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At least 559 records · Page 31Linked to original sources
PubMed2005

Scapular position and orientation in throwing athletes.

BACKGROUND: Despite the recognized importance of proper 3-dimensional motion of the scapula in throwers, minimal research has quantified scapular position and orientation in throwing athletes. HYPOTHESIS: Throwing athletes exhibit scapular position and orientation differences when compared to nonthrowing control subjects. STUDY DESIGN: Descriptive laboratory study. METHODS: Scapular position and orientation during scapular plane humeral elevation were assessed with electromagnetic tracking in a group of 21 throwing athletes and 21 control subjects. Scapular upward/downward rotation, internal/external rotation, anterior/posterior tipping, elevation/depression, and protraction/retraction were assessed. RESULTS: The throwing athletes demonstrated significantly increased upward rotation, internal rotation, and retraction of the scapula during humeral elevation. No differences in anterior/posterior tipping and elevation/depression were present. CONCLUSIONS: The results indicate that throwing athletes have scapular position and orientation differences compared to non-throwing athletes. This suggests that throwers develop chronic adaptation for more efficient performance of the throwing motion. CLINICAL RELEVANCE: Clinicians evaluate scapular position, orientation, and movement in throwing athletes as part of the evaluation of shoulder injuries associated with the throwing motion. The current study provides clinicians with an understanding of the types of adaptations that may be observed in normal, healthy throwing athletes.

Adaptation, Physiological↗
PubMed1985

Unrecognized dislocations of the shoulder.

The missed anterior dislocation is not such a diagnostic trap given that the shoulder injury is brought to the attention of a physician. Any roentgenogram will determine the diagnosis and the appropriate treatment can be implemented. The presence of an associated cuff lesion may compromise the surgical results. Missed anterior dislocations may function slightly better overall than missed posterior dislocations.

Adult↗
PubMed1996

The effect of positioning on shoulder isokinetic measures in females.

Weakness of the shoulder rotator musculature is a frequently encountered clinical concern in shoulder injuries. However, glenohumeral internal and external rotation in the frontal plane (FP) in an abducted position often causes impingement of the supraspinatus tendon, whereas similar activity in the scapular plane (SP) does not cause impingement. Therefore, the purpose of this study was to determine if assessment in two planes affected bilateral internal and external peak torque (PT), total work (TW), and average power (AP). Twenty recreationally active females (age = 24.9 yr; ht = 163.3 cm; wt = 60.7 kg) were randomly assessed in FP and SP for dominant and nondominant side shoulder internal rotation (IR) and external rotation (ER) isokinetic strength (Cybex 6000, Lumex Inc., Ronkonkoma, NY). Subjects were assessed at 1.047 and 2.094 rad.s-1 in the supine position with the shoulder abducted to 90 degrees. Four-way MANOVA revealed significant differences for PT, TW, and AP in all measured conditions (P < 0.05). These findings indicate that muscular strength is affected by positioning in different planes. Due to differences in PT, TW, and AP, it is advisable to maintain consistent positioning during assessment to assure consistency in the reporting of muscular performance variables.

Adult↗
PubMedDate not supplied

Atraumatic osteolysis of the distal clavicle: MR findings.

OBJECTIVE: The purpose of this study was to describe the MRI appearance in atraumatic osteolysis of the distal clavicle (AODC). MATERIALS AND METHODS: We retrospectively evaluated MRI, medical records, ancillary diagnostic imaging studies and clinical course in five men and two women (mean age, 39 years) in whom the final clinical diagnosis of AODC was established. None of the patients had significant shoulder injury, but all participated in activities involving repetitive strain of the acromioclavicular (AC) joint. In three of these patients, we performed follow-up MRI (ranging from 5 1/2 to 15 months after the initial MRI). RESULTS: In all seven patients, signal intensity changes within the intramedullary portion of the distal clavicle on MRI were consistent with diffuse bone marrow edema. Marrow edema was most conspicuous on STIR imaging and occasionally could be misinterpreted as normal marrow signal patterns on spin-echo imaging. Cortical thinning or irregularity of the distal clavicle was seen in six cases and tiny subchondral cysts were seen in three, corresponding to subtle cystic changes on shoulder radiography. Limited bone scans obtained in two patients showed markedly increased uptake of radiotracer at the distal clavicle and AC joint. Histologic examination in one case showed disruption of articular cartilage, subchondral cysts, and metaplastic bone formation with increased osteoclastic activity. Follow-up MRI in three patients who were asymptomatic following conservative therapy showed normalization of marrow signal intensity. CONCLUSION: Atraumatic osteolysis of the distal clavicle is a relatively uncommon but important cause of shoulder pain. Particularly when the clinical history is suggestive of repetitive AC joint stress, MRI of the distal clavicle should be examined closely for marrow edema, cortical irregularity, and cystic changes. Such abnormalities may be especially conspicuous when STIR imaging techniques are used.

