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Sample records for anterior shoulder dislocations

  1. A Case of Simultaneous Bilateral Anterior Shoulder Dislocation

    PubMed Central

    Patil, Mallanagouda N

    2013-01-01

    Introduction: Anterior dislocation of shoulder is commonest dislocation one encounters in day to day Orthopaedic practice. But bilateral shoulder dislocations are relatively uncommon frequently posterior and secondary to violent muscle contraction. Simultaneous bilateral anterior dislocations of shoulder following trauma is rare occurrence. Case Report: 35 year old male presented to emergency department with history fall by tripping on a stone (fall on outstretched hand). He complained of pain and difficulty in moving both the shoulders. On clinical examination, patient's both upper limbs were abducted and externally rotated. Bilaterally shoulder contour was lost with flattening. Other classical signs of shoulder dislocation viz, Bryants test, Callway sign, Hamilton's ruler test were positive. Diagnosis was confirmed on X rays. Both shoulders were reduced in emergency operation theater under general anaesthesia by Kocher's method and were immobilised in sling. Conclusion: Though bilateral shoulder dislocations are commonly posterior, usually either secondary to convulsions or electric shock, anterior dislocation has to be kept in mind , especially in post traumatic injuries. This bilateral dislocation also presents with practical problems immobilization and day to day care of patients. PMID:27298905

  2. Bilateral Traumatic Anterior Dislocation of Shoulder - A Rare Entity

    PubMed Central

    Kumar, Yashavantha C; Nalini, K B; Maini, Lalit; Nagaraj, Prashanth

    2013-01-01

    Introduction: Bilateral shoulder dislocation are most commonly posterior type. These are most commonly due to seizure disorder and electrocution. Anterior shoulder dislocations occurring bilaterally without any predisposing factors are very rare. These types of injuries are due to trauma with a unique mechanism of injury. To best of our knowledge there are only few cases of similar kind are reported in literature. We hereby report a interesting case of posttraumatic, bilateral anterior dislocation of shoulder without associated fracture in a 45 old women without any predisposing pathoanatomy. Case report: A 45-year-old women presented to casualty with sudden onset of pain and restriction of movement in both shoulders fallowing trauma. Immediately post trauma she had severe pain and restriction of both shoulders. On examination arms were abducted and externally rotated. Bilateral shoulder movements were painful and restricted. There was loss of round contour of shoulder with increased vertical diameter of axilla anteriorly. Radiological examination revealed bilateral anterior dislocation of the shoulders without any associated fractures. Closed reduction done by Milch technique after intraraticular lignocaine injection. MRI of bilateral shoulder showed no pathological lesion. Both shoulders were immobilized with a shoulder immobilizer for three weeks. Conclusion: Most of the bilateral shoulder dislocations are posterior type seen in seizure disorders. Bilateral traumatic anterior shoulder dislocations are rare and are seen as a result of unique mechanism of injury. In our case patient had a fall on her elbows causing forced extension. If diagnosed and treated promptly completely normal function of the shoulders can be restored. PMID:27298892

  3. Anterior shoulder dislocation with axillary artery and nerve injury.

    PubMed

    Razif, M A Mohamed; Rajasingam, V

    2002-12-01

    We report a rare case of left axillary artery injury associated with anterior dislocation of the left shoulder in a 25 yrs old male as a result of a road traffic accident. The shoulder dislocation was reduced. A left upper limb angiogram showed an obstructed left axillary artery. The obstructed segment was surgically reconstructed with a Dacron graft. Six months post operation in follow up, he was found to have good left shoulder function and no neurovascular deficit. This is an injury that could have been easily missed without a simple clinical examination. PMID:12733178

  4. Endovascular treatment of axillary artery dissection following anterior shoulder dislocation.

    PubMed

    Fass, G; Barchiche, M Reda; Lemaitre, J; De Quin, I; Goffin, C; Bricart, R; Bellens, B

    2008-01-01

    Injury to the axillary artery is a rare complication of anterior shoulder dislocation. Open surgical repair is technically demanding because of the anatomical position of the vessel and the propensity for concomitant injuries. Standard surgical exposure techniques involve extensive dissection, including a combination of supraclavicular or infraclavicular incision, median sternotomy, and thoracotomy causing significant morbidity and mortality rates. Endovascular techniques may offer an alternative to these surgically demanding procedures. We present a patient with a traumatic dissection of the axillary artery following anterior shoulder dislocation who was successfully managed with an endovascular stent. PMID:18411587

  5. Bipolar bone defect in the shoulder anterior dislocation.

    PubMed

    Di Giacomo, Giovanni; de Gasperis, Nicola; Scarso, Paolo

    2016-02-01

    In the anterior shoulder instability with glenoid bone loss among 25 % or more of the inferior glenoid diameter (inverted-pear glenoid), the consensus of recent authors is that glenoid bone grafting (Latarjet procedure) should be performed. The engaging Hill-Sachs lesion has been recognized as a risk factor for recurrent anterior shoulder instability. We have developed a method using radiographic and arthroscopic studies and the concept of the glenoid track to determine whether a Hill-Sachs lesion will engage the anterior glenoid rim, whether or not there is concomitant anterior glenoid bone loss. If the Hill-Sachs lesion engages, it is called an "off-track" Hill-Sachs lesion; if it does not engage, it is an "on-track" lesion. On the basis of our quantitative method, we have developed a treatment paradigm with specific surgical criteria for all patients with anterior shoulder instability (first dislocation or recurrent dislocation), both with and without bipolar bone loss. PMID:26704802

  6. Bilateral Anterior Shoulder Dislocation with Symmetrical Greater Tuberosity Fracture following Seizure

    PubMed Central

    Suryavanshi, Ashish; Mittal, Amber; Dongre, Snehal; Kashyap, Neeti

    2012-01-01

    Introduction: Majority of bilateral shoulder dislocations are posterior. Simultaneous bilateral anterior shoulder dislocations and bilateral anterior fracture-dislocations are rare and mostly of traumatic origin. We present a rare case of bilateral anterior shoulder dislocation with symmetrical greater tuberosity fracture following an episode of seizure with an unusual injury mechanism which was treated conservatively. Case Report: A 45 year old office worker presented to the Casualty of our hospital with bilateral anterior shoulder dislocations with greater tuberosity fractures following an episode of seizure. Both shoulders were reduced by Kocher manoeuvre using total intravenous anaesthesia (TIVA) & were strapped to the chest for 6 weeks. At the end of 1 year follow-up, there were no reasonable loss of strength or restriction of motion and the shoulders were defined as stable. Conclusion: Although bilateral shoulder dislocations are mostly posterior, bilateral anterior dislocations may not be as rare as previously thought and are frequently missed by the orthopaedic residents in the casualty department. Further to the best of our knowledge, our case represents the first case of bilateral anterior shoulder dislocation with symmetrical greater tuberosity fracture with an unusual mechanism of injury following an episode of seizure in a young male patient that was successfully managed by conservative means.

  7. Chloroquine-induced bilateral anterior shoulder dislocation: a unique aetiology for a rare clinical problem.

    PubMed

    Martin, Alexander Nicholas; Tsekes, Dimitris; White, William James; Rossouw, Dan

    2016-01-01

    Bilateral anterior shoulder dislocation is a rare clinical entity with few case reports and limited series published in the literature. Bilateral shoulder dislocations are rare and of them, most are posterior. We present a highly unusual case of bilateral, atraumatic, anterior shoulder dislocation with concomitant comminuted greater tuberosity fracture on the right side, secondary to seizure, in a patient without known epilepsy, induced by oral chloroquine medication. We demonstrate the treatment approach that led to a satisfactory clinical outcome, evidenced by radiological union, clinical assessment and Patient Reported Outcome Measure data, following non-operative management of both shoulders. The unusual mechanism for anterior shoulder dislocation, the asymmetric dislocation pattern and peculiar precipitant for the causative seizure all provide interesting learning points from this case. PMID:27005796

  8. Endovascular Repair of a Traumatic Axillary Pseudoaneurysm Following Anterior Shoulder Dislocation

    SciTech Connect

    Stahnke, Michaela; Duddy, Martin J.

    2006-04-15

    Pseudoaneurysms due to musculoskeletal trauma are rare and comprise less than 2% of all pseudoaneurysms. We report a case of axillary pseudoaneurysm following anterior dislocation of the shoulder. The patient was successfully treated by endovascular intervention.

  9. Neglected Anterior Dislocation of Shoulder: is surgery necessary? A Rare Case with review of literature

    PubMed Central

    Shah, Kunal; Ubale, Tushar; Ugrappa, Harish; Pilankar, Samir; Bhaskar, Atul; Kale, Satishchandra

    2015-01-01

    Introduction: Shoulder joint is the most frequently dislocated joint. However, it is rarely neglected and treatment is sought immediately. Delayed or neglected shoulder dislocations are difficult to manage and require extensive procedures to obtain good functional outcome. Very few cases are described in literature showing neglected shoulder dislocation with good functional range of movement. We report a case with 3 years of neglected anterior shoulder dislocation with preserved joint function. Case Report: A 40 years old gentleman presented withfracture distal end of the radius (left). On clinical examination we observed that he had anterior dislocation of his left shoulder which was confirmed on radiographic evaluation. He had history of seizures 3 years back, which may be the cause of dislocation which went unnoticed. On examination he had good range of motion without any pain. Patient could perform all routine activities with no major functional limitation. At three years after dislocation CT Scan showed neocavity formation. Conclusion: Neglected shoulder dislocation with preserved joint function without major functional limitation is a rare presentation. This condition should be kept in mind in patients with history of seizures. Proper evaluation and counseling of patients avoids extensive procedures and avoids complications of surgery. Observation can be a treatment option in patients with preserved range of movement especially involving non dominant handand having low functional demand. This report presents rare presentation of neglected shoulder dislocation highlighting its natural history and its outcome following conservative treatment. PMID:27299102

  10. A new autoreduction method for anterior shoulder dislocation: the GONAIS method.

    PubMed

    Gonai, Shiro; Kamio, Yoshito; Matsuoka, Tomoyuki; Harunari, Manabu; Saito, Yutaka; Takuma, Kiyotsugu

    2016-01-01

    Although techniques for autoreduction of anterior shoulder dislocation have been developed, no reports have detailed an autoreduction method using the zero position and traction on the affected arm. Therefore, we developed a new autoreduction technique using the zero position and gentle autotraction. The objective of this study is to present our experience with a new method for autoreduction of anterior shoulder dislocation called the GONAIS (a backronym for “Grasp a waist-high object, Opposite arm assists, Nonsedated, Autoreduction/autotraction, Immobilize the grasped object, and Squatting and stooping”) method. A 41-year-old healthy woman with a history of left shoulder dislocation presented to the emergency department with left shoulder pain while attaching her seatbelt. The X-ray examination revealed subcoracoid dislocation of the left shoulder. The patient tried the GONAIS method after simple guidance and demonstration. Although she felt pain once when weakening traction, she achieved autoreduction successfully in only 2 min and 50 s. Clinical examination after autoreduction revealed normal neurovascular findings and appearance of the shoulder. The X-ray revealed glenohumeral joint reduction and no fracture. Here, our patient using the GONAIS method achieved shoulder autoreduction in a short time. The GONAIS method does not require lying down or sitting on the ground, does not necessarily require the opposite arm, and is minimally invasive. This method would likely be helpful for those who cannot quickly reach a hospital for treatment of anterior shoulder dislocation. PMID:26168697

  11. Return to Play Following Anterior Shoulder Dislocation and Stabilization Surgery.

    PubMed

    Donohue, Michael A; Owens, Brett D; Dickens, Jonathan F

    2016-10-01

    Anterior shoulder instability in athletes may lead to time lost from participation and decreases in level of play. Contact, collision, and overhead athletes are at a higher risk than others. Athletes may successfully be returned to play but operative stabilization should be considered for long-term treatment of recurrent instability. Open and arthroscopic stabilization procedures for athletes with less than 20% to 25% bone loss improve return to play rates and decrease recurrent instability, with a slightly lower recurrence with open stabilization. For athletes with greater than 20% to 25% bone loss, an open osseous augmentation procedure should be considered. PMID:27543398

  12. Bilateral Anterior Fracture-Dislocation of Shoulder Joint- A rare case with Delayed Presentation

    PubMed Central

    Sunku, Nithin; Kalaiah, Kiran; Marulasidappa, G.; Gopinath, P.

    2012-01-01

    Introduction: The shoulder is the most frequently dislocated joint. Bilateral glenohumeral dislocations are rare and almost always posterior. Bilateral anterior fracture dislocations of humeral neck in a patient with seizure are extremely rare. We report one such case of delayed presentation of bilateral anterior fracture dislocation of shoulder after an epileptic attack. Case Report: We describe a rare case of 30 year old gentleman who presented with first episode of seizure following alcohol withdrawal. Physical examination and radiographic assessment revealed fracture dislocation of bilateral proximal humeri (4 part fracture on right side and two part fracture on left). Patient presented 20 days after injury during which he was treated by local osteopath by immobilization and massage. Open reduction and internal fixation with simple T plate was done on right side and multiple K – wires were used on left side. At one year follow up the patient had acceptable range and was able to carry out daily activities. Conclusions: Bilateral anterior fracture dislocation of shoulder behave similar to unilateral fracture dislocations and treatment needs to be planned appropriately. Even in cases with delayed presentation good results can be achieved

  13. ASSESSMENT OF THE RESULTS FROM ARTHROSCOPIC SURGICAL TREATMENT FOR TRAUMATIC ANTERIOR SHOULDER DISLOCATION: FIRST EPISODE

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Botelho, Vinicius; Duarte, Clodoaldo; Checchia, Sergio Luiz

    2015-01-01

    Objective: To assess the clinical results obtained of patients who underwent arthroscopic surgical treatment following a first episode of traumatic anterior shoulder dislocation. Methods: Between August 2000 and October 2008, 14 shoulders of 14 patients were treated by the Shoulder and Elbow Group of Santa Casa Hospital, São Paulo. Thirteen patients (93%) were male and one (7%) was female; their ages ranged from 17 to 41 years, with a mean of 28 years. All of the patients evaluated were regularly practicing a sports activity (which required physical vigor of the upper limbs). The time that had elapsed between the trauma and the surgical treatment ranged from seven to 60 days, with a mean of 20 days. The surgical procedure was performed with arthroscopic viewing, with the patient positioned in lateral decubitus. Fixation of the labral-ligamentous complex was achieved using bioabsorbable anchors. The postoperative clinical assessment was made using Rowe and UCLA criteria. Joint mobility was measured according to the guidance from ASES (American Shoulder and Elbow Surgeons). The length of postoperative follow-up ranged from 24 to 120 months, with a mean of 45 months. Results: All the patients achieved satisfactory results, (85% excellent and 15% good), as shown by UCLA, while 100% of the results were excellent according Rowe. The “grip test” was negative for all the patients. Conclusion: Surgical treatment after a first episode of traumatic anterior shoulder dislocation seems to be a good therapeutic option for young active patients who practice sports activities. PMID:27042625

  14. Remifentanil versus Fentanyl/Midazolam in Painless Reduction of Anterior Shoulder Dislocation; a Randomized Clinical Trial

    PubMed Central

    Gharavifard, Mohammad; Tafakori, Azadeh; Zamani Moghadam, Hamid

    2016-01-01

    Introduction: Performance of painful diagnostic and therapeutic procedures is common in emergency department (ED), and procedural sedation and analgesia (PSA) is a fundamental skill for every emergency physician. This study was aim to compare the efficacy of remifentanil with fentanyl/midazolam in painless reduction of anterior shoulder dislocation. Method: In this randomized, double blind, clinical trial the procedural characteristics, patients’ satisfaction as well as adverse events were compared between fentanyl/midazolam and remifentanil for PSA of 18–64 years old patients, which were presented to ED following anterior shoulder dislocation. Results: 96 cases were randomly allocated to two groups (86.5% male). There were no significant difference between groups regarding baseline characteristics. Remifentanil group had lower duration of procedure (2.5 ± 1.6 versus 4.6 ± 1.8 minutes, p < 0.001), higher pain reduction (53.7 ± 13.3 versus 33.5 ± 19.6, p < 0.001), lower failure rate (1 (2.1%) versus 15 (31.3%), p < 0.001), higher satisfaction (p = 0.005). Adverse events were seen in 12 (25%) patients in midazolam/fentanyl and 8 (16.7%) cases in remifentanil group (p = 0.122). Conclusion: It seems that use of remifentanil resulted in lower procedural time, lower failure rate, and lower pain during procedure as well as higher patient satisfaction in comparison with midazolam/fentanyl combination in anterior shoulder dislocation. PMID:27274520

  15. Dislocated shoulder - aftercare

    MedlinePlus

    Shoulder dislocation - aftercare; Shoulder subluxation - aftercare; Shoulder reduction - aftercare ... You most likely dislocated your shoulder from a sports injury or accident, such as a fall. You have likely injured (stretched or torn) some of the muscles, ...

  16. Long-Lever-Arm Manipulation Under Anesthesia With Resultant Traumatic Anterior Shoulder Dislocation.

    PubMed

    Roubal, Paul J; Placzek, Jeffrey D

    2016-08-01

    The patient was a 61-year-old woman who underwent long-lever manipulation under anesthesia (MUA) for adhesive capsulitis. Two weeks following MUA, the constellation of clinical findings raised concern for possible adverse outcomes. Radiographs were obtained, as well as subsequent magnetic resonance imaging and computed tomography scans. Images revealed anterior shoulder dislocation with Bankart and Hill-Sachs lesions, and an anterior rotator cuff tear. J Orthop Sports Phys Ther 2016;46(8):707. doi:10.2519/jospt.2016.0412. PMID:27477474

  17. Dislocated shoulder - aftercare

    MedlinePlus

    Shoulder dislocation - aftercare; Shoulder subluxation - aftercare; Shoulder reduction - aftercare ... Horn AE, Ufberg JW. Management of common dislocations. In: ... Extremity 6th ed. Philadelphia, PA: ElsevierMosby; 2011:chap 92.

  18. [Pre-hospital treatment of an anterior shoulder dislocation: medico-legal concerns].

    PubMed

    Möhler, A; Arikan, H; Gris, M

    2015-01-01

    A man of 23 years, diabetic of type 1, shows a functional handicap of the right upper limb following a convulsion in the context of hypoglycemia. On arrival of the "S.A.M.U.", the physician diagnoses an anterior shoulder dislocation that he decides to reduce on the spot after analgesic treatment. The X-ray examination at the emergency shows a reduction of the dislocation as well as a fracture of the greater tuberosity. Has the fracture followed the convulsion or the reduction movement ? The absence of an X-ray examination before the reduction movement presents a forensic medical problem. Certain criteria mentioned in several studies would allow the reduction without X-ray before. However, these studies remain controversial. PMID:26749634

  19. Treating the initial anterior shoulder dislocation--an evidence-based medicine approach.

    PubMed

    Kuhn, John E

    2006-12-01

    This manuscript presents the best available evidence to answer questions regarding the treatment of the patient with an initial anterior shoulder dislocation. The highest levels of evidence available offer the following conclusions: (1) of the many methods to reduce the dislocated shoulder, little data exist to identify the best method. Recommendations are based on low levels of evidence (levels 4 and 5). (2) Premedication with intra-articular lidocaine has fewer complications and requires a shorter time in the emergency room than intravenous sedation with no detectable differences in reduction success rates (level 1). (3) Postreduction immobilization in external rotation may reduce recurrence (level 2), but immobilization in internal rotation does not (level 1). (4) Arthroscopic surgery significantly reduces recurrence compared to a nonoperative approach (level 1), and (5) there are limited data on features that would allow a safe return to play. Expert opinion suggests that return is allowed when motion and strength are nearly normal, and the athletes can engage in sport-specific activities, however, the athlete is at risk for recurrence while playing (levels 4 and 5). PMID:17135968

  20. Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit

    PubMed Central

    Chung, Hoejeong; Yoon, Yeo-Seung; Shin, Ji-Soo; Shin, John Junghun

    2016-01-01

    Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment. PMID:27583119

  1. Chronic Irreducible Anterior Dislocation of the Shoulder without Significant Functional Deficit.

    PubMed

    Chung, Hoejeong; Yoon, Yeo-Seung; Shin, Ji-Soo; Shin, John Junghun; Kim, Doosup

    2016-09-01

    Shoulder dislocation is frequently encountered by orthopedists, and closed manipulation is often sufficient to treat the injury in an acute setting. Although most dislocations are diagnosed and managed promptly, there are rare cases that are missed or neglected, leading to a chronically dislocated state of the joint. They are usually irreducible and cause considerable pain and functional disability in most affected patients, prompting the need to find a surgical method to reverse the worsening conditions caused by the dislocated joint. However, there are cases of even greater rarity in which chronic shoulder dislocations are asymptomatic with minimal functional or structural degeneration in the joint. These patients are usually left untreated, and most show good tolerance to their condition without developing disabling symptoms or significant functional loss over time. We report on one such patient who had a chronic shoulder dislocation for more than 2 years without receiving treatment. PMID:27583119

  2. Acute spontaneous atraumatic bilateral anterior dislocation of the shoulder joint with Hill-Sach’s lesions: A rare case

    PubMed Central

    Sachit, Malhan; Shekhar, Agarwal; Shekhar, Srivastav; joban, Singh Har

    2015-01-01

    Introduction: Late diagnoses of orthopedic injuries after epileptic crisis are a matter of concern. The rarity of correlation between seizure and specific trauma incidences such as bilateral anterior shoulder dislocation, may lead to improper estimation of the patient’s clinical state, wrong treatment and unpleasant complications. Case Report: We report a rare case of bilateral anterior shoulder dislocation associated with coracoid processes fracture after a seizure episode, in a young lady of 29 years. This is a rare event, however as patient is often disoriented after seizures, frequently this can be missed diagnosis. So this article puts emphasis on possibilities of rare diagnosis, which if treated promptly can lead to early restoration of complete movement. Conclusion: Although it is not a common problem, but one should have a high degree of suspicion and should always opt for further radiological examination if there is any doubt. PMID:27299022

  3. Acute spontaneous atraumatic bilateral anterior dislocation of the shoulder joint with Hill-Sachs lesions: first reported case and review of literature

    PubMed Central

    Manoharan, Gopikanthan; Singh, Rohit; Ahmed, Bessam; Kathuria, Vinod

    2014-01-01

    The anatomy of the shoulder joint comprises a relatively large humeral head with a shallow glenoid cavity allowing a remarkable range of motion at the expense of inherent instability. Despite anterior shoulder dislocations being the most common type encountered, bilateral dislocations are rare and almost always posterior. The aetiology is usually direct or indirect trauma related to sports, seizures, electric shock or electroconvulsive therapy. We present the first reported case of atraumatic bilateral acute anterior shoulder dislocations with associated Hill-Sachs lesions in a young, fit and well patient with no comorbidities. MRI illustrated the Hill-Sachs lesions with superior labral tear from anterior to posterior, and confirmed the acute nature of the injury by demonstrating the bone marrow oedema. The patient was treated surgically with arthroscopic anterior stabilisation. At 6 months following surgery, the patient has a pain free full range of movement of both shoulders with no further dislocations and has returned to work. PMID:24895390

  4. Evaluation of the results and complications of the Latarjet procedure for recurrent anterior dislocation of the shoulder

    PubMed Central

    da Silva, Luciana Andrade; da Costa Lima, Álvaro Gonçalves; Kautsky, Raul Meyer; Santos, Pedro Doneux; do Val Sella, Guilherme; Checchia, Sergio Luiz

    2015-01-01

    Objective Evaluate the results and complications of Latarjet procedure in patients with anterior recurrent dislocation of the shoulder. Methods Fifty-one patients (52 shoulders) with anterior recurrent dislocation, surgically treated by Latarjet procedure, were analyzed retrospectively. The average follow-up time was 22 months, range 12–66 months; The age range was 15–59 years with a mean of 31; regarding sex, 42 (82.4%) patients were male and nine (17.6%) were female. The dominant side was affected in 29 (55.8%) shoulders. Regarding the etiology, 48 (92.3%) reported trauma and four (7.6%) had the first episode after a convulsion. Results The average elevation, lateral rotation and medial rotation of the operated shoulder were, respectively, 146° (60–80°), 59° (0–85°) and T8 (T5 gluteus), with statistical significance for decreased range of motion in all planes, compared with the other side. The scores of Rowe and UCLA were 90.6 and 31.4, respectively, in the postoperative period. Eleven shoulders (21.2%) had poor results: signs of instability (13.4%), non-union (11.5%) and early loosening of the synthesis material (1.9%). There was a correlation between poor results and convulsive patients (p = 0.026). Conclusion We conclude that the Latarjet procedure for correction of anterior recurrent dislocation leads to good and excellent results in 82.7% of cases. Complications are related to errors in technique. PMID:27218076

  5. Patient Participation Approach to Reduction of Anterior Shoulder Dislocation: P-R-I-M/O-Y-E-S.

    PubMed

    Lachance, Paul-André; Taieb-Lachance, Catherine Isabelle

    2016-07-01

    A variety of successful techniques are available for reduction of shoulder dislocation; none have been shown to be clearly superior to another. Analgesic methods vary as well from none to deep sedation-analgesia. The literature hints at the importance of optimal muscle relaxation as a factor of success. Yet, the literature describes only cursorily the means by which muscle relaxation is optimized. Patient-centered participation and relaxation methods have been used in other contexts to reduce pain, anxiety, and muscle tension. This article proposes to integrate a patient-centered participation approach to the reduction of anterior shoulder dislocation as a way to optimize muscular relaxation nonpharmacologically. It can be used in the field in combination with the practitioner's reduction technique of choice. It minimizes risks because it entails no deep pharmacological sedation. The mnemonic P-R-I-M/O-Y-E-S is used to respectively represent the four phases: Preparation, Rehearsal, Intervention, and Mobilization as well as the 4 repeated steps in each phase of the procedure: Observe, Yield control, Explain, and Support. The focus is on (1) securing optimal patient participation within a patient-centered approach and (2) achieving nonpharmacological muscular relaxation through a simple relaxation routine. More studies are needed to identify the factors that determine success and guide the practitioner's choice among available options in shoulder dislocation reductions. PMID:26584435

  6. Outcome of modified Bristow-Laterjet procedure in post-traumatic recurrent anterior shoulder dislocation in young population.

