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PubMedDate not supplied

Trauma-instability-voluntarism classification for glenohumeral instability.

Classification of glenohumeral instability is confusing. We think that the existence of trauma, directions of instability, voluntarism, and other factors make classification difficult. The purpose of this article is to create a new classification. One hundred eighty-nine patients with glenohumeral instability involving 207 joints (mean patient age 21.5 years) were subjects of this investigation. Our new classification, which is composed of three main factors (level of trauma, direction of instability, and voluntarism) and some subfactors, simplified it quite well. Abbreviations also make it easier to indicate each joint's condition. About half the subjects had no trauma or mild trauma. Two thirds of the joints with more than one dislocation or subluxation showed instability in other directions in addition to the direction of dislocation or subluxation. This classification is very useful to compare pathogenesis and results of treatment in patients with glenohumeral instability.

Adolescent↗
PubMedDate not supplied

Strength of the glenoid labrum and adjacent shoulder capsule.

This study evaluates the role of the glenoid labrum and capsule in the prevention of shoulder dislocation. Fifteen shoulder joints from nine fresh cadavers were used. The labrum and capsule were cut into sections 5 mm wide, and the strength of each slice to rupture was measured. The rupture site was observed microscopically. The anterior-inferior portion was the weakest, with a mean force necessary to cause rupture of 3.84 +/- 1.00 kg/5 mm. The rupture site was the portion of the labrum close to the cartilage of the glenoid. Histologic structure and degenerative changes of the labrum did not differ in the anterior to posterior portions. These results show that the anterior-inferior portion of the labrum is relatively weak. This finding may explain the lesion commonly identified in anterior shoulder dislocation.

Aged↗
PubMedDate not supplied

Modular shoulder arthroplasty.

One hundred consecutive Biomet modular shoulder arthroplasties were studied prospectively and were evaluated with a minimum 2-year follow-up (average 41 months). Fifty-seven women and 43 men with an average age of 64 years were evaluated for pain, activities of daily living, range of motion, cost, and complications. Fourteen patients had undergone previous surgery to the shoulder. Seventy patients underwent total shoulder arthroplasty, and thirty underwent hemiarthroplasty. Pain and range of motion demonstrated statistically significant improvement. Eight activities of daily living were rated on a 0 to 3 scale, and all were significantly improved. Complications were noted in 18 patients and included urinary retention, pulmonary embolus, rotator cuff tear, titanium synovitis, subluxation, and dislocation. Twelve shoulders underwent secondary procedures for rotator cuff repair, open reduction, and component revision for instability. Lucent lines were present in 62.5% of glenoids, 92.3% of cemented stems, and 0% of cementless stems on postoperative radiographs. No patients underwent revision surgery for component loosening, and no cases of humeral head-stem dissociation were seen. Ninety-five shoulders were rated by the patients as improved, and five were made worse.

Activities of Daily Living↗
PubMedDate not supplied

Shoulder arthroplasty in recreational golfers.

A retrospective review of 24 patients who had shoulder arthroplasty revealed that 23 were able to resume playing golf. The 23 patients (mean age 52.4 years, range 26.4 to 71.9 years) underwent 26 shoulder arthroplasties, 20 total shoulder arthroplasties, and 6 hemiarthroplasties. The average follow-up was 53.4 months (range 24.4 to 127.2 months). The average length of time from shoulder arthroplasty to playing an entire round of golf was 4.5 months. Eighteen patients were able to report their preoperative handicap and noted an average improvement after surgery of almost 5 strokes. Playing golf did not result in increased radiographic evidence of component loosening, and no increase occurred in lucent lines when the golfers were compared with a control group of 76 patients with osteoarthritis who had 103 shoulder arthroplasties (P < .05). Fifty members of the American Shoulder and Elbow Society were mailed a standardized questionnaire of 11 questions concerning patients who had shoulder arthroplasty and played golf. Most surgeons (91%) encouraged such patients to resume playing golf. The average length of time members of the Society recommended that patients should wait after shoulder arthroplasty before resuming golf was 4.3 months. Approximately 60% of surgeons believed that no limit should be placed on the number of golf rounds played weekly, and 91% denied an increase in complications among those who returned to playing golf after undergoing shoulder arthroplasty. Fewer than one third of the surgeons (29.5%) believed that component wear would be a problem in patients who undergo shoulder arthroplasty and play golf frequently and would recommend a hemiarthroplasty for an active golfer because of concern about future glenoid problems.