Acromioclavicular Joint↗
PubMed1985

Shoulder rehabilitation.

All injuries to the shoulder either directly or indirectly involve the muscles of the shoulder. The involved muscles can easily be identified by examination and rehabilitated utilizing isotonic and isokinetic exercises. The majority of recurring injuries or symptoms following the treatment of a shoulder injury and return to activity are due to either lack of adequate rehabilitation or inappropriate rehabilitation.

Adult↗
PubMed1998

Rapid prototyping for orthopaedic surgery.

The revision of an orthopaedic procedure can present surgeons with the challenge of a complex reconstructive process. Orthopaedic surgery can also face considerable challenges in cases presenting extensive primary injuries with multiple bone fragmentation, as well as in cases presenting bone deformities. Radiographs are used routinely for orthopaedic surgical planning, yet they provide inadequate information on the precise three-dimensional extent of bone defects. Three-dimensional reconstructions from X-ray computed tomography offer superior visualization but are not portable for consultation or readily available in the operating theatre for guidance during a procedure. A physical model manufactured from X-ray computed tomography data can offer surgeons a clear understanding of complex anatomical detail, by providing an intuitive physical relationship between patient and model. Rapid prototyping was used for the construction of an anatomical model in a case presenting with a complex shoulder injury. The model provided a definitive interpretation of joint pathology and enabled a full assessment of the degree of injury.

Adult↗
PubMedDate not supplied

Flexible foil exercise and shoulder internal and external rotation strength.

CONTEXT: The efficacy of exercise using a flexible foil to increase strength in the shoulder rotator muscles is unknown. OBJECTIVE: To compare the effects of exercises using a flexible foil (Bodyblade) with exercises using elastic bands on shoulder internal and external rotator muscle strength. DESIGN: We used a randomized, controlled pretest-posttest design. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: Forty young adults with no previous shoulder injury. INTERVENTION(S): Experimental subjects participated in an 8-week program of internal and external rotation exercises consisting of 3 sessions per week. MAIN OUTCOME MEASURE(S): Strength was tested by internal and external rotation isometric and isokinetic strength tests at 60 degrees .s (-1) and 120 degrees .s (-1). RESULTS: The group exercising with elastic bands had a greater pretest-posttest increase in maximal internal rotation isometric torque at 10 degrees of internal rotation and greater maximal external rotation isometric torque at 65 degrees of external rotation than the control group. The group using a flexible foil did not show an increase in strength significantly different from either the control or elastic band groups. We found no other statistically significant differences. CONCLUSIONS: Our results do not support the use of a flexible foil for strength gains in shoulder internal and external rotation in the asymptomatic young adult population.

Journal Article↗
PubMedDate not supplied

Shoulder and elbow injuries in the skeletally immature athlete.

The intensity of training and competition among young athletes can place them at increased risk of acute and chronic injuries, which occur in patterns unique to the skeletally immature athlete. Prompt recognition and treatment of these injuries are critical to prevent long-term functional disability and deformity. Children and adolescents participating in recreational and organized sports are particularly susceptible to a broad spectrum of shoulder and elbow injuries involving both osseous and soft-tissue structures. Understanding the relevant functional anatomy, biomechanics of throwing, and pathophysiology of injury can help the clinician manage common acute traumatic injuries, some of which may result in chronic problems. Over-use injuries occur more frequently than do acute, traumatic injuries, and early recognition, coupled with appropriate treatment or prevention, can help restore and maintain normal shoulder and elbow function.

Adolescent↗
PubMed1992

[Osteosynthesis in dislocated fractures of the humerus head].

The operative treatment of displaced fractures of the proximal humerus has changed during the last few years. Minimal osteosynthesis takes into consideration to a great extent the biological aspects of these fractures and provides sufficient stability for early functional therapy. Neer's classification has proved very useful for both the indication for and the choice of an operative procedure. The high necrosis rate of the operatively stabilized humeral head has considerably influenced the operative strategy. This is shown in two separately controlled patient groups. From 1970 to 1980, 65 patients and from 1983 to 1987, 30 patients with displaced fractures of the proximal humerus were treated operatively. Within the first group, in more than half the cases a T-plate osteosynthesis was performed, a minimal osteosynthesis being performed in only 1 out of 5 patients. In the second group, we exclusively performed minimal osteosynthesis. More favourable results were achieved in fractures with two or three fragments, in younger patients and in isolated shoulder injuries than with four-fragment fractures or luxated fractures, in older and in polytraumatized patients. Using minimal osteosynthesis instead of plate osteosynthesis in four-fragment fractures, functional results were achieved which, in 75%, were satisfactory or better. The necrosis rate of the humeral head also declined. We conclude that head-preserving methods seem advisable in these severe forms of humeral fractures.

