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PubMed1993

Surgical decompression of impingement in the weightbearing shoulder.

Shoulder pain is a common affliction, posing particular limitations on the spinal cord injured person. Abnormalities of the rotator cuff mechanism are a common cause of shoulder injury in the general population and it has recently been observed that a large percentage of persons with paraplegia suffer from chronic shoulder pain. This report describes six cases of impingement syndrome in four spinal cord injured persons who depend on upper extremity function for the execution of activities of daily living and mobility. All had failed prolonged trials of conservative therapy and subsequently underwent anterior acromioplasty and when indicated, repair of the supraspinatus tendon. In each case, functional capacity that approached or equalled premorbid levels was achieved. Pain complaints also markedly decreased from preoperative levels. It is suggested that surgical decompression of shoulder impingement and rotator cuff repair may be beneficial in spinal cord injured persons who have failed conservative therapy. Further study is required to determine the long-term efficacy of surgical intervention in this population.

Chronic Disease↗
PubMedDate not supplied

NIOSH research efforts to prevent musculoskeletal disorders in the healthcare industry.

Healthcare workers, including orthopaedic nurses, face a number of risk factors in the workplace for musculoskeletal disorders such as back and shoulder injuries. These disorders are associated with excessive back and shoulder loading due to manual patient handling, applying excessive forces during pushing and/or pulling of objects, required use of awkward postures during patient care, and working long hours and shiftwork. No healthcare workers are immune from injury because workers in all clinical areas are exposed to occupational risk factors, including hospitals, nursing homes, emergency services, critical care, operating rooms, orthopaedic units, and home healthcare environments. This article includes a summary of the scientific efforts of the researchers and their partners at the National Institute for Occupational Safety and Health (NIOSH) in evaluating and developing the best practice recommendations for reducing risk of these disorders for exposed workers. The studies conducted by NIOSH researchers and their partners approach the problem from a variety of perspectives, ranging from comprehensive epidemiological studies examining the effectiveness of implementation of a safe patient handling and movement program to laboratory studies evaluating the biomechanical stress associated with using patient handling equipment, and education training programs for use in schools of nursing to educate new workers about safe work practices. Results of these studies have provided scientific evidence that significant occupational risks for musculoskeletal disorders exist and that effective interventions are available to reduce the risk for these workers.

Accidental Falls↗
PubMed2006

Shoulder muscle recruitment patterns during a kayak stroke performed on a paddling ergometer.

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

Adult↗
PubMed1986

Heterotopic ossification of the shoulder following head injury. A case report.

Heterotopic ossification of the shoulder following head injury is a rare occurrence. In a 26-year-old woman with a head injury and extraarticular ossification of the glenohumeral joint, the heterotopic bone was resected surgically when the mass had matured. A vigorous physical therapy program was instituted early after operation to maintain shoulder mobility. Despite the formation of adhesions, the partial reformation of heterotopic bone, and an axillary neuropraxia, the patient achieved an excellent range of active shoulder motion ten months after operation.

Adult↗
PubMed1995

Common injuries of the shoulder. Diagnosis and treatment.

Shoulder pain is often the presenting complaint of patients seeing their primary care physicians. Overuse and traumatic injuries make up most of the causes. A physical examination with minimal diagnostic tests can lead to the correct diagnosis in most cases. Most conditions can be treated conservatively (nonsurgically). Appropriate referral to a specialist depends on the severity of the initial injury or the patient's lack of response to conservative treatment (or both). We discuss common injuries of the shoulder, emphasizing a practical diagnostic and therapeutic approach.

Cumulative Trauma Disorders↗
PubMed2002

Injuries to the pectoralis major.

Pectoralis major injuries typically occur in active individuals participating in manual labour or sports. While these injuries are rarely reported, the actual incidence of pectoralis tears among all shoulder injuries is unknown. Diagnosis can usually be made based on a patient's history and physical examination. However, ultrasound and magnetic resonance imaging are helpful tools for diagnosis and pre-operative planning. Specific treatment options should be based on the severity of the injury and the patient's individual needs. Nonoperative management consisting of immobilisation and physical therapy can offer a functional result with return of shoulder motion and activities of daily living. In recent studies, operative repair of pectoralis major rupture has been shown to restore normal chest-wall muscle contours and pre-operative strength (even in competitive athletes). Although complications such as re-rupture, infection, and heterotopic ossification do occasionally occur, favourable results should be expected when surgical repair is performed either acutely or in a delayed fashion.

Athletic Injuries↗
PubMed1984

Swedish research in sports traumatology.

With long-established traditions in both sports medicine and trauma in Sweden, investigations are in progress on prevention, diagnosis, treatment, and rehabilitation, with special emphasis on soft-tissue injuries. The following subjects are of current interest: injuries to the ankle ligaments, compartment syndromes, knee ligament and meniscus injuries, thigh and groin muscle injuries, shoulder dislocation, lateral epicondylitis, and rupture of the ulnar collateral ligament of the thumb. Skiing injuries and the prevention of trauma in soccer players represent important unsolved problems.

Achilles Tendon↗
PubMed2003

Overuse and throwing injuries in the skeletally immature athlete.

Over 25 million children participate in school-sponsored sports, and an additional 20 million participate in extracurricular organized sports. Over the past decade, increased intensity of training, more pressure for success, new opportunities for structured play, and more organized advanced leagues and traveling teams have led to a corresponding increase in overuse injuries in the skeletally immature athlete. Perhaps the classic sports model for overuse injuries of the upper extremity is baseball. Throwing sports contribute to an increased incidence of elbow and shoulder injuries that might be related to intensity of training, throwing mechanics, and poor conditioning, including core strength. Specific areas of concern regarding overuse injuries in young athletes include such diagnoses as little leaguer's shoulder, little leaguer's elbow, osteochondritis dissecans of the elbow, tennis elbow, and distal radial epiphysitis. Ultimately, overuse injuries, and particularly physeal injuries, should be suspected in any young athlete who has pain in the upper extremity. Comparative bilateral radiographs are the rule in workup.

