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PubMedDate not supplied

[The architecture of the subacromial space after full thickness supraspinatus tears].

AIM: The etiology of rotator cuff tears is multifactorial. An important factor is the damage of the rotator cuff by narrowing of the subacromial space. The purpose of this investigation was to estimate the influence of various metrical parameters on the size of the subacromial space. METHOD: We investigated 161 human macerated scapulae, 36 of them had a known tear of the supraspinatus tendon. All scapulae were photographed in two standard positions from the front and the lateral side. Defined distances and angles were measured using an image analyzing system followed by statistical analysis. RESULTS: Shoulders with a tear of the supraspinatus tendon showed a trend towards higher incidences of hooked acromions. Furthermore we found a significant higher incidence of elongated oval shaped glenoids in the group with supraspinatus tendon tear. In comparison to normal shoulders a significantly smaller distance from the top of the glenoid to the tip of the acromion and a greater distance from the top of the glenoid to the tip of the coracoid process was measured. In addition there was a significantly smaller coracoid angle and a smaller glenoid-spinal angle in this group. CONCLUSION: The width of the subacromial space depends on various parameters. Our data suggest that besides the acromion type the shape of the coracoid, the acromial angle, the spine-scapula angle and the cavitas-spine angle should be taken into account for diagnostic and therapeutic decisions.

Acromion↗
PubMed1984

[The value of computed tomography in the diagnosis of the rotator cuff tears and bone and soft tissue tumors].

This report consists of 2 parts. Part I: The usefulness of computed tomography (CT) in the diagnosis of rotator cuff tear was assessed. The rotator cuff could not be visualized in detail by CT unless introduction of contrast material into the joint cavity was performed. CT arthrography was performed on 21 cases of rotator cuff tears. The most detailed information was obtained when a relatively low concentration of contrast material (3.25% Angiografin) was filled in the joint cavity, and when the shoulder joint was rotated to the maximum outwards at the side. CT arthrography proved to be the most reliable method for assessing the extent and portion of the rotator cuff tears, so that it demonstrated conclusive evidence of diagnosis and management in 89% of patients studied. Part II: The usefulness of CT in the diagnosis of bone and soft tissue tumors was assessed. CT examination provided unique preoperative information which could imagine a more precise histological characteristics and anatomical localization of the lesion. Contrast enhancement (CE), when used, proved to be helpful in predicting the nature of tumors. The CE by intra-arterial infusion, or intravenous bolus injection of contrast material during the scan was more useful than that by intravenous drip infusion of the material. The information regarding change of tumor size, CT number and CE were appropriate indicators which directly corresponded to responsiveness of the tumor to the chemotherapy and radiotherapy performed. Preoperative ABC classification of the tumor by information regarding its size, location, definition and anatomical relation of tumors to vital structures (neural, vascular, and visceral) was done by using CT. The classification clearly corresponded to the status of patients regarding the treatment required for the patients.

Adolescent↗
PubMed1992

Obesity in a high school football candidate: a case presentation.

A 14-yr-old male presented for medical clearance to play fall football for his high school team. He had stayed out of the prior spring football practice sessions after a shoulder injury on the first day of practice, but indicated no other positive responses to the standard medical questionnaire. He was severely overweight with height of 180 cm, weight 133.4 kg, and his estimated body fat was 36%. His examination was otherwise not revealing. He demonstrated poor aerobic fitness, exercise-induced bronchospasm, residual left shoulder weakness, and a dyslipoproteinemia on further medical evaluation. He was disqualified on an empirical basis, the attending physician making the clinical decision that it would be of greater harm than good for this adolescent to participate. However, there is little data and no established guidelines for this type of situation. The overweight football athlete is a challenge to the sports medicine team, both in managing the condition and in determining athletic eligibility.

Adolescent↗
PubMed2005

Treatment of comminuted proximal humerus fractures with shoulder hemiarthroplasty in elderly patients.