Adolescent↗
PubMed2003

Age specific isokinetic glenohumeral internal and external rotation strength in elite junior tennis players.

The high incidence of overuse shoulder injuries in elite junior tennis players is often attributed to both the high repetitive stresses inherent in the game, as well as muscular imbalances in the humeral rotators. The purpose of this study was to isokinetically measure concentric glenohumeral joint internal and external rotation strength, to develop a bilateral descriptive profile in elite junior tennis players across two age ranges. One hundred forty seven elite junior players between the ages of 12 and 21 were bilaterally tested on a Cybex isokinetic dynamometer with 90 degrees of abduction. Players were analysed in two groups (12-17 and 18-21 years of age), using isokinetic variables of peak torque and work relative to body weight. Data analysis consisted of ANOVAs, with dependent t-tests used for post-hoc testing where main effect differences were identified. Results indicated no significant main effect difference in the isokinetic relative parameters between the two age groups (p > .01). Significantly greater (p < .001) dominant arm internal rotation was measured in both groups for both males and females, with no significant difference in external rotation strength measured between extremities in either age group. These data show specific adaptations in shoulder strength and identify a relative muscular imbalance between the internal and external rotators on the dominant arm of elite junior tennis players. Normative data presented in this study can assist clinicians and researchers in interpreting isokinetic test results in elite junior tennis players.

Adolescent↗
PubMedDate not supplied

[Posterior shoulder luxations (author's transl)].

In one out of two cases, posterior shoulder luxation is a diagnostic, clinical, and radiological "trap", which we feel has no true justification. In fact, contrary to what is generally admitted, a good analysis of the frontal image can easily suggest the diagnosis in most cases. All that is required is knowledge of the two principal indirect signs of posterior luxation. Increase in size of the glenohumeral interline is almost constantly present (12 out of 14 cases), and the "compression-fracture" of the anterior face of the head is often visible (9 out of 14 cases). Furthermore, if a strictly frontal film of the glenohumeral interline is requested in all cases of shoulder injury, the diagnosis of luxation is evident as the head is projected into the glenoid cavity. Profile films must also be taken. When the luxation is of recent origin, axillary profile films are usually impossible to take, and trans-thoracic profile films of the upper end of the humerus are taken, even though these do not show the glenohumeral interline. For this reason, it is essential to request an immediate Bloom and Obatas' profile. This incidence confirms the presence of posterior luxation and enables the anterior face of the head and the posterior glenoid rim to be studied. The diagnostic value of the two principal indirect signs of posterior luxation, as seen in frontal films and Bloom and Obatas' glenohumeral profile, is undeniable. The joint prognosis depends, in fact, on how early treatment is applied.

Adult↗
PubMedDate not supplied

Qualitative clinical evaluation of scapular dysfunction: a reliability study.

The purpose of this study was to determine the intrarater and interrater reliability of a clinical evaluation system for scapular dysfunction. No commonly accepted terminology presently exists for describing the abnormal dynamic scapular movement patterns that are commonly associated with shoulder injury. A method of observation was devised for clinical evaluation of scapular dysfunction. Blinded evaluators (2 physicians and 2 physical therapists) were familiarized with the evaluation method of scapular movement patterns before viewing a videotape of 26 subjects with and without scapular dysfunction. Each evaluator was asked to categorize the predominant scapular movement pattern observed during bilateral humeral scaption and abduction motions. Reliability was assessed by a kappa coefficient. Intertester reliability (kappa = 0.4) was found to be slightly lower than intratester reliability (kappa = 0.5). These results indicate that, with refinement, this qualitative evaluation method may allow clinicians to standardize the categorization of dynamic scapular dysfunction patterns.

Adult↗
PubMed1985

[Late results following the surgical treatment of proximal humerus fractures in adults].

In this paper late results of 65 proximal humeral fractures, operated upon between 1970 and 1980 are reported. Fractures were classified according to Neer in two-part-(28), three-part-(15), four-part-fractures (21) and fractures of the articular surface (1). In 34 cases internal fixation was performed by a T-plate. In 15 cases either open reduction without internal fixation or open reduction and minimal internal fixation was done using screws and K-wires. Primary prosthetic replacement of the head was done in 8 patients with four-part-fractures. The follow-up period ranged from 2.5 years up to 13 years with an average of 7 years. The functional results were excellent in 25 patients, good in 14, fair in 10 and poor in 16 patients. Better results were obtained in young patients, isolated shoulder injuries and patients with two- or three-part-fractures. On the contrary the results in aged and polytraumatized patients or patients with four-part-fractures and fracture dislocations were less favourable. Avascular necrosis of the humeral head was encountered in 4 cases of four-part-fractures and fracture dislocations, 3 of them fixed by T-plate and 1 by minimal internal fixation. No case of avascular necrosis of the humeral head was encountered in two- or three-part-fractures, fixed by T-plate. We can conclude, that cases, having a high risk for developing avascular necrosis of the humeral head, i.e. four-part-fractures and fracture dislocations, are better treated with minimal internal fixation avoiding the use of T-plate, for it was found to increase the already present damage.