Adult↗
PubMedDate not supplied

Ultrasonic measurement of the anterior translation in the shoulder joint.

A new method for measuring the anterior translation in the shoulder joint by dynamic ultrasound was evaluated. We placed a 3.5-MHz transducer on the shoulder anteriorly. By using 3 bony landmarks, we then measured the anterior translation of the humeral head with a force of 90 N applied posteriorly. We performed such measurements in 20 subjects with healthy shoulders and in 20 patients with unilateral shoulder instability. There was a mean translation of 1.9 mm in healthy shoulders and 4.9 mm in unstable shoulders (P < .01). The mean difference between the 2 sides in subjects with normal shoulders was 0.7 mm, whereas the mean difference in patients with instability was 2.8 mm (P < .01). The normal shoulders were examined by 2 examiners to determine the degree to which different examiners' measurements might vary. Although one examiner recorded higher values than the other, the new method seems suitable for measuring increased laxity in unstable shoulders.

Adolescent↗
PubMedDate not supplied

Recurrences after the open Bankart repair: a potential risk with use of suture anchors.

Eighty-seven consecutive patients were treated with an open Bankart repair for traumatic, recurrent anterior instability of the shoulder. Forty-six of these patients underwent a transosseous suture technique. Forty-one patients were operated on with suture anchors. After follow-ups that ranged from 18 to 85 months, 7 of the 87 patients showed signs of recurrence and another 14 patients reported apprehension. Compared with the 66 patients without residual instability, these 21 patients were more likely to have been operated on with suture anchors (P < .05), had a greater incidence of hypermobility in joints other than the shoulder (P < .05), and had had a greater number of preoperative episodes (P < .05). In light of this data we recommend the transosseous suture technique for open Bankart repairs. In addition, a cautious and extensive capsular repair may be required when a patient reports frequent subluxations preoperatively or has hypermobility in some joints, if not in the shoulder per se.

Adolescent↗
PubMedDate not supplied

Aberrant muscle anterior to the shoulder joint: its clinical relevance.

Thirteen shoulders of 13 cases with aberrant muscle attached to the subscapularis encountered during surgery are described. The distal part of the subscapularis was completely or incompletely covered by aberrant muscle in all cases, and the anterior circumflex vessels were covered in 3 cases. Knowledge concerning these aberrant muscles is indispensable in minimizing confusion concerning surgical anatomy and in achieving adequate exposure of the shoulder during surgery while preserving the anterior circumflex artery, which constitutes the main nutrient vessel of the humeral head.

Female↗
PubMedDate not supplied

Evolution of lesions of the labrum-ligament complex in posttraumatic anterior shoulder instability: a prospective study.

The aim of this study was to evaluate the evolution of intraarticular disease in posttraumatic shoulder instability. Ninety-one patients with posttraumatic shoulder instability were examined arthroscopically. The intraarticular disease was recorded on a special documentation sheet (containing 67 descriptive items). The patients were divided into 5 subgroups: first-time dislocation (n = 9); first or second recurrence (n = 12); 3 to 5 recurrences (n = 23); 6 or more recurrences (n = 32); and chronic subluxations (n = 15). All data were examined statistically. Each lesion was correlated with stage of evolution, age, and number of recurrences. The most frequent lesions were regrouped into "lesion families." The initial and most constant lesion was the periosteal disinsertion of the anteroinferior labrum (single lesion). The labral detachment was succeeded in a second stage by the disinsertion of the glenohumeral ligament complex (double lesion). With additional recurrences, stress mechanisms altered the detached structures through tissue damage (triple lesion). The fourth stage saw the extension of the degenerative process, which led to failure at the insertion site and destruction of the labrum-ligament complex (quadruple lesion). This study reveals that recurrences progressively damage stabilizing structures. A pathophysiological classification into 4 stages is proposed, however, that would permit a precise therapeutic strategy for arthroscopic shoulder stabilization.

