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PubMed1982

Rotator cuff tears: the role of surgery.

The indications for operative intervention in patients with rotator cuff tears and the reasonable expectations of such surgery are not well defined. This retrospective study of 37 such patients treated operatively at Ottawa General Hospital showed good results in 65% of cases. However, efforts to re-establish continuity of the cuff did not always result in a permanent cuff reconstruction. The persisting defect did not impede functional recovery as long as the edges of the tear were debrided along with division of the coracoacromial ligament, acromioplasty, or excision of osteophytes at the greater tuberosity. Impingement plays a major role in the disability associated with this condition.

Adult↗
PubMed1982

Subscapular muscle transposition for repair of chronic rotator cuff tears.

Subscapularis transposition into a supraspinatus or supraspinatus and infraspinatus rotator cuff defect has been overlooked as a method of tendon repair. The surgical technique for this type of repair, with or without the concomitant use of a glenohumeral resurfacing prosthesis, is described. Postoperatively, the extremity is supported in a position that does not allow stress to be placed on a repair until healing has occurred. Generally, physical therapy is begun early and continued for many months. In the present series, satisfactory relief of pain was achieved in 22 of the 26 patients. Active abduction in the plane of the scapula averaged 120 degrees for patients with rotator cuffs repair and prosthetic replacement and 130 degrees for those with rotator cuff repair alone. Twelve patients gained more than 30 degrees active abduction, and four lost this amount of motion, or greater, as compared with preoperative capabilities. In two of the 26 patients, the rotator cuff repair was completely disrupted during the acute postoperative period. Twenty-five of the 26 patients were satisfied with the surgical procedure. This type of repair seems to be a secure repair, bring healthy tendon tissue into an area of tendon degeneration and loss of tissue substance. As such, it satisfies the basic surgical principles of achieving repair with healthy tissue that is not under tension. The results compare favorably with those reported in the literature on rotator cuff repair and further suggest that this technique is an acceptable alternative for repairing large or massive rotator cuff tears that have tendon substance loss. However, this technique should not be used for smaller tears, for which more simple techniques are more adequate, because if a retear occurs during the postoperative period, the cuff detect might be quite large, with significant pain postoperatively and functional limitations resulting.

Adult↗
PubMed1981

Shoulder arthrography.

Arthrography of the glenohumeral joint is an important diagnostic tool. The procedure is easy to perform and can be accomplished without significant complications in most individuals. If care is exercised in performing the arthrogram, inadvertent injection of the subacromial (subdeltoid) bursa and soft tissue extravasation of contrast material can be avoided. Mild patient discomfort following the procedure may be diminished if small amounts of xylocaine are added to the injection material. Double-contrast or single-contrast examination can be utilized, depending upon the nature of the suspected underlying process. Arthrography of the glenohumeral joint is most useful in delineating the presence of a complete tear of the rotator cuff. It is also valuable in investigating patients with partial (inner) tears of the cuff, adhesive capsulitis, previous anterior dislocations of the joint, and articular diseases. The procedure can define subtle abnormalities of the bicipital tendon and sheath, and can demonstrate the nature of periarticular soft tissue masses. Although it is expected that additional procedures, such as subacromial bursography and arthrography of the acromioclavicular joint will be advocated in the years to come, arthrography of the glenohumeral joint will remain the most important contrast examination of the abnormal shoulder.

Acromioclavicular Joint↗
PubMed1981

Intra-articular steroids in the treatment of rotator cuff tear: reappraisal by arthrography.

Previous studies have cast doubt on the efficacy of intra-articular steroids in the treatment of rotator cuff tears. This investigation re-evaluated the question, using shoulder arthrography both to substantiate the diagnosis of rotator cuff tear and to assure accurate intra-articular injection of steroid. Successful results followed in 13/15 patients so treated. Intra-articular steroid administration is appropriate therapy for rotator cuff tear providing the steroid is properly injected into the shoulder joint cavity.