Adult↗
PubMed1992

Intramuscular wire electromyography of the subscapularis.

The action of the subscapularis muscle is an important component in maintaining shoulder stability. Because of its relative inaccessibility, there have been few electromyographic (EMG) studies of its normal patterns of activity. The subscapularis is innervated by two or more distinct nerves, and therefore the upper and lower parts of the muscle may have different functional roles depending on the position of the humerus. The purpose of this study was to develop safe, reproducible insertion paths to the upper and lower parts of the subscapularis. Six subjects with no previous history of shoulder injury were evaluated. The paths of insertion were designed based on previous anatomical studies as well as dissections. Two pairs of intramuscular wire electrodes were inserted: one directed toward the upper subscapularis and one toward the lower subscapularis. Electrode locations were confirmed using posteroanterior and lateral radiographs and through electrical stimulation. EMG data were recorded during isometric internal rotation exercises with the humerus in 0 or 90 degrees abduction. Significant differences were observed in the EMG activity recorded from the two pairs of electrodes. The EMG activity of the upper subscapularis either remained the same or decreased in going from 0 to 90 degrees abduction, while that of the lower subscapularis increased. The observed differential response confirmed that the electrodes were in different parts of the subscapularis. These preliminary results suggest that in future EMG studies, the subscapularis should be considered as at least two independent muscle units.

Electric Stimulation↗
PubMedDate not supplied

An electromyographic analysis of the shoulder during a medicine ball rehabilitation program.

We used dynamic electromyography and a motion analysis system to describe the muscle firing patterns in 10 shoulder muscles and the basic kinematics of a two-handed overhead medicine ball throw. Ten healthy male subjects with no history of shoulder injury were evaluated. The two-handed medicine ball throw was divided into three phases for analysis: cocking, acceleration, and deceleration. The average duration of the throw was 1.92 seconds; the cocking phase represented 56%, the acceleration phase 15.5%, and the deceleration phase 28.5% of the throw. In the cocking phase, the upper trapezius, pectoralis major, and anterior deltoid muscles showed high activity ( > 40% to 60% maximum manual test), and the rotator cuff muscles had moderate activity ( > 20% to 40%). In the acceleration phase, five of the muscles demonstrated high levels of activity ( > 40% to 60%) and the upper trapezius and lower subscapularis muscles had very high levels of activity ( > 60%). Analysis of the deceleration phase revealed high activity in the upper trapezius muscle and moderate activity in all other muscles except the pectoralis major. Our findings support the use of medicine ball training as a bridge between static resistive training and dynamic throwing in the rehabilitation of the overhead athlete. This training technique provides a protective method of strengthening that closely simulates portions of the throwing motion.

Acceleration↗
PubMed1996

Glenohumeral joint internal and external rotation range of motion in elite junior tennis players.

Objective measurement of range of motion of the glenohumeral joint is important for the rehabilitation and prevention of shoulder injury. The primary purpose of this study was to determine whether significant differences exist between the dominant (tennis playing) and nondominant extremity in active internal and external rotation range of motion in elite junior tennis players 11-17 years of age. Two hundred three elite junior tennis players (113 males, 90 females) were bilaterally measured for internal and external rotation at 90 degrees of abduction in a supine position with a specific methodology attempting to isolate glenohumeral motion, while minimizing or negating scapulothoracic motion. A standard universal goniometer was utilized to measure active range of motion (AROM). Dependent t tests were used to compare differences between extremities. No significant difference was found for males or females between the dominant and nondominant arm in external rotation. Analysis of internal rotation (AROM) differences showed significantly less (p < .001) internal rotation (AROM) on the dominant arm for both males and females. Significantly less (p < .001) dominant arm total rotational range of motion was also found in both males and females. The loss of dominant arm internal rotation (AROM) has clinical application for both the development of rehabilitation and preventative flexibility/range of motion programs.

Adolescent↗
PubMed1993

Throwing injuries of the shoulder.

A review of the mechanism of throwing is presented and split into the different phases. The presentation and history is often more important than the clinical signs which may only be present after repetitive throwing activity. The pathological relationship between instability and impingement is discussed. Arthroscopy has been found to be extremely helpful in extending knowledge of pathological anatomy as well as defining diagnosis and aiding treatment.

Athletic Injuries↗