    PubMed

    Sakeb, N; Islam, M A; Jannat, S N

    2015-01-01

    Anterior shoulder dislocation (ASD) is a common injury of young population which may progress to recurrent episodes. The treatment is initially conservative but surgery is indicated when it fails. Out of more than 150 techniques, modified Bristow-Latarjet procedure has become most favorable even to arthroscopic techniques. We have intended to retrospectively assess the outcome of it in post-traumatic recurrent ASD of young non-athletes, performed at our different private settings between January 2007 and July 2012; which included 15 male patients of 20-39 years with minimum 2 years follow up. Clinical, functional, radiological and overall outcome status were evaluated. There was significant improvement of shoulder stability (p<0.05, chi-square test) despite significant deterioration (p<0.05, paired t-test) of external rotation (21.67°±00.61° loss). The patient self assessed pain and instability had highly significant (p<0.001, paired t-test) and all components of activities of daily living (except above shoulder weight carrying and overhead throwing) had significant improvement (p<0.05, paired t-test). Despite of intra-operative difficulties, radiological transplant errors (33.33%) and post-operative complications (06.67%), overall satisfactory outcome (86.67%) had been significant (p<0.05, chi-square test). PMID:25725671

  7. Proximal coracobrachialis tendon rupture, subscapularis tendon rupture, and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation.

    PubMed

    Saltzman, Bryan M; Harris, Joshua D; Forsythe, Brian

    2015-01-01

    Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160° of active forward elevation, 45° of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5. PMID:25937715

  8. Proximal coracobrachialis tendon rupture, subscapularis tendon rupture, and medial dislocation of the long head of the biceps tendon in an adult after traumatic anterior shoulder dislocation

    PubMed Central

    Saltzman, Bryan M.; Harris, Joshua D.; Forsythe, Brian

    2015-01-01

    Rupture of the coracobrachialis is a rare entity, in isolation or in combination with other muscular or tendinous structures. When described, it is often a result of direct trauma to the anatomic area resulting in rupture of the muscle belly. The authors present a case of a 57-year-old female who suffered a proximal coracobrachialis tendon rupture from its origin at the coracoid process, with concomitant subscapularis tear and medial dislocation of the long head of biceps tendon after first time traumatic anterior shoulder dislocation. Two weeks after injury, magnetic resonance imaging suggested the diagnosis, which was confirmed during combined arthroscopic and open technique. Soft-tissue tenodesis of coracobrachialis to the intact short head of the biceps, tenodesis of the long head of biceps to the intertubercular groove, and double-row anatomic repair of the subscapularis were performed. The patient did well postoperatively, and ultimately at 6 months follow-up, she was without pain, and obtained 160° of active forward elevation, 45° of external rotation, internal rotation to T8, 5/5 subscapularis and biceps strength. Scoring scales had improved from the following preoperative to final follow-up: American Shoulder and Elbow Surgeons, 53.33-98.33; constant, 10-100; visual analogue scale-pain, 4-0. DASH score was 5. PMID:25937715

  9. BILATERAL ANTERIOR GLENOHUMERAL DISLOCATION: CLINICAL CASE

    PubMed Central

    Silva, Luís Pires; Sousa, Cristina Varino; Rodrigues, Elisa; Alpoim, Bruno; Leal, Miguel

    2015-01-01

    Bilateral anterior glenohumeral dislocation is a rare occurrence. We present a case of bilateral anterior glenohumeral dislocation caused by a fall. The interest in publishing this case is that this is a clinical rarity with few cases reported in the literature. An 89-year-old female patient was brought to the emergency department after a fall, complaining of intense pain in both shoulders and inability to move them. Objective examination showed clinical signs giving the suspicion of bilateral anterior glenohumeral dislocation, which was confirmed by x-ray imaging. Both dislocations were successfully reduced in the emergency department using the modified Milch technique. When a synchronous and symmetrical force has acted on both shoulders and these are painful with significant functional limitation, the suspicion of bilateral glenohumeral dislocation is a differential diagnosis to be considered, even though it is rare. PMID:27047826

  10. Concept of healing of recurrent shoulder dislocation.

    PubMed

    D'Angelo, Donato

    2014-01-01

    This paper presents the main surgical techniques applied in the treatment of anterior recurrent shoulder dislocation, aiming the achievement of the normality of articulate movements. This was obtained by combining distinct surgical procedures, which allowed the recovery of a complete functional capacity of the shoulder, without jeopardizing the normality of movement, something that has not been recorded in the case of the tense sutures of the surgical procedures of Putti-Platt, Bankart, Latarjet, Dickson-O'Dell and others. The careful review of the methods applied supports the conclusion that recurrent shoulder dislocation can be cured, since cure has been obtained in 97% of the treated cases. However, some degree of limitation in the shoulder movement has been observed in most of the treated cases. Our main goal was to achieve a complete shoulder functional recovery, by treating simultaneously all of the anatomical-pathological lesions, without considering the so-called essential lesions. The period of post-operatory immobilization only last for the healing of soft parts; this takes place in a position of neutral shoulder rotation, since the use of vascular bone graft eliminates the need for long time immobilization, due to the shoulder stabilization provided by rigid fixation of the coracoid at the glenoid edge, as in the Latarjet's technique. Our procedure, used since 1959, comprises the association of several techniques, which has permitted shoulder healing without movement limitation. That was because of the tension reduction in the sutures of the subescapularis, capsule, and coracobraquialis muscles. PMID:26229839

  11. Low-Cost Alternative External Rotation Shoulder Brace and Review of Treatment in Acute Shoulder Dislocations

    PubMed Central

    Lacy, Kyle; Cooke, Chris; Cooke, Pat; Schupbach, Justin; Vaidya, Rahul

    2015-01-01

    Traumatic dislocations of the shoulder commonly present to emergency departments (EDs). Immediate closed reduction of both anterior and posterior glenohumeral dislocations is recommended and is frequently performed in the ED. Recurrence of dislocation is common, as anteroinferior labral tears (Bankart lesions) are present in many anterior shoulder dislocations.14,15,18,23 Immobilization of the shoulder following closed reduction is therefore recommended; previous studies support the use of immobilization with the shoulder in a position of external rotation, for both anterior and posterior shoulder dislocations.7–11,19 In this study, we present a technique for assembling a low-cost external rotation shoulder brace using materials found in most hospitals: cotton roll, stockinette, and shoulder immobilizers. This brace is particularly suited for the uninsured patient, who lacks the financial resources to pay for a pre-fabricated brace out of pocket. We also performed a cost analysis for our low-cost external rotation shoulder brace, and a cost comparison with pre-fabricated brand name braces. At our institution, the total materials cost for our brace was $19.15. The cost of a pre-fabricated shoulder brace at our institution is $150 with markup, which is reimbursed on average at $50.40 according to our hospital billing data. The low-cost external rotation shoulder brace is therefore a more affordable option for the uninsured patient presenting with acute shoulder dislocation. PMID:25671019

  12. Evaluation of functional results from shoulders after arthroscopic repair of complete rotator cuff tears associated with traumatic anterior dislocation

    PubMed Central

    Godinho, Glaydson Gomes; Freitas, José Márcio Alves; de Oliveira França, Flávio; Santos, Flávio Márcio Lago; de Simoni, Leandro Furtado; Godinho, Pedro Couto

    2016-01-01

    Objective To evaluate the clinical outcome of arthroscopic rotator cuff fixation and, when present, simultaneous repair of the Bankart lesion caused by traumatic dislocation; and to assess whether the size of the rotator cuff injury caused by traumatic dislocation has any influence on the postoperative clinical outcomes. Methods Thirty-three patients with traumatic shoulder dislocation and complete rotator cuff injury, with at least two years of follow up, were retrospectively evaluated. For analysis purposes, the patients were divided into groups: presence of fixed Bankart lesion or absence of this lesion, and rotator cuff lesions smaller than 3.0 cm (group A) or greater than or equal to 3.0 cm (group B). All the patients underwent arthroscopic repair of the lesions and were evaluated postoperatively by means of the UCLA (University of California at Los Angeles) score and strength measurements. Results The group with Bankart lesion repair had a postoperative UCLA score of 33.96, while the score of the group without Bankart lesion was 33.7, without statistical significance (p = 0.743). Group A had a postoperative UCLA score of 34.35 and group B, 33.15, without statistical significance (p = 0.416). Conclusion The functional outcomes of the patients who only presented complete rotator cuff tearing after traumatic shoulder dislocation, which underwent arthroscopic repair, were similar to the outcomes of those who presented an associated with a Bankart lesion that was corrected simultaneously with the rotator cuff injury. The extent of the original rotator cuff injury did not alter the functional results in the postoperative evaluation. PMID:27069884

  13. Simultaneous shoulder and elbow dislocation

    PubMed Central

    Çobanoğlu, Mutlu; Yumrukcal, Feridun; Karataş, Cengiz; Duygun, Fatih

    2014-01-01

    Ipsilateral shoulder and elbow dislocation is very rare and only six articles are present in the literature mentioning this kind of a complex injury. With this presentation we aim to emphasise the importance of assessing the adjacent joints in patients with trauma in order not to miss any accompanying pathologies. We report a case of a 43-year-old female patient with ipsilateral right shoulder and elbow dislocation treated conservatively. The patient reported elbow pain when first admitted to emergency service but she was diagnosed with simultaneous ipsilateral shoulder and elbow injury and treated conservatively. As a more painful pathology may mask the additional ones, one should hasten to help before performing a complete evaluation. Any harm caused to the patient due to this reason would not be a complication but a malpractice. PMID:24859563

  14. Atraumatic Bilateral Neglected Anterior Shoulder Dislocation: Case Report of a Jehovah’s Witness 28-Year-Old Male Affected by Iron-Deficiency Anemia and Treated with Bilateral Latarjet Procedure

    PubMed Central

    Poggetti, Andrea; Castellini, Iacopo; Neri, Elisabetta; Marchettil, Stefano; Lisanti, Michele

    2015-01-01

    Introduction: Neglected bilateral anterior shoulder dislocation is a very rare condition, often related to seizures or major trauma. Open reduction is recommended whenever Hill-Sachs lesion is >25% of the joint and the dislocation is elder than 3 weeks. Case Report: We describe a case report of a 28-year-old man left handed Jehovah’s Witness laborer assessed 12 weeks after bilateral anterior shoulder dislocation. The patient was evaluated with clinical examination, and it was observed an asymptomatic intrarotation of both shoulders with a mild left circumflex nerve deficit. He was able to perform flexion and abduction of both arms up to 60° and 10° of extrarotation. Pre-operative constant scores were 49 in left and 55 in right shoulder, pre-operative disabilities of the arm, shoulder, and hand (DASH) scores were 57 in left and 53 in right shoulder, and visual analogue scales (VAS) was 2. Radiological examination were bilateral anteroposterior shoulder X-rays and computer tomography scan. The surgeon treated both shoulder (not simultaneously) by open reduction and Bristow-Latarjet coracoids transfer procedure. A 1 year after operations, left flexion was 180° while right was 160, bilateral abduction was 180. He was able to return to his pre-injury activities, the constant score was 89 left and 83 right, DASH score was 17 left and 13 right and VAS was 0. Conclusion: Atraumatic bilateral neglected anterior shoulder dislocation can be treated with open Bristow-Latarjet procedure to provide a stable glenohumeral joint in laborer patient and permit a return to the pre-injury activities, to create a greater extension of the glenoid arc and to avoid future dislocation. PMID:27299079

  15. PREVALENCE OF LESIONS ASSOCIATED WITH TRAUMATIC RECURRENT SHOULDER DISLOCATION

    PubMed Central

    Carrazzone, Oreste Lemos; Tamaoki, Marcel Jun Sugawara; Ambra, Luiz Felipe Morlin; Neto, Nicola Archetti; Matsumoto, Marcelo Hide; Belloti, João Carlos

    2015-01-01

    Objective: To evaluate the prevalence of lesions associated with traumatic anterior shoulder instability and the relationships between the prevalence of these lesions and the number of episodes and time since symptoms started. Method: Fifty-seven patients aged 18 to 40 years, with traumatic anterior shoulder instability, more than one episode of shoulder dislocation and at least six months since the first dislocation, who required surgery to treat the instability, were selected. Arthroscopic inspection was performed on all the patients to assess any associated lesions. Results: The prevalence of lesions was assessed, and Bankart lesions were the most prevalent, followed by Hill-Sachs lesions, while rotator cuff injuries were the least prevalent. There was no correlation from comparison between the number of episodes of dislocation and the prevalence of associated lesions. On the other hand, in relation to the time since symptoms started, the patients who had had symptoms for longer times had fewer Hill-Sachs lesions. Conclusion: It was not possible to affirm that, in patients with chronic shoulder instability, the numbers of associated lesions increased with the time since symptoms started, or with the number of episodes of dislocation. PMID:27027020

  16. The management of bilateral posterior fracture dislocations of the shoulder: a case series illustrating management options

    PubMed Central

    Robinson, Peter W; Packham, Iain; Crowther, Mark

    2016-01-01

    Background Although dislocation of the shoulder is a relatively common event, the overwhelming majority of injuries are anterior. Posterior shoulder dislocation is more uncommon, comprising between 3% and 5% of all shoulder dislocations. One percent of shoulder dislocations involve a fracture, whereas only 0.9% of the 1500 cases reported by Neer (J Bone Joint Surg Am 1970; 52:1077–89; J Bone Joint Surg Am 1970; 52:1090–103) concerned posterior fracture dislocations. Bilateral posterior fracture dislocation is an even rarer event, comprising just 5% of all posterior fracture dislocations. Given the rarity and relative poor outcome often observed after these severe injuries, it is important that upper limb function is optimized. Methods Bilateral posterior fracture dislocations of the shoulder pose a difficult clinical challenge that requires careful management planning. To date, there have been three isolated case reports of using contralateral osteochondral humeral autograft and hemiarthroplasty. We report our experiences and clinical outcomes in managing four such cases using a variety and combination of treatments, including the first reported use of reverse shoulder arthroplasty with contralateral osteochondral humeral autografting. Results Shoulders reconstructed with humeral autograft demonstrated superior Oxford Shoulder Scores and an improved range of motion, as measured by a markerless machine vision system, compared to hemiarthroplasty. Conclusions Our results support the use of a contralateral humeral autograft in bilateral posterior shoulder fracture dislocation.

  17. Atraumatic Anterior Dislocation of the Hip Joint

    PubMed Central

    Ohtsuru, Tadahiko; Morita, Yasuyuki; Murata, Yasuaki; Itou, Junya; Morita, Yuji; Munakata, Yutaro; Kato, Yoshiharu

    2015-01-01

    Dislocation of the hip joint in adults is usually caused by high-energy trauma such as road traffic accidents or falls from heights. Posterior dislocation is observed in most cases. However, atraumatic anterior dislocation of the hip joint is extremely rare. We present a case of atraumatic anterior dislocation of the hip joint that was induced by an activity of daily living. The possible causes of this dislocation were anterior capsule insufficiency due to developmental dysplasia of the hip, posterior pelvic tilt following thoracolumbar kyphosis due to vertebral fracture, and acetabular anterior coverage changes by postural factor. Acetabular anterior coverage changes in the sagittal plane were measured using a tomosynthesis imaging system. This system was useful for elucidation of the dislocation mechanism in the present case. PMID:26819791

  18. Enlargement of Glenoid Defects in Traumatic Anterior Shoulder Instability

    PubMed Central

    Nakagawa, Shigeto; Ozaki, Ritsuro; Take, Yasuhiro; Mizuno, Naoko; Mae, Tatsuo

    2014-01-01

    Background: Large glenoid rim defects in patients with traumatic anterior shoulder instability are often regarded as a contraindication for arthroscopic Bankart repair, with a defect of 20% to 27% considered as the critical size. While recurrence of dislocations, male sex, and collision sports were reported to be the significant factors influencing large glenoid defects, the influences of subluxations and more detailed types of sports were not investigated. Purpose: To investigate the influence of the number of dislocations and subluxations and type of sport on the occurrence and size of glenoid defects in detail. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 223 shoulders (60 with primary instability, 163 with recurrent instability) were prospectively examined by computed tomography. Glenoid rim morphology was compared between primary and recurrent instability. In patients with recurrent instability, the relationship between the glenoid defect and the number of dislocations and subluxations was investigated. In addition, glenoid defects were compared among 49 male American football players, 41 male rugby players, 27 male baseball players, and 25 female athletes. Results: The mean extent of the glenoid defect was 3.5% in shoulders with primary instability and 11.3% in those with recurrent instability. A glenoid defect was detected in 108 shoulders (66.2%) with recurrent instability versus 12 shoulders (20%) with primary instability. Regarding the influence of the total number of dislocations/subluxations, the average extent of the glenoid defect was 6.3% in 85 shoulders with 2 to 5 events, 12.9% in 34 shoulders with 6 to 10 events, and 19.6% in 44 shoulders with 11 or more events. The glenoid defect became significantly larger along with an increasing number of recurrences. Although recurrent subluxation without dislocation also influenced the glenoid defect size, the number of dislocations did not. The average extent of the glenoid

  19. Anterior capsulolabral reconstruction of the shoulder in athletes.

    PubMed

    Rubenstein, D L; Jobe, F W; Glousman, R E; Kvitne, R S; Pink, M; Giangarra, C E

    1992-09-01

    We did an anterior capsulolabral reconstruction for recurrent subluxation or dislocation of the shoulder in 75 athletes after failure of conservative therapy. Average follow-up was 39 months (range 28 to 60 months). The results were 77% excellent, 75% good, 3% fair, and 5% poor. Seventy-five percent of the professional and 100% of the college baseball players returned to their previous level of competition. Seventy-seven percent of the professional pitchers were able to return to professional pitching. The range of motion at follow-up was full in 79% of the athletes. No infections or nerve injuries occurred. The anterior capsulolabral reconstruction procedure combined with an early rehabilitation program appears to provide an improved outcome compared with previously reported procedures for anterior instability of the shoulder in athletes. PMID:22959195

  20. Treatment of chronic anterior locked glenohumeral dislocation with hemiarthroplasty

    PubMed Central

    Nicolas, Andrea Pujol; Liow, Raymond

    2014-01-01

    Restoring good shoulder function in an active patient with a chronic anterior locked dislocation of the glenohumeral joint can be challenging. This case report describes a 58-year-old active patient who presented with a very late missed locked anterior dislocation of the glenohumeral joint. He had coexisting large bony defects in the anterior glenoid and humeral head with resultant loss of motion and pain secondary to glenohumeral arthrosis. He underwent a humeral hemiarthroplasty, glenoid structural bone grafting, glenoid biological resurfacing and reinforcement of anterior capsule with the graft jacket to achieve a pain-free, stable, mobile joint with good range of movements and function. The clinical decision-making process and the surgical technique used in the management of this difficult condition are discussed.

  1. Asymmetrical Fracture Dislocation of Shoulder – A Case Report and Review of Literature

    PubMed Central

    Sharma, Deep; M, Karthikeyan; R, Natraj A; Poduval, Murali; Patro, D K

    2013-01-01

    Introduction: A bilateral shoulder dislocation is an extremely rare injury with only a few reported cases in English literature, and most of these cases have occurred following a seizure episode or an electric shock. We present the first ever reported case of simultaneous bilateral anterior and posterior fracture dislocation of shoulders and its unique mechanism of injury in a 48 year old diabetic male. Case Report: A 48 year old male presented to our emergency department with pain and restriction of movements involving both shoulders following a fall. The patient was standing by the side of a two wheeler when he had a sudden syncopal attack and toppled on the other side of the vehicle. On examination there was flattening of deltoid contour with a positive Dugas test in both sides. Humeral head was palpable posteriorly on the right side and anteriorly on the left side. Plain radiograph anteroposterior view of both shoulders showed posterior dislocation of right shoulder with a fracture of greater tuberosity and anterior dislocation of left shoulder with a greater tuberosity fracture. Closed reduction was achieved for both shoulders under general anaesthesia. After a couple of weeks, complete range of motion exercises was started. X-ray of bilateral shoulders, at 3 months, showed complete union of the fracture. Conclusion: Bilateral shoulder dislocation is suspected only following a violent mechanism of injury, however, we would like to point out, giving an example of our case that this injury may also occur after a trivial fall. And if associated with a fracture sometimes, the characteristic attitude of the limb may not be seen leading to a missed diagnosis. However a thorough clinical examination and the knowledge that such injuries may occur after a simple fall will help prevent missing these injuries. PMID:27298925

  2. Nocturnal seizure and simultaneous bilateral shoulder fracture-dislocation.

    PubMed

    Sahbudin, Ilfita; Filer, Andrew

    2016-01-01

    An otherwise fit and well 27-year-old man presented with acute onset unexplained bilateral shoulder pain, and was found to have bilateral shoulder fractures and dislocations on imaging. Although features were atypical, a nocturnal seizure causing the bilateral shoulder fractures was suspected and EEG showed features compatible with epilepsy. PMID:26838296

  3. Pilot Study to Determine Accuracy of Posterior Approach Ultrasound for Shoulder Dislocation by Novice Sonographers

    PubMed Central

    Lahham, Shadi; Becker, Brent; Chiem, Alan; Joseph, Linda M.; Anderson, Craig L.; Wilson, Sean P.; Subeh, Mohammad; Trinh, Alex; Viquez, Eric; Fox, John C.

    2016-01-01

    Introduction The goal of this study was to investigate the efficacy of diagnosing shoulder dislocation using a single-view, posterior approach point-of-care ultrasound (POCUS) performed by undergraduate research students, and to establish the range of measured distance that discriminates dislocated shoulder from normal. Methods We enrolled a prospective, convenience sample of adult patients presenting to the emergency department with acute shoulder pain following injury. Patients underwent ultrasonographic evaluation of possible shoulder dislocation comprising a single transverse view of the posterior shoulder and assessment of the relative positioning of the glenoid fossa and the humeral head. The sonographic measurement of the distance between these two anatomic structures was termed the Glenohumeral Separation Distance (GhSD). A positive GhSD represented a posterior position of the glenoid rim relative to the humeral head and a negative GhSD value represented an anterior position of the glenoid rim relative to the humeral head. We compared ultrasound (US) findings to conventional radiography to determine the optimum GhSD cutoff for the diagnosis of shoulder dislocation. Sensitivity, specificity, positive predictive value, and negative predictive value of the derived US method were calculated. Results A total of 84 patients were enrolled and 19 (22.6%) demonstrated shoulder dislocation on conventional radiography, all of which were anterior. All confirmed dislocations had a negative measurement of the GhSD, while all patients with normal anatomic position had GhSD>0. This value represents an optimum GhSD cutoff of 0 for the diagnosis of (anterior) shoulder dislocation. This method demonstrated a sensitivity of 100% (95% CI [82.4–100]), specificity of 100% (95% CI [94.5–100]), positive predictive value of 100% (95% CI [82.4–100]), and negative predictive value of 100% (95% CI [94.5–100]). Conclusion Our study suggests that a single, posterior

  4. Bilateral posterior shoulder dislocation after electrical shock: A case report

    PubMed Central

    Ketenci, Ismail Emre; Duymus, Tahir Mutlu; Ulusoy, Ayhan; Yanik, Hakan Serhat; Mutlu, Serhat; Durakbasa, Mehmet Oguz

    2015-01-01

    Introduction Posterior dislocation of the shoulder is a rare and commonly missed injury. Unilateral dislocations occur mostly due to trauma. Bilateral posterior shoulder dislocations are even more rare and result mainly from epileptic seizures. Electrical injury is a rare cause of posterior shoulder dislocation. Injury mechanism in electrical injury is similar to epileptic seizures, where the shoulder is forced to internal rotation, flexion and adduction. Presentation of case This report presents a case of bilateral posterior shoulder dislocation after electrical shock. We were able to find a few individual case reports describing this condition. The case was acute and humeral head impression defects were minor. Our treatment in this case consisted of closed reduction under general anesthesia and applying of orthoses which kept the shoulders in abduction and external rotation. A rehabilitation program was begun after 3 weeks of immobilization. After 6 months of injury the patient has returned to work. 20 months postoperatively, at final follow-up, he was painless and capable of performing all of his daily activities. Discussion The amount of bilateral shoulder dislocations after electrical injury is not reported but is known to be very rare. The aim of this case presentation is to report an example for this rare entity, highlight the difficulties in diagnosis and review the treatment options. Conclusion Physical examination and radiographic evaluation are important for quick and accurate diagnosis. PMID:26904192

  5. Anterior Shoulder Instability with Concomitant Superior Labrum from Anterior to Posterior (SLAP) Lesion Compared to Anterior Instability without SLAP Lesion

    PubMed Central

    Durban, Claire Marie C.; Kim, Je Kyun; Kim, Sae Hoon

    2016-01-01

    Background The aims of this study were to investigate the clinical characteristics of patients with combined anterior instability and superior labrum from anterior to posterior (SLAP) lesions, and to analyze the effect of concomitant SLAP repair on surgical outcomes. Methods We retrospectively reviewed patients who underwent arthroscopic stabilization for anterior shoulder instability between January 2004 and March 2013. A total of 120 patients were available for at least 1-year follow-up. Forty-four patients with reparable concomitant detached SLAP lesions (group I) underwent combined SLAP and anterior stabilization, and 76 patients without SLAP lesions (group II) underwent anterior stabilization alone. Patient characteristics, preoperative and postoperative pain scores, Rowe scores, and shoulder ranges of motion were compared between the 2 groups. Results Patients in group I had higher incidences of high-energy trauma (p = 0.03), worse preoperative pain visual analogue scale (VAS) (p = 0.02), and Rowe scores (p = 0.04). The postoperative pain VAS and Rowe scores improved equally in both groups without significant differences. Limitation in postoperative range of motion was similar between the groups (all p-value > 0.05). Conclusions Anterior instability with SLAP lesion may not be related to frequent episodes of dislocation but rather to a high-energy trauma. SLAP fixation with anterior stabilization procedures did not lead to poor functional outcomes if appropriate surgical techniques were followed. PMID:27247742

  6. Chronic unreduced shoulder dislocations: Experience in a developing country trauma centre.

    PubMed

    Babalola, Oladimeji Ranti; Vrgoč, Goran; Idowu, Oluwaseyi; Sindik, Joško; Čoklo, Miran; Marinović, Marin; Bakota, Bore

    2015-11-01

    Chronic shoulder dislocations are extremely rare. The goal of this retrospective study was to describe the epidemiology of chronic shoulder dislocation in our environment and to evaluate the outcome of treatment. Bio-demographic data and injury details were retrieved from case files. Definitive method of reduction and stabilisation and duration of follow-up care were also noted. Nine cases of subcoracoid anterior chronic shoulder dislocation were seen during the 6-year period of the study. Seven (78%) of these patients were male and two (22%) were female. The mean age was 42 (±17.5) years. The common mechanisms of injury were road traffic crash in four patients (44%), domestic falls in four patients (44%) and dislocation while getting out of bed in one patient (12%). None of the patients had neurovascular deficit at presentation. Five patients were managed operatively and four were managed non-operatively. Mean follow-up was 8 months (range 6-12 months). Clinical evaluation by Rowe shoulder score revealed that operated cases had significantly higher mean rank scores than non-operated cases using the Mann-Whitney U test. Two operated cases were graded fair and three poor. All cases managed non-operatively had poor outcome grades. Meticulous attempt at soft tissue repair and early supervised physiotherapy can contribute to a favourable outcome. PMID:26573898

  7. latrogenic fracture of humerus – complication of a diagnostic error in a shoulder dislocation: a case report

    PubMed Central

    Ahmad, Riaz; Ahmed, Shahbaz; Bould, Michael

    2007-01-01

    Shoulder dislocation is the commonest dislocation presenting to the emergency department, anterior being more common than posterior. The latter being less common has a tendency of being missed; this is supported by many cases in the literature. Kocher's method is one of the many methods of reducing anterior dislocation; there are many reported complications of employing this method. To the best of our knowledge we are reporting the first case of an iatrogenic fracture of the proximal humerus, due to the use of Kocher's method of shoulder reduction in a posterior dislocation following a diagnostic error which led to an avoidable difficult surgical intervention. We also discuss the mechanism of the iatrogenic fracture and the measures that can be undertaken to prevent it. PMID:17605806

  8. Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder Instabilities.

