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At least 253 records · Page 14Linked to original sources
PubMed2001

Coracoid impingement syndrome, rotator interval reconstruction, and biceps tenodesis in the overhead athlete.

Anterior shoulder problems are extremely common in throwing athletes. Coracoid impingement syndrome, lesions of the long head of the biceps tendon, and rotator interval lesions are included in the extensive differential diagnosis which exists for anterior shoulder pain. In this article, we focus on the anatomy, pathophysiology, clinical presentation, diagnosis, and surgical treatment of these conditions.

Aftercare↗
PubMed1997

Shoulder injuries in the athlete.

Musculoskeletal injuries constantly provide challenges to the team physician, including those to the shoulder. Shoulder injuries are common in athletes, whether as a result of direct contact from a collision or from repetitive overhead motion. This article reviews sports-related injuries to the shoulder, including similarities between sports, clinical evaluation, and rehabilitation of the athletes.

Acromioclavicular Joint↗
PubMedDate not supplied

Kinetics of baseball pitching with implications about injury mechanisms.

Elbow and shoulder kinetics for 26 highly skilled, healthy adult pitchers were calculated using high-speed motion analysis. Two critical instants were 1) shortly before the arm reached maximum external rotation, when 67 N-m of shoulder internal rotation torque and 64 N-m of elbow varus torque were generated, and 2) shortly after ball release, when 1090 N of shoulder compressive force was produced. Inability to generate sufficient elbow varus torque may result in medial tension, lateral compression, or posteromedial impingement injury. At the glenohumeral joint, compressive force, joint laxity, and 380 N of anterior force during arm cocking can lead to anterior glenoid labral tear. Rapid internal rotation in combination with these forces can produce a grinding injury factor on the labrum. After ball release, 400 N of posterior force, 1090 N of compressive force, and 97 N-m of horizontal abduction torque are generated at the shoulder; contribution of rotator cuff muscles in generating these loads may result in cuff tensile failure. Horizontal adduction, internal rotation, and superior translation of the abducted humerus may cause subacromial impingement. Tension in the biceps tendon, due to muscle contraction for both elbow flexion torque and shoulder compressive force, may tear the anterosuperior labrum.

Acceleration↗
PubMed1993

Applied MRI anatomy of the shoulder.

Magnetic resonance imaging (MRI) of the shoulder is rapidly evolving as the choice diagnostic procedure for management of shoulder derangement, particularly for soft tissue injuries not well delineated by conventional radiography. With application of appropriate MRI protocol/sequences and familiarity with applied shoulder MRI anatomy, valuable diagnostic information may be derived that can greatly assist management/therapy of common problems, such as rotator cuff tears, impingement, and instability as well as less frequent causes of shoulder pain and dysfunction.

Humans↗
PubMed2003

[Biomechanical investigations for the development of a SLAP-II-lesion].

The superior labral-biceps-tendon-complex forms an anatomical and functional unit and combines static and dynamic elements of shoulder stability. At present, only theoretical hypotheses exist on the etiology of the microtraumatic SLAP-II-lesion. To gain further insight into this, an instrument was developed to simulate throwing motions such as the late-cocking/early acceleration phase as well as deceleration/follow-through. Sixteen freshly frozen shoulder specimens were tested, varying the loads on the biceps tendon (25 N, 50 N, 100 N) and the compression of the humeral head against the glenoid (25 N, 50 N, 80 N). Each shoulder had to run through a certain number of cycles during the particular phase of throwing. The tests were stopped after a SLAP-II-lesion was observed, or after a limit of 15,000 cycles. Every 1,000 cycles the results of the tests were checked arthroscopically. A SLAP-II-lesion developed in only 10% of the specimens during the acceleration/ late cocking phase whereas in the deceleration/ follow-through phase 83% developed such a lesion. According to our results, the deceleration/follow-through of the throwing motion seems to be responsible for creating microtraumatic SLAP-II-lesions. One reason is the loss of the centering function of the long head of the biceps tendon during total internal rotation, another is the increased posterosuperior translation of the humeral head in this position, which leads to a non-physiological contact, creating lesions in this area due to the large sheering forces.

Acceleration↗
PubMed2001

Laser-assisted capsulorrhaphy for multidirectional instability of the shoulder.

PURPOSE: The purpose of this study was to review the clinical results of laser-assisted capsulorrhaphy performed on 27 shoulders in 26 patients for multidirectional shoulder instability with minimum follow-up of 2 years. TYPE OF STUDY: Prospective case series. METHODS: Laser shrinkage was performed on the entire capsule. In patients in whom the rotator interval did not shrink, suture plication of this area was performed. All patients were evaluated with respect to the incidence of recurrent instability, need for reoperation, and ability to return to their previous level of activity or sports participation. In addition, all patients were rated as satisfactory or unsatisfactory using criteria established by Neer. RESULTS: Twenty-six of 27 shoulders (96%) remained stable and asymptomatic a minimum of 2 years after surgery. Of 14 athletes in the study group, 12 (86%) returned to their previous level of sports participation. CONCLUSION: Our results suggest that laser-assisted capsulorrhaphy is an effective treatment alternative for multidirectional instability.