Adolescent↗
PubMed2002

Administrative barriers reduce emergency physician ordering of nasal and acromioclavicular joint radiographs.

The objective of this study was to determine whether administrative barriers to clinician ordering of nasal bone and acromioclavicular (AC) joint radiographs would result in a significant diminution in emergency department use of these films and in patient charges. This study involved a retrospective cohort or pre-post analysis of radiograph ordering by emergency care providers seeing adult patients with nasal area or shoulder injuries. Numbers of films ordered before and after enactment of a restrictive policy change were determined, as well as any charge reductions associated with diminished film use. For each radiograph type, there was a 1-year preintervention period, and 2 subsequent 12-month periods after the policy change. Nasal bone radiographs decreased from 166 in 1994 to 10 in 1995 and 4 in 1996 (P <.001, chi(2)). This resulted in potential annual charge savings of 33,176 dollars. AC joint radiographs decreased from 35 films in 1994 to 5 in 1995 and 8 in 1996 (P <.001, chi(2)), with potential annual charge savings of 6,578 dollars. Adoption of an interdepartmental policy that prohibits physicians from routinely ordering radiographs of limited clinical value can result in significant reduction of radiograph use. This drop in use can lead to considerable reductions in patient charges.

Acromioclavicular Joint↗
PubMed2000

Immediate response of glenohumeral abduction range of motion to a caudally directed translational mobilization: a fresh cadaver simulation.

OBJECTIVE: To investigate the immediate effect of caudal glide translational mobilization on the range of motion (ROM) of passive glenohumeral abduction with a fresh cadaver model to simulate the mobilization movement performed by a physical therapist treating patients with glenohumeral hypomobility. DESIGN: Mechanical simulation of caudal glide mobilization and abduction torque range of motion (TROM) measurement of the glenohumeral joint with 2 material testing systems. Mobilizations were conducted with the glenohumeral joint positioned at a resting position (IGR) and at the end range of abduction (IGE). SETTING: Biomechanics laboratory. CADAVERS: Twenty fresh shoulder specimens from 10 cadavers (mean age, 68 +/- 8 yr). MAIN OUTCOME MEASURE: Changes in TROM of the glenohumeral abduction in response to 5 bouts of caudal glide mobilization. RESULTS: At least 3 repetitions of TROM were required to attain consistent measurements on glenohumeral abduction ROM. Significant differences were found among changes in TROM because of rest, IGR, and IGE (Kruskal-Wallis statistics, (chi2 = 14.58, p = .001). A greater increase in glenohumeral abduction TROM was found after IGE (mean +/- standard error of the mean, 4.38 degrees +/- 0.95 degrees) compared with the rest control (0.03 degrees +/- 0.07 degrees; Mann-Whitney test, p = .001, alpha = .017) or its IGR counterpart (0.26 degrees +/- 0.46 degrees, p = .001, alpha = .017). CONCLUSION: This simulation of caudal glide translational mobilization at the end range using cadaver models improved passive glenohumeral abduction ROM but was ineffective when performed with the shoulder placed in a resting position. The mechanical responses of the glenohumeral joint to translational mobilization in a live patient may be similar, but some caution should be used in generalizing these findings.

Aged↗
PubMed2001

Variation in shoulder position sense at mid and extreme range of motion.