    PubMed

    Field, Larry D; Ryu, Richard K N; Abrams, Jeffrey S; Provencher, Matthew

    2016-01-01

    Arthroscopic shoulder stabilization offers several potential advantages compared with open surgery, including the opportunity to more accurately evaluate the glenohumeral joint at the time of diagnostic assessment; comprehensively address multiple pathologic lesions that may be identified; and avoid potential complications unique to open stabilization, such as postoperative subscapularis failure. A thorough understanding of normal shoulder anatomy and biomechanics, along with the pathoanatomy responsible for anterior, posterior, and multidirectional shoulder instability patterns, is very important in the management of patients who have shoulder instability. The treating physician also must be familiar with diagnostic imaging and physical examination maneuvers that are required to accurately diagnose shoulder instability. PMID:27049209

  9. Posterior shoulder pain and anterior instability: a preliminary clinical study.

    PubMed

    Castagna, Alessandro; Conti, Marco; Borroni, Mario; Massazza, Giuseppe; Vinci, Enzo; Franceschi, Giorgio; Garofalo, Raffaele

    2008-02-01

    Different clinical tests have been suggested in the literature as significant indicators of anterior shoulder instability. Sometimes patients with recurrent anterior shoulder instability may show some muscular guarding thus making the evaluation of specific clinical tests very difficult. These patients may also report a medical history with posterior shoulder pain that can be also elicited during some clinical manoeuvres. From September 2005 to September 2006 we prospectively studied patients who underwent an arthroscopic anterior capsuloplasty. Shoulder clinical examination was performed including anterior shoulder instability tests (drawer, apprehension and relocation tests). Furthermore the exam was focused on the presence of scapular dyskinesia and posterior shoulder pain. The patients were also evaluated with ASES, Rowe, SST (Simple Shoulder Test), Constant and UCLA (University of California at Los Angeles) scoring system preoperatively and at the latest follow-up time. In the period of this study we observed 16 patients treated for anterior gleno-humeral arthroscopic stabilisation, who preoperatively complained also of a posterior scapular pain. The pain was referred at the level of lower trapezium and upper rhomboids tendon insertion on the medial border of the scapula. It was also reproducible upon local palpation by the examiner. Four of these patients also referred pain in the region of the insertion of the infraspinatus and teres minor. After arthroscopic stabilisation the shoulder was immobilised in a sling with the arm in the neutral rotation for a period of 4 weeks. A single physician supervised shoulder rehabilitation. After a mean time of 6.8 months of follow-up, all the shoulder scores were significantly improved and, moreover, at the same time the patients referred the disappearance of the posterior pain. Posterior scapular shoulder pain seems to be another complaint and sign that can be found in patients affected by anterior shoulder instability

  10. Evaluation of propofol and remifentanil for intravenous sedation for reducing shoulder dislocations in the emergency department

    PubMed Central

    Dunn, M J G; Mitchell, R; De Souza, C; Drummond, G

    2006-01-01

    Objectives To assess the combination of propofol and remifentanil for sedation to reduce shoulder dislocations in an ED. Methods Eleven patients with anterior glenohumeral dislocation were given propofol 0.5 mg/kg and remifentanil 0.5 μg/kg iv over 90 seconds and then further doses of 0.25 mg/kg and 0.25μg/kg, respectively, if needed. Another practitioner attempted reduction using the Milch technique. Results Reduction was achieved in all patients within four minutes of giving sedation (range 0.3–4; mean 1.6). Seven required one attempt at shoulder reduction, three required two attempts, and one required three attempts. Mean time to recovery of alert status was three minutes (range 1–6). The mean pain score during the reduction was 1.7 out of 10 (range 0–5). Nine patients had full recall, one had partial recall, and one had no recall at all. Eight patients were “very satisfied” with the sedation and three were “satisfied”. There were no respiratory or haemodynamic complications that required treatment. Conclusions Propofol and remifentanil provide excellent sedation and analgesia for the reduction of anterior glenohumeral dislocation, enabling rapid recovery. PMID:16373806

  11. Neglected Bilateral Posterior Shoulder Fracture Dislocation in an Uncontrolled Seizure patient.

    PubMed

    Amir, Moaath A; Alenazi, Bashir; Wyse, Richard K H; Tamimi, Waleed; Kujan, Omar; Khan, Tajdar; Alenzi, Faris Q

    2015-01-01

    Posterior dislocation of the shoulder is a rare injury that occurs secondary to trauma and seizures. Diagnosis is often missed and treatment is challenging. Neglected posterior dislocation is associated with Hill-Sachs lesion which leads to locking of dislocation. Correct diagnosis is achieved by history taking, a physical examination and appropriate imaging. In neglected shoulder dislocation with uncontrolled seizure and humeral head defects of up to 45% the McLaughlin procedure shows excellent results at follow-up. PMID:26430452

  12. Neglected Bilateral Posterior Shoulder Fracture Dislocation in an Uncontrolled Seizure patient

    PubMed Central

    Amir, Moaath A.; Alenazi, Bashir; Wyse, Richard K.H.; Tamimi, Waleed; Kujan, Omar; Khan, Tajdar; Alenzi, Faris Q.

    2015-01-01

    Posterior dislocation of the shoulder is a rare injury that occurs secondary to trauma and seizures. Diagnosis is often missed and treatment is challenging. Neglected posterior dislocation is associated with Hill-Sachs lesion which leads to locking of dislocation. Correct diagnosis is achieved by history taking, a physical examination and appropriate imaging. In neglected shoulder dislocation with uncontrolled seizure and humeral head defects of up to 45% the McLaughlin procedure shows excellent results at follow-up. PMID:26430452

  13. A Case of Bilateral Anterior Gleno-Humeral Dislocation following First Time Seizure

    PubMed Central

    Wheelton, Andrew; Dowen, Daniel

    2015-01-01

    Introduction: Bilateral anterior shoulder dislocation following a seizure has recently been demonstrated as being more common than previously believed with 44 cases in the literature. This case is unique as it was caused by a first time seizure and there was no associated fracture of the humerus. Case Report: A previously fit and well 32 year old man presented to the Emergency Department following a convulsive episode. On initial assessment he was drowsy and the focus of investigation was the cause of the seizure, he was prepared for transfer to the medical ward. As he became more alert he complained of bilateral shoulder pain. Further clinical exam highlighted he had reduced range of movement in the shoulder joint bilaterally with a symmetrical clinical appearance of gleno-humeral dislocation. Radiographs confirmed bilateral anterior gleno-humeral dislocations which were reduced under sedation uneventfully. Conclusion: Post ictal patients can be difficult to assess when drowsy. Although not all seizures require musculoskeletal examination attending medical staff should remain vigilant to the possibility of injury following seizure to afford prompt diagnosis and treatment. PMID:27299040

  14. Recurrent anterior shoulder instability: Review of the literature and current concepts

    PubMed Central

    Sofu, Hakan; Gürsu, Sarper; Koçkara, Nizamettin; Öner, Ali; Issın, Ahmet; Çamurcu, Yalkın

    2014-01-01

    The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends on the procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients. PMID:25405191

  15. Open Anterior Dislocation of the Hip in Togo

    PubMed Central

    Anani, Abalo; Yannick, Dellanh; Gamal, Ayouba; Assang, Dossim

    2016-01-01

    Anterior traumatic dislocations of the hip are much less common than posterior dislocations. To date, 14 cases of open anterior dislocation of the hip associated with such injuries, acetabular and femoral head fractures and femoral vascular and nerve damage have been reported. We present a case of a 23-year-old male who sustained open anterior dislocation of the hip with ipsilateral fracture of the greater trochanter after an accident on the public highway. Additional lesions included an iliac wing fracture and a perineal wound. We report this case because of the rarity and seriousness of this injury due to its progressive complications and difficulties related to its management, which are typical to a developing country like ours. PMID:27247749

  16. Dislocations

    MedlinePlus

    Dislocations are joint injuries that force the ends of your bones out of position. The cause is often a fall or a blow, sometimes from playing a contact sport. You can dislocate your ankles, knees, shoulders, hips, elbows and jaw. You can also dislocate your finger and toe joints. Dislocated joints often are ...

  17. Computational modelling of mobile bearing TKA anterior-posterior dislocation.

    PubMed

    Müller, J H; Zakaria, T; van der Merwe, W; D'Angelo, F

    2016-01-01

    Anterior-posterior stability in an unconstrained mobile-bearing total knee arthroplasty (TKA) and one with rotational constraints is compared in a computational model based on an ASTM test. Both TKA designs dislocate at loads greater than reported maximum in vivo forces. The posterior drawer forces (mean: 3027 N vs. 1817 N) needed to induce subluxation increase with a greater anterior jump distance (12 mm vs. 7 mm; refers to the vertical height of the anterior or posterior border of the tibial insert's articulating surface). The posterior jump distance for both tested TKA differed by 1.5 mm and had minimal effect on the magnitude of the anterior drawer forces at dislocation in mid-flexion (unconstrained vs. constrained: 445 N vs. 412 N). The unconstrained insert dislocated by means of spin-out whereas in the constrained TKA the femur dislocated from the bearing during posterior drawer and the bearing from the baseplate during anterior drawer. MCL function is an important consideration during ligament balancing since a ± 10% variation in MCL tension affects dislocation forces by ± 20%. The simulation platform provided the means to investigate TKA designs in terms of anterior-posterior stability as a function of knee flexion, collateral ligament function and mechanical morphology. PMID:26047039

  18. Factors Affecting Return to Baseline Function at 6 months Following Anterior Shoulder Instability Surgery

    PubMed Central

    Hettrich, Carolyn M.; Buckwalter, Joseph; Wolf, Brian R.; Bollier, Matthew; MOON, Shoulder Group; Glass, Natalie

    2016-01-01

    placed into a multivariate model, significant differences were identified in age (p=0.0316), SF-36 General health (p=0.0118), and Beighton score (p=0.0016). Conclusion: Older age, perception of general health and generalized joint laxity are associated with failure to return to baseline function at 6 months after anterior shoulder instability surgery. Duration of symptoms and number of dislocation events did not reach significance in the multivariate model, but trended toward likelihood of failure to return to baseline findings. Moreover, open vs. arthroscopic surgery and number of suture anchors were not significant, suggesting that pre-operative condition and not surgical factors predict return to baseline in the short-term.

  19. The anterior approach to the shoulder from the lateral position.

    PubMed

    Steingard, M A

    1996-11-01

    An alternative method of operating on the anterior structures of the shoulder is presented. With the patient in the decubitus lateral position, the joint is readily accessible without cutting the conjoined tendon or performing an osteotomy of the coracoid process. The lateral decubitus positioning of the patient allows the surgeon to reinsert the arthroscope into the shoulder after open surgery to check the repair. This approach eliminates repositioning the patient to the supine position. It can be performed without a surgical assistant if the scrub technician is able to rotate the arm at certain times during the operation. PMID:8959262

  20. Anterior subtalar dislocation with comminuted fracture of the anterior calcaneal process.

    PubMed

    Hui, Siu Hung Kenneth; Lui, Tun Hing

    2016-01-01

    Anterior subtalar dislocation is a very rare injury. We report a case of an 81-year-old woman who had her right foot injured during a motor vehicle accident. Radiographs showed anterior subtalar dislocation with comminuted fracture of the anterior calcaneal process. The dislocation was closely reduced and protected by a short leg cast. One year postinjury, the patient had only mild pain when walking on uneven ground. There was mild tenderness over the lateral heel. Subtalar motion was mildly painful. There was no pain with ankle motion. PMID:26887882

  1. Shoulder Instability

    MedlinePlus

    ... Risk Factors Is shoulder instability the same as shoulder dislocation? No. The signs of dislocation and instability might ... the same to you--weakness and pain. However, dislocation occurs when your shoulder goes completely out of place. The shoulder ligaments ...

  2. An Alternate Conservative Management of Shoulder Dislocations and Subluxations

    PubMed Central

    Sawa, Thomas M.

    1992-01-01

    This paper presents clinical observations/results of the application of an alternate method to traditional conservative management of subluxations and dislocations of the glenohumeral joint on major junior hockey players. The proposed program involves three stages: 1) rest and nutrition, 2) interferential current and faradic muscle stimulation, and 3) a traditional progressive-resistance weight-training program in conjunction with a specially designed orthosis. Current scientific theory on soft tissue healing and repair is reviewed as the backdrop to the proposed regimen. The resulting 100% success rate is compared to the success rate of conventional conservative therapeutic programs. The orthosis is a potentially useful therapeutic device permitting safe ranges of shoulder movement during the healing process, but scientific investigation is needed to determine the precise effect of the orthosis within the proposed therapy program. PMID:16558196

  3. [Has the duration of cast fixation after shoulder dislocations an influence on the frequency of recurrent dislocation? (author's transl)].

    PubMed

    Ehgartner, K

    1977-08-26

    102 primary shoulder dislocations have been evaluated. Some were retained in a Velpeau bandage reinforced with plaster immediately after reposition for three weeks, others were treated with a sling or tube gauze only. The frequency of recurrent dislocation in both groups was compared. It could be demonstrated that the results were equal for both groups. We conclude that fixation with Velpeau Sling and cast reinforcement does not significantly influence the occurrence of recurrent dislocations. PMID:907550

  4. Coracoid syndrome: a neglected cause of anterior shoulder pain

    PubMed Central

    GIGANTE, ANTONIO; BOTTEGONI, CARLO; BARBADORO, PAMELA

    2016-01-01

    Purpose the present prospective open-label study was designed to gain further insights into a condition thought to constitute a neglected but not uncommon syndrome characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process, not related to rotator cuff or pectoralis minor tendinopathy, long head of the biceps tendon disorders, or instability. The aim was to clarify its prevalence, clinical characteristics, differential diagnosis and response to corticosteroid injections. Methods patients with primary anterior shoulder pain precisely reproduced by deep pressure on the apex of the coracoid process were recruited. Patients with clinical or instrumental signs of other shoulder disorders were excluded. Patients were given an injection of triamcinolone acetonide 40 mg/ml 1 ml at the coracoid trigger point. They were evaluated after 15, 30 and 60 days and at 2 years using Equal Visual Analog Scale (EQ-VAS) and the Italian version of the Simple Shoulder Test (SST). Results between January 1 and December 31 2010, we treated 15 patients aged 26–66 years. The majority were women (86.67%). At 15 days, 6 (40%) patients reported complete resolution of their symptoms, while 9 (60%) complained of residual symptoms and received another injection. At 30 days, 14 (93.33%) patients were pain-free and very satisfied. At 2 years, the 14 patients who had been asymptomatic at 30 days reported that they had experienced no further pain or impaired shoulder function. The analysis of variance for repeated measures showed a significant effect of time on EQ-VAS and SST scores. Conclusions the present study documents the existence, and characteristics, of a “coracoid syndrome” characterized by anterior shoulder pain and tenderness to palpation over the apex of the coracoid process and showed that the pain is usually amenable to steroid treatment. This syndrome should be clearly distinguished from anterior shoulder pain due to other causes, in

  5. Effect of bone loss in anterior shoulder instability

    PubMed Central

    Garcia, Grant H; Liu, Joseph N; Dines, David M; Dines, Joshua S

    2015-01-01

    Anterior shoulder instability with bone loss can be a difficult problem to treat. It usually involves a component of either glenoid deficiency or a Hill-Sachs lesion. Recent data shows that soft tissue procedures alone are typically not adequate to provide stability to the shoulder. As such, numerous surgical procedures have been described to directly address these bony deficits. For glenoid defects, coracoid transfer and iliac crest bone block procedures are popular and effective. For humeral head defects, both remplissage and osteochondral allografts have decreased the rates of recurrent instability. Our review provides an overview of current literature addressing these treatment options and others for addressing bone loss complicating anterior glenohumeral instability. PMID:26085984

  6. Superior Labral Anterior Posterior Lesions of the Shoulder

    PubMed Central

    Malal, Joby Jacob George; Khan, Yousaf; Farrar, Graville; Waseem, Mohammed

    2013-01-01

    Superior labrum anterior and posterior (SLAP) lesion is of fairly recent description and its understanding is rapidly evolving. Its incidence and need for surgical treatment has increased exponentially in line with the increase in shoulder arthroscopies. It is of particular importance in the elite over head athlete and the young. A range of arthroscopic techniques and devices have been described with good functional results. The ability to return to pre injury level of sports remains a concern. PMID:24082975

  7. A rare injury to a rear seat passenger: bilateral fracture dislocation of the shoulders.

    PubMed

    Madi, Sandesh; Pandey, Vivek; Acharya, Kiran; Ramakrishna, Krishna Prasad Peruvaje

    2015-01-01

    Injury prevention measures in automobiles are mainly focused on the front seat passengers and driver. In the event of a head-on collision, rear seat passengers usually escape with minimal injuries. Most commonly observed injuries to rear passengers are to the head, chest wall or lower extremities. We report a case of bilateral anterior dislocation of the shoulders with asymmetrical fractures of the greater tuberosities in a 42-year-old man who was apparently injured in a head-on collision while travelling in a car as an unstrapped rear seat passenger. This kind of injury pattern in an unrestrained rear seat passenger is very unusual and has not been previously described. PMID:26065552

  8. Traumatic posterior shoulder dislocation with a large engaging Hill-Sachs lesion: splinting technique.

    PubMed

    Aldebeyan, Sultan; Aoude, Ahmed; Van Lancker, Hans

    2016-03-01

    Posterior shoulder dislocations are rare and are often associated with seizures, electrocution, and high-energy trauma. They can be missed and, therefore, left untreated. Early diagnosis and treatment can help avoid future complications and surgical intervention. PMID:26254506

  9. Gene expression analysis in patients with traumatic anterior shoulder instability suggests deregulation of collagen genes.

    PubMed

    Belangero, Paulo Santoro; Leal, Mariana Ferreira; Figueiredo, Eduardo Antônio; Cohen, Carina; Pochini, Alberto de Castro; Smith, Marília Cardoso; Andreoli, Carlos Vicente; Belangero, Sintia Iole; Ejnisman, Benno; Cohen, Moises

    2014-10-01

    Shoulder dislocation occurs in 1-2% of the population. Capsular deformation is a key factor in shoulder dislocation; however, little is known about capsule biology. We evaluated, for the first time in literature, the expression of COL1A1, COL1A2, COL3A1 and COL5A1 in the antero-inferior, antero-superior and posterior regions of the glenohumeral capsule of 31 patients with anterior shoulder instability and eight controls. The expression of collagen genes was evaluated by quantitative reverse transcription-PCR. The expression of COL1A1, COL3A1 and the ratio of COL1A1/COL1A2 were increased in all three portions of the capsule in patients compared to controls (p < 0.05). COL1A2 expression was upregulated in the antero-superior and posterior sites of the capsule of patients (p < 0.05). The ratio of COL1A2/COL3A1 expression was reduced in capsule antero-inferior and posterior sites of patients compared to controls (p < 0.05). In the capsule antero-inferior site of patients, the ratios of COL1A1/COL5A1, CO1A2/COL5A1 and COL3A1/COL5A1 expression were increased (p < 0.05). In patients, COL1A1/COL5A1 was also increased in the posterior site (p < 0.05). We found deregulated expression of collagen genes across the capsule of shoulder instability patients. These molecular alterations may lead to modifications of collagen fibril structure and impairment of the healing process, possibly with a role in capsular deformation. PMID:25042113

  10. Effects of hook plate on shoulder function after treatment of acromioclavicular joint dislocation

    PubMed Central

    Chen, Chang-Hong; Dong, Qi-Rong; Zhou, Rong-Kui; Zhen, Hua-Qing; Jiao, Ya-Jun

    2014-01-01

    Introduction: Internal fixation with hook plate has been used to treat acromioclavicular joint dislocation. This study aims to evaluate the effect of its use on shoulder function, to further analyze the contributing factors, and provide a basis for selection and design of improved internal fixation treatment of the acromioclavicular joint dislocation in the future. Methods: A retrospective analysis was performed on patients treated with a hook plate for acromioclavicular joint dislocation in our hospital from January 2010 to February 2013. There were 33 cases in total, including 25 males and 8 females, with mean age of 48.27 ± 8.7 years. There were 29 cases of Rockwood type III acromioclavicular dislocation, 4 cases of type V. The Constant-Murley shoulder function scoring system was used to evaluate the shoulder function recovery status after surgery. Anteroposterior shoulder X-ray was used to assess the position of the hook plate, status of acromioclavicular joint reduction and the occurrence of postoperative complications. Results: According to the Constant-Murley shoulder function scoring system, the average scores were 78 ± 6 points 8 to 12 months after the surgery and before the removal of the hook plate, the average scores were 89 ± 5 minutes two months after the removal of hook plate. Postoperative X-ray imaging showed osteolysis in 10 cases (30.3%), osteoarthritis in six cases (18.1%), osteolysis associated with osteoarthritis in four cases(12.1%), and steel hook broken in one case (3%). Conclusion: The use of hook plate on open reduction and internal fixation of the acromioclavicular joint dislocation had little adverse effect on shoulder function and is an effective method for the treatment of acromioclavicular joint dislocation. Osteoarthritis and osteolysis are the two common complications after hook plate use, which are associated with the impairment of shoulder function. Shoulder function will be improved after removal of the hook plate. PMID

  11. Bony Versus Soft Tissue Reconstruction for Anterior Shoulder Instability

    PubMed Central

    McLaughlin, Richard James; Miniaci, Anthony; Jones, Morgan H.

