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PubMed1992

Magnetic resonance imaging of the shoulder joint.

Because the shoulder is the most mobile joint in the body, it is naturally predisposed to several disorders. The most commonly encountered disorders requiring diagnostic imaging are rotator cuff disease and glenohumeral instability. Plain film radiography and arthrography have for many years been the mainstays of shoulder imaging. CT added a third dimension to shoulder imaging, improving its sensitivity with respect to glenoid labral pathology. Ultrasonography of the rotator cuff showed early promise in noninvasive evaluation of cuff tears, but it did not gain universal acceptance because of various negative factors, including inadequate visualization of the cuff, poor results regarding partial tears, and most importantly, operator dependency. The development of MR imaging afforded the radiologist improved comprehensive visualization of the shoulder joint in a noninvasive manner.

Humans↗
PubMed1988

Office evaluation and management of the shoulder impingement syndrome.

The shoulder impingement syndrome is the most common cause of shoulder pain. A complete office evaluation can be aided by a printed exam sheet. Careful consideration of the differential diagnosis is important, often employing the Xylocaine injection test. The impingement syndrome responds to conservative treatment the majority of the time. Long follow-up determines the need for an invasive evaluation or surgical treatment.

Adolescent↗
PubMed1988

Current concepts in the radiographic evaluation of the rotator cuff.

This review discusses the disease of the rotator cuff and evaluates our current tools for imaging it. The rotator cuff consists of the cojoined tendons of the short rotator muscles of the shoulder. Derangements of the cuff, which can result from degeneration, trauma, or overuse, are frequent causes of shoulder pain. Until the present decade, imaging of the cuff depended on injection of contrast into either the underlying joint (arthrogram) or overlying bursa (bursogram). Computed tomography (CT) has added additional dimensions to arthrography but has not played a major role in the diagnosis of cuff pathology. Ultrasonography (US) has been shown to be of diagnostic value in imaging cuff tears and has shown promise in defining pathology in the intact cuff. Magnetic resonance imaging (MRI) has the potential for imaging the cuff; its roles here are not yet defined.

Humans↗
PubMed1983

Cuff-tear arthropathy.

In this report we describe the clinical and pathological findings of cuff-tear arthropathy in twenty-six patients and discuss the differential diagnosis and a hypothesis on the pathomechanics that lead to its development. This lesion is thought to be peculiar to the glenohumeral joint because of the unique anatomy of the rotator cuff. Following a massive tear of the rotator cuff there is inactivity and disuse of the shoulder, leaking of the synovial fluid, and instability of the humeral head. These events in turn result in both nutritional and mechanical factors that cause atrophy of the glenohumeral articular cartilage and osteoporosis of the subchondral bone of the humeral head. A massive tear also allows the humeral head to be displaced upward, causing subacromial impingement that in time erodes the anterior portion of the acromion and the acromioclavicular joint. Eventually the soft, atrophic head collapses, producing the complete syndrome of cuff-tear arthropathy. The incongruous head may eventually erode the glenoid so deeply that the coracoid becomes eroded as well. Although treatment of cuff-tear arthropathy is extremely difficult, the preferred method appears to be a resurfacing total shoulder replacement with rotator-cuff reconstruction and special rehabilitation. We think that it is important to recognize cuff-tear arthropathy as a distinct pathological entity, as such recognition enhances our understanding of the more common impingement lesions. Cuff-tear arthropathy is especially difficult to treat, and although many tears of the rotator cuff do not enlarge sufficiently to allow this condition to develop, it is a factor to consider when deciding whether or not a documented tear of the rotator cuff should be surgically repaired.

Aged↗
PubMedDate not supplied

Arthroscopic findings in the frozen shoulder.