Adolescent↗
PubMed2005

Brachial plexus injury after anterior shoulder dislocation: a case report.

Brachial plexus injury is a rare complication of anterior dislocation of the shoulder: nine cases have been reported in the literature. We report a unique case of anterior dislocation of the shoulder with associated brachial plexus palsy involving the posterior and medial cords. This is the first reported case of such an injury. Previous case reports of brachial plexus palsy in association with anterior shoulder dislocation are reviewed. Conservative management affords good recovery from these injuries over a period of up to 18 months.

Accidental Falls↗
PubMed1986

[Prosthetic arthroplasty in recent and old complex injuries of the shoulder].

Thirty-four acute and 22 old injuries of the shoulder have been operated on, using either a humeral prosthesis (24 cases) or a total Neer prosthesis (32 cases). The mean age of the patients was 66 years. There were 32 acute and 13 old four-part fractures of the upper end of the humerus and 6 dislocations of the shoulder. The surgical technique and the method of rehabilitation are described. There were 17 post-operative complications, including 4 dislocations, 2 cases of secondary displacements of bone fragments and 2 loosenings of the glenoid component. In only 4 cases was a further operation needed. The results were analysed in 43 cases with a follow-up greater than one year. In 34 cases, there was no pain, but only 17 cases had more than 90 degrees of active flexion. There were no loosenings of the humeral stem. In two cases of humeral replacement, a narrowing of the joint space was noted. There was moderate peri-articular ossifications on 6 occasions. An upward displacement of the prosthesis was noted on 10 occasions, due to rupture of the rotator cuff. The results were much better in acute lesions than in chronic ones. The authors conclude that prosthetic replacement is indicated in severe fractures of the upper end of the humerus, whether acute or chronic, and if the patient is elderly.

Adult↗
PubMedDate not supplied

Injuries to emergency medicine residents on EMS rotations.

OBJECTIVES: To study the incidence and nature of injuries sustained by emergency medicine (EM) residents during EMS rotations, and steps taken at EM residency programs to increase resident safety during field activities. METHODS: An eight-question survey form was mailed to all 114 U.S. EM residency directors, with a second mailing to nonresponders eight weeks after the initial mailing. RESULTS: A total of 105 surveys were returned (92%). Six surveys were from new programs whose residents have not yet rotated on EMS. These were excluded from further analysis, leaving 99 programs. Of these, 91 (92%) reported no injuries. One EM resident died in a helicopter crash in 1985. Seven other injury events were reported: 1) facial lacerations, rib fractures, and a shoulder injury in an ambulance accident; 2) an open finger fracture (crushed by a backboard); 3) contusions and a concussion when an ambulance was struck by a fire engine; 4) a groin pull sustained while entering a helicopter; 5) bilateral metatarsal fractures in a fall; 6) rib fractures, a pneumothorax, and a concussion in an ambulance accident; and 7) "minor injuries" sustained in a crash while responding to a scene in a program-owned response vehicle. Actions taken at residency programs to reduce the risk of injury include the use of ballistic vests (four programs), requiring helmets on flights (five programs), and changing flight experience from mandatory to optional (two programs). Ten programs (10%) reported using ground scene safety lectures, and nine programs (15% of those offering flights) reported various types of flight safety instruction. Sixty-nine programs (70%) reported no formal field safety training or other active steps to increase resident safety on EMS rotations. CONCLUSIONS: Injuries sustained by EM residents during EMS rotations are uncommon but nontrivial, with several serious injuries and one fatality reported. The majority of EM residency programs have no formal safety training programs for EMS rotations.

Accidents, Occupational↗
PubMed2003

Shoulder musculature activation during upper extremity weight-bearing exercise.

STUDY DESIGN: Repeated-measures design comparing 7 static weight-bearing shoulder exercises. OBJECTIVE: The purpose of this study was to determine the demand on shoulder musculature during weight-bearing exercises and the relationship between increasing weight-bearing posture and shoulder muscle activation. BACKGROUND: Weight-bearing shoulder exercises are commonly prescribed in the rehabilitation of shoulder injuries. Limited information is available as to the demands placed on shoulder musculature while these exercises are performed. METHODS: Eighteen healthy college students volunteered for this study. Surface bipolar electrodes were applied over the infraspinatus, posterior deltoid, anterior deltoid, and pectoralis major muscles. Fine-wire bipolar intramuscular electrodes were inserted into the supraspinatus muscle. Electromyographic (EMG) root mean square signal intensity was normalized to 1 second of EMG obtained with a maximal voluntary isometric contraction (MVIC). Subjects were tested under 7 isometric exercise positions that progressively increased upper extremity weight-bearing posture. RESULTS: There was a high correlation between increasing weight-bearing posture and muscular activity (r = 0.97, P < 0.01). There was relatively little demand on the shoulder musculature for the prayer and quadruped positions (2%-10% MVIC). Muscular activation was greater for the infraspinatus than for other shoulder muscles throughout most of the exercise positions tested. CONCLUSION: These results indicate that alterations of weight-bearing exercises, by varying the amount of arm support and force, resulted in very different demands on the shoulder musculature. Specifically, the infraspinatus was particularly active during the weight-bearing exercises used in this study.

Adult↗