    2015-01-01

    Background: One complication of anteroinferior glenohumeral shoulder dislocation is a critical bone defect that requires surgical repair to prevent recurrent instability. However, controversy exists regarding the surgical management because both open and arthroscopic surgeries have respective advantages and disadvantages. Moreover, it is difficult to determine the patient’s preferred treatment, as factors that influence treatment choice include recurrence rates, morbidity of the procedures, and patient preferences. Hypothesis: Patients who have a higher probability of recurrent instability after arthroscopic surgery will select open surgery whereas patients with a lower probability of recurrent instability after arthroscopic surgery will favor arthroscopy. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A decision tree was constructed to model each hypothetical outcome after open or arthroscopic surgery for glenohumeral instability in patients with bone defects. A literature review was performed to determine the probability of occurrence for each node while utility values for each outcome were obtained via patient-administered surveys given to 50 patients without prior history of shoulder injury or dislocation. Fold-back analysis was then performed to show the optimal treatment strategy. Finally, sensitivity analysis established the thresholds at which open treatment becomes the optimal treatment. Results: The ultimate expected value—the objective evaluation of all potential outcomes after choosing either open or arthroscopic surgery—was found to be greater for arthroscopic surgery than for open surgery (87.17 vs 81.64), indicating it to be the preferred treatment. Results of sensitivity analysis indicated that open surgery becomes the preferred treatment when probability of recurrence after arthroscopic treatment is ≥23.8%, although varying the utility, defined as an aggregate patient preference for a particular outcome, has no

  12. Posttraumatic persistent shoulder pain: Superior labrum anterior-posterior (SLAP) lesions

    PubMed Central

    Gulacti, Umut; Can, Cagdas; Erdogan, Mehmet Ozgur; Lok, Ugur; Buyukaslan, Hasan

    2013-01-01

    Patient: Male, 57 Final Diagnosis: Typ 2 Superior labrum anterior-posterior lesion Symptoms: Shoulder pain after trauma Medication: — Clinical Procedure: — Specialty: Orthopedics and Traumatology • Emergency Medicine Objective: Rare disease Background: Due to the anatomical and biomechanical characteristics of the shoulder, traumatic soft-tissue lesions are more common than osseous lesions. Superior labrum anterior-posterior (SLAP) lesions are an uncommon a cause of shoulder pain. SLAP is injury or separation of the glenoid labrum superior where the long head of biceps adheres. SLAP lesions are usually not seen on plain direct radiographs. Shoulder MRI and magnetic resonance arthrography are useful for diagnosis. Case Report: A 57-year-old man was admitted to the emergency department due to a low fall on his shoulder. In physical examination, active and passive shoulder motion was normal except for painful extension. Anterior-posterior shoulder x-ray imaging was normal. The patient required orthopedics consultation in the emergency observation unit due to persistent shoulder pain. In shoulder MRI, performed for diagnosis, type II lesion SLAP was detected. The patient was referred to a tertiary hospital due to lack of arthroscopy in our hospital. Conclusions: Shoulder traumas are usually soft-tissue injuries with no findings in x-rays. SLAP lesion is an uncommon cause of traumatic shoulder pain. For this reason, we recommend orthopedic consultation in post-traumatic persistent shoulder pain. PMID:23961305

  13. Expression analysis of genes involved in collagen cross-linking and its regulation in traumatic anterior shoulder instability.

    PubMed

    Belangero, Paulo Santoro; Leal, Mariana Ferreira; Cohen, Carina; Figueiredo, Eduardo Antônio; Smith, Marília Cardoso; Andreoli, Carlos Vicente; de Castro Pochini, Alberto; Ejnisman, Benno; Cohen, Moises

    2016-03-01

    The molecular alterations involved in the capsule deformation presented in shoulder instability patients are poorly understood. Increased TGFβ1 acts as a signal for production of matrix macromolecules by fibrogenic cells at joint injury sites. TGFβ1, through its receptor TGFβR1, regulates genes involved in collagen cross-linking, such as LOX, PLOD1, and PLOD2. We evaluated TGFβ1, TGFβR1, LOX, PLOD1, and PLOD2 gene expression in the antero-inferior (macroscopically injured region), antero-superior and posterior regions of the glenohumeral capsule of 29 shoulder instability patients and eight controls. We observed that PLOD2 expression was increased in the anterior-inferior capsule region of the patients compared to controls. LOX expression tended to be increased in the posterior portion of patients. Patients with recurrent shoulder dislocation presented upregulation of TGFβR1 in the antero-inferior capsule portion and of PLOD2 in the posterior region. Conversely, LOX was increased in the posterior portion of the capsule of patients with a single shoulder dislocation episode. In the antero-inferior, LOX expression was inversely correlated and TGFβR1 was directly correlated with the duration of symptoms. In the posterior region, PLOD2, TGFβ1, and TGFβR1 were directly correlated with the duration of symptoms. In conclusion, PLOD2 expression was increased in the macroscopically injured region of the capsule of patients. Upregulation of TGFβ1, TGFβR1, and PLOD2 seems to be related with the maintenance of disease symptoms, especially in the posterior region. LOX upregulation seems to occur only in the initial phase of the affection. Therefore, TGFβ1, TGFβR1, LOX, and PLOD2 may play a role in shoulder instability. PMID:26185036

  14. The role of TNXB single-nucleotide polymorphisms in recurrent shoulder dislocation.

    PubMed

    Geiger, Emanuel V; Henrich, Dirk; Wutzler, Sebastian; Schneidmüller, Dorien; Jakob, Heike; Frank, Johannes M; Marzi, Ingo

    2013-02-01

    Tenascin-X (TNX) is an extra-cellular matrix glycoprotein associated with collagen fibril deposition. Recent reports have linked truncated TNX mutations (TNXB) to generalized joint hypermobility and most importantly recurrent joint dislocation. In the present study, we investigated whether there is an association between joint dislocation recurrence rate and the frequency of TNXB single-nucleotide polymorphisms (SNPs). Seventy-eight patients treated for post-traumatic shoulder instability and 82 healthy controls were genotyped for selected TNXB SNP using TaqMan® Genotyping Assays. At a mean follow-up of 24 months recurrence rate and clinical outcomes were evaluated using the Constant and Murley, Rowe, and DASH scores. The association between genotypes and joint dislocation was tested using the dominant, recessive and additive models, and the model-free approach. Genotype distribution of the examined SNPs did not significantly deviate from the Hardy-Weinberg equilibrium (HWE) neither in patients nor in the controls. Moreover, there was no significant difference in genotype and allele distribution between patients and controls. Finally, no difference in genotype frequency was detected between patients who experienced a re-dislocation after the initial surgery and patients who did not sustain a re-dislocation. The SNPs investigated in this study have no clinically relevant influence on TNXB gene expression and/or TNX function. Therefore, these SNPs could not be used for predicting individual risk of recurrent shoulder dislocation. PMID:22991340

  15. Acute traumatic anterior glenohumeral dislocation complicated by axillary nerve damage: a case report

    PubMed Central

    Kazemi, Mohsen

    1998-01-01

    An elite soccer player presented with a classic acute anterior dislocation of the glenohumeral joint complicated by axillary nerve damage. The incidence, mechanism of injury, clinical presentation, conservative treatment and rehabilitation of the anterior glenohumeral joint dislocation and associated axillary nerve damage are discussed in this paper. ImagesFigure 3

  16. Traumatic First Time Shoulder Dislocation: Surgery vs Non-Operative Treatment

    PubMed Central

    Polyzois, Ioannis; Dattani, Rupen; Gupta, Rohit; Levy, Ofer; Narvani, A Ali

    2016-01-01

    Management of first shoulder dislocation following reduction remains controversial. The two main options are immobilisation and arthroscopic stabilisation. The aim of this article is to highlight some of the issues that influence decision making when discussing management options with these patients, including natural history of the first time dislocation, outcomes of surgery and non-operative management particularly on the risk of future osteoarthritis (OA), the effects of delaying surgery and the optimal method of immobilisation. Extensive literature review was performed looking for previous publication addressing 4 points. i) Natural history of primary shoulder dislocation ii) Effect of surgical intervention on natural history iii) Risk of long term osteoarthritis with and without surgical intervention iv) Immobilisation techniques post reduction. Individuals younger than 25 years old are likely to re-dislocate with non-operative management. Surgery reduces risk of recurrent instability. Patients with recurrent instability appear to be at a higher risk of OA. Those who have surgical stabilisation do not appear to be at a higher risk than those who dislocate just once, but are less likely to develop OA than those with recurrent instability. Delaying surgery makes the stabilisation more demanding due to elongation of capsule, progressive labro-ligamentous injury, prevalence and severity of glenoid bone loss. Recent studies have failed to match the preliminary outcomes associated with external rotation braces. Defining the best timing and type of treatment remains a challenge and should be tailored to each individual’s age, occupation and degree of physical activity. PMID:27200385

  17. Frequency of Fractures Identified on Post-Reduction Radiographs After Shoulder Dislocation

    PubMed Central

    Gottlieb, Michael; Nakitende, Damali; Krass, Laurie; Basu, Anupam; Christian, Errick; Bailitz, John

    2016-01-01

    Introduction Most emergency physicians routinely obtain shoulder radiographs before and after shoulder dislocations. However, currently there is limited literature demonstrating how frequently new fractures are identified on post-reduction radiographs. The primary objective of this study was to determine the frequency of new, clinically significant fractures identified on post-reduction radiographs with a secondary outcome assessing total new fractures identified. Methods We conducted a retrospective chart review using appropriate International Classification of Diseases, 9th Revision (ICD-9) codes to identify all potential shoulder dislocations that were reduced in a single, urban, academic emergency department (ED) over a five-year period. We excluded cases that required operative reduction, had associated proximal humeral head or shaft fractures, or were missing one or more shoulder radiograph reports. All charts were abstracted separately by two study investigators with disagreements settled by consensus among three investigators. Images from indeterminate cases were reviewed by a radiology attending physician with musculoskeletal expertise. The primary outcome was the percentage of new, clinically significant fractures defined as those altering acute ED management. Secondary outcomes included percentage of new fractures of any type. Results We identified 185 total patients meeting our study criteria. There were no new, clinically significant fractures on post-reduction radiographs. There were 13 (7.0%; 95% CI [3.3%–10.7%]) total new fractures identified, all of which were without clinical significance for acute ED management. Conclusion Post-reduction radiographs do not appear to identify any new, clinically significant fractures. Practitioners should re-consider the use of routine post-reduction radiographs in the ED setting for shoulder dislocations. PMID:26823928

  18. Late Anterior Dislocation Due to Posterior Pelvic Tilt in Total Hip Arthroplasty

    PubMed Central

    Kobayashi, Hiroki; Nakashima, Yasuharu; Yamamoto, Takuaki; Motomura, Goro; Kanazawa, Masayuki; Takagishi, Kenji; Iwamoto, Yukihide

    2016-01-01

    Background: Excessive pelvic tilt may be one of the factors leading to instability in total hip arthroplasty (THA), even when the acetabular cup is placed properly. To our knowledge, only a few studies have described late anterior dislocation due to posterior pelvic tilt. We present 3 cases with late anterior dislocations possibly due to posterior pelvic tilt. Cases Presentations: Case-1: An 84-years-old woman fell and presented with an anterior dislocation 12-years after THA. Her pelvis had tilted to approximately 30° posteriorly in a supine position. After conservative treatment, she presented with 10 recurrent anterior dislocations. She had thoracolumbar kyphosis due to multiple compression fractures. Revision with anterior placement of an elevated liner and a 32-mm head corrected the dislocation, and no further dislocations occurred. Case-2: A 78-years-old woman fell and presented with an anterior dislocation 4-years after THA. Her posterior pelvic tilt had increased 23° due to a lumbar compression fracture. Revision by decreasing the cup anteversion was performed, but recurrent posterior dislocations occurred. Owing to her worsened general condition, further treatment was abandoned. Case-3: A 79-years-old woman twisted her body and presented an anterior dislocation 3-years after THA. After manual reduction and conservative treatment, the dislocation recurred. Her posterior pelvic tilt had increased 16°. Conclusion: Although minor trauma triggered the anterior instability in these patients, the underlying pathomechanism existed in the progressive pelvic posterior tilt due to thoracolumbar kyphosis. As longer life expectancy as well as implant survivorship is predicted, attention must be paid to the change of pelvic tilt in elderly patients. PMID:27398108

  19. Iliac crest allograft glenoid reconstruction for recurrent anterior shoulder instability in athletes: Surgical technique and results

    PubMed Central

    Mascarenhas, Randy; Raleigh, Eden; McRae, Sheila; Leiter, Jeff; Saltzman, Bryan; MacDonald, Peter B.

    2014-01-01

    Performing a labral repair alone in patients with recurrent anterior instability and a large glenoid defect has led to poor outcomes. We present a technique involving the use of the iliac crest allograft inserted into the glenoid defect in athletes with recurrent anterior shoulder instability and large bony defects of the glenoid (>25% of glenoid diameter). All athletes with recurrent anterior shoulder instability and a large glenoid defect that underwent open anterior shoulder stabilization and glenoid reconstruction with the iliac crest allograft were followed over a 4-year period. Preoperatively, a detailed history and physical exam were obtained along with standard radiographs and magnetic resonance imaging of the affected shoulder. All patients also completed the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) evaluation forms preoperatively. A computed tomography scan was obtained postoperatively to assess osseous union of the graft and the patient again went through a physical exam in addition to completing the SST, ASES, and Western Ontario Shoulder Instability Index (WOSI) forms. 10 patients (9 males, 1 female) were followed for an average of 16 months (4–36 months) and had a mean age of 24.4 years. All patients exhibited a negative apprehension/relocation test and full shoulder strength at final follow-up. Eight of 10 patients had achieved osseous union at 6 months (80.0%). ASES scores improved from 64.3 to 97.8, and SST scores improved from 66.7 to 100. Average postoperative WOSI scores were 93.8%. The use of the iliac crest allograft provides a safe and clinically useful alternative compared to previously described procedures for recurrent shoulder instability in the face of glenoid deficiency. PMID:25538432

  20. Radial head button holing: a cause of irreducible anterior radial head dislocation.

    PubMed

    Shin, Su-Mi; Chai, Jee Won; You, Ja Yeon; Park, Jina; Bae, Kee Jeong

    2016-10-01

    "Buttonholing" of the radial head through the anterior joint capsule is a known cause of irreducible anterior radial head dislocation associated with Monteggia injuries in pediatric patients. To the best of our knowledge, no report has described an injury consisting of buttonholing of the radial head through the annular ligament and a simultaneous radial head fracture in an adolescent. In the present case, the radiographic findings were a radial head fracture with anterior dislocation and lack of the anterior fat pad sign. Magnetic resonance imaging (MRI) clearly demonstrated anterior dislocation of the fractured radial head through the torn annular ligament. The anterior joint capsule and proximal portion of the annular ligament were interposed between the radial head and capitellum, preventing closed reduction of the radial head. Familiarity with this condition and imaging findings will aid clinicians to make a proper diagnosis and fast decision to perform an open reduction. PMID:27502623

  1. Arthroscopic Augmentation With Subscapularis Tendon in Anterior Shoulder Instability With Capsulolabral Deficiency

    PubMed Central

    Maiotti, Marco; Massoni, Carlo

    2013-01-01

    The treatment of chronic shoulder instability with poor quality of the anterior capsulolabral tissue is still controversial. In these cases the Latarjet procedure is certainly more effective in preventing recurrence than an arthroscopic capsular repair. However, several studies have reported a variety of severe complications related to the Latarjet procedure because of the use of bone augmentation and hardware implantation; moreover, the arthroscopic version of the Latarjet procedure is technically difficult and potentially dangerous because of the proximity of neurovascular structures. The aim of this report is to describe an innovative arthroscopic technique consisting of an augmentation of the anterior capsulolabral tissue using the articular portion of the subscapularis tendon and knotless suture anchors paired with high-strength tape for its fixation to the anterior glenoid edge. In the absence of severe bone deficiency of the anterior glenoid edge, this procedure can minimize arthroscopic technique failures, restoring the anterior capsulolabral wall without any significant reduction of shoulder functionality. PMID:24266004

  2. EVALUATION OF THE RESULTS FROM ARTHROSCOPIC SURGICAL TREATMENT FOR TRAUMATIC ANTERIOR SHOULDER INSTABILITY USING SUTURING OF THE LESION AT THE OPENED MARGIN OF THE GLENOID CAVITY

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Duarte, Clodoaldo; Botelho, Vinícius; Checchia, Sergio Luiz

    2015-01-01

    Objective: To evaluate the clinical results from patients with traumatic anterior shoulder instability that was treated surgically through arthroscopic viewing, using bioabsorbable anchors and a technique for remove the cartilage of the anterior glenoid rim for repairing a Bankart lesion. Method: Between March 2006 and October 2008, 27 shoulders in 27 patients with a diagnosis of traumatic anterior shoulder instability were operated. The patients’ mean age was 28 years and they had had between two and 25 previous episodes of dislocation. The patients were predominantly male (24; 89%). The minimum length of follow-up was 24 months and the mean was 36 months. None of the patients had previously undergone surgery on the affected shoulder or had any significant bone lesion at the glenoid margin. The postoperative clinical assessment was done using the Rowe scale. To measure the preoperative and postoperative joint range of motion, we used the method described by the American Academy of Orthopaedic Surgeons (AAOS). Results: According to the Rowe criteria, 25 patients (93%) achieved excellent results and two (7%) had poor results. None of the patients presented good or fair results. Twenty-three patients were satisfied with the results obtained (85%), and returned to their activities without limitations, while four patients (15%) had some degree of limitation. There was recurrence of instability in two patients (7%). Conclusion: Treatment of traumatic anterior shoulder instability through arthroscopic viewing using a technique for remove the cartilage of the anterior glenoid rim for repairing a Bankart lesion provided excellent results for 93% of the patients operated. PMID:27042640

  3. Evaluation of postoperative results from videoarthroscopic treatment for recurrent shoulder dislocation using metal anchors☆

    PubMed Central

    Martel, Éder Menegassi; Rodrigues, Airton; dos Santos Neto, Francisco José; Dahmer, Cleiton; Ranzzi, Abel; Dubiela, Rafaella Scuzziato

    2016-01-01

    Objective To clinically and radiologically evaluate the results from videoarthroscopic treatment using metal anchors in patients with recurrent shoulder dislocation and its complications. Methods This was a retrospective study on 47 patients (47 shoulders) operated by the shoulder group of the orthopedic hospital between February 2010 and February 2012. A questionnaire, interview and physical and radiographic examinations were used, with the classification of Samilson and Pietro. The mean postoperative follow-up was 33 months (range 12–47 months). The statistical analysis consisted of using Fisher's exact test through the IBM SPSS 22 statistical software. The significance level used was 5%. Results Recurrence was observed in nine cases. The patients were, on average, 26.5 years old at the first episode, and 19.1% were aged 20 years or under. Among these, 55.6% presented recurrence. In relation to age at the time of the surgical procedure, the average age was 27 years, and 12.8% were aged 20 years or under. Nineteen patients presented prominent anchors and, of these, 21% manifested arthrosis. Conclusion There was a statistically identified correlation between the recurrence rate and age less than or equal to 20 years at the times of first dislocation and the surgical procedure. Further studies should be conducted in order to compare the use of absorbable anchors, which despite higher cost, may provide lower risk of developing glenohumeral arthrosis in some cases. PMID:26962500

  4. Joystick reduction and percutaneous pinning for an acutely anteriorly dislocated coccyx: a case report.

    PubMed

    Kim, Weon-Yoo; Han, Chang-Whan; Kim, Yong-Hwan

    2004-07-01

    A sacrococcygeal dislocation is a rare occurrence, and the treatment options vary. Initial treatment is nonoperative, consisting of a manual reduction with a gloved finger and local rest. Acute operative treatment of a failed closed reduction is unusual. We report a case of an acute irreducible anteriorly dislocated coccyx successfully treated with a minimally invasive technique: joystick reduction and Steinman pin fixation. PMID:15213506

  5. Bilateral anterior chamber intraocular lenses dislocation in a patient with habitual eye rubbing.

    PubMed

    Poh, E P; Fariza, N Nor; Mariam, I

    2005-08-01

    A 61-year-old Chinese man presented with bilateral posteriorly dislocated anterior chamber intraocular lenses (AC IOLs) one year after successful vitrectomy, removal of bilateral dislocated mature cataractous lenses and AC IOLs implantation. A thorough clinical evaluation revealed habitual eye rubbing as the only possible cause. PMID:16379196

  6. Anterior fracture dislocation of sacroiliac joint: A rare type of crescent fracture

    PubMed Central

    Trikha, Vivek; Singh, Vivek; Kumar, V Senthil

    2015-01-01

    Crescent fractures of the pelvis are usually described as posterior sacro iliac fracture dislocations. Rarely anterior displacement of the fractured iliac fragment along with dislocation has been reported in crescent fractures. Four cases of anterior fracture dislocation of the sacro iliac joint managed in the last two years by a single surgeon are presented. The injury mechanism, radiological diagnosis, management protocol along with functional outcomes of all the four patients have been discussed. CT scan is essential in the diagnosis and preoperative planning of this injury pattern. Early fixation along with proper reduction leads to excellent functional outcome in this subset of lateral compression injuries of the pelvis. PMID:26015619

  7. Evaluation of functional outcomes and complications following modified Latarjet reconstruction in athletes with anterior shoulder instability

    PubMed Central

    van der Watt, Christelle; de Beer, Joe F

    2015-01-01

    Background The optimal management of anterior shoulder instability in athletes continues to be a challenge. The present study aimed to evaluate the functional outcomes of athletes with anterior shoulder instability following modified Latarjet reconstruction through assessing the timing of return to sport and complications. Methods Retrospective assessment was performed of athletes (n = 56) who presented with recurrent anterior shoulder instability and were treated with modified congruent arc Latarjet reconstruction over a 1-year period. Rugby union was the predominant sport performed. Pre-operative instability severity index scores were assessed. Postoperative complications were recorded as was the time taken for the athlete to return to sport. Results Arthroscopic evaluation revealed that 86% of patients had associated bony lesions affecting the glenohumeral joint. The overall complication rate relating to the Latarjet reconstruction was 7%. No episodes of recurrent shoulder instability were noted. Of the patients, 89% returned to competitive sport at the same level as that prior to surgery. The mean time post surgery to returning to full training was 3.2 months. Conclusions The modified congruent arc Latarjet procedure facilitates early rehabilitation and return to sport. These results support our systematic management protocol of performing modified Latarjet surgery in contact sport athletes with recurrent anterior instability.

  8. Comparison of accuracy of anterior and superomedial approaches to shoulder injection: an experimental study

    PubMed Central

    Chernchujit, Bancha; Zonthichai, Nutthapon

    2016-01-01

    Introduction: We aimed to compare the accuracy between the standard anterior technique of shoulder injection and the new superomedial technique modified from Neviaser arthroscopic portal placement. Intra-articular placement, especially at the long head of biceps (LHB) tendon, and needle depth were evaluated. Methods: Fifty-eight patients (ages 57 ± 10 years) requiring shoulder arthroscopy in the beach-chair position were recruited. Needle punctures for both techniques were performed by an experienced sports medicine orthopedist. Patients were anesthetized, and the shoulder placed in the neutral position. A single needle was passed through the skin, with only one redirection allowed per trial. The superomedial technique was performed, then the anterior technique. Posterior-portal arthroscopy determined whether needle placement was inside the joint. The percentage of intra-articular needle placements for each technique defined accuracy. When inside the joint, the needle’s precise location was determined and its depth measured. A marginal χ2 test compared results between techniques. Results: The superomedial technique was significantly more accurate than the anterior technique (84% vs. 55%, p < 0.05). For superomedial versus anterior attempts, the LHB tendon was penetrated in 4% vs. 28% of patients, respectively, and the superior labrum in 35% vs. 0% of patients, respectively; the needle depth was 42 ± 7 vs. 32 ± 7 mm, respectively (all p < 0.05). Conclusions: The superomedial technique was more accurate, penetrating the LHB tendon less frequently than the standard anterior technique. A small-diameter needle was needed to minimize superior labral injury. The superomedial technique required a longer needle to access the shoulder joint. PMID:27163102

  9. [Anterior dislocation of the fibula resulting from surgical malreduction: a case report].