We report 24 patients with a clinical diagnosis of frozen shoulder who underwent an arthroscopic examination and were reviewed. A painful and stiff shoulder was present for an average of 8 months prior to the arthroscopy. The examinations were performed under general anesthesia and through a posterior route. The capacity of the genohumeral joint was measured by infiltration of physiologic saline and it was subnormal in almost 60% of the cases. Only 1 rupture of the rotator cuff was noted which had been previously demonstrated by arthrography. A torn long head of biceps was identified in 2 cases. No intraarticular adhesions were noted. These observations implicate an extra-articular cause for this clinical entity.

Adult↗
PubMed1993

Magnetic resonance arthrography of the shoulder.

Recently, there have been attempts to improve the accuracy of MR imaging by distending the glenohumeral joint with fluid prior to imaging. This article reviews the techniques employed in performing MR arthrography, imaging characteristics of MR arthrography, and diagnostic use of the procedure.

Contrast Media↗
PubMed1993

Magnetic resonance imaging of the biceps complex.

A variety of disorders primarily involving the long head of the biceps tendon is discussed. By virtue of its particular intra-articular position, this tendon may be affected by primary articular and degenerative processes because of impingement by the coracoacromial arch. Disorders of the biceps, including traumatic tears and displacement out of the bicipital groove, are best evaluated by MR imaging.

Arm↗
PubMed1993

[Sonographic diagnosis in shoulder joint instability. Possibilities and limitations].

Ultrasound evaluation expands the possibilities of diagnostic imaging techniques for patients with shoulder instabilities. Static ultrasound investigation documents the acute or chronic dislocated shoulder. Dynamic evaluation demonstrates the direction of instability. Concomitant Hill-Sachs lesions or rotator cuff tears can be diagnosed with high diagnostic accuracy. Clinically relevant documentation of labrum defects (Bankart lesions) by ultrasound is not possible with the technique currently available.

Humans↗
PubMedDate not supplied

An eccentric- and concentric-strength profile of shoulder external and internal rotator muscles in professional baseball pitchers.

The purpose of this study was to establish a data base on the isokinetic eccentric muscular performance characteristics of external and internal rotator muscles in the shoulders of professional baseball pitchers. Concentric data are also included and compared with previously published concentric studies. Twenty-five professional baseball pitchers were evaluated with a Kin-Com isokinetic dynamometer. The subjects tested had a mean age of 23.5 years and a mean body weight of 199 pounds. Eccentric and concentric isokinetic tests were performed at 60 and 120 deg/sec. The testing protocol was standardized for each subject. Test results indicated no statistically significant difference in mean torque between throwing and nonthrowing shoulders for either external or internal rotator muscle groups. Eccentric strength was significantly greater than concentric strength for all muscle groups tested. The external-to-internal rotator muscle strength ratios were well above those previously published for high school through professional pitchers. Mean torque-to-lean body weight ratios were also included to establish a data base. This study establishes one of the first data bases for eccentric isokinetic muscle strength of shoulder rotator muscles in professional baseball pitchers. The data may help clinicians prevent and rehabilitate shoulder injuries in professional throwing athletes.

Adult↗
PubMed2004

Prevention of disabling back injuries in nurses by the use of mechanical patient lift systems.