Adult↗
PubMed1980

An extensile exposure for subacromial derangements.

To allow adequate access to the subacromial region of the shoulder the authors designed a multipurpose approach. The exposure consists of an anterior and a posterior part. In the anterior part, the deltoid fibres are separated between the anterior and middle thirds form the acromioclavicular joint for 5 cm distally; this provides the required access for the management of impingement syndrome, calcific tendinitis, bicipital tendon lesions and most tears of the rotator cuff. By extending the anterior part of the incision posteriorly over the supraspinatus muscle, this muscle may be advanced laterally for closure of a large tear. With this approach, osteotomy of the acromion or detachment of the deltoid muscle is avoided so that the integrity of the deltoid mechanism is maintained.

Acromioclavicular Joint↗
PubMed2006

Magnetic resonance imaging of the canine shoulder: an anatomic study.

OBJECTIVES: To describe the normal anatomy of the soft tissue stabilizing components of the canine shoulder identified by magnetic resonance imaging (MRI) and to evaluate specific acquisition sequences and planes for observing structures of diagnostic interest. STUDY DESIGN: Descriptive study. ANIMAL: Canine cadavers (n=3). METHODS: T1-weighted, proton density fat saturation (PD), and T2(*)-weighted gradient echo (GE) MRI sequences were obtained in the sagittal, transverse, and dorsal planes of the left shoulder of 3 canine cadavers. After imaging, each shoulder was embedded and thin sectioned. The corresponding right shoulder was frozen and thick sectioned. The anatomic structures on the histologic and frozen thick sections were visually correlated with the MR images. RESULTS: The sagittal plane provided a longitudinal view of the bicep, infraspinatus, and supraspinatus tendons. The biceps, supraspinatus, infraspinatus, and subscapularis tendons, and the medial and lateral glenohumeral ligaments were identified in the transverse and dorsal planes. The dorsal plane allowed for the bicep tendon to be evaluated transversely as it passed over the humeral head. The GE sequence was more useful in identifying tendons and ligaments. The PD sequence was more helpful in identifying fluid accumulations in the joint and around tendons. CONCLUSIONS: The tendinous and ligamentous structures that stabilize the canine shoulder joint can be readily identified with MRI. CLINICAL RELEVANCE: MRI has the potential to be a useful tool in the diagnosis of canine soft tissue shoulder injuries.

Animals↗
PubMed1996

Shoulder pain in the work place.

The incidence of shoulder injuries in the work place has risen significantly over the last 10 years. The purpose of this article is to review the anatomy and examination of the shoulder and to present an approach to treating shoulder disorders commonly seen in the injured worker.

Humans↗
PubMed2004

Nerve injuries in anterior shoulder dislocations.

A retrospective study was conducted to determine the incidence of nerve injuries in anterior dislocations of the shoulder and to determine if a neurological examination is routinely performed in such cases. One hundred and fifteen shoulder dislocations in 100 patients (74 males, 26 females; mean age 35+/-18 years) were reviewed. Eighty-seven patients were examined for neurological injuries prior to reduction and 8 of these patients (9.2%) were found to have sustained neurological injuries. Following reduction, neurological examination was performed in 85 patients. Three patients who were not examined initially prior to reduction were subsequently found to have nerve injuries after reduction. Seven patients (7%) were not examined for neurological injury both before and after reduction of the dislocation. Eleven patients were found to have sustained nerve injuries in the final analysis. Axillary nerve injuries were the most common, occurring in 8 patients. In conclusion, nerve injuries are common in shoulder dislocations. The importance of performing and documenting the findings of neurological examination anterior shoulder dislocations needs to be reiterated.

Adolescent↗
PubMed1983

Painful athletic injuries of the shoulder.