    PubMed

    Wang, Z Y; Wu, X B

    2016-04-18

    Ankle joint fracture is one of the most common types of fracture. There are many researches on the injury mechanism, treatment principles and surgical techniques. A type of injury which combines posterior dislocation of fibula, known as the Bosworth injury, is relatively rare. In 1947, Bosworth first described this type of injury as an unusual ankle fracture dislocation with fixed posterior fracture dislocation of the distal part of the fibula. In this type of fracture, the proximal fibular shaft fragment locks behind the tibialis posterior tubercle. This rare ankle fracture variant is often not recognized in initial radiographs and requires a computed tomographic (CT) scan for verification. But there are already many reports, discussing the injury mechanism, treatment principles and surgical techniques. However, there are few reports of anterior dislocation of the fibula, caused by either injury or surgery. The mechanism of the injury is still not clear. This article reports a case of anterior dislocation of the fibula. We report a patient with left ankle open fracture (Lauge-Hansen pronation-external rotation stage III, Gustilo IIIA). Open reduction and internal fixation was done in the initial surgery, but ended up with poor reduction, resulting in fibula anterior dislocation, anterior dislocation of talus and tibia fibular dislocation. The fibula was dislocated anteriorly of the tibia, which rarely happened. The patient suffered severe ankle joint dysfunction. The second operation took out the original internal fixation, reduced the fracture, and reset the internal fixation. The function of ankle joint was improved obviously after operation. But because of the initial injury and the two operations, the soft tissue around the fracture was greatly damaged. 6 months after the second operation, and the fracture still not healed, so the bone graft was carried out in the third surgery. Two months after the third surgery, the function of the ankle was significantly

  10. Use of 3-Dimensional Printing for Preoperative Planning in the Treatment of Recurrent Anterior Shoulder Instability

    PubMed Central

    Sheth, Ujash; Theodoropoulos, John; Abouali, Jihad

    2015-01-01

    Recurrent anterior shoulder instability often results from large bony Bankart or Hill-Sachs lesions. Preoperative imaging is essential in guiding our surgical management of patients with these conditions. However, we are often limited to making an attempt to interpret a 3-dimensional (3D) structure using conventional 2-dimensional imaging. In cases in which complex anatomy or bony defects are encountered, this type of imaging is often inadequate. We used 3D printing to produce a solid 3D model of a glenohumeral joint from a young patient with recurrent anterior shoulder instability and complex Bankart and Hill-Sachs lesions. The 3D model from our patient was used in the preoperative planning stages of an arthroscopic Bankart repair and remplissage to determine the depth of the Hill-Sachs lesion and the degree of abduction and external rotation at which the Hill-Sachs lesion engaged. PMID:26759768

  11. Surgical interventions for anterior shoulder instability in rugby players: A systematic review

    PubMed Central

    Sabharwal, Sanjeeve; Patel, Nirav K; Bull, Anthony MJ; Reilly, Peter

    2015-01-01

    AIM: To systematically evaluate the evidence-based literature on surgical treatment interventions for elite rugby players with anterior shoulder instability. METHODS: We conducted a systematic review according to the PRISMA guidelines. A literature search was performed in PubMed, EMBASE and Google Scholar using the following search terms: “rugby” and “shoulder” in combination with “instability” or “dislocation”. All articles published from inception of the included data sources to January 1st 2014 that evaluated surgical treatment of elite rugby players with anterior shoulder instability were examined. RESULTS: Only five studies were found that met the eligibility criteria. A total of 379 shoulders in 376 elite rugby union and league players were included. All the studies were retrospective cohort or case series studies. The mean Coleman Methodological Score for the 5 studies was 47.4 (poor). Owing to heterogeneity amongst the studies, quantitative synthesis was not possible, however a detailed qualitative synthesis is reported. The overall recurrence rate of instability after surgery was 8.7%, and the mean return to competitive play, where reported, was 13 mo. CONCLUSION: Arthroscopic stabilization has been performed successfully in acute anterior instability and there is a preference for open Latarjet-type procedures when instability is associated with osseous defects. PMID:25992318

  12. Spontaneous bilateral anterior lens dislocation in an 8-year-old girl.

    PubMed

    Ismail, Shatriah; Khairy-Shamel, Sonny-Teo; Hussein, Adil; Shaharuddin, Bakiah; Embong, Zunaina; Ibrahim, Mohtar

    2010-01-01

    The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment. PMID:20349906

  13. Bilateral spontaneous anterior dislocation of intraocular lens with the capsular bag in a patient with pseudoexfoliation

    PubMed Central

    Bhattacharjee, Harsha; Saxena, Rushil Kumar; Medhi, Jnanankar

    2015-01-01

    We report a rare case of bilateral spontaneous anterior partial in-the-bag intraocular lens (IOL) dislocation in a 75-year-old man with pseudoexfoliation (PXF). He underwent uneventful phacoemulsification in both eyes with in-the-bag IOL implantation 9 years back. In the right eye, single piece poly (methyl methacrylate) (PMMA) IOL (+19 D) and in the left eye, single piece acrylic foldable IOL (+19 D) were implanted. An attempt at pharmacological IOL repositioning was unsuccessful. The dislocated IOLs were explanted and exchanged with scleral suture fixated PMMA IOLs. Vision improved to 20/30 in both eyes following surgery, without any associated ocular morbidity. We believe that zonular weakness secondary to PXF, capsular contraction, and myopia together were the predisposing factors for partial anterior dislocation of IOLs and IOL exchange with scleral suture fixation of IOL is a safe and effective treatment option. PMID:26655008

  14. Biomechanical benefits of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: A cadaveric study.

    PubMed

    Kim, Hyun-Min Mike; Chacon, Alexander C; Andrews, Seth H; Roush, Evan P; Cho, Edward; Conaway, William K; Kunselman, Allen R; Lewis, Gregory S

    2016-04-01

    Restoration of joint stability during total shoulder arthroplasty can be challenging in the face of severe glenoid retroversion. A novel technique of humeral head component anterior-offsetting has been proposed to address posterior instability. We evaluated the biomechanical benefits of this technique in cadaveric specimens. Total shoulder arthroplasty was performed in 14 cadaveric shoulders from 7 donors. Complementary shoulders were assigned to either 10° or 20° glenoid retroversion, with retroversion created by eccentric reaming. Two humeral head component offset positions were tested in each specimen: The anatomic (posterior) and anterior (reverse). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. The force and energy required to displace the humeral head posteriorly increased significantly with the anterior offset position compared to the anatomic offset position. The joint contact pressures were significantly shifted anteriorly, and the joint contact area significantly increased with the anterior offset position. Anterior offsetting of the humeral head component increased the resistance to posterior humeral head translation, shifted joint contact pressures anteriorly, and increased joint contact area, thus, potentially increasing the joint stability in total shoulder arthroplasty with simulated glenoid retroversion. PMID:26356804

  15. Anterior Hip Fracture Dislocation with Intrapelvic Retention of the Femoral Head and Ureter Fistula

    PubMed Central

    Patrascanu, Calin; Cibu, Dan

    2014-01-01

    Introduction: The anterior dislocation of the hip represents only a small percentage of all hip dislocations: 85% are posterior. Most commonly associated with this dislocation is a fracture of the femoral head and, in rare cases, a femoral neck fracture. We have found in literature no report of an anterior dislocation of the hip associated with femoral neck fracture, pelvic retention of the head and ureteral fistula. We report such a case of a 68 year old male. Case Report: A 68 year old male was presented to our attention, following a severe injury of the hip when falling from a high bridge, with severe pain in the hip and a clinical aspect of femoral neck fracture. The X-ray confirmed the femoral neck fracture but following an anterior dislocation with the head retained into the pelvis. The patient also had hematuria. An Austin Moore prosthesis was implanted for the femoral neck fracture and the head was extracted by the urologist by a new abdominal incision. Urological evaluation revealed a fistula of the ureter, treated by an internal drainage for three months. One month later the Moore prosthesis was extracted and the patient had a Girldestone hip for 5 months. Revision with a Muller cemented prosthesis had a normal evolution. Conclusion: The anterior fracture dislocation of the hip with pelvic retention of the femoral head and ureteral fistula is a rare condition resulting from high energy trauma. A multidisciplinary team is necessary to diagnose and treat fracture and soft tissue lesions. Early diagnosis and treatment is necessary to avoid septic complications. PMID:27298980

  16. Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report

    PubMed Central

    Sim, Yeo Hae; Choi, Jeong-Hyun

    2016-01-01

    Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position. PMID:27482316

  17. Arytenoid cartilage dislocation after reversed total shoulder replacement surgery in the beach chair position: a case report.

    PubMed

    Sim, Yeo Hae; Choi, Jeong-Hyun; Kim, Mi Kyeong

    2016-08-01

    Arytenoid cartilage dislocation is not a common complication, but its delayed diagnosis reduces the therapeutic effect of treatment. A male patient underwent reversed total shoulder replacement surgery in the beach chair position under general anesthesia. The patient experienced postoperative hoarseness, and it was revealed that he had right arytenoid dislocation. Voice restoration was accomplished with closed reduction. We discussed changes in patient position during the operation and how they may contribute to the arytenoid dislocation. Flexion and a slight rotation of the neck during the operation can lead to an increase in intracuff pressure of the endotracheal tube. It is necessary to check neck position and monitor intracuff pressure in patients undergoing operations in the beach chair position. Also, the anesthesiologist should suspect arytenoid dislocation in the case of persistent hoarseness after surgery in the beach chair position. PMID:27482316

  18. RESULTS FROM LATARJET SURGERY FOR TREATING TRAUMATIC ANTERIOR SHOULDER INSTABILITY ASSOCIATED WITH BONE EROSION IN THE GLENOID CAVITY, AFTER MINIMUM FOLLOW-UP OF ONE YEAR

    PubMed Central

    Ikemoto, Roberto Yukio; Murachovisky, Joel; Nascimento, Luis Gustavo Prata; Bueno, Rogério Serpone; Almeida, Luiz Henrique Oliveira; Strose, Eric; Helmer, Fábio Fernando

    2015-01-01

    Objective: Evaluate the results from the Latarjet procedure in patients with anterior recurrent dislocation of the shoulder who present bone loss of the glenoid cavity greater than 25%. Methods: Twenty six male patients underwent the Latarjet procedure, The bone loss was evaluated by means of radiography using the Bernageau view and by means of CAT scan. The patients were evaluated with regard to range of motion, using the Rowe and UCLA scales, before and after the operation, and by radiographs to assess the presence of arthrosis, position and consolidation of the graft and positioning of the screws. Statistical analysis was used to assess whether there was any relationship between the number of episodes of dislocation and the presence of arthrosis, , and any relationship between arthrosis and limitations on lateral rotation. Differences in range of motion between the operated and unaffected sides and in the UCLA and Rowe scale. Results: The means for elevation and lateral rotation were statistically poorer on the operated side. The UCLA and Rowe scale showed that there was a statistically significant improvement in the clinical-functional results (P < 0.001 for both). There was a relationship between the number of episodes of dislocation and the presence of arthrosis, We also did not observe any correlation between limitations on lateral rotation and arthrosis. Conclusion: The Latarjet procedure is an efficient method for cases of severe erosion of the glenoid margin. PMID:27027053

  19. Shoulder Injuries and Disorders

    MedlinePlus

    ... of many common problems. They include sprains, strains, dislocations, separations, tendinitis, bursitis, torn rotator cuffs, frozen shoulder, fractures and arthritis. Usually shoulder problems are treated ...

  20. [Review of 19 cases of dislocation and fracture-dislocation of the cervical spine treated with anterior screw plates without intersomatic graft].

    PubMed

    Loembe, P M

    1993-01-01

    In comparison to posterior fixation by Roy-Camille plates which does not require bone grafting, 19 cases of anterior plate fixation, also without bone grafting, are presented (11 dislocations, 2 severe sprains, 4 fracture-dislocations and 2 "tear-drop" fractures of the lower cervical spine). A satisfactory osteoligamentary consolidation was obtained in every patient. The advantages of this technique are discussed. PMID:8484324

  1. Anterior Glenohumeral Laxity and Stiffness After a Shoulder-Strengthening Program in Collegiate Cheerleaders

    PubMed Central

    Laudner, Kevin G; Metz, Betsy; Thomas, David Q

    2013-01-01

    Context Approximately 62% of all cheerleaders sustain some type of orthopaedic injury during their cheerleading careers. Furthermore, the occurrence of such injuries has led to inquiry regarding optimal prevention techniques. One possible cause of these injuries may be related to inadequate conditioning in cheerleaders. Objective To determine whether a strength and conditioning program produces quantifiable improvements in anterior glenohumeral (GH) laxity and stiffness. Design Descriptive laboratory study. Setting University laboratory. Patients or Other Participants A sample of 41 collegiate cheerleaders (24 experimental and 17 control participants) volunteered. No participants had a recent history (in the past 6 months) of upper extremity injury or any history of upper extremity surgery. Intervention(s) The experimental group completed a 6-week strength and conditioning program between the pretest and posttest measurements; the control group did not perform any strength training between tests. Main Outcome Measure(s) We measured anterior GH laxity and stiffness with an instrumented arthrometer. We conducted a group × time analysis of variance with repeated measures on time (P < .05) to determine differences between groups. Results A significant interaction was demonstrated, with the control group having more anterior GH laxity at the posttest session than the strengthening group (P = .03, partial η2 = 0.11). However, no main effect for time (P = .92) or group (P = .97) was observed. In another significant interaction, the control group had less anterior GH stiffness at the posttest session than the strengthening group (P = .03, partial η2 = 0.12). Main effects for time (P = .02) and group (P = .004) were also significant. Conclusions Cheerleaders who participate in a shoulder-strengthening program developed less anterior GH laxity and more stiffness than cheerleaders in the control group. PMID:23672322

  2. [Classification of anterior instability of the shoulder by arthroscopy - the authors clinical material.].

    PubMed

    Masár, J; Petriscák, S

    1997-01-01

    The authors review briefly the evaluation of anterior instability of the shoulder joint from different aspects. The objective of their work was to present different types of morphological changes, as suggested by Resch (6). During the two-year period since June 1995 so far a total of 96 patients with the clinical picture of anterior instability of the humeroscapular joint were examined arthroscopically. The group comprised 69 men and 27 women, all in productive age. Type 1 lesions according to Resch were found in 52 %, type 2 in 21 %, type 3 in 6 %, type 4 in 13 %, type 5 in 1 % and type 6 in 7 % of the patients, which is consistent with data reported in the literature. In their opinion type 5 lesions are most difficult to diagnose. A certain amount of routine is needed also to differentiate type 1 and 4 and type 2 and 6 according to Resch's classification. Conversely, they consider type 3 findings standard and unequivocal. Key words: humeroscapular joint, anterior instability, arthroscopic diagnosis, type of lesions. PMID:20470642

  3. Dislocation

    MedlinePlus

    Joint dislocation ... It may be hard to tell a dislocated joint from a broken bone . Both are emergencies. You ... to repair a ligament that tears when the joint is dislocated is needed. Injuries to nerves and ...

  4. Results of Arthroscopic Bankart Lesion Repair in Patients with Post-Traumatic Anterior Instability of the Shoulder and a Non-Engaging Hill-Sachs Lesion with a Suture Anchor after a Minimum of 6-Year Follow-Up

    PubMed Central

    Szyluk, Karol; Jasiński, Andrzej; Widuchowski, Wojciech; Mielnik, Michał; Koczy, Bogdan

    2015-01-01

    Background Shoulder instability is an important clinical problem. Arthroscopic surgery is an established treatment modality in shoulder instability, but it continues to be associated with a high rate of recurrences and complications. The purpose of the study was to analyze late outcomes of arthroscopic repair of Bankart lesions in patients with post-traumatic anterior shoulder instability and non-engaging Hill-Sachs lesion, with special focus on the incidence and causes of recurrences and complications. Material/Methods We investigated 92 patients (92 shoulders) who underwent surgery on account of post-traumatic anterior shoulder instability. The duration of follow-up ranged from 6 to 12.5 years (mean: 8.2 years). All patients were operated on in the lateral decubitus position using FASTak 2.8-mm suture anchors (FASTak, Arthrex, Naples, Florida). Treatment outcomes were evaluated using the Rowe and University of California at Los Angeles rating system (UCLA). Results According to Rowe scores, there were 71 (81.5%) excellent, 12 (12.6%) good, 5 (5.3%) satisfactory, and 2 (2.1%) poor results. Rowe scores improved in a statistically significant manner (p=0.00) post-surgery, to a mean of 90 (range: 25–100). Treatment outcomes measured as UCLA scores improved in a statistically significant manner (p=0.00), reaching post-operative levels of 12–35 (mean: 33.5). There were 9 recurrences, 1 case of axillary nerve praxia, and 1 case of anchor loosening. Conclusions With rigorous criteria for qualifying patients for surgery, arthroscopic treatment of post-traumatic anterior shoulder instability produces good outcomes and low recurrence and complication rates irrespective of the number of previous dislocations, age, or sex. PMID:26256225

  5. Combination of a floating clavicle and a posterior shoulder dislocation: An “Unhappy Triad” of the shoulder girdle

    PubMed Central

    Schliemann, Benedikt; Theisen, Christina; Kösters, Clemens; Weimann, Andre

    2014-01-01

    We present a case of a 31-year-old man who suffered from a floating clavicle in combination with a reverse Hill-Sachs lesion of his right shoulder girdle after a bicycle accident. Operative treatment was performed using minimal-invasive and arthroscopically assisted techniques. We strongly recommend an early CT scan with later 3-dimensional reconstruction to detect and fully understand these complex injuries. PMID:24926161

  6. Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management

    PubMed Central

    Aydin, Nuri; Sirin, Evrim; Arya, Alp

    2014-01-01

    After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management. PMID:25035838

  7. Superior labrum anterior to posterior lesions of the shoulder: Diagnosis and arthroscopic management.

    PubMed

    Aydin, Nuri; Sirin, Evrim; Arya, Alp

    2014-07-18

    After the improvement in arthroscopic shoulder surgery, superior labrum anterior to posterior (SLAP) tears are increasingly recognized and treated in persons with excessive overhead activities like throwers. Several potential mechanisms for the pathophysiology of superior labral tears have been proposed. The diagnosis of this condition can be possible by history, physical examination and magnetic resonance imaging combination. The treatment of type 1 SLAP tears in many cases especially in older patients is non-operative but some cases need arthroscopic intervention. The arthroscopic management of type 2 lesions in older patients can be biceps tenodesis, but young and active patients like throwers will need an arthroscopic repair. The results of arthroscopic repair in older patients are not encouraging. The purpose of this study is to perform an overview of the diagnosis of the SLAP tears and to help decision making for the surgical management. PMID:25035838

  8. Anterior and posterior fixation for delayed treatment of posterior atlantoaxial dislocation without fracture.

    PubMed

    Yu, Hai Ming; Malhotra, Karan; Butler, Joseph S; Wu, Shi Qiang

    2015-01-01

    Posterior atlantoaxial dislocation (PAAD) without fracture of the odontoid process is a rare injury. Authors have variously reported closed or open reduction, followed by either anterior or posterior fixation, but there is no consensus on best treatment. We present a particularly unstable case of PAAD. Open reduction through a retropharyngeal approach with odontoidectomy was required for reduction. Anterior fixation with transarticular lag screws was required prior to posterior fixation with pedicle screws. Despite non-compliance with postoperative immobilisation, imaging at 20-month follow-up confirmed solid fusion. The patient is pain-free with a good range of movement of the neck and has returned to a manual job. Our case had a greater degree of instability than was previously reported, which necessitated 360° fixation. This is the first reported case of this treatment strategy, which provided a very stable fixation allowing fusion despite early movement and without causing undue stiffness. PMID:26516249

  9. Effect of shoulder flexion angle and exercise resistance on the serratus anterior muscle activity during dynamic hug exercise.

    PubMed

    Yoo, Won-Gyu

    2016-01-01

    [Purpose] The primary aim of this study was to determine the effect of shoulder flexion angle and exercise resistance on the serratus anterior muscle during dynamic hug exercise. [Subjects] Ten men aged 22-32 years were recruited. [Methods] The subjects performed dynamic hug exercise at different shoulder flexion angles and under resistance weight conditions. Serratus anterior muscle activities were measured by using the surface electromyographic system during the dynamic hug exercises. After performing the exercise, each subject described the exercise intensity by using the Borg rating of perceived exertion (RPE) scale. [Results] The normalized serratus anterior muscle activity increased significantly in the order of Conditions 1 and 4 < Condition 3 < Condition 2. The Borg RPE scale increased significantly in the order of Condition 1 < Condition 2 < Condition 3 < Condition 4. [Conclusion] The results suggest that dynamic hug exercise with the use of a multi-air-cushion biofeedback device is an effective scapular stability exercise. PMID:26957774

  10. Comparison of different approaches to the reduction of anterior temporomandibular joint dislocation: a randomized clinical trial.

    PubMed

    Ardehali, M M; Tari, N; Bastaninejad, Sh; Amirizad, E

    2016-08-01

    This randomized clinical trial was designed to compare three different reduction methods for anterior temporomandibular joint (TMJ) dislocation. The three methods evaluated were the conventional method, wrist pivot method, and extraoral method. The study sample comprised 90 consecutive patients suffering from anterior dislocation of the TMJ, who were allocated randomly to one of the three groups. This study found success rates of 86.7% for the conventional method, 96.7% for the wrist pivot method, and 66.7% for the extraoral method. The extraoral method was more difficult for the physician and the patient than the other two methods. For the patients, the wrist pivot method was easier than the other methods. For the doctors, the extraoral method was significantly more difficult than the other methods. In conclusion, due to the absence of a biting risk with the extraoral method and the lack of a significant difference in success between this method and the conventional method, the extraoral method could be considered the appropriate first-line treatment where there is a risk of the patient biting the surgeon's hand. Given the overall benefits of the wrist pivot method, this method could be considered the first-line and gold standard treatment modality in other cases. PMID:27160610

  11. Spontaneous dislocation of a crystalline lens to the anterior chamber with pupillary block glaucoma in Noonan Syndrome: a case report

    PubMed Central

    Mukhopadhyaya, Udayaditya; Chakraborti, Chandana; Mondal, Anindita; Pattyanayak, Ujjal; Agarwal, Rajesh Kumar; Tripathi, Partha

    2014-01-01

    We report a 13-year-old child with Noonan Syndrome who developed spontaneous dislocation of the crystalline lens in anterior chamber leading to pupillary block glaucoma in the left eye and subluxation of lens in right eye. Intracapsular extraction of the dislocated lens was done in the left eye. Prompt diagnosis and management is needed in such cases to avoid glaucoma and corneal endothelial cell damage. We could not find any such case after thorough Medline search. PMID:25374640

  12. Bilateral posterior sternoclavicular dislocation.

    PubMed

    Baumann, Matthias; Vogel, Tobias; Weise, Kuno; Muratore, Tim; Trobisch, Per

    2010-07-01

    Posterior sternoclavicular dislocations are a rare injury, representing <5% of all sternoclavicular dislocations and 1 in 1600 shoulder girdle injuries. Proper imaging with computed tomography and prompt diagnosis are essential steps in preventing potentially lethal complications observed in approximately 3% of all posterior sternoclavicular dislocations. Surgical treatment is necessary if closed reduction fails. With the medial clavicular epiphysis being the last to close (between ages 22 and 25), children and adolescents typically present with epiphyseal fractures rather than joint dislocations. If closed reduction fails, open reduction and internal fixation (ORIF) should be considered in fractures, whereas complex reconstructions with tendon graft procedures have been recommended for joint dislocations. This article presents a case of a traumatic bilateral posterior sternoclavicular dislocation due to an epiphyseal fracture in a 15-year-old boy. To our knowledge, this is the first reported case of a bilateral posterior sternoclavicular dislocation. Attempted closed reduction failed with redislocation after 2 days. The patient subsequently required ORIF. This article describes our technique with anterior retraction of the medial clavicle, closure of the posterior periosteum, and ORIF using nonabsorbable sutures. Postoperative shoulder mobilization was started on day 1. At final follow-up, the patient was completely asymptomatic. PMID:20608625

  13. Recurrent laryngeal edema imitating angioedema caused by dislocated screw after anterior spine surgery.

    PubMed

    Wójtowicz, Piotr; Szafarowski, Tomasz; Migacz, Ewa; Krzeski, Antoni

    2015-01-01

    The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis. PMID:25755901

  14. Massive rotator cuff tear associated with acute traumatic posterior shoulder dislocation: report of two cases and literature review.

    PubMed

    Luenam, Suriya; Kosiyatrakul, Arkaphat

    2013-12-01

    A massive rotator cuff tear in association with acute traumatic posterior glenohumeral dislocation is rare. To our knowledge, only four documented cases have been reported in the literature. We present two additional cases of such injury secondary to the traffic accident. The first patient had an unsuccessful closed reduction due to the posterior instability while the second developed the profound shoulder weakness following the reduction. From the findings of our cases together with the previous reports, every patient had a unique injury mechanism of high-energy directed axial loading on an outstretched, adducted, and internally rotated arm. The glenohumeral capsule and rotator cuff were uniformly avulsed from the humeral attachment, and the supraspinatus and infraspinatus were always involved. However, the clinical presentations were variable based on the severity of the associated rotator cuff tear. The outcomes of operative treatment in this type of injury with the open repair were favorable. PMID:22782426

  15. Open anterior dislocation of the hip in an adult: a case report and review of literature☆☆☆

    PubMed Central

    de Oliveira, Anderson Luiz; Machado, Eduardo Gomes

    2014-01-01

    Open anterior hip dislocation is a rare condition and results from high‐energy trauma. Ten cases of open anterior dislocation have been described in the literature so far. Its rarity is due to the inherent stability of the joint, its deep position in the pelvis, with strong ligaments and bulky muscles around the articulation. Several factors influence the prognosis, such as the degree of compounding, the associated soft tissue injuries, the age of the patient and, mainly, the delay in reduction. The main complications are: arthrosis of the hip, with incidence of 50% of cases, when associated with fractures of the femoral head; and osteonecrosis of the femoral head, with incidence between 1.7 and 40% (in closed anterior dislocation). Because of the rarity and the potential disability of this lesion, we report a case in a 46‐year‐old man, involved in an automobile accident. The hip was reduced (anterior superior dislocation) in the first three hours of the trauma. The patient was kept non‐weight bearing until sixth week, with complete weight bearing after 10th week. After one year follow‐up, the functional result was poor (Harris Hip Score: 52), probably because of the associated labral tear, but without signs of osteonecrosis of the femoral head in magnetic resonance imaging. PMID:26229781

  16. Irreducible Atlanto-Axial Dislocation in Neglected Odontoid Fracture Treated with Single Stage Anterior Release and Posterior Instrumented Fusion

    PubMed Central

    Rathod, Ashok Keshav; Chaudhary, Kshitij Subhash

    2016-01-01

    It is a well-know fact that type 2 odontoid fractures frequently go into nonunion. If left untreated, patients may develop irreducible atlantoaxial dislocation (AAD). We describe the surgical management of two patients with neglected odontoid fractures and irreducible AAD treated with single stage anterior release followed by posterior instrumented fusion. Both patients presented with history of neglected trauma and progressive myelopathy. Traction under anesthesia failed to achieve reduction of AAD. Anterior release was done by trans-oral approach in one patient and retrophayngeal approach in the other. Posterior fixation was performed with transarticular screws in both the patients. Both patients had full neurological recovery and demonstrated fusion at follow-up. Anterior release followed by posterior instrumented correction may be an effective alternative to the traditional means of treating irreducible dislocations associated with neglected odontoid fractures. PMID:27114778

  17. The effects of shoulder joint abduction angles on the muscle activity of the serratus anterior muscle and the upper trapezius muscle while vibrations are applied

    PubMed Central

    Jung, Da-eun; Moon, Dong-chul

    2015-01-01

    [Purpose] The purpose of this study was to examine the ratio between the upper trapezius and the serratus anterior muscles during diverse shoulder abduction exercises applied with vibrations in order to determine the appropriate exercise methods for recovery of scapular muscle balance. [Subjects and Methods] Twenty-four subjects voluntarily participated in this study. The subjects performed shoulder abduction at various shoulder joint abduction angles (90°, 120°, 150°, 180°) with oscillation movements. [Results] At 120°, all the subjects showed significant increases in the muscle activity of the serratus anterior muscle in comparison with the upper trapezius muscle. However, no significant difference was found at angles other than 120°. [Conclusion] To selectively strengthen the serratus anterior, applying vibration stimuli at the 120° shoulder abduction position is considered to be appropriate. PMID:25642052

  18. Shoulder Pain and Common Shoulder Problems

    MedlinePlus

    ... and muscles around the shoulder become loose or torn, dislocations can occur repeatedly. Recurring dislocations, which may ... involve arthroscopy to remove scar tissue or repair torn tissues, or traditional, open procedures for larger reconstructions ...

