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PubMed2004

Shoulder anatomy and biomechanics.

The evaluation of shoulder disorders is challenging because of anatomic and biomechanical complexities. The shoulder comprises three synovial joints and two movement interfaces. The following principles are important to establish an accurate anatomic diagnosis and to develop a treatment plan: (1) perform a careful history and physical examination; (2) determine whether or not the problem is mechanical; (3) for mechanical problems, establish pathophysiologic and mechanical diagnoses; and (4) use mechanical impairments as the basis for therapeutic interventions.

Biomechanical Phenomena↗
PubMed2003

A trial into the effectiveness of soft tissue massage in the treatment of shoulder pain.

The purpose of this single blinded randomised controlled trial was to investigate the effects of soft tissue massage on range of motion, reported pain and reported function in patients with shoulder pain. Twenty-nine patients referred to physiotherapy for shoulder pain were randomly assigned to a treatment group that received six treatments of soft tissue massage around the shoulder (n = 15) or to a control group that received no treatment while on the waiting list for two weeks (n = 14). Measurements were taken both before and after the experimental period by a blinded assessor. Active range of motion was measured for flexion, abduction and hand-behind-back movements. Pain was assessed with the Short Form McGill Pain Questionnaire (SFMPQ) and functional ability was assessed with the Patient Specific Functional Disability Measure (PSFDM). The treatment group showed significant improvements in range of motion compared with the control group for abduction (mean 42.2 degrees, 95% CI 24.1 to 60.4 degrees), flexion (mean 22.6 degrees, 95% CI 12.4 to 32.8 degrees) and hand-behind-back (mean 11.0 cm improvement, 95% CI 6.3 to 15.6 cm). Massage reduced pain as reported on the descriptive section of the SFMPQ by a mean of 4.9 points (95% CI 2.5 to 7.2 points) and on the visual analogue scale by an average of 26.5 mm (95% CI 5.3 to 47.6 mm), and it improved reported function on the PSFDM by a mean of 8.6 points (95% CI 4.9 to 12.3 points). We conclude that soft tissue massage around the shoulder is effective in improving range of motion, pain and function in patients with shoulder pain. The mechanisms behind these effects remain unclear.

Adult↗
PubMed1977

Investigation of shoulder disability by arthrography.

Fifty patients with pain and limitation of movement at the shoulder joint were investigated by arthrography. Normal findings using a double contrast technique are described. The main arthrographic patterns encountered were found in complete and incomplete tears of the rotator cuff, and capsulitis. Abnormalities of the bicipital tendon sheath were non-filling and leakage of contrast medium from the sheath. Extravasation of contrast medium from the bicipital tendon sheath and subscapularis bursa was considered to be due to over-distension of a joint with a reduced capacity. The accuracy of the procedure and the reasons for false negative arthrograms and surgical exploration are discussed.

Adolescent↗
PubMed2001

Diagnosis of rotator cuff tears.

Rotator cuff tears account for almost 50% of major shoulder injuries but are sometimes difficult to diagnose. To aid diagnosis, we did a prospective study, comparing results of 23 clinical tests from 400 patients with and without rotator cuff tears. Three simple tests were predictive for rotator cuff tear: supraspinatus weakness, weakness in external rotation, and impingement. When all three were positive, or if two tests were positive and the patient was aged 60 or older, the individual had a 98% chance of having a rotator cuff tear; combined absence of these features excluded this diagnosis.

Adult↗
PubMed1991

Pet avian medicine. Case reports.

Four case reports are presented. The first involves chronic lead toxicity in a Yellow-naped Amazon Parrot, which presented for a shoulder injury. The second discusses Aspergillosis in an African Grey Parrot following smoke inhalation and systemic antibiotic use. The third describes Chlamydiosis in a recently imported Amazon Parrot, and the final case concerns rhinitis/sinusitis in a cockatiel.

Animals↗
PubMed2000

Arthroscopic Bankart repair. Operative technique and surgical pitfalls.

The arthroscopic management of patients with shoulder instability continues to evolve. The obvious benefits include a reduction of operative time, preservation of the subscapularis, improved visualization, and less blood loss. Newer techniques that allow the plastic deformation of the IGHLC to be addressed are emerging, which may yield results as successful as those of open Bankart repair. The ability to adequately tension the IGHLC may result in some loss of external rotation, which may improve results. Capsular tensioning must be critically analyzed at the time of surgery. Adequate stabilization with an arthroscopic approach should provide a convincing postoperative examination of stability. A careful examination after suture placement may indicate residual laxity that must be addressed. Finally, periods of immobilization are similar in open and arthroscopic techniques. The process of biologic healing is not accelerated by arthroscopic techniques, and early return to sport activities that may endanger the repair will likely result in early failure.