This retrospective study was done to find out the outcome of hemiarthroplasty of the shoulder following comminuted proximal humeral fractures in 20 elderly patients. Their average age was 77.6 years. The average follow-up was 33 months. All patients were reviewed in the outpatient clinic using the Constant Score. The median Constant Score was 47.5. None of the patients had severe pain. Four had moderate and 16 had no or mild pain. Range of movement was not good. The activities of daily living were significantly reduced in patients with moderate shoulder pain. Sixteen patients (80%) were satisfied with the outcome of the management of their shoulder injury. Radiological assessment showed malrotation of the prosthesis and ectopic ossification in one patient each. Osteolysis around the greater tuberosity was noted with three isoelastic prostheses. Seven patients showed proximal migration of the prosthesis although there was no significant difference in functional results. Complications included fatal pulmonary embolism in one patient. Overall, hemiarthroplasty of the shoulder gave good pain relief but there was only moderate functional improvement.

Aged↗
PubMed2004

Cryotherapy does not impair shoulder joint position sense.

OBJECTIVE: To determine the effects of a cryotherapy treatment on shoulder proprioception. DESIGN: Crossover design with repeated measures. SETTING: University athletic training and sports medicine research laboratory. PARTICIPANTS: Thirty healthy subjects (15 women, 15 men). INTERVENTION: A 30-minute cryotherapy treatment. MAIN OUTCOME MEASURES: Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception. RESULTS: Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application. CONCLUSIONS: Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

Adult↗
PubMed2005

Mini-open repair technique of HAGL (humeral avulsion of the glenohumeral ligament) lesion.

This article describes a limited open technique to repair humeral avulsions of the glenohumeral ligament (HAGL). The main feature of this technique is the sparing of the superior 50% of the subscapularis tendon. Essentially, an L-type incision is made in the lower third of the subscapularis tendon approximately 1 cm medial to the lesser tuberosity. The transverse limb of this incision is made just superior to the anterior circumflex vessels. Beginning inferiorly, the subscapularis tendon is lifted up, exposing the humeral ligament avulsion. The HAGL lesion is then repaired with 2 or 3 suture anchors anatomically. The advantages of this technique are preservation of the important superior tendinous portion of the subscapularis tendon, thereby preserving strength, easier rehabilitation, and return to full activity.

Exercise Therapy↗
PubMed2004

Reliable change and minimum important difference (MID) proportions facilitated group responsiveness comparisons using individual threshold criteria.

OBJECTIVE: This study contrasted the use of responsiveness indices at the group level vs. individual patient level. STUDY DESIGN AND SETTING: We followed a cohort of 211 patients (50% male; mean age 47.5 years; SD 14) with musculoskeletal upper extremity problems for a total of 3 months. Outcome measures included the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Shoulder Pain and Disability Index (SPADI), Patient-Rated Wrist Evaluation (PRWE), and the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12). We calculated confidence intervals on various group-level responsiveness statistics based on effect size and correlation with global change. The proportion of patients exceeding the minimum detectable change (or reliable change proportion) and minimum important difference (MID proportion) were included as indices applicable to the individual patient. RESULTS: For the DASH, effect size ranged from 1.06 to 1.67 for various patient subgroups, and the reliable change and MID proportions indicated that 50%-70% of individuals exhibited change based on individual change scores. Only the SRM and reliable change proportion indicated differences among the outcome measures used in this study. CONCLUSION: The reliable change and MID proportions have an intuitive interpretation and facilitate quantitative responsiveness comparisons among outcome measures based on individual patient criteria.

Adult↗
PubMed2001

[Radiography of the upper limb revisited: the shoulder and the wrist].

CT scan and MR imaging are the most efficient techniques to evaluate the upper limb, however, standard radiography remains a valuable method to explore this anatomical region. In most situations, it is sufficient to allow a precise diagnosis and determine therapeutic protocols. However, this method can present a real diagnostic value only when it is guided by medical history and clinical data. The purpose of this work is to propose a practical approach for radiographic evaluation of the shoulder and the wrist, suited to the main clinical situations. CT-scan and MR imaging correlations will help to understand radiographic findings.

Humans↗
PubMed1983

Oblique angled view for coracoid fractures.