  19. Shoulder Problems in Athletes.

    ERIC Educational Resources Information Center

    Clancy, William G., Jr.

    A description is given of typical sport-related injuries to the shoulder area. These include: (1) brachial plexus injuries; (2) peripheral nerve injuries about the shoulder; (3) acromioclavicular injuries; (4) sternoclavicular injuries; (5) shoulder dislocations; (6) recurrent traumatic subluxation/dislocations; and (7) overuse injuries.…

  20. Dislocation

    MedlinePlus

    ... likely to happen again. Follow-up with an orthopedic surgeon is recommended after a dislocation. ... SE, Mehta A, Maddow C, Luber SD. Critical orthopedic skills and procedures. Emergency Medicine Clinics of North ...

  1. INTEGRITY OF THE SUBSCAPULARIS TENDON AFTER OPEN SURGERY FOR THE TREATMENT OF ANTERIOR SHOULDER INSTABILITY: A CLINICAL AND RADIOLOGICAL EVALUATION

    PubMed Central

    Lech, Osvandré; Piluski, Paulo; Tambani, Renato; Castro, Nero; Pimentel, Gilnei

    2015-01-01

    Objective: To evaluate the integrity of the subscapularis tendon by strength, function and magnetic resonance imaging after deltopectoralis access for anterior shoulder instability. Methods: 20 patients with anterior shoulder instability have been evaluated. Minimum follow-up was 12 months, with a mean of 40 months. Only male patients were included, with a mean of age of 29 years (20 − 42 years). The patients have been submitted to physical examinations of mobility, muscular strength, Belly Test and Gerber Test. The isokinetic strength in internal and external rotation, in angular speeds of 600/s and 1800/s, for both shoulders was measured using a dynamometer. In 15 patients magnetic resonance imaging (MRI) was carried out on both shoulders for evaluating the thickness, cross-sectional area and atrophy of the subscapularis muscle. Results: A significant difference was found between torque peaks at the speed of 600/s for internal (p=0.036) and external (p=0.008) rotation. However, at 1800/s the opposite happens (internal rotation: p=0.133; external rotation: p=0.393). Subscapularis muscle thickness and area are significantly smaller than the normal side, with a deficit of 19% and 23%, respectively. According to Rowe and UCLA scores, we find excellent and good results for the majority of patients, with a mean of 88 and 31.6 points, respectively. Conclusion: Despite of the good functional results, open surgery can limit strength and reduce the thickness and the cross-sectional area of subscapularis muscle. However, the best results were found in the patients who had the dominant side operated. PMID:27004190

  2. Dislocations

    MedlinePlus

    ... Attempting to move or jam a dislocated bone back in can damage blood vessels, muscles, ligaments, and nerves. Apply an ice pack. Ice can ease swelling and pain in and around the joint. Use ibuprofen or acetaminophen for pain. Think Prevention! Make sure kids wear the appropriate safety gear ...

  3. “8 Plate”: An Alternative Device to Fix Highly Recurrent Traumatic Anterior Gleno-Humeral Instability in Patients with Severe Impairment of the Anterior Capsule

    PubMed Central

    Tudisco, C; Bisicchia, S; Savarese, E; Ippolito, E

    2014-01-01

    Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy. Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder. Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate. Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim. PMID:25621080

  4. Emerging Indications for Reverse Shoulder Arthroplasty.

    PubMed

    Urch, Ekaterina; Dines, Joshua S; Dines, David M

    2016-01-01

    Historically, reverse shoulder arthroplasty was reserved for older, low-demand patients in whom rotator cuff arthropathy was diagnosed. Other common indications included sequelae of previously treated proximal humerus fractures, failed anatomic total shoulder arthroplasty, tumor resection, and rheumatoid arthritis in the elderly population. Unpredictable implant durability and high complication rates have limited the use of reverse shoulder arthroplasty to a narrow group of patients. Over the past decade, however, research has led to an improved understanding of the biomechanics behind reverse shoulder prostheses, which has improved implant design and surgical techniques. Consequently, orthopaedic surgeons have slowly begun to expand the indications for reverse shoulder arthroplasty to include a wider spectrum of shoulder pathologies. Recent studies have shown promising results for patients who undergo reverse shoulder arthroplasty for the treatment of acute proximal humerus fractures, massive rotator cuff tears without arthropathy, primary osteoarthritis, and chronic anterior dislocation, as well as for younger patients who have rheumatoid arthritis. These data suggest that, with judicious patient selection, reverse shoulder arthroplasty can be an excellent treatment option for a growing patient cohort. PMID:27049188

  5. Scleral Fixation of Posteriorly Dislocated Intraocular Lenses by 23-Gauge Vitrectomy without Anterior Segment Approach

    PubMed Central

    Nadal, Jeroni; Kudsieh, Bachar; Casaroli-Marano, Ricardo P.

    2015-01-01

    Background. To evaluate visual outcomes, corneal changes, intraocular lens (IOL) stability, and complications after repositioning posteriorly dislocated IOLs and sulcus fixation with polyester sutures. Design. Prospective consecutive case series. Setting. Institut Universitari Barraquer. Participants. 25 eyes of 25 patients with posteriorly dislocated IOL. Methods. The patients underwent 23-gauge vitrectomy via the sulcus to rescue dislocated IOLs and fix them to the scleral wall with a previously looped nonabsorbable polyester suture. Main Outcome Measures. Best corrected visual acuity (BCVA) LogMAR, corneal astigmatism, endothelial cell count, IOL stability, and postoperative complications. Results. Mean follow-up time was 18.8 ± 10.9 months. Mean surgery time was 33 ± 2 minutes. Mean BCVA improved from 0.30 ± 0.48 before surgery to 0.18 ± 0.60 (p = 0.015) at 1 month, which persisted to 12 months (0.18 ± 0.60). Neither corneal astigmatism nor endothelial cell count showed alterations 1 year after surgery. Complications included IOL subluxation in 1 eye (4%), vitreous hemorrhage in 2 eyes (8%), transient hypotony in 2 eyes (8%), and cystic macular edema in 1 eye (4%). No patients presented retinal detachment. Conclusion. This surgical technique proved successful in the management of dislocated IOL. Functional results were good and the complications were easily resolved. PMID:26294964

  6. Rugby and Shoulder Trauma: A Systematic Review

    PubMed Central

    Papalia, R.; Tecame, A.; Torre, G.; Narbona, P.; Maffulli, N.; Denaro, V.

    2015-01-01

    Rugby is a popular contact sport worldwide. Collisions and tackles during matches and practices often lead to traumatic injuries of the shoulder. This review reports on the epidemiology of injuries, type of lesions and treatment of shoulder injuries, risk factors, such as player position, and return to sport activities. Electronic searches through PubMed (Medline), EMBASE, and Cochrane Library retrieved studies concerning shoulder injuries in rugby players. Data regarding incidence, type and mechanisms of lesion, risk factors and return to sport were extracted and analyzed. The main reported data were incidence, mechanism of injury and type of lesion. Most of the studies report tackle as the main event responsible for shoulder trauma (between 50% and 85%), while the main lesions reported were Bankart lesions, Superior Labral tear from Anterior to Posterior (SLAP tears), anterior dislocation and rotator cuff tears. Open or arthroscopic repair improve clinical outcomes. Shoulder lesions are common injuries in rugby players. Surgical treatment seems to be effective in for rotator cuff tears and shoulder instability. More and better designed studies are needed for a higher Level of Evidence analysis of this topic. PMID:26535182

  7. Superior labral anterior posterior lesions of the shoulder: Current diagnostic and therapeutic standards

    PubMed Central

    Popp, Dominik; Schöffl, Volker

    2015-01-01

    Surgical treatment of superior labral anterior posterior (SLAP) lesion becomes more and more frequent which is the consequence of evolving progress in both, imaging and surgical technique as well as implants. The first classification of SLAP lesions was described in 1990, a subdivision in four types existed. The rising comprehension of pathology and pathophysiology in SLAP lesions contributed to increase the types in SLAP classification to ten. Concerning the causative mechanism of SLAP lesions, acute trauma has to be differed from chronic degeneration. Overhead athletes tend to develop a glenohumeral internal rotation deficit which forms the basis for two controversial discussed potential mechanisms of pathophysiology in SLAP lesions: Internal impingement and peel-back mechanism. Clinical examination often remains unspecific whereas soft tissue imaging such as direct or indirect magnetic resonance arthrography has technically improved and is regarded to be indispensable in detection of SLAP lesions. Concomitant pathologies as Bankart lesions, rotator cuff tears or perilabral cysts should be taken into consideration when planning a personalized therapeutic strategy. In addition, normal variants such as sublabral recess, sublabral hole, Buford complex and other less common variants have to be distinguished. The most frequent SLAP type II needs a sophisticated approach when surgical teatment comes into consideration. While SLAP repair is considered to be the standard operative option, overhead athletes benefit from a biceps tenodesis because improved patient-reported satisfaction and higher rate of return to pre-injury level of sports has been reported. PMID:26495243

  8. Differential expression of extracellular matrix genes in glenohumeral capsule of shoulder instability patients.

    PubMed

    Belangero, Paulo Santoro; Leal, Mariana Ferreira; Figueiredo, Eduardo Antônio; Cohen, Carina; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

    2016-07-01

    Anterior shoulder instability is a common orthopedic problem. After a traumatic shoulder dislocation, patients present a plastic deformation of the capsule. The shoulder instability biology remains poorly understood. We evaluated the expression of genes that encode the cartilage oligomeric matrix protein (COMP), fibronectin 1 (FN1), tenascin C (TNC) and tenascin XB (TNXB) in the glenohumeral capsule of anterior shoulder instability patients and controls. Moreover, we investigated the associations between gene expression and clinical parameters. The gene expression was evaluated by quantitative reverse transcription-polymerase chain reaction in the antero-inferior (macroscopically injured region), antero-superior and posterior regions of the capsule of 29 patients with shoulder instability and 8 controls. COMP expression was reduced and FN1 and TNC expression was increased in the antero-inferior capsule region of cases compared to controls (p < 0.05). TNC expression was increased in the posterior capsule portion of shoulder instability patients (p = 0.022). COMP expression was reduced in the antero-inferior region compared to the posterior region of shoulder instability patients (p = 0.007). In the antero-inferior region, FN1 expression was increased in the capsule of patients with more than one year of symptoms (p = 0.003) and with recurrent dislocations (p = 0.004) compared with controls. FN1 and TNXB expression was correlated with the duration of symptoms in the posterior region (p < 0.05). Thus, COMP, FN1, TNC and TNXB expression was altered across the capsule of shoulder instability patients. Dislocation episodes modify FN1, TNC and TNXB expression in the injured tissue. COMP altered expression may be associated with capsule integrity after shoulder dislocation, particularly in the macroscopically injured portion. PMID:27093129

  9. Evaluating the Center of Gravity of Dislocations in Soccer Players With and Without Reconstruction of the Anterior Cruciate Ligament Using a Balance Platform

    PubMed Central

    Alonso, Angelica Castilho; Greve, Júlia Maria D’Andréa; Camanho, Gilberto Luis

    2009-01-01

    OBJECTIVE The objective of this study was to compare the dislocation of the center of gravity and postural balance in sedentary and recreational soccer players with and without anterior cruciate ligament (ACL) reconstruction using the Biodex Balance System (BBS). METHOD Sixty-four subjects were divided into three groups: a) soccer players who were post- anterior cruciate ligament reconstruction; b) soccer players with no anterior cruciate ligament injuries; and c) sedentary subjects. The subjects were submitted to functional stability tests using the Biodex Balance System. The instability protocols used were level eight (more stable) and level two (less stable). Three stability indexes were calculated: the anteroposterior stability index, the mediolateral stability index, and the general stability index. RESULTS Postural balance (dislocation) on the reconstructed side of the athletes was worse than on the side that had not undergone reconstruction. The postural balance of the sedentary group was dislocated less on both sides than the reconstructed knees of the athletes without anterior cruciate ligament injuries. There were no differences in postural balance with relation to left/right dominance for the uninjured athletes and the sedentary individuals. CONCLUSION The dislocation of the center of gravity and change in postural balance in sedentary individuals and on the operated limb of Surgery Group are less marked than in the soccer players from the Non Surgery Group and on the non-operated limbs. The dislocation of the center of gravity and the change in postural balance from the operated limb of the soccer players is less marked than in their non-operated limbs. PMID:19330239

  10. Mutations in ASPH Cause Facial Dysmorphism, Lens Dislocation, Anterior-Segment Abnormalities, and Spontaneous Filtering Blebs, or Traboulsi Syndrome

    PubMed Central

    Patel, Nisha; Khan, Arif O.; Mansour, Ahmad; Mohamed, Jawahir Y.; Al-Assiri, Abdullah; Haddad, Randa; Jia, Xiaofei; Xiong, Yong; Mégarbané, André; Traboulsi, Elias I.; Alkuraya, Fowzan S.

    2014-01-01

    We have previously described a syndrome characterized by facial dysmorphism, lens dislocation, anterior-segment abnormalities, and spontaneous filtering blebs (FDLAB, or Traboulsi syndrome). In view of the consanguineous nature of the affected families and the likely autosomal-recessive inheritance pattern of this syndrome, we undertook autozygosity mapping and whole-exome sequencing to identify ASPH as the disease locus, in which we identified two homozygous mutations. ASPH encodes aspartyl/asparaginyl β-hydroxylase (ASPH), which has been found to hydroxylate aspartic acid and asparagine residues on epidermal growth factor (EGF)-domain-containing proteins. The truncating and missense mutations we identified are predicted to severely impair the enzymatic function of ASPH, which suggests a possible link to other forms of ectopia lentis given that many of the genes implicated in this phenotype encode proteins that harbor EGF domains. Developmental analysis of Asph revealed an expression pattern consistent with the proposed link to the human syndrome. Indeed, Asph-knockout mice had a foreshortened snout, which corresponds to the facial abnormalities in individuals with Traboulsi syndrome. These data support a genetic basis for a syndromic form of ectopia lentis and the role of aspartyl hydroxylation in human development. PMID:24768550

  11. Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

    PubMed

    Ingram, David; Engelhardt, Christoph; Farron, Alain; Terrier, Alexandre; Müllhaupt, Philippe

    2016-01-01

    Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation. PMID:26158646

  12. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?

    PubMed Central

    Lädermann, Alexandre; Denard, Patrick J.; Tirefort, Jérôme; Kolo, Frank C.; Chagué, Sylvain; Cunningham, Grégory; Charbonnier, Caecilia

    2016-01-01

    Abstract Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation. Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography. Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values. While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder. PMID:27495043

  13. Managing shoulder dystocia.

    PubMed

    Brew, J

    1993-01-01

    In midwifery textbooks not much has been written about the management of shoulder dystocia, although it sometimes occurs, and midwives conducting the delivery have to know how to manage it. Should dystocia occurs when the shoulders are stuck in the antero-posterior diameter of the outlet. Sometimes the shoulders fail to rotate into the antero-posterior diameter; in this situation the shoulders are in the oblique diameter of the outlet. This usually happens when the baby is big, weighing more than 4 kilograms. In such cases, the head is big, and it is difficult to deliver the face and the chin. The woman should be in lithotomy position, with the buttocks slightly beyond the end of the bed. The baby's air passages should be sucked of mucus and liquid, so that respiration is initiated. A wide episiotomy should be performed to enlarge the outlet. If the shoulders are in the oblique diameter of the outlet, the midwife should correct the position by hooking a finger into the anterior axilla and rotate the shoulders forward to the antero-posterior diameter of the outlet, before attempting to deliver the shoulders. The next step is the delivery of the posterior shoulder. The midwife puts a finger into the axilla of the posterior shoulder, and by gentle traction downwards, the posterior shoulder is freed. After this, the anterior shoulder is delivered the normal way. This can be aided by applying pressure on the anterior shoulder above the pubic. If the above management fails, then the assistance of the obstetrician must be sought. It is important to recognize large babies before birth in order to initiate appropriate measures before the woman goes into labor. During delivery, the shoulders must be rotated into the antero-posterior diameter of the outlet before attempting to deliver them. PMID:12179356

  14. Understanding Multidirectional Instability of the Shoulder

    PubMed Central

    Cordasco, Frank A.

    2000-01-01

    Objective: To provide an overview of the evaluation and treatment of the patient with multidirectional shoulder instability. Data Sources: I searched MEDLINE for the years from 1980 to 2000 using the key words “shoulder joint,” “instability,” “dislocation,” “multidirectional shoulder instability,” and “inferior capsular shift.” Data Synthesis: Multidirectional instability is symptomatic glenohumeral subluxation or dislocation in more than 1 direction: anterior, inferior, or posterior. The primary pathology is a loose and patulous capsule, and the entity is more common than previously recognized. Multidirectional instability affects young, sedentary patients with generalized ligamentous laxity, often with bilateral symptoms and an atraumatic history, but it also affects athletes, many of whom have sustained injuries. Patients with multidirectional instability may also have Bankart lesions and humeral head impression defects. Conclusions/Recommendations: Patients with multidirectional instability must be identified before appropriate treatment can be initiated. If a course of rehabilitation fails to improve the patient's symptoms, an inferior capsular shift procedure has been demonstrated to be an effective surgical option. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6.Figure 7.Figure 8.Figure 9.Figure 10. PMID:16558641

  15. Predictors for Surgery in Shoulder Instability

    PubMed Central

    Lebus, George F.; Raynor, Martin B.; Nwosu, Samuel K.; Wagstrom, Emily; Jani, Sunil S.; Carey, James L.; Hettrich, Carolyn M.; Cox, Charles L.; Kuhn, John E.

    2015-01-01

    Background: Shoulder instability is a common cause of pain and dysfunction in young, active patients. While studies have analyzed risk factors for recurrent instability and failure after instability surgery, few have examined which variables are associated with initial surgery in this patient population. Purpose: To identify variables that may be associated with surgical intervention in patients with shoulder instability in the context of the FEDS (frequency, etiology, direction, severity) classification, a system that may be useful in the surgical treatment of shoulder instability patients. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: A database of patients treated for shoulder instability from 3 separate institutions from 2005 to 2010 was generated using International Classification of Diseases–9th Revision data. Data were collected via retrospective review. Injury data were categorized according to the FEDS system. Data were analyzed for significance, with the primary outcome of surgical intervention. Summary statistics were used to assess which variables were associated with eventual surgery. To test the unadjusted bivariate associations between shoulder surgery and each data point, Pearson chi-square tests were used for categorical variables and Wilcoxon tests were used for continuous variables. Results: Over the study time period, 377 patients were treated for shoulder instability. Patients who had surgery were more likely younger, had recurrent instability, and had their initial injury while playing a sport. Most patients had anterior instability; however, there was a greater proportion of posterior instability patients in the operative group. Severity of dislocation, measured by whether the patient required help to relocate the shoulder, was not significantly associated with eventual surgery. While imaging was not available for all patients, surgical patients were more likely to have magnetic resonance imaging findings of

  16. Shoulder replacement - discharge

    MedlinePlus

    Total shoulder arthroplasty - discharge; Endoprosthetic shoulder replacement - discharge; Partial shoulder replacement - discharge; Partial shoulder arthroplasty - discharge; Replacement - shoulder - discharge; ...

  17. Does surgery for instability of the shoulder truly stabilize the glenohumeral joint?: A prospective comparative cohort study.

    PubMed

    Lädermann, Alexandre; Denard, Patrick J; Tirefort, Jérôme; Kolo, Frank C; Chagué, Sylvain; Cunningham, Grégory; Charbonnier, Caecilia

    2016-08-01

    Despite the fact that surgery is commonly used to treat glenohumeral instability, there is no evidence that such treatment effectively corrects glenohumeral translation. The purpose of this prospective clinical study was to analyze the effect of surgical stabilization on glenohumeral translation.Glenohumeral translation was assessed in 11 patients preoperatively and 1 year postoperatively following surgical stabilization for anterior shoulder instability. Translation was measured using optical motion capture and computed tomography.Preoperatively, anterior translation of the affected shoulder was bigger in comparison to the normal contralateral side. Differences were significant for flexion and abduction movements (P < 0.001). Postoperatively, no patients demonstrated apprehension and all functional scores were improved. Despite absence of apprehension, postoperative anterior translation for the surgically stabilized shoulders was not significantly different from the preoperative values.While surgical treatment for anterior instability limits the chance of dislocation, it does not seem to restore glenohumeral translation during functional range of motion. Such persistent microinstability may explain residual pain, apprehension, inability to return to activity and even emergence of dislocation arthropathy that is seen in some patients. Further research is necessary to better understand the causes, effects, and treatment of residual microinstability following surgical stabilization of the shoulder. PMID:27495043

  18. A michigan-type occlusal splint with spring-loaded mandibular protrusion functionality for treatment of anterior disk dislocation with reduction.

    PubMed

    Proff, Peter; Richter, Ernst-Jürgen; Blens, Torsten; Fanghänel, Jochen; Hützen, Daniel; Kordass, Bernd; Gedrange, Tomas; Rottner, Kurt

    2007-01-01

    For treatment of temporomandibular disorders Michigan-type splints are frequently used, as are mandibular advancement appliances for patients diagnosed with anterior disk dislocation. As both types show good results, the combination of these two mechanisms into one bimaxillary appliance was tested on eight patients where splint therapy had brought reduction but not complete elimination of the symptoms. An existing maxillary Michigan splint was modified so that advancement springs could be fitted and the generated forces were transmitted to a mandibular retainer, which did not interfere with the function of the splint. Treatment progress was monitored with computerized axiography and in all cases the axiographic tracings after the bimaxillary treatment showed no pattern indicative of disk dislocation under normal jaw movements. Myofascial pain symptoms, already improved by the pre-treatment with the Michigan splint, were found to be reduced further or eliminated completely. The approach of retrofitting a Michigan splint with the springs allowed for a versatile appliance, which required no occlusal alteration to the finely adapted splint but could as easily be brought back to the simple splint-functionality either for daytime use or for a period of stabilization of the result after successful treatment. Compliance was found to be very good and the short treatment period, together with the small force levels did not produce any detectable dental side effects. PMID:17695993

  19. Management of sternoclavicular dislocation in young children: considerations about diagnosis and treatment of four cases.

    PubMed

    Gil-Albarova, J; Rebollo-González, S; Gómez-Palacio, V E; Herrera, A

    2013-08-01

    The records of 4 children of under 14 years of age treated at our institution for traumatic sternoclavicular dislocation (SCJ) were reviewed. Closed reduction in posterior SCJ after computed tomography (CT) was successful as immediate procedure. For anterior SCJ instability, open reduction and SCJ reconstruction obtained satisfactory results. Conservative treatment of SCJ subluxation for asymptomatic children was sufficient. Radiographs in "serendipity view" were useful for confirming reduction and stability in children. No postoperative CT was needed for this purpose. Closed reduction in posterior SCJ dislocation and surgical treatment in anterior SCJ dislocation in young children can provide stability and a satisfactory return to a normal function, but with some limitation when intense or competitive shoulder motion is required during sport. Young children and parents should be aware about this possibility. Conservative treatment of SCJ subluxation for asymptomatic children is useful. Reflection is required regarding the correct imaging examination after treatment to check stable reduction in a SCJ injury. PMID:23314981

  20. Frozen shoulder

    MedlinePlus

    Frozen shoulder is a condition in which the shoulder is painful and loses motion because of inflammation. ... The capsule of the shoulder joint has ligaments that hold the shoulder bones to each other. When the capsule becomes inflamed, the shoulder bones are ...

  1. A Comparison of Glenohumeral Internal and External Range of Motion and Rotation Strength in healthy and Individuals with Recurrent Anterior Instability

    PubMed Central

    Sadeghifar, Amirreza; Ilka, Shahab; Dashtbani, Hasan; Sahebozamani, Mansour

    2014-01-01

    Background: The glenohumeral joint becomes dislocated more than any other major joint because it maintains a wide range of motion and its stability is inherently weak. The most common complication following acute initial shoulder dislocation is recurrent dislocation or chronic instability. Imbalance of strength and range of motion in individuals with anterior dislocation can be a contributing factor in recurrent dislocation as well. Methods: This case-control study consisted of 24 individuals with a mean age of 24.29±4.33 years, and a mean dislocation rate of 5.37±3.62 times. Isometric cuff strength was measured using a handheld dynamometer and for range of motion, the Leighton flexometer was used in internal and external rotational motions of both upper extremities. Independent t-test was used for data analysis. Results: The internal and external range of motion of the injured glenohumeral joint was lower than the uninjured joint (P<0.001). Similarly, the internal and external rotation strength of the injured joint was lower than the uninjured joint (P<0.001). Conclusions: According to previous data, imbalance of strength and range of motion in individuals with anterior shoulder dislocation can be a contributing factor in long-term disability and increased recurrent dislocation and our finding confirm decreased range of motion and strength in our patients. Hence, proper exercise and rehabilitation plans need to be developed for those suffering from this complication. PMID:25386585

  2. Shoulder arthroscopy

    MedlinePlus

    ... Surgery for shoulder instability: If you have a torn labrum, the surgeon will repair it. The labrum ... may be recommended for these shoulder problems: A torn or damaged cartilage ring (labrum) or ligaments Shoulder ...