Occupational back pain in nurses (OBPN) constitutes a major source of morbidity in the health care environment. According to the National Institute for Occupational Safety and Health (NIOSH), occupational back injury is the second leading occupational injury in the United States. Among health care personnel, nurses have the highest rate of back pain, with an annual prevalence of 40-50% and a lifetime prevalence of 35-80%. The American Nursing Association believes that manual patient handling is unsafe and is directly responsible for musculoskeletal disorders encountered in nurses. It has been well documented that patient handling can be done safely with the use of assistive equipment and devices that eliminate these hazards to nurses that invite serious back injuries. The benefit of assistive patient handling equipment is characterized by the simultaneous reduction of the risk of musculoskeletal injury to the nursing staff and improvement in the quality of care for patient populations. To understand the cause of disabling injuries in health care workers, several factors must be considered, including the following: (1) anatomy/physiology of the back, (2) risk factors, (3) medical legal implications, and (4) prevention. Among nurses, back, neck, and shoulder injuries are commonly noted as the most prevalent and debilitating. While mostly associated with dependant patient care, the risk for musculoskeletal injury secondary to manual patient handling crosses all specialty areas of nursing. The skeletal defects of an abnormal back make the back more susceptible to occupational injury, even under normal stress conditions. Workers compensation guidelines for occupational back injury differ in public and private health care sectors from state to state. Nursing personnel should be reminded that the development of back pain following occupational activities in the hospital should be reported immediately to the Occupational Health Department. A nurse's failure to report OBPN immediately has resulted in numerous denials of claims for rehabilitation and compensation that nurses deserve. Experts believe that training in proper body mechanics does not prevent back injury. Consequently, focus has been placed on other innovative injury prevention programs, including the use of engineering controls as well as the "lift team" method. Ergonomics involves the use of mechanical devices (e.g., walking belt and mechanical hoist) to aid in patient lifting and transferring tasks. Guldmann Inc. has devised ceiling lift systems and slings during the past 20 years. They have successfully completed thousands of installations worldwide, covering a wide range of challenging conditions and complex environments. The Guldmann ceiling-mounted hoist system consists of a wide range of lifting units, rail components, and a complete assortment of lifting slings and accessories. Its sling is made of polyester, which is characterized by its strength and elasticity. It retains its shape and is dirt repellent and easy to maintain. The Guldmann network has one of the largest and indisputably most experienced group of certified installers in the United States. The "lift team" method was devised to remove nursing personnel from the everyday task of moving patients. This type of intervention assumes that lifting is a specialized skill to be performed only by expert professional patient movers who have been thoroughly trained in the latest lifting device techniques.

Back Injuries↗
PubMed2003

Magnetic resonance imaging of the rotator cuff muscles after baseball pitching.

AIM: The purposes of present study were to investigate quantitatively using functional MR imaging the effect of a series of throwing activities on rotator cuff muscles and to compare the effect of pitching with that of all-out shoulder external rotator exercise as the targeted external rotator muscle group (the infraspinatus and the teres minor). METHODS EXPERIMENTAL DESIGN: MRI measurements after 135 baseball pitches or all-out shoulder external rotator exercise (concentric mode) in each subject's nondominant shoulder. PARTICIPANTS: 6 amateur baseball pitchers. MEASURES: serial T2-weighted images of rotator cuff muscles were obtained before pitching (or shoulder exercise) and immediately, 30, 60 min, 24, 48, 96 hrs after pitching (or shoulder exercise). T2 relaxation times (T2) at each measurement time were calculated for the rotator cuff muscles. RESULTS: Both the supraspinatus and the external rotator muscle group showed significant T2 elevations until 96 hrs after pitching. The subscapularis also showed significantly increased T2 until postpitching 48 hrs. On the other hand, a significant T2 elevation continued until 60 min after shoulder exercise, but thereafter returned towards the value at rest over the next 24 hrs. CONCLUSION: Long lasting T2 elevations in rotator cuff muscles would be associated with an increase in each intramuscular water content, and may be attributed to the muscle damage that resulted from eccentric contraction during pitching. This information should serve as a useful complement to shoulder injury prevention for baseball pitchers.

Adult↗
PubMed1995

Rehabilitation of shoulder and elbow injuries in tennis players.

Optimization of treatment of the tennis player with an upper extremity overuse injury requires a thorough understanding and analysis of the biomechanical and physiologic stresses inherent in the game of tennis. Anatomic adaptations found in the upper extremity of elite tennis players provide the framework for evaluation and treatment of overuse injury through both an anatomically based total-arm strength program and efforts to normalize joint arthrokinematics. Integration of these key factors allows the clinician to rehabilitate the patient and design preventive conditioning programs in a scientifically based, sport-specific manner.

Athletic Injuries↗