In cases of shoulder injury when clinical signs suggest a possible coracoid fracture, a 20 degree posterior oblique film with 20 degrees of cephalad angulation has been shown to demonstrate coracoid fractures when other views have been inconclusive.

Adult↗
PubMedDate not supplied

Posterior instability of the shoulder with secondary impingement in elite golfers.

BACKGROUND: Shoulder injuries in golf are related to the biomechanics of the golf swing and typically occur in the lead arm at the top of the back swing. PURPOSE: We report a newly recognized entity in a series of elite golfers: posterior glenohumeral instability associated with subacromial impingement. STUDY DESIGN: Retrospective review. METHODS: Eight elite golfers were treated between March 1991 and July 1998 for pain occurring in the nondominant, lead shoulder at the top of the back swing. Posterior instability was diagnosed in all eight patients; six of the eight also demonstrated signs of subacromial impingement. Initial treatment consisted of rehabilitation. For patients in whom rehabilitation failed, surgery was performed. RESULTS: Two patients improved with nonoperative treatment and returned to play immediately. Six patients underwent shoulder arthroscopy with posterior thermal capsulorrhaphy. Four of the six also underwent arthroscopic subacromial decompression. The six surgically treated patients returned to play at an average 4 months after surgery. At an average 4.5 years of follow-up, all eight patients were playing at their previous level of competitive play. One patient had complications that led to the need for subsequent arthroscopic subacromial decompression; she eventually returned to competitive play. CONCLUSION: Clinicians should be aware of posterior shoulder instability and the associated secondary diagnosis of rotator cuff impingement as a possible cause of shoulder pain in elite golfers.

Adolescent↗
PubMed1998

Shoulder and elbow injuries and painful syndromes.

Childhood participation in organized sports has led to increased incidence of orthopedic complaints in the pediatric and adolescent populations, and year-round participation in a single sport allows no rest period from muscle use, bone development, and maturation. What effect do these factors have on the musculoskeletal system of the young athlete? They may lead to injuries such as dislocations, fractures, and problems of bone growth. This comprehensive review of shoulder and elbow anatomy and mechanisms of injury includes specific recommendations for rehabilitation.

Adolescent↗
PubMed2004

[Shoulder dystocia--risk factors and fetal outcome].

The purpose of this retrospective study is to evaluate the perinatal outcome in cases with birth injuries, suggesting shoulder dystocia. This survey involves 92 cases of live newborns (gestational age between 37 and 42 weeks) with shoulder injuries. Another control group of 120 cases of live mature newborns without any shoulder injuries is studied for comparison. There are no significant differentialities between those two groups, regarding age, parity, weight and height of the parturients. Shoulder dystocia is most frequently found in newborns of 3500-4000 g birthweight. Antepartum, risk factors for shoulder dystocia are: diabetes, obesity of the mother and chronological postterm pregnancy. Intrapartum, the evaluated risk factors prove to be unreliable because the same were found in as many as one half of the non-traumatic vaginal deliveries. In 27% of the cases, shoulder dystocia occurs most probably after the passage of the shoulder through the pelvic inlet. The most frequent type of shoulder injury is fracture of the clavicle (90.2%), followed by paresis of the brachial plexus (7.6%). Severe shoulder dystocia both from obstetrical and neonatological point of view is found in 2-3% of the cases.

Adult↗
PubMed2006

Simultaneous bilateral posterior dislocation of the shoulder: diagnostic problems and management. A case report.

We present the case of a patient who sustained simultaneous bilateral posterior dislocation of the shoulder after a possible epileptic fit. The confirmation of the diagnosis was reached only by a computed tomography (CT) scan, after the clinical suspicion. Under general anesthesia, close reduction of both shoulder dislocations was done. Posterior dislocation of the shoulder-especially the bilateral one-is very rare. When the history describes an electric shock or convulsive seizure, any shoulder injury demands a careful clinical and radiological evaluation. It is usually associated with reverse Hill-Sachs lesion (an impression defect of the anteromedial aspect of the humeral head), in which the size determines the treatment options.

Humans↗