segment of the contrast coated humeral articular cartilage were well demonstrated in erect views, with air-fluid levels in axillary recess, biceps tendon sheath and subscapular bursa. 8. The 2 cases of adhesive capsulitis revealed small joint space, obliteration of the axillary recess and subscapular bursa, and failure to fill the bicipital sheath. 9. The 2 cases of capsular deformities by chronic shoulder dislocation demonstrated loss of normal concavity of

  19. The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment

    Directory of Open Access Journals (Sweden)

    Mafu TS

    2018-01-01

    Full Text Available Trevor S Mafu,1 Alison V September,1 Delva Shamley2 1Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, 2Clinical Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa Abstract: Shoulder morbidity is a well-documented sequela of breast cancer treatment, which includes various manifestations such as pain, reduced range of motion, and lymphedema, among others. Th