Arthroscopy↗
PubMed2000

Anatomical basics, variations, and degenerative changes of the shoulder joint and shoulder girdle.

This paper summarizes the anatomical basics of the shoulder, their variations, and precise definitions, including differential diagnoses. It also describes the characteristic degenerative changes caused by aging. A typical variation (7-15%) is the os acromiale, which forms the triangular epiphysis of the scapular spine. This abnormality must be differentiated from a fracture of the acromion or a pseudarthrosis. Because ossification of the acromion is complete after age 25, the os acromiale should be diagnosed only after this age. The shape of the acromion is a further important feature. In a recent anatomical study, the following frequencies of the Bigliani-types of the acromial shape were anatomically determined - type 1 (flat), 10.2% and type 2 (curved), 89.8%. Type 3 (hooked) was not observed, which indicates that this type is probably a misinterpretation of the so-called acromial spur. Minor dehiscences and perforations in the infraspinate or supraspinate fossa should not be confused with malignant osteolyses. The scapula has three ligaments of its own, (1) the coracoacromial ligament and its osseous fixations form an osteofibrous arch above the shoulder joint, which plays a part in impingement syndrome; (2) the superior transverse scapular ligament or its ossified correlate arches the scapular incisure and can cause a typical compression syndrome of the suprascapular nerve; (3) the inferior transverse scapular ligament is of no great clinical importance. Two intraarticular structures (glenoid labrum and tendon of the long bicipital head) must be mentioned. The glenoid labrum consists of dense connective tissue and surrounds the margin of the glenoid cavity. Two areas exhibit specialized conditions, cranial at the supraglenoid tubercle an intimate relationship exists to the tendon of the long bicipital head and in about 55% of cases, the labrum is stretched over the glenoid rim at the ventral side. At the area of the biceps-tendon-labrum complex, so-called SLAP-lesions may occur and at the glenoid rim, where the labrum is often not fixed to the bony margin, avulsions of the labrum may occur. This well-established anatomical condition must not be mistaken for a manifest Bankart-lesion. The glenohumeral ligaments, which are located in the ventral articular capsule, have a stabilizing function for the ventral part of the glenoid labrum. The glenohumeral ligaments lift the articular lip where it crosses the glenoid notch. This 'labrum-lift effect' supports the stabilizing features of the articular lip and the glenohumeral ligaments. The rotator cuff is composed of the tendons of the teres minor, infraspinatus, supraspinatus, and subscapularis muscles. This cuff has a poorly vascularized area, due to mechanical conditions, about 1.5 cm from the major tubercle, which causes degenerative changes and eventually may lead to ruptures. Results of the impingement-syndrome and the osteoarthrotic changes of the shoulder and acromioclavicular joint are also presented and discussed. Finally, the coracoclavicular joint, which probably represents no congenital entity but appears due to a changed, lowered position of the shoulder girdle, is discussed. The paper also presents instructive figures of anatomical preparations that can be used to make more precise radiological and differential diagnoses. All preparations were done by the author and are part of a series of more than 300 preparations of the shoulder joint and girdle.

Acromion↗
PubMed2000

Classification, clinical findings and operative treatment of degenerative and posttraumatic shoulder disease: what do we really need to know from an imaging report to establish a treatment strategy?

Successful patient care involves interdisciplinary Cupertino. Images allow an interpretation of a static dimension, but may not be sufficient to develop a surgical treatment strategy, since many shoulder problems have its origin in a dynamic pathology. This article outlines dynamic clinical tests of shoulder pathology, classifies various degenerative and posttraumatic shoulder problems and stresses key facts an imaging report should include in order to plan surgery. This article conveys basic knowledge of those tests and the dynamic background of shoulder pathology. Basic surgical treatment principles are summarised briefly.

Biomechanical Phenomena↗
PubMed2000

Imaging of degenerative and posttraumatic disease in the shoulder joint with ultrasound.