Pain in the athlete's shoulder is likely to have a mechanical origin, because the athlete performs repetitive high-stress activity. Proper treatment is based on understanding the biomechanics and physiology of the tissues, as well as the demands of the patient's specific athletic activity. Correct rehabilitation is the key to successful conservative and surgical management. A return to previous activity depends on restoring the normal biomechanics, either through conservative management or surgery. Some of these problems are unsolved and remain fruitful areas for future research.

Athletic Injuries↗
PubMed1991

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

Eighty prostheses, including 46 humeral prostheses and 34 total ones, have been laid for complex injuries of the shoulder. In 56 cases, these were recent fractures, mainly of the head and tubercle of the humerus, in subject ages 65 in average. In 34 cases, the injuries were older and comprised malunion or epiphyseal necrosis. Five cases of subluxation and six of secondary displacement of the tubercles were noted. Pain was suppressed in most cases, but mobility was less satisfactory (37% exceeding 90 degrees active elevation). The humeral sealing evolved in a reassuring way, but a poorly evolutive glenoid rim was often observed. Finally, upper subluxation may occur during the evolution, which suggests the possibility of secondary ruptures in the rotator cuff.

Adult↗
PubMed1994

Common intrapartum denominators of shoulder dystocia related birth injuries.

The intrapartum background of fetal injuries associated with shoulder dystocia was studied retrospectively on the basis of 107 relevant medical records. Intrapartum use of oxytocin and protraction-arrest disorders, the latter particularly during the second stage of labor, were frequent findings. Delivery was effected by forceps or vacuum extraction in almost one-half of the cases. Shoulder dystocia related permanent fetal impairments were closely connected to macrosomia. The fetal weight was > or = 4,000 grams in about 75% and > or = 4,500 grams in approximately 40% of the instances. Permanent hypoxic or traumatic cerebral damage was documented in almost one-third of the cases. The data indicate that in connection with coincidental neonatal afflictions, the birth weights of the fetuses are higher and instrumental extractions are more frequent than in relation to all clinically diagnosed cases of shoulder dystocia.

Adolescent↗
PubMedDate not supplied

Electrothermally-assisted capsular shift.

The marriage of biomedical instrumentation and patient care has once again proven itself successful. The ETAC is a new procedure with various potential applications. Despite its embryonic stage, this procedure is being used by a handful of shoulder surgeons who are cautiously pursuing new and improved ways to prevent the common and debilitating diagnosis of shoulder instability. Follow-up thus far is short, and the current literature lacks studies that compare the time-honored conventional standard of open stabilization to this new procedure. However, those surgeons who have been using this device are optimistic about its role in the future repair of shoulder injuries.

Arthroscopy↗
PubMed2006

Posterior capsular contracture of the shoulder.

Posterior capsular contracture is a common cause of shoulder pain in which the patient presents with restricted internal rotation and reproduction of pain. Increased anterosuperior translation of the humeral head occurs with forward flexion and can mimic the pain reported with impingement syndrome; however, the patient with impingement syndrome presents with normal range of motion. Initial management of posterior capsular contracture should be nonsurgical, emphasizing range-of-motion stretching with the goal of restoring normal motion. For patients who fail nonsurgical management, arthroscopic posterior capsule release can result in improved motion and pain relief. In the throwing athlete, repetitive forces on the posteroinferior capsule may cause posteroinferior capsular hypertrophy and limited internal rotation. This may be the initial pathologic event in the so-called dead arm syndrome, leading to a superior labrum anteroposterior lesion and, possibly, rotator cuff tear. Management involves regaining internal rotation such that the loss of internal rotation is not greater than the increase in external rotation. In the athlete who fails nonsurgical management, a selective posteroinferior capsulotomy can improve motion, reduce pain, and prevent further shoulder injury.

Arthroscopy↗
PubMed1986

[Concomitant osseous and ligamentous injuries of traumatic shoulder dislocation and its significance for the pathogenesis of habitual dislocation].