Adolescent↗
PubMed2000

Neuromusculoskeletal syndromes in wheelchair athletes.

With the growth of wheelchair athletics at both grassroots and national levels, there has been an increased incidence of sports-related and overuse syndromes in the wheelchair-user population. This article provides an overview of the available literature on the incidence, prevalence, evaluation, prevention, and rehabilitative management of these types of clinical syndromes.

Athletic Injuries↗
PubMed1996

Etiologies of shoulder pain in cervical spinal cord injury.

A protocol including physical examination, plain radiography, and shoulder arthrography was designed to study prospectively the causes of shoulder pain in patients with cervical spinal cord injury. Twenty-four patients (30 shoulders) were studied and subdivided into acute and chronic groups. The causes of shoulder pain in the acute group of 11 patients (15 shoulders) included capsular contracture or capsulitis or both in 6 shoulders; rotator cuff tears in 4; anterior instability in 2; and rotator cuff impingement, osteoarthritis with osteonecrosis, and osteoarthritis in 1 each. Of 13 patients (15 shoulders) assigned to the chronic group, the diagnoses included anterior instability in 5 shoulders; multidirectional instability in 3; capsular contracture or capsulitis or both in 3; and Charcot arthropathy, rotator cuff tear, rotator cuff impingement, and scapular pain in 1 each. To prevent and treat shoulder pain, therapeutic protocols for these patients must be individualized after a correct diagnosis is made.

Adult↗
PubMed1997

The hung up shoulder: anterior subluxation locking in abduction.

The hung up shoulder, or anterior subluxation locking in abduction, is a bizarre clinical picture which is not frequently seen. It is probably due to the fact that, in the subluxed position, the subscapularis muscle becomes an abductor, rather than an internal rotator. External rotation might shift the subscapular muscle fibres towards the proximal aspect of the humeral head, while joint laxity favors subluxation. It is possible that the hung up shoulder is just one aspect of multidirectional shoulder instability, given the tendency to generalised joint laxity, the frequent autoreduction, the positive sulcus sign, and initiation of subluxation by either abduction-external rotation or extension. In this series three out of four patients were treated conservatively and performed well in daily life; however, only the fourth patient had almost unlimited access to sports, thanks to surgical stabilization.

Acromioclavicular Joint↗
PubMed2004

Complete, superior labral radial tear and type II slap tear associated with greater tuberosity fracture.

This case report presents a unique variant of superior labral-bicep complex injury. The combination of a complete anterior-superior radial tear of the labrum and bicep anchor instability has not been described in previous classifications of these injuries. The injury was traumatic in nature and was associated with a displaced fracture of the greater tuberosity. The labral pathology was treated by an anatomic repair technique as described. Rationale for the repair performed, as well as implications of the injury treated by debridement alone, are discussed. Clinicians should be aware of different patterns of superior labral-bicep complex injuries and the implications on function and stability of the glenohumeral joint.

Adult↗
PubMed2005

Arthroscopic treatment of anterior shoulder instability using knotless suture anchors.

PURPOSE: In this study, we evaluated the results of arthroscopic stabilization of the shoulder using knotless anchors and the lesions associated with anterior-inferior labrum avulsion. TYPE OF STUDY: Retrospective clinical study. METHODS: Twenty consecutive patients affected with anterior unidirectional post-traumatic shoulder instability were treated with arthroscopic reconstruction using knotless anchors. During the surgical procedure, associated lesions such as superior labrum anterior posterior (SLAP) (15%) and rotator interval (15%) were repaired. The patients were evaluated at a mean follow-up of 43 months. RESULTS: Eighty percent of patients resumed sports activity without any limitation and 90% of patients were satisfied with the results of surgery. One patient (5%) had a recurrent dislocation; this patient resumed a contact sport activity despite medical advice. One patient (5%) related signs of shoulder insecurity at the extreme degree of abduction and external rotation; this patient had resumed sports activity with a moderate limitation and was the only patient who was not completely satisfied with the results of surgery. No significant difference was observed between the operated and the contralateral shoulder according to the Rowe and Constant scores. The mean loss of external rotation was 3 degrees . We did not have any cases of anchor loosening, nor did we find signs of shoulder degenerative osteoarthritis on the radiographs. CONCLUSIONS: The knotless anchor seems to be a viable alternative for arthroscopic labrum repair, allowing a good capsular shift. Arthroscopic management of shoulder instability allows us to diagnose and treat associated lesions, thus improving the success rate of this type of surgery. LEVEL OF EVIDENCE: Level IV, case series.