OBJECTIVE: To determine the effect of different joint positions on position sense of asymptomatic shoulders. DESIGN: Repeated-measures design. SETTING: Laboratory in an educational institution. PARTICIPANTS: Thirty-four asymptomatic, right-handed men. INTERVENTIONS: The ability of subjects to replicate 3 criterion positions was examined on subjects' right shoulders by using an isokinetic dynamometer. Three criterion positions were the 50th, 75th, and 90th percentiles of each individual's total passive shoulder rotation range measured from the full internal rotation position. MAIN OUTCOME MEASURE: Repositioning accuracy, indicating the difference in degrees between the criterion and matching positions. RESULTS: All subjects were able to reproduce the criterion position near the end of external rotation range more accurately and consistently than in the middle range of motion (ROM). CONCLUSIONS: Position sense acuity at the shoulder complex varied across the ROM and may be enhanced near the end of rotation range where there is more tension on the restraints to movement. Therefore, an individual's ROM should be factored into any attempt to assess or rehabilitate shoulder proprioception.

Adult↗
PubMed2001

The measurement level and trait-specific reliability of 4 scales of shoulder functioning: an empiric investigation.

OBJECTIVE: To evaluate 4 scales of shoulder function with respect to (1) their precision at different levels of shoulder function and (2) the measurement level of their raw scores (interval vs ordinal). DESIGN: Partial credit model calibration. SETTING: Office of private practice orthopedic surgeon with practice limited to the shoulder. PARTICIPANTS: One-hundred ninety-two shoulder patients. INTERVENTIONS: Participants completed the American Shoulder and Elbow Surgeons Patient Self-Evaluation Form (function subscale, modified), the disability subscale of the Shoulder Pain and Disability Index, the Simple Shoulder Test, and the function subscale of the University of Pennsylvania Shoulder Scale. MAIN OUTCOME MEASURES: The patients' responses were calibrated by using a partial credit model. We calculated standard errors of measurement and plotted the 95% confidence interval for different levels of shoulder functioning. We compared scales' raw scores with their equal interval measures obtained in the Rasch calibration. RESULTS: The scales did not measure all levels of shoulder functioning with equal precision, suggesting that commonly used reliability estimates misrepresent scale precision in certain subpopulations. CONCLUSIONS: The scales' raw scores were found to be not of equal interval, calling into question the scoring systems recommended by the developers of these scales and the use of the scores in some statistical procedures.

Adult↗
PubMed2002

A comparison of the effects of exercise and lifestyle modification on the resolution of overuse symptoms of the shoulder in polio survivors: a preliminary study.

OBJECTIVE: To compare the effectiveness of exercise and lifestyle modification therapy in treating shoulder symptoms in polio survivors with lower-extremity weakness. DESIGN: A randomized parallel group study. SETTING: Research laboratory. PARTICIPANTS: Twenty-three subjects recruited from a cohort of 194 polio survivors who had participated in a previous study had bilateral hip-extensor and knee-extensor weakness and reported experiencing shoulder pain on a regular basis with daily activity. INTERVENTIONS: Subjects were randomly assigned to 1 of 3 treatment groups. Members of group 1 were placed on a home exercise program that focused on strengthening their hip and knee extensors. Members of group 2 were instructed in lifestyle modification techniques designed to avoid shoulder overuse. Members of group 3 received both interventions. MAIN OUTCOME MEASURES: Shoulder symptoms were quantified in terms of number and severity. Isometric strength of bilateral hip and knee extensors was measured with a hand-held dynamometer. RESULTS: Symptoms improved in all 3 groups. However, members of the exercise-only group (group 1) were the only ones to show a significant difference in both number and severity of symptoms when pre- and posttreatment values were compared. CONCLUSIONS: Both exercise and lifestyle modification therapies that focus on reducing the stress related to lower-extremity weakness are effective in treating shoulder overuse symptoms in polio survivors. A trend toward greater improvement in shoulder symptoms in subjects who participated in the exercise program and who also showed a trend toward increased knee-extensor strength supports muscle strength and/or endurance as a key factor.

Aged↗
PubMed1999

Paralabral cyst: an unusual cause of quadrilateral space syndrome.

A paralabral cyst arising from a detached inferior glenoid labral tear was shown by magnetic resonance imaging (MRI) to dissect into the quadrilateral space, resulting in a compressive neuropathy of the axillary nerve. Three consecutive MRI examinations were performed over a 5-year period in a 47-year-old man with a long history of worsening shoulder pain. The MRI examinations revealed a slowly enlarging paralabral cyst extending into the quadrilateral space with progressive atrophy of the teres minor muscle.