161 consecutive patients with traumatic shoulder luxation between 1975 and 1983 are followed, concerning their evolution to recurrent shoulder dislocation. In 26 patients there was a recurrent shoulder dislocation in a mean time of 19 months after the first luxation. In literature the common level of recurrent dislocation is higher than our 16.1%, despite of the shorter immobilising time after the first shoulder luxation in our center. When there is no evolution to recurrent dislocation, a stable shoulder and a normal shoulder function without pain can be expected in 95%. The compression fracture of the humeral head and the avulsion of the glenoid margin were made responsible for the recurrent dislocation, mostly appearing in adult men, younger than 35 (55% of all recurrent dislocations). Because avulsion fractures of the tuberculum majus don't lead to an unstable fracture neither the existence of a compression defect in the humeral head is pathognomonic for an unstable shoulder, nor a lack of such radiological appearance excludes a recurrent dislocation. In first instance rotatory cuff injuries could be responsible for the instability of the shoulder joint. All patients with this invalidating injuries should be stimulated to an operative procedure, because after correction of an unstable shoulder by a derotation osteotomy of Weber or the elevation of the anterior margin of glenoid in the technique of Trillat good results with normal functional capacities of the shoulder can be expected.

Adolescent↗
PubMedDate not supplied

Upper extremity snowboarding injuries. Ten-year results from the Colorado snowboard injury survey.

A survey of snowboarding injuries was conducted over 10 seasons (1988 to 1998). A questionnaire evaluating 20 variables was used to collect data from 47 medical facilities near Colorado ski resorts. A total of 7430 snowboarding-related injuries were seen. A control group consisted of 3107 noninjured snowboarders. Most of those injured were 30 years of age or younger; 74% of injuries occurred in men and 26% in women; 39% of injured snowboarders were beginners and 61% were intermediate or experts. Men rode at more advanced levels than women. Injured snowboarders were more likely than noninjured snowboarders to be beginners. There were 3645 (49.06% of total) upper extremity injuries; 56.43% were fractures, 26.78% sprains, and 9.66% dislocations. The most common site of injury was the wrist (21.6% of all snowboarding injuries). Wrist fractures (except to the scaphoid) and sprains were more common in beginners, women, and younger age groups. Intermediate and expert men were more likely to sustain hand, elbow, and shoulder injuries, as well as more severe injuries. Falling was the predominant mechanism of upper extremity injuries. Snowboarders who wore protective wrist guards were half as likely to sustain wrist injuries as those who did not wear guards.

Adolescent↗
PubMed1997

Concentric isokinetic shoulder internal and external rotation strength in professional baseball pitchers.

Objective measurement of shoulder internal and external rotation strength is an important part in the comprehensive evaluation and rehabilitation of athletes who perform predominantly unilateral upper extremity movement patterns. Apparatus- and population-specific descriptive data are needed to enhance the interpretation of results from isokinetic dynamometers. The primary purpose of this study was to measure isokinetically glenohumeral joint internal and external rotator peak torque and work in professional baseball pitchers and determine whether significant differences exist between the dominant (throwing) extremity and nondominant extremity. One hundred twenty-five healthy professional baseball pitchers were tested bilaterally on a Cybex 300 series isokinetic dynamometer at 210 and 300 degrees/sec for concentric internal and external rotation of the glenohumeral joint with the arm in 90 degrees of abduction. A standardized protocol and testing guidelines were strictly followed. A dependent t test was used to test for differences between extremities for peak torque and single repetition work isokinetic parameters. No significant difference between the dominant and nondominant shoulder was found for external rotation peak torque or single repetition work at either testing speed. Significantly greater (p < .001) dominant arm shoulder internal rotation was measured for both peak torque and single repetition work at 210 and 300 degrees/sec compared with the nondominant extremity. The results of this study are important for the application and interpretation of isokinetic data on unilaterally dominant upper extremity athletes. The use of a population-specific, descriptive isokinetic data profile is important in both rehabilitation and prevention of shoulder injuries.

Adolescent↗