  3. Shoulder pain

    MedlinePlus

    Pain - shoulder ... The shoulder is the most movable joint in the human body. A group of 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or ...

  4. Shoulder arthroscopy

    MedlinePlus

    ... repair; SLAP lesion; Acromioplasty; Bankart repair; Bankart lesion; Shoulder repair; Shoulder surgery; Rotator cuff repair ... their tendons that form a cuff over the shoulder joint. These muscles and tendons hold the arm ...

  5. [Post-traumatic bipolar dislocation of the clavicle: is operative treatment reasonable?].

    PubMed

    Dudda, M; Kruppa, C; Schildhauer, T A

    2013-02-01

    Bipolar dislocation of the clavicle ("floating clavicle") is extremely rare. It exists no standardised treatment for this trauma and the treatment is often conservative. This is mainly an anterior displacement of the sternoclavicular joint (type III according to Allman) and a posterior dislocation of the acromioclavicular joint (type IV according to Rockwood).We report on a 60 year old male who fell onto the right shoulder. He sustained a 'floating clavicle' and had a massive dislocation, impairment of range of motion and pain. Venous congestion was observable. We stabilised the dislocated acromioclavicular joint with a Balser's plate, the sternoclavicular joint was fixed with PDS cord tension band technique around the first rip and the sternum. In addition we resected the anterior part of the distal clavicle to get a better cosmetic result. Post-operatively the patient had an excellent range of motion without any further symptoms after six weeks and one year. Venous congestion was not more observable.In most of the cases dislocations of both ends of the clavicle are treated conservatively. We recommend an operative treatment especially in young and active patients to avoid re-dislocation and to archive better cosmetic results. PMID:22367519

  6. Shoulder Instability in the Overhead Athlete

    PubMed Central

    Nassiri, Nima; Eliasberg, Claire; Jones, Kristofer J.; McAllister, David R.; Petrigliano, Frank A.

    2015-01-01

    Objectives: Overhead athletes place extraordinary physiologic demands on the shoulder during athletic activity. Repetitive microtrauma can result in attenuation of important capsuloligamentous structures that are responsible for providing glenohumeral stability resulting in symptomatic instability. Surgical management can utilize either an arthroscopic or open approach to shoulder stabilization; however, there is a paucity of data to support a specific technique and guide surgical decision making in this unique patient population. The purpose of the present study was to determine functional outcomes, including return to play, range of motion (ROM), validated outcome scores and recurrent instability following arthroscopic and open shoulder stabilization in overhead athletes diagnosed with anterior instability. Methods: MEDLINE and the Cochrane Database of Systematic Reviews were searched. Eleven articles matched our selection criteria for randomized controlled trials in which a cohort of overhead athletes participating in sports including baseball, tennis, volleyball, and freestyle swimming, were surgically treated by capsular plication or Bankart repair through either an open or arthroscopic approach for anterior shoulder subluxation or dislocation. The studies were assessed for methodological quality and relevant data was extracted and further evaluated. Results of comparable groups of trials were pooled and mean differences as well as 95% confidence intervals were calculated for continuous outcomes. A grading schema was designed to assess return to play: return to the same level of play (Grade 1), diminished level of play (Grade 2), and failure to return to play (Grade 3). Results: In overhead athletes with anterior glenohumeral subluxation or dislocation, return to play was similar between arthroscopic and open approaches (Grade 1 = arthroscopic 72 ± 22.6%, open 68.7 ± 7.8%; Grade 2 = arthroscopic 24.2 ± 18.3%, open 34.5 ± 7.8%; Grade 3 = arthroscopic 7.2

  7. The influence of various resistance loads on the ratio of activity of the external rotator muscles of the shoulder and the anterior gliding of the humeral head during external rotation exercise.

    PubMed

    Jo, Marg-Eun; Lee, Seung-Min; Jang, Jun-Hyeok; Lee, Sang-Yeol

    2015-10-01

    [Purpose] To quantify the ratio of activation of the infraspinatus and posterior deltoid muscles and the anterior gliding motion of the humeral head during external rotation (ER) motions of the shoulder performed in prone position against different external resistance loads. [Subjects] Twenty healthy women between the ages of 20 and 30 years. [Methods] Activity ratio was quantified as the difference in the root mean square of the smoothed electromyography signal (EMG) of the posterior deltoid to the infraspinatus muscle, and anterior gliding pressure of the humeral head using a pressure biofeedback unit (PBU), for three resistance loads: 0, 1 and 2 kg. [Results] There was a significant correlation among all three variables (load, ratio, and pressure). Anterior gliding pressure correlated with the activity ratio, with activity of the posterior deltoid increasing with the magnitude of the resistance load. [Conclusion] There was a positive association between the magnitude of resistance load, activity of the posterior deltoid and anterior gliding pressure of the humeral head. The PBU could be used to facilitate the recruitment of the infraspinatus muscle at higher loads to improve glenohumeral joint stability during ER exercise against higher resistance. PMID:26644683

  8. Shoulder replacement

    MedlinePlus

    ... the opening at the end of the shoulder blade, called the socket. This type of joint allows ... head. The socket part (glenoid) of your shoulder blade will be replaced with a smooth plastic shell ( ...

  9. Shoulder Arthroscopy

    MedlinePlus

    ... synovial fluid that lubricates the shoulder joint. Rotator cuff. Four tendons surround the shoulder capsule and help ... This thick tendon material is called the rotator cuff. The cuff covers the head of the humerus ...

  10. Shoulder pain

    MedlinePlus

    ... 4 muscles and their tendons, called the rotator cuff, give the shoulder its wide range of motion. Swelling, damage, or bone changes around the rotator cuff can cause shoulder pain. You may have pain ...

  11. Acromioclavicular dislocation: postoperative evaluation of the coracoclavicular ligaments using magnetic resonance☆

    PubMed Central

    Faria, Rafael Salomon Silva; Ribeiro, Fabiano Rebouças; Amin, Bruno de Oliveira; Tenor Junior, Antonio Carlos; da Costa, Miguel Pereira; Filardi Filho, Cantídio Salvador; Batista, Cleber Gonçalves; Brasil Filho, Rômulo

    2015-01-01

    Objective To radiologically evaluate the healing of the coracoclavicular ligaments after surgical treatment for acromioclavicular dislocation. Methods Ten patients who had undergone surgical treatment for acromioclavicular dislocation via a posterosuperior route at least one year earlier were invited to return for radiological assessment using magnetic resonance. This evaluation was done by means of analogy with the scale described in the literature for studying the healing of the anterior cruciate ligament of the knee and for measuring the healed coracoclavicular ligaments. Results A scar structure of fibrous appearance had formed in 100% of the cases. In 50% of the cases, the images of this structure had a good appearance, while the other 50% were deficient. Conclusion Late postoperative evaluation using magnetic resonance, on patients who had been treated for acute acromioclavicular dislocation using a posterosuperior route in the shoulder, showed that the coracoclavicular ligaments had healed in 100% of the cases, but that this healing was deficient in 50%. PMID:26229916

  12. Comparison of Bristow procedure and Bankart arthroscopic method as the treatment of recurrent shoulder instability

    PubMed Central

    Zarezade, Abolghasem; Dehghani, Mohammad; Rozati, Ali Reza; Banadaki, Hossein Saeid; Shekarchizade, Neda

    2014-01-01

    Background: Anterior shoulder dislocation is the most common major joint dislocation. In patients with recurrent shoulder dislocation, surgical intervention is necessary. In this study, two methods of treatment, Bankart arthroscopic method and open Bristow procedure, were compared. Materials and Methods: This clinical trial survey had been done in the orthopedic department of Alzahra and Kashani hospitals of Isfahan during 2008-2011. Patients with recurrent anterior shoulder dislocation who were candidates for surgical treatment were randomly divided into two groups, one treated by Bankart arthroscopic technique and the other treated by Bristow method. All the patients were assessed after the surgery using the criteria of ROWE, CONSTANT, UCLA, and ASES. Data were analyzed by SPSS software. Results: Six patients (16.22%) had inappropriate condition with ROWE score (score less than 75); of them, one had been treated with Bristow and five with Bankart (5.26 vs. 27.78). Nine patients (24.32%) had appropriate condition, which included six from Bristow group and three treated by Bankart technique (31.58 vs. 16.67). Finally, 22 patients (59.46%) showed great improvement with this score, which included 12 from Bristow and 10 from Bankart groups (63.16 vs. 55.56). According to Fisher's exact test, there were no significant differences between the two groups (P = 0.15). Conclusion: The two mentioned techniques did not differ significantly, although some parameters such as level of performance, pain intensity, use of analgesics, and range of internal rotation showed more improvement in Bristow procedure. Therefore, if there is no contraindication for Bristow procedure, it is preferred to use this method. PMID:25590034

  13. Bristow-Latarjet Technique: Still a Very Successful Surgery for Anterior Glenohumeral Instability - A Forty Year One Clinic Experience

    PubMed Central

    Ruci, Vilson; Duni, Artid; Cake, Alfred; Ruci, Dorina; Ruci, Julian

    2015-01-01

    AIM: To evaluate the functional outcomes of the Bristow-Latarjet procedure in patients with recurrent anterior glenohumeral instability. PATIENTS AND METHODS: Personal clinical records of 42 patients with 45 operated shoulders were reviewed retrospectively. Patient age at time of first dislocation, injury mechanism, and number of recurring dislocations before surgery were recorded. The overall function and stability of the shoulder was evaluated. RESULTS: Thirty five (78%) of the scapulohumeral humeral instabilities were caused by trauma. The mean number of recurring dislocations was 9 (95% confidence interval [CI], 0–18); one patient had had 17 recurrences. Mean follow-up 46 months (95% CI, 16-88). No dislocation happened postoperatively. Four patients have fibrous union (9%). Only two had clinical sign of pain and discomfort. One of them was reoperated for screw removal with very good post-operative result. The overall functional outcome was good, with a mean Rowe score of 88 points (95% CI, 78–100). Scores of 27 (64%) of the patients were excellent, 9 (22%) were good, 4 (9.5%) were fair, and 2 (4.5%) were poor. CONCLUSION: The Bristow-Latarjet procedure is a very good surgical treatment for recurrent anterior-inferior instability of the glenohumeral joint. It must not be used for multidirectional instability or psychogenic habitual dislocations.

  14. Bipolar dislocation of the clavicle.

    PubMed

    Jiang, Wei; Gao, Shu-Guang; Li, Yu-Sheng; Lei, Guang-Hua

    2012-11-01

    Bipolar dislocation of the clavicle at acromioclavicular and sternoclavicular joint is an uncommon traumatic injury. The conservative treatments adopted in the past is associated with redislocation dysfunction and deformity. A 41 years old lady with bipolar dislocation of right shoulder is treated surgically by open reduction and internal fixation by oblique T-plate at sternoclavicular joint and Kirschner wire stabilization at acromioclavicular joint. The patient showed satisfactory recovery with full range of motion of the right shoulder and normal muscular strength. The case reported in view of rarity and at 2 years followup. PMID:23325981

  15. Shoulder manifestations of diabetes mellitus.

    PubMed

    Garcilazo, Cintia; Cavallasca, Javier A; Musuruana, Jorge L

    2010-09-01

    The musculoskeletal system can be affected by diabetes in a number of ways. The shoulder is one of the frequently affected sites. One of the rheumatic conditions caused by diabetes is frozen shoulder (adhesive capsulitis), which is characterized by pain and severe limited active and passive range of motion of the glenohumeral joint, particularly external rotation. This disorder has a clinical diagnosis and the treatment is based on physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs), corticosteroid injections and, in refractory cases, surgical resolution. As with adhesive capsulitis, calcific periarthritis of the shoulder causes pain and limited joint mobility, although usually it has a better prognosis than frozen shoulder. Reflex sympathetic dystrophy, also known as shoulder-hand syndrome, is a painful syndrome associated with vasomotor and sudomotor changes in the affected member. Diabetic amyotrophy usually affects the peripheral nerves of lower limbs. However, when symptoms involve the shoulder girdle, it must be considered in the differential diagnosis of shoulder painful conditions. Osteoarthritis is the most common rheumatic condition. There are many risk factors for shoulder osteoarthritis including age, genetics, sex, weight, joint infection, history of shoulder dislocation, and previous injury, in older age patients, diabetes is a risk factor for shoulder OA. Treatment options include acetaminophen, NSAIDs, short term opiate, glucosamine and chondroitin. Corticosteroid injections and/or injections of hyaluronans could also be considered. Patients with continued disabling pain that is not responsive to conservative measures may require surgical referral. The present review will focus on practice points of view about shoulder manifestations in patients with diabetes. PMID:20701586

  16. Posterior sternoclavicular Salter-Harris fracture-dislocation in a patient with unossified medial clavicle epiphysis.

    PubMed

    Beckmann, Nicholas; Crawford, Lindsay

    2016-08-01

    Sternoclavicular injuries are relatively rare, composing less than 1 % of all musculoskeletal fractures or dislocations. When sternoclavicular injuries do occur, they typically present as an isolated dislocation of the sternoclavicular joint without associated fracture of the clavicle or manubrium. However, in patients with unfused medial clavicle physis, sternoclavicular joint injuries can present as a fracture-dislocation through the unfused physis. These physeal injuries are important to recognize as the displaced epiphysis can block reduction of the sternoclavicular joint. We present a case of a 15-year-old female basketball player presenting with suspected sternoclavicular joint injury after sustaining a direct blow to the left shoulder. An initial shoulder CT confirmed the presence of the clinically suspected posterior sternoclavicular dislocation without fracture identified. An MRI of the left sternoclavicular joint was then performed for suspected physeal fracture, which confirmed the presence of a fracture through the medial clavicle physis with anterior displacement of the unossified epiphysis, blocking reduction of the metaphysis. Given the findings on MRI, the pediatric orthropedic surgeon was able to counsel the family of the high likelihood of failed closed reduction of the sternoclavicular joint requiring conversion to open reduction and internal fixation. The patient underwent successful open reduction and internal fixation of the medial clavical physeal fracture after an initial gentle attempt at closed reduction was unsuccessful. PMID:27107998

  17. Avoiding Shoulder Injury from Resistance Training.

    ERIC Educational Resources Information Center

    Durall, Chris J.; Manske, Robert C.; Davies, George J.

    2001-01-01

    Identifies shoulder exercises commonly performed in fitness centers that may contribute to or exacerbate glenohumeral joint (shoulder) injury, describing alternative exercises that may be substituted and a offering rationale for the variations. The article focuses on anterior and posterior glenohumeral instability, subacromial impingement (primary…

  18. Central Hypersensitivity in Chronic Hemiplegic Shoulder Pain

    PubMed Central

    Hoo, Jennifer Soo; Paul, Tracy; Chae, John; Wilson, Richard

    2013-01-01

    Objective This study aimed to examine the association of hemiplegic shoulder pain with central hypersensitivity through pressure-pain thresholds (PPT) at healthy, distant tissues. Design This study is a cross-sectional study. A total of 40 patients (n=20 hemiplegic shoulder pain (HSP), n=20 stroke without HSP) were enrolled in this study. Pressure-pain thresholds were measured at the affected deltoid and contralateral deltoid and tibialis anterior using a handheld algometer. Differences in PPTs were analyzed by Wilcoxon Rank Sum test and with linear regression analysis controlling for gender, a known confounder of PPTs. Results Subjects with hemiplegic shoulder pain had lower local PPTs than stroke control subjects when comparing the painful to dominant shoulders and comparing the non-painful shoulder and tibialis anterior to the non-dominant side controls. Similarly, those with hemiplegic shoulder pain had lower PPTs when comparing to controls in contralesional-to-contralesional comparisons as well as ipsilesional-to-ipsilesional comparisons. Conclusions Subjects with hemiplegic shoulder pain have lower local and distal PPTs than subjects without hemiplegic shoulder pain. Our study suggests that chronic shoulder pain may be associated with widespread central hypersensitivity, which has been previously found to be associated with other chronic pain syndromes. This further understanding can then help develop better treatment options for those with this hemiplegic shoulder pain. PMID:23255268

  19. Multiligamentous injuries and knee dislocations.

    PubMed

    Gimber, Lana H; Scalcione, Luke R; Rowan, Andrew; Hardy, Jolene C; Melville, David M; Taljanovic, Mihra S

    2015-11-01

    Complex capsular ligamentous structures contribute to stability of the knee joint. Simultaneous injury of two or more knee ligaments, aside from concurrent tears involving the anterior cruciate and medial collateral ligaments, is considered to be associated with femorotibial knee dislocations. Proximal tibiofibular joint dislocations are not always easily recognized and may be overlooked or missed. Patellofemoral dislocations can be transient with MR imaging sometimes required to reach the diagnosis. In this article, the authors describe the mechanism of injury, ligamentous disruptions, imaging, and treatment options of various types of knee dislocations including injuries of the femorotibial, proximal tibiofibular, and patellofemoral joints. PMID:26002747

  20. Electromyographic analysis of the infraspinatus and scapular stabilizing muscles during isometric shoulder external rotation at various shoulder elevation angles

    PubMed Central

    Uga, Daisuke; Endo, Yasuhiro; Nakazawa, Rie; Sakamoto, Masaaki

    2016-01-01

    [Purpose] This study aimed to clarify activation of the infraspinatus and scapular stabilizing muscles during shoulder external rotation at various shoulder elevation angles. [Subjects] Twenty subjects participated in this study and all measurements were performed on the right shoulder. [Methods] Isometric shoulder external rotation strength and surface electromyographic data were measured with the shoulder at 0°, 45°, 90°, and 135° elevation in the scapular plane. The electromyographic data were collected from the infraspinatus, upper trapezius, middle trapezius, lower trapezius, and serratus anterior muscles. These measurements were compared across the various shoulder elevation angles. [Results] The strength measurements did not differ significantly by angulation. The infraspinatus activity was 92%, 75%, 68%, and 57% of the maximum voluntary contraction, which significantly decreased as shoulder elevation increased. The serratus anterior activity was 24%, 48%, 53%, and 62% of the maximum voluntary contraction, which significantly increased as shoulder elevation increased. [Conclusion] Shoulder external rotation torque was maintained regardless of shoulder elevation angle. The shoulder approximated to the zero position as the shoulder elevation increased so that infraspinatus activity decreased and the scapular posterior tilting by the serratus anterior might generate shoulder external rotation torque. PMID:26957748

  1. [Shoulder impingement].

    PubMed

    Wurnig, C

    2000-10-01

    The impingement syndrome is a common disorder of the shoulder girdle. The causes for this syndrome may be anatomic changes in the coracoacromial arch, also within the ultrastructural regions, on the one hand, or changes in the biomechanics which have developed for various reasons, on the other. Diagnosis is based on roentgenograms using the appropriate technique. In large-scale-studies, sonography has proved to be an extremely sensitive screening method for differential diagnosis of rupture of the rotator cuff. Magnetic resonance imaging might gain in value in the diagnosis of impingement as regards differential diagnosis of rupture of the rotator cuff because this technique--when employed appropriately--allows exact viewing of the soft tissue and the anterior part of the acromion. In the majority of cases conservative treatment is the method of choice. Methods of treatment are sonography, galvanization, and application of heat. Physiotherapy should not be initiated until pain relief has been achieved by other measures. Infiltration therapy is of considerable value in the management of pain due to impingement. Application of cortisone into the subacromial space must also be considered critically. As regards conservative therapy, only few evidence-based publications provide information on the effectiveness of different treatment regimens. Surgical therapy is only indicated in cases of pain resistant to the conservative therapy for a certain period. Furthermore, only an outlet impingement can be treated successfully by surgical decompression. The surgeon decides on the surgical method--open surgery or arthroscopy. Of course, arthroscopic methods are less invasive; however, up to now the superiority of one of the surgical methods over the other could not yet be proven by mid-term clinical results. Other surgical methods such as wedge osteotomy in the region of the spina scapulae are still in the experimental stage. By surgical and conservatives methods, good and even

  2. Dislocation-Free Czochralski Silicon Crystal Growth without the Dislocation-Elimination-Necking Process

    NASA Astrophysics Data System (ADS)

    Hoshikawa, Keigo; Huang, Xinming; Taishi, Toshinori; Kajigaya, Tomio; Iino, Takayuki

    1999-12-01

    Dislocation-free silicon crystals have been grown successfully from heavily-boron-doped silicon melts by the Czochralski method without the dislocation-elimination-necking process (Dash neck). A dislocation-free silicon seed of <001> orientation with a boron concentration of about 4×1019 atoms/cm3 was used to grow a silicon crystal with the same boron concentration. No dislocation was generated in the seed during the dipping process, and no misfit dislocation occurred in the grown crystal. These results show that shoulder and body growth can be started immediately after the seeding process.

  3. Shoulder replacement

    MedlinePlus

    ... are able to return to sports such as golf, swimming, gardening, bowling, and others. Your new shoulder ... important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy , ...

  4. Frozen shoulder

    MedlinePlus

    ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine: Principles and Practice . 4th ed. Philadelphia, PA: Elsevier ... by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, ...

  5. Shoulder Problems

    MedlinePlus

    ... weak? Yes You may have a TORN ROTATOR CUFF or SHOULDER INSTABILITY. See your doctor. No *7. ... redness? Yes You may have BURSITIS or ROTATOR CUFF SYNDROME. Use an anti-inflammatory medicine, such as ...

  6. A Biomechanical Model Correlating Shoulder Kinetics to Pain in Young Baseball Pitchers

    PubMed Central

    Keeley, David W.; Oliver, Gretchen D.; Dougherty, Christopher P.

    2012-01-01

    Previous work has postulated that shoulder pain may be associated with increases in both peak shoulder anterior force and peak shoulder proximal force. Unfortunately these relationships have yet to be quantified. Thus, the purpose of this study was to associate these kinetic values with reported shoulder pain in youth baseball pitchers. Nineteen healthy baseball pitchers participated in this study. Segment based reference systems and established calculations were utilized to identify peak shoulder anterior force and peak shoulder proximal force. A medical history questionnaire was utilized to identify shoulder pain. Following collection of these data, the strength of the relationships between both peak shoulder anterior force and peak shoulder proximal force and shoulder pain were analyzed. Although peak anterior force was not significantly correlated to shoulder pain, peak proximal force was. These results lead to the development of a single variable logistic regression model able to accurately predict 84.2% of all cases and 71.4% of shoulder pain cases. This model indicated that for every 1 N increase in peak proximal force, there was a corresponding 4.6% increase in the likelihood of shoulder pain. The magnitude of peak proximal force is both correlated to reported shoulder pain and capable of being used to accurately predict the likelihood of experiencing shoulder pain. It appears that those pitchers exhibiting high magnitudes of peak proximal force are significantly more likely to report experiencing shoulder pain than those who generate lower magnitudes of peak proximal force. PMID:23486209

  7. Arthroscopic Treatment for Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation - Short Term Results

    PubMed Central

    Wong, Ivan; Amar, Eyal; Coady, Catherine M.; Dilman, Daryl B.; Smith, Ben

    2016-01-01

    Objectives: Background: The results of arthroscopic anterior labral (Bankart) repair have been shown to have high failure rate in patients with significant glenoid bone loss. Several reconstruction procedures using bone graft have been described to overcome the bone loss, including autogenous coracoid transfer to the anterior glenoid (Latarjet procedure) as well as iliac crest autograft and tibial allografts. In recent years, trends toward minimally invasive shoulder surgery along with improvements in technology and technique have led surgeons to expand the application of arthroscopic treatment. Purpose: This study aims to perform a retrospective analysis of prospectively collected data to evaluate the clinical and radiological follow up of patient who underwent anatomic glenoid reconstruction using distal tibia allograft for the treatment of shoulder instability with glenoid bone loss at 1-year post operation time point. Methods: Between December 2011 and January 2015, 55 patients underwent arthroscopic stabilization of the shoulder by means of capsule-labral reattachment to glenoid ream and bony augmentation of glenoid bone loss with distal tibial allograft for recurrent instability of the shoulder. Preoperative and postoperative evaluation included general assessment by the western Ontario shoulder instability index (WOSI) questionnaire, preoperative and postoperative radiographs and CT scans. Results: Fifty-five patients have been evaluated with mean age of 29.73 years at time of the index operation. There were 40 males (mean age of 29.66) and 15 female (mean age of 29.93). Minimum follow up time was 12 months. The following adverse effects were recorded: none suffered from recurrent dislocation, 2 patients suffered from bone resorption but without overt instability, 1 patient had malunion due to screw fracture, none of the patients had nonunion. The mean pre-operative WOSI score was 36.54 and the mean postoperative WOSI score was 61.0. Conclusion: Arthroscopic

  8. Muscle activation patterns in patients with recurrent shoulder instability

    PubMed Central

    Jaggi, Anju; Noorani, Ali; Malone, Alex; Cowan, Joseph; Lambert, Simon; Bayley, Ian

    2012-01-01

    Purpose: The aim of this study is to present muscle patterns observed with the direction of instability in a series of patients presenting with recurrent shoulder instability. Materials and Methods: A retrospective review was carried out on shoulder instability cases referred for fine wire dynamic electromyography (DEMG) studies at a specialist upper limb centre between 1981 and 2003. An experienced consultant clinical neurophysiologist performed dual needle insertion into four muscles (pectoralis major (PM), latissimus dorsi (LD), anterior deltoid (AD) and infraspinatus (IS)) in shoulders that were suspected to have increased or suppressed activation of muscles that could be contributing to the instability. Raw EMG signals were obtained while subjects performed simple uniplanar movements of the shoulder. The presence or absence of muscle activation was noted and compared to clinical diagnosis and direction of instability. Results: A total of 140 (26.6%) shoulders were referred for fine wire EMG, and 131 studies were completed. Of the shoulders tested, 122 shoulders (93%) were identified as having abnormal patterns and nine had normal patterns. PM was found to be more active in 60% of shoulders presenting with anterior instability. LD was found to be more active in 81% of shoulders with anterior instability and 80% with posterior instability. AD was found to be more active in 22% of shoulders with anterior instability and 18% with posterior instability. IS was found to be inappropriately inactive in only 3% of shoulders with anterior instability but in 25% with posterior instability. Clinical assessment identified 93% of cases suspected to have muscle patterning, but the specificity of the clinical assessment was only correct in 11% of cases. Conclusion: The DEMG results suggest that increased activation of LD may play a role in both anterior and posterior shoulder instability; increased activation of PM may play a role in anterior instability. PMID:23493512

  9. Delayed Axillary Artery Occlusion after Reverse Total Shoulder Arthroplasty

    PubMed Central

    Heitmiller, Richard F.