Accidents↗
PubMed2003

Arthroscopic repair of anterior glenohumeral instability and rotator interval lesions.

As the techniques and instrumentation for shoulder arthroscopy continue to improve and evolve, its role in the treatment of anterior shoulder instability progresses also. With more surgeons becoming familiar with these advancements and techniques, arthroscopic stabilization results continue to improve and help arthroscopy become the "preferred method" for the treatment of shoulder instability. Adjunct procedures such as closure of the rotator interval also are helping to improve our arthroscopic results and are an important improvement in our understanding of the pathoanatomy of shoulder instability repairs.

Arthroscopy↗
PubMed2003

[Superior labrum-biceps anchor complex].

The focus in overhead sport injuries of the shoulder has been directed on lesions of the superior labrum-biceps complex during the last few years. This is due to improved imaging modalities as well as a better understanding of the anatomy and biomechanics. Arthroscopy is capable of diagnosing and treating these lesions. The anatomy, biomechanics, and operative treatment strategies and techniques are described in detail. The superior labrum anterior-posterior (SLAP) lesion is found in young active overhead athletes. Based on their classification and concomitant lesions, the unstable SLAP lesions (types II and IV) have to be repaired in order to restore stability to the superior labrum-biceps complex for stabilizing the glenohumeral joint. According to our own results and after review of the current literature, SLAP repair yields good results in overhead athletes enabling them to return to pain-free participation in their sport.

Adult↗
PubMed1983

Anterior glenohumeral instability.

Anterior glenohumeral instability is an important cause of shoulder disability in athletes. Recurrent glenohumeral instability can seriously impair the athlete's performance. Since the surgical repair of recurrent instability may result in a loss of flexibility, particularly in the thrower and gymnast, the physician must optimize both joint stability and joint flexibility.

Athletic Injuries↗
PubMed1994

Exercise and soft tissue injury.

Once the almost exclusive domain of the orthopaedic surgeon, sports injuries are now being seen with increasing frequency by other specialists, including rheumatologists. It is therefore important for rheumatologists to be able to diagnose and manage the various musculoskeletal conditions that are associated with physical activity. Soft tissue injuries are a very common cause of morbidity in both competitive and recreational athletes. Most of these conditions are provoked by muscle-tendon overload (or overuse) that is usually the result of excessive training or improper training techniques. However, despite an emerging literature on the natural history of soft tissue overuse syndromes, relatively little is known about the causes, incidence and outcome of many of these injuries. Of the methodologically robust epidemiological studies that have been done, most have focused on habitual distance runners. In this population, it has been reported that the incidence of injury can be as high as 50% or more, and that overtraining and the presence of previous injury are the most significant predictors of future injury. In other popular forms of exercise, such as walking, swimming, cycling, aerobics and racquet sports, injuries are also reported with high frequency but, to date, no prospective studies have examined actual incidences in these populations, and risk factors for injury in these activities remain speculative. Several of the more commonly occurring soft tissue injuries (such as rotator cuff tendinitis, lateral and medial epicondylitis, patellar tendinitis, the iliotibial band friction syndrome, Achilles tendinitis and plantar fasciitis) exemplify the overuse concept and are therefore highlighted in this review. The management of these, and most other, exercise-related soft tissue injuries is directed towards promptly restoring normal function and preventing re-injury.

Exercise↗
PubMed1997

Anterior dislocation of the shoulder in elderly patients.

Of 545 consecutive patients with anterior shoulder dislocations, 108 (20%) were aged 60 years or more at the time of injury. We reviewed and radiographed 95 of these elderly patients after a mean follow-up of 7.1 years. Axillary nerve injuries were seen in 9.3% of the 108 patients, but all recovered completely in 3 to 12 months. There were single or multiple recurrences of dislocation in 21 patients (22.1%), but within this group age had no influence on the tendency to redislocate. Tears of the rotator-cuff were diagnosed by imaging studies or clinically in 58 patients (61%), including all who had redislocations. Sixteen patients required surgery. Eight with a single dislocation and a cuff tear had only repair of the torn cuff. Of the eight patients with multiple dislocations requiring operation, five also had a torn cuff and needed either a stabilising procedure and a cuff repair or repair of the cuff only. All patients who were operated on had a satisfactory result, with the exception of those with multiple redislocations and a cuff tear who had repair of the cuff only. Anterior shoulder dislocation in elderly subjects is more common than is generally believed; 20% suffer redislocation and 60% have a cuff tear. Operation may be needed to repair a torn cuff or to stabilise the shoulder. Patients with multiple redislocations will probably require both procedures.

Aged↗