Axilla↗
PubMed2001

Complications of metallic suture anchors in shoulder surgery: A report of 8 cases.

PURPOSE: Metallic suture anchors are widely used in open and arthroscopic operations about the shoulder. We report the cases of 8 patients who were referred to our institution with complications following shoulder surgery in which metallic suture anchors were used. TYPE OF STUDY: Retrospective case series. METHODS: There were 7 male patients and 1 female patient with an average age of 36 years (range, 18 to 76 years). The initial operation was open anterior reconstruction for anterior instability of the glenohumeral joint in 5 patients, open rotator cuff tear repair in 2 patients, and an open posterior capsular reconstruction for posterior instability in 1 patient. All patients were referred for evaluation after a failed index reconstructive procedure. RESULTS: On average, 5.5 suture anchors (range, 3 to 8) per shoulder were used. Of 4 patients undergoing reconstruction with glenoid anchors only, 3 patients had an extraosseously positioned device. In this subset of glenoid-sided reconstructions, when more than 3 anchors were used, at least 1 anchor was inserted in an extraosseous position. In 2 of 3 patients with isolated humeral anchors, there was evidence of migration over time (1 intra-articular, 2 bursal). Three patients (38%) developed severe articular damage that was directly caused by a loose or intra-articular metal suture anchor. One patient developed a wound infection after reconstructive surgery. In all 8 patients, the index procedure failed and required subsequent surgery. CONCLUSIONS: The use of metallic suture anchors about the shoulder is commonplace and useful, but, as with other hardware used about the shoulder, there are significant risks if the anchors are improperly placed or if the index procedure fails.

Adult↗
PubMed2001

Half pipe cannula for shoulder arthroscopy.

Shoulder arthroscopy makes it possible to diagnose and to reconstruct different pathologies. This article describes the use of a half pipe cannula for changing instruments in shoulder arthroscopy without using a closed cannula system. The use of this new device is not an alternative to standard cannula systems, but it is very helpful for changing different arthroscopic instruments without altering the soft tissues, thus minimizing postoperative swelling.

Arthroscopy↗
PubMed2001

Biomechanical evaluation of the origin of the long head of the biceps tendon.

PURPOSE: Lesions of the superior glenoid labrum extending anterior and posterior (SLAP) have recently been recognized as important sources of shoulder pain and dysfunction. Among the 4 described types of SLAP lesions, the type II SLAP involves detachment of the superior labrum from the bony glenoid and destabilization of the origin of the long head of the biceps tendon (LHBT). The purpose of this cadaveric biomechanical study was to evaluate the relative contribution regarding linear stiffness and displacement under load of the 2 origins of the LHBT: the superior glenoid labrum and the supraglenoid tubercle (the biceps anchor). TYPE OF STUDY: Cadaveric biomechanical study. METHODS: Seven pairs of fresh-frozen cadaveric shoulders were dissected free of all soft tissue except for the glenoid labrum and LHBT. Tension from 0 to 55 N was applied to the LHBT while keeping the tendon perpendicular to the face of the glenoid. Each specimen was tested for linear stiffness and biceps tendon displacement in the intact state, after releasing 1 of the LHBT origins, and after releasing the remaining origin. RESULTS: The average stiffness of the LHBT origin was 103 N/mm. Sectioning the anchor alone resulted in a 52% reduction in linear stiffness, whereas only detaching the superior glenoid labrum from the 10 o'clock to the 2 o'clock position resulted in a 15% reduction in linear stiffness. Maximum displacement of the biceps tendon origin in the intact state at the 55 N load averaged 0.99 mm. With a minimum load applied, displacement changed less than 1 mm unless both origins were released. CONCLUSIONS: The results indicate that the biceps anchor is the primary restraint of the LHBT and that the superior labrum is a secondary restraint in regard to linear stiffness. However, disruption of both restraints is required to produce the laxity typically seen in a type II SLAP lesion.

Adult↗