This article reviews the examination technique of shoulder ultrasound, normal and abnormal ultrasound findings in acute (posttraumatic) and chronic (degenerative) lesions. Moreover, it reviews the effectiveness of ultrasound in relation to magnetic resonance (MR) imaging. Most authors report that full-thickness tears of the supraspinatus can reliably be diagnosed by ultrasound. However, the simple diagnosis of a full-thickness rotator cuff tear is no longer sufficient for surgical management. The precise localization and size of rotator cuff tears as well as the extent of muscle degeneration is important for surgical planning. For this aspect and for partial-thickness tears of the supraspinatus, for subscapularis lesions as well as for lesions of the long biceps tendons there is no consensus regarding the diagnostic value of ultrasound. To the present, ultrasound (contrary to MR imaging) has failed to demonstrate that it consistently influences the clinician's degree of confidence in the clinical diagnosis or the treatment plan. Therefore, some orthopedic surgeons prefer MR imaging to ultrasound in the evaluation of rotator cuff tears and other abnormalities of the glenohumeral joint. Moreover, MR imaging, especially when combined with arthrography, represents a one-step investigation, which not only allows for assessment of rotator cuff lesion but also of lesions of the labrum (Bankart lesions, SLAP lesions), the joint capsule and the biceps tendon. It also demonstrates muscle atrophy, which represents an important predictor of surgical outcome in rotator cuff repair.

Diagnosis, Differential↗
PubMedDate not supplied

Arthroscopic coracoplasty through the rotator interval.

Coracoid impingement has been increasingly recognized as a cause of shoulder pain. Although most decompressive techniques involve open anterior surgery, the arthroscopic treatment of such impingement has only rarely been reported. In this report, the authors describe an intra-articular method of coracoplasty through the rotator interval. This method is easier to perform than a subacromial approach and allows appropriate orientation of the coracoplasty in the plane of the subscapularis tendon.

Adult↗
PubMed2003

Electrothermal capsulorrhaphy in glenohumeral instability without Bankart tear.

PURPOSE: The purpose of this study is to review the clinical results of electrothermal capsulorrhaphy (ETC) performed on 23 patients for the treatment of glenohumeral instability at an minimum follow-up of 2 years. TYPE OF STUDY: Retrospective case series. METHODS: Twenty-six patients with symptomatic unidirectional or multidirectional glenohumeral instability without Bankart tear were treated with ETC using a radiofrequency probe. No labral repairs were performed. A standard postoperative rehabilitation protocol was followed. Patients were evaluated with respect to motion, direction of instability, need for repeat surgery, return to overhand sports, and symptoms of pain and instability using various scores. RESULTS: Twenty-three patients were available for follow-up evaluation at an average of 30 months. The overall average ASES and Rowe scores were 84.2 and 79.3, respectively. Recurrent instability requiring an open stabilization procedure occurred in 4 patients (17%), 2 with anterior and 2 with multidirectional instability. Seven of 14 overhead athletes (50%) reported inability to return to their previous level. According to Rowe scores, overall results were 11 excellent, 5 good, 4 fair, and 3 poor. No postoperative nerve complications occurred. CONCLUSIONS: The ETC procedure was safely performed to treat glenohumeral instability without Bankart lesions. The recurrence rate is similar to that for other arthroscopic procedures but higher than for open surgery. In the absence of Bankart tear, patients with multidirectional instability and overhand athletes may require something other than an isolated ETC procedure to address instability. Long-term results of ETC are needed to better define its surgical indications.

Adolescent↗
PubMed2003

Radiographic analysis of bone defects in chronic anterior shoulder instability.

PURPOSE: To describe the incidence of bony lesions accompanying chronic anterior shoulder instability using fluoroscopically controlled radiography. TYPE OF STUDY: Case series of radiographic findings of patients with chronic anterior shoulder instability. METHODS: Radiographs of 160 shoulders in 156 patients with recurrent anterior shoulder instability were retrospectively evaluated; 132 shoulders had experienced recurrent dislocations, 18 shoulders had experienced recurrent subluxations, and 10 shoulders showed evidence of anterior instability at arthroscopy despite no reported history of instability. Fluoroscopically controlled radiographic views included an anteroposterior view with the humeral head in 3 rotations and a glenoid profile view with a comparison view of the contralateral shoulder. RESULTS: A humeral impaction fracture was identified on the anteroposterior radiographs in 117 of 160 shoulders (73.1%). The glenoid profile view showed an osseous lesion of the glenoid in 126 of 160 shoulders (78.8%). The anteroposterior radiograph showed an osseous lesion of the glenoid in an additional 13 shoulders (8.2%). Overall, an osseous lesion, either humeral or glenoid, was identified in 152 of 160 shoulders (95.0%). CONCLUSIONS: This study shows the frequent presence of bony lesions in patients with anterior shoulder instability.

Adolescent↗