    2016-01-01

    Axillary artery injury has been associated with shoulder dislocation and surgery. We describe a case of delayed axillary artery occlusion after reverse total shoulder arthroplasty. The injury was confirmed by Doppler and angiography and was treated with angioplasty and stenting. Early recognition and treatment of this injury are mandatory for patients' recovery. PMID:27555975

  10. The thrower's shoulder.

    PubMed

    Kinsella, Stuart D; Thomas, Stephen J; Huffman, G Russell; Kelly, John D

    2014-07-01

    Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball comprise the majority of patients seeking orthopedic care for throwing related injuries. Injuries specific to throwers most commonly involve the labrum and the undersurface of the rotator cuff. In addition, tissue changes in both the anterior and posterior glenohumeral capsule are common with repetitive overhead motions. These capsular changes alter. This article will examine the pathomechanics of injuries to throwers, elaborate means of diagnoses of cuff and labral injury and discuss recent advances in both non-operative and operative interventions, including preventative principles. PMID:24975765

  11. Postoperative pectoral swelling after shoulder arthroscopy

    PubMed Central

    ERCIN, ERSIN; BILGILI, MUSTAFA GOKHAN; ONES, HALIL NADIR; KURAL, CEMAL

    2015-01-01

    Fluid extravasation is possibly the most common complication of shoulder arthroscopy. Shoulder arthroscopy can lead to major increases in the compartment pressure of adjacent muscles and this phenomenon is significant when an infusion pump is used. This article describes a case of pectoral swelling due to fluid extravasation after shoulder arthroscopy. A 24-year-old male underwent an arthroscopic Bankart repair for recurrent shoulder dislocation. The surgery was performed in the beach chair position and lasted two hours. At the end of the procedure, the patient was found to have left pectoral swelling. A chest radiography showed no abnormality. Pectoral swelling due to fluid extravasation after shoulder arthroscopy has not previously been documented. PMID:26889473

  12. Shoulder CT scan

    MedlinePlus

    CAT scan - shoulder; Computed axial tomography scan - shoulder; Computed tomography scan - shoulder; CT scan - shoulder ... Mosby; 2012:chap 57. Shaw AS, Prokop M. Computed tomography. In: Adam A, Dixon AK, Gillard JH, Schaefer- ...

  13. Shoulder surgery - discharge

    MedlinePlus

    SLAP repair - discharge; Acromioplasty - discharge; Bankart - discharge; Shoulder repair - discharge; Shoulder arthroscopy - discharge ... You had shoulder surgery to repair the tissues inside or around your shoulder joint. The surgeon may have used a tiny ...

  14. Frozen Shoulder

    MedlinePlus

    ... to control pain and restore motion. Non-steroidal anti-inflammatory medicines. Drugs like aspirin and ibuprofen reduce pain ... Surgeons, 2010. Steroid injections. Cortisone is a powerful anti-inflammatory medicine that is injected directly into your shoulder ...

  15. Acute Shoulder Injuries in Adults.

    PubMed

    Monica, James; Vredenburgh, Zachary; Korsh, Jeremy; Gatt, Charles

    2016-07-15

    Acute shoulder injuries in adults are often initially managed by family physicians. Common acute shoulder injuries include acromioclavicular joint injuries, clavicle fractures, glenohumeral dislocations, proximal humerus fractures, and rotator cuff tears. Acromioclavicular joint injuries and clavicle fractures mostly occur in young adults as the result of a sports injury or direct trauma. Most nondisplaced or minimally displaced injuries can be treated conservatively. Treatment includes pain management, short-term use of a sling for comfort, and physical therapy as needed. Glenohumeral dislocations can result from contact sports, falls, bicycle accidents, and similar high-impact trauma. Patients will usually hold the affected arm in their contralateral hand and have pain with motion and decreased motion at the shoulder. Physical findings may include a palpable humeral head in the axilla or a dimple inferior to the acromion laterally. Reduction maneuvers usually require intra-articular lidocaine or intravenous analgesia. Proximal humerus fractures often occur in older patients after a low-energy fall. Radiography of the shoulder should include a true anteroposterior view of the glenoid, scapular Y view, and axillary view. Most of these fractures can be managed nonoperatively, using a sling, early range-of-motion exercises, and strength training. Rotator cuff tears can cause difficulty with overhead activities or pain that awakens the patient from sleep. On physical examination, patients may be unable to hold the affected arm in an elevated position. It is important to recognize the sometimes subtle signs and symptoms of acute shoulder injuries to ensure proper management and timely referral if necessary. PMID:27419328

  16. Profile of collagen gene expression in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder☆☆☆

    PubMed Central

    Belangero, Paulo Santoro; Leal, Mariana Ferreira; de Castro Pochini, Alberto; Andreoli, Carlos Vicente; Ejnisman, Benno; Cohen, Moises

    2014-01-01

    Objective To evaluate the expression of the genes COL1A1, COL1A2, COL3A1 and COL5A1 in the glenohumeral capsule of patients with traumatic anterior instability of the shoulder. Methods Samples from the glenohumeral capsule of 18 patients with traumatic anterior instability of the shoulder were evaluated. Male patients with a positive grip test and a Bankart lesion seen on magnetic resonance imaging were included. All the patients had suffered more than one episode of shoulder dislocation. Samples were collected from the injured glenohumeral capsule (anteroinferior region) and from the macroscopically unaffected region (anterosuperior region) of each patient. The expression of collagen genes was evaluated using the polymerase chain reaction after reverse transcription with quantitative analysis (qRT-PCR). Results The expression of COL1A1, COL1A2 and COL3A1 did not differ between the two regions of the shoulder capsule. However, it was observed that the expression of COL5A1 was significantly lower in the anteroinferior region than in the anterosuperior region (median ± interquartile range: 0.057 ± 0.052 vs. 0.155 ± 0.398; p = 0.028) of the glenohumeral capsule. Conclusion The affected region of the glenohumeral capsule in patients with shoulder instability presented reduced expression of COL5A1. PMID:26229875

  17. Subtalar dislocation

    SciTech Connect

    El-Khoury, G.Y.; Yousefzadeh, D.K.; Mulligan, G.M.; Moore, T.E.

    1982-05-01

    Over a period of three years we have seen nine patients with subtalar dislocation, all of whom sustained violent trauma to the region of the ankle and hind foot. All but one patient were males. Clinically a subtalar dislocation resembles a complicated fracture dislocation of the ankle but a definitive diagnosis can only be made radiographically. The mechanism of injury and radiographic features of this injury are discussed.

  18. Shoulder instability surgery in Norway

    PubMed Central

    2012-01-01

    Background and purpose In January 2008, we established the Norwegian Register for Shoulder Instability Surgery. We report on the establishment, the baseline data, and the results at 1-year follow-up. Methods Primary and revision shoulder stabilization is reported by the surgeon on a 1-page paper form containing the patient's history of shoulder injury, clinical findings, and perioperative findings. The WOSI questionnaire for self-assessment of shoulder function is completed at baseline and at follow-up after 1, 2, and 5 years. To evaluate the completeness of registration, we compared our data with those in the Norwegian Patient Registry (NPR). Results The NPR reported 39 hospitals performing shoulder stabilizations. 20 of these started to report to our register during 2009, and 464 procedures (404 primary, 59 revisions) were included up to December 31, 2009, which represented 54% of the procedures reported to NPR. Of the 404 primary procedures, 83% were operations due to anterior instability, 10% were operations due to posterior instability, and 7% were operations due to multidirectional instability. Arthroscopic soft tissue techniques were used in 88% of the patients treated for primary anterior instability and open coracoid transfer was used in 10% of such patients. At 1-year follow-up of 213 patients, we found a statistically significantly improved WOSI score in all types of instability. 10% of the patients treated with arthroscopic anterior labral repair and 16% treated with arthroscopic posterior labral repair reported recurrent instability. No statistically significant difference in functional improvement or rate of recurrence was found between these groups. Interpretation The functional results are in accordance with those in previous studies. However, the incidence of recurrent instability 1 year after arthroscopic labral repair is higher than expected. PMID:22112155

  19. Injury patterns to other body regions and load vectors in nearside impact occupants with and without shoulder injuries

    PubMed Central

    Yoganandan, Narayan; Stadter, Gregory W.; Halloway, Dale E.; Pintar, Frank A.

    2013-01-01

    CIREN and NASS-CDS databases were used to analyze nearside impact injuries. Front seat occupants with and without shoulder injuries were examined on an individual basis in both databases. All vehicles were from model year 2000 or newer. Variables such as the type of collision, change in velocity, principal direction force, demographics, injuries scored by the MAIS and ISS metrics, and injuries to the head, thorax, abdomen and pelvis were included. Shoulder injuries included fractures to the humerus, scapula and clavicle, and associated joint traumas. The median changes in velocities for occupants with and without shoulder injuries were 36 and 32 km/h in CIREN and 29 and 32 km/h in NASS databases. Approximately two-thirds of all cases occurred below 40 km/h. In both databases, the clavicle, scapula and humerus fractures, and AC joint dislocations were found, and the scapula fracture was associated with the clavicle, AC joint, acromion and humerus injuries in few occupants. The clavicle fracture was associated with AC joint and humerus injuries only in the NASS database. Thorax, abdomen and pelvic injuries and skull fractures increased with the presence of shoulder injuries in both databases, albeit not at the same rate. Anterior oblique loading was more frequent than pure lateral loading in both databases suggesting the importance of the oblique vector in side impact trauma. These findings underscore a need for detailed examinations of shoulder load-sharing using biomechanical studies to better understand its role in side impact traumas, shoulder biofidelity and injury assessments in dummies. PMID:24406953

  20. Injury patterns to other body regions and load vectors in nearside impact occupants with and without shoulder injuries.

    PubMed

    Yoganandan, Narayan; Stadter, Gregory W; Halloway, Dale E; Pintar, Frank A

    2013-01-01

    CIREN and NASS-CDS databases were used to analyze nearside impact injuries. Front seat occupants with and without shoulder injuries were examined on an individual basis in both databases. All vehicles were from model year 2000 or newer. Variables such as the type of collision, change in velocity, principal direction force, demographics, injuries scored by the MAIS and ISS metrics, and injuries to the head, thorax, abdomen and pelvis were included. Shoulder injuries included fractures to the humerus, scapula and clavicle, and associated joint traumas. The median changes in velocities for occupants with and without shoulder injuries were 36 and 32 km/h in CIREN and 29 and 32 km/h in NASS databases. Approximately two-thirds of all cases occurred below 40 km/h. In both databases, the clavicle, scapula and humerus fractures, and AC joint dislocations were found, and the scapula fracture was associated with the clavicle, AC joint, acromion and humerus injuries in few occupants. The clavicle fracture was associated with AC joint and humerus injuries only in the NASS database. Thorax, abdomen and pelvic injuries and skull fractures increased with the presence of shoulder injuries in both databases, albeit not at the same rate. Anterior oblique loading was more frequent than pure lateral loading in both databases suggesting the importance of the oblique vector in side impact trauma. These findings underscore a need for detailed examinations of shoulder load-sharing using biomechanical studies to better understand its role in side impact traumas, shoulder biofidelity and injury assessments in dummies. PMID:24406953

  1. Shoulder separation - aftercare

    MedlinePlus

    Separated shoulder - aftercare; Acromioclavicular joint separation - aftercare; A/C separation - aftercare ... Shoulder separation is not an injury to the main shoulder joint itself. It is an injury to the top ...

  2. Shoulder separation - aftercare

    MedlinePlus

    Separated shoulder - aftercare; Acromioclavicular joint separation - aftercare; A/C separation - aftercare ... Shoulder separation is not an injury to the main shoulder joint itself. It is an injury to ...

  3. Reverse Shoulder Arthroplasty for Trauma: When, Where, and How.

    PubMed

    Szerlip, Benjamin W; Morris, Brent J; Edwards, T Bradley

    2016-01-01

    Reverse shoulder arthroplasty has become increasingly popular for the treatment of complex shoulder injuries, including proximal humerus fractures and fixed glenohumeral dislocation, in the elderly population. The early to midterm results of reverse shoulder arthroplasty for the treatment of proximal humerus fractures are promising compared with the results of unconstrained humeral head replacement, and patients may have more predictable improvement with less dependence on bone healing and rehabilitation. However, long-term follow-up is needed, and surgeons must be familiar with various complications that are specific to reverse shoulder arthroplasty. To achieve optimal patient outcomes for the management of traumatic shoulder injuries, surgeons must have a comprehensive understanding of the current implant options, indications, and surgical techniques for reverse shoulder arthroplasty. PMID:27049189

  4. Synovial cutaneous fistula complicating a reverse total shoulder arthroplasty.

    PubMed

    Letter, Haley P; Limback, Joseph; Wasyliw, Christopher; Bancroft, Laura; Scherer, Kurt

    2016-06-01

    Reverse total shoulder arthroplasty is becoming a common form of shoulder arthroplasty that is often performed in the setting of rotator cuff pathology. Infection is a rare complication but is more common in reverse total shoulder arthroplasty than in hemiarthroplasty or anatomic total shoulder arthroplasty. We present the case of a 69-year-old patient with a reverse total shoulder arthroplasty who presented with purulent drainage from the skin of his anterior shoulder. Computed tomography arthrogram confirmed the presence of a synovial cutaneous fistula. Synovial cutaneous fistula is a rare variant of periprosthetic infection that, to our knowledge, has not been described previously in the setting of a reverse total shoulder arthroplasty. Computed tomography arthrogram proved to be a reliable method for confirming the diagnosis and was used for operative planning to remove the hardware. PMID:27257460

  5. Functional outcome after open and arthroscopic Bankart repair for traumatic shoulder instability

    PubMed Central

    2009-01-01

    Purpose Both open and arthroscopic Bankart repair are established procedures in the treatment of anterior shoulder instability. While the open procedure is still considered as the "golden standard" functional outcome is supposed to be better in the arthroscopic procedure. The aim of this retrospective study was to compare the functional outcome between open and arthroscopic Bankart repair. Materials and methods In 199 patients a Bankart procedure with suture anchors was performed, either arthroscopically in presence of an detached, but not elongated capsulolabral complex (40) or open (159). After a median time of 31 months (12 to 67 months) 174 patients were contacted and agreed to follow-up, 135 after open and 39 after arthroscopic Bankart procedure. Results Re-dislocations occurred in 8% after open and 15% after arthroscopic Bankart procedure. After open surgery 4 of the 11 re-dislocations occurred after a new adequate trauma and 1 of the 6 re-dislocations after arthroscopic surgery. Re-dislocations after arthroscopic procedure occured earlier than after open Bankart repair. An external rotation lag of 20° or more was observed more often (16%) after open than after arthroscopic surgery (3%). The Rowe score demonstrated "good" or "excellent" functional results in 87% after open and in 80% patients after arthroscopic treatment. Conclusion In this retrospective investigation the open Bankart procedure demonstrated good functional results. The arthroscopic treatment without capsular shift resulted in a better range of motion, but showed a tendency towards more frequently and earlier recurrence of instability. Sensitive patient selection for arthroscopic Bankart repair is recommended especially in patients with more than five dislocations. PMID:19258206

  6. Total shoulder replacement by magnetic arthroplasty.

    PubMed

    Doursounian, L; Honiger, J; Pujade-Lauraine, E; Apoil, A

    1998-01-01

    Permanent magnets offer a novel solution to the problem of shoulder implant instability when the rotator cuff has been destroyed. We report a case of their use in a 66-year-old patient with a large proximal humerol breast cancer metastasis. Humerol resection was below the deltoid insertion. The polyacetal device had samarium-cobalt magnets in the humeral head. The glenoid component (the keeper in the magnetic circuit) was made of titanium nitride-coated F17 stainless steel. The system's breakaway force was ca. 40 N. At 24 months the shoulder was free of pain and stable, with an active range of movement of 30 degrees flexion, 45 degrees external rotation, and internal rotation to T8. The patient could perform household tasks and drive an automatic car. Radiography showed no implant loosening or upward humeral head dislocation. Subsequently, the patient's condition deteriorated; at 33 months she was bedridden, and radiography showed dislocation of the humeral component. PMID:9524336

  7. [Acute acromioclavicular dislocations].

    PubMed

    Riand, N; Sadowski, C; Hoffmeyer, P

    1999-12-01

    Acromioclavicular dislocations represent over 10% of acute traumatic injuries to the shoulder girdle. The mechanism is usually a direct impact on the shoulder with the arm in adduction, producing rupture of the acromioclavicular (AC) ligaments, then of the coracoclavicular (CC) ligament, with displacement of the lateral end of the clavicle. Rockwood described 6 grades of injury. Physical examination usually provides the diagnosis, which is confirmed by radiological examination. X-rays centered on the AC joint, if necessary with forceful adduction of both shoulders or under traction, are useful to evaluate the severity of the lesion. Grade I and II lesions are usually treated conservatively by simply immobilizing the arm for 3 to 4 weeks. Surgical treatment is usually advocated for grade IV, V and VI lesions: AC or CC fixation, sometimes associated with ligament repair, depending on the surgeons. AC pinning or C-C screw fixation are the techniques most often used. Management of grade III lesions remains controversial. Some authors advocate immediate surgical treatment in young, active patients, in heavy laborers and even in slender individuals. The choice of the operative technique is controversial, as no single technique has clearly proved to be superior to others. Other authors advocate conservative treatment, which gives functional results which patients consider quite acceptable, with faster recovery; patients should be informed that results are essentially similar, whatever the treatment. The possibility of performing secondary operations with good results in cases with failure of conservative management is a further argument in favor of applying conservative therapy first in acute injuries. PMID:10675933

  8. Knee Dislocations

    PubMed Central

    Schenck, Robert C.; Richter, Dustin L.; Wascher, Daniel C.

    2014-01-01

    Background: Traumatic knee dislocation is becoming more prevalent because of improved recognition and increased exposure to high-energy trauma, but long-term results are lacking. Purpose: To present 2 cases with minimum 20-year follow-up and a review of the literature to illustrate some of the fundamental principles in the management of the dislocated knee. Study Design: Review and case reports. Methods: Two patients with knee dislocations who underwent multiligamentous knee reconstruction were reviewed, with a minimum 20-year follow-up. These patients were brought back for a clinical evaluation using both subjective and objective measures. Subjective measures include the following scales: Lysholm, Tegner activity, visual analog scale (VAS), Short Form–36 (SF-36), International Knee Documentation Committee (IKDC), and a psychosocial questionnaire. Objective measures included ligamentous examination, radiographic evaluation (including Telos stress radiographs), and physical therapy assessment of function and stability. Results: The mean follow-up was 22 years. One patient had a vascular injury requiring repair prior to ligament reconstruction. The average assessment scores were as follows: SF-36 physical health, 52; SF-36 mental health, 59; Lysholm, 92; IKDC, 86.5; VAS involved, 10.5 mm; and VAS uninvolved, 2.5 mm. Both patients had excellent stability and were functioning at high levels of activity for their age (eg, hiking, skydiving). Both patients had radiographic signs of arthritis, which lowered 1 subject’s IKDC score to “C.” Conclusion: Knee dislocations have rare long-term excellent results, and most intermediate-term studies show fair to good functional results. By following fundamental principles in the management of a dislocated knee, patients can be given the opportunity to function at high levels. Hopefully, continued advances in the evaluation and treatment of knee dislocations will improve the long-term outcomes for these patients in the

  9. [Bilateral elbow dislocation related to Essex-Lopresti injury].

    PubMed

    Romero Pérez, B; Marcos García, A; Medina Henríquez, J A; Muratore Moreno, G

    2012-01-01

    Elbow dislocation is second in frequency, after the shoulder, whereas bilateral dislocation is uncommon, even less than dislocations with concurrent associated fractures. One of the least frequent associations is the Essex-Lopresti injury which consists of a fracture of the radial head affecting the distal radioulnar joint with injury to the interosseous membrane. This is a case of bilateral elbow dislocation, one of the elbows associated with the Essex-Lopresti injury. During treatment, the premature closed reduction prevails, previously making sure the elbow is stable, the premise which will determine the orthopedic or surgical treatment of the injury. PMID:23177945

  10. Strength and muscle activity of shoulder external rotation of subjects with and without scapular dyskinesis

    PubMed Central

    Uga, Daisuke; Nakazawa, Rie; Sakamoto, Masaaki

    2016-01-01

    [Purpose] This study aimed to clarify the relationship between scapular dyskinesis and shoulder external rotation strength and muscle activity. [Subjects and Methods] Both shoulders of 20 healthy males were evaluated. They were classified into 19 normal, 8 subtly abnormal, and 13 obviously abnormal shoulders using the scapular dyskinesis test. Subtly abnormal shoulders were subsequently excluded from the analysis. Shoulder external rotation strength and muscle activity (infraspinatus, serratus anterior, upper, middle, and lower trapezius) were measured in 2 positions using a handheld dynamometer and surface electromyography while sitting in a chair with shoulder 0° abduction and flexion (1st position), and while lying prone on the elbows with the shoulders elevated in the zero position (zero position). The strength ratio was calculated to quantify the change in strength between the positions (zero position / 1st position). [Results] In the obviously abnormal shoulder group, the strength in the 1st position was significantly stronger, the strength ratio was significantly smaller, and the serratus anterior in the zero position showed significantly lower activity than the normal shoulder group. [Conclusion] In shoulder external rotation in the zero position, in obviously abnormal shoulders, the serratus anterior is poorly recruited, weakening the shoulder external rotation strength. PMID:27190434

  11. The lateral impaction of the shoulder.

    PubMed

    Scarlat, M M; Cuny, C; Goldberg, B A; Harryman, D T; Matsen, F A

    1999-01-01

    17 patients had radiographic demonstration of injury to the clavicle, scapula and ribs from an impact delivered to the lateral shoulder. The study included 13 males and 4 females whose ages ranged from 18 to 83 years (average 45 years). Most injuries were sustained in falls or motor vehicle accidents. Analysis of these cases suggests a biomechanical hypothesis concerning the transmission of the impact forces within the shoulder girdle. According to this hypothesis, the impaction force applied to the lateral shoulder is transmitted from outside inward following two paths. The anterior and superior path passes through the acromio-clavicular joint, the clavicle, the costo-clavicular joint and the sterno-clavicular joint. The posterior and inferior path is transmitted within the gleno-humeral joint, the scapula and the scapulo-thoracic joint. Major impacting force is required to disrupt the anterior and posterior arches of the shoulder girdle. When both of these supporting structures are damaged, the patient is at risk for more serious injuries, including disruption of the thorax, shoulder joint, brachial plexus and neck. PMID:10653299

  12. [Biomechanics of the shoulder and therapeutic applications].

    PubMed

    Weinstabl, R; Huber, G; Kropik, K; Khakpour, Z; Barisani, G R; Fialka, C; Krösel, P

    1996-12-01

    The influence of biomechanics in surgery of the locomotor apparatus has been constantly increasing over the last few decades. The purpose of this study was to determine wether biomechanical studies can significantly influence therapy and treatment of shoulder injuries, especially shoulder instability. The investigation was performed on 23 fresh human specimens with intact capsular ligaments of the glenohumeral joint. A Bankart lesion from 3 o'clock to 6 o'clock was repaired, and a Bankart repair and anterior inferior capsular shift, as described by Neer, were performed. The measurement was done on six clinically relevant positions of instability: superior, anterior, anterior-inferior, inferior, posterior-inferior, posterior. Measurement was done using a specially developed strain-gauge system. It was demonstrated that both instability and too much stability of the shoulder joint lead to a significant change in shoulder biomechanics. The anatomical O-position of the glenohumeral joint in 110 degrees of abduction is a position of about 60 degrees of external rotation compared to the O-position for clinical measurement. From the therapy point of view, one has to ask for anatomical reconstruction instead of tight repair in soft-tissue repair in the glenohumeral joint. Immediate post-operative rehabilitation in a 60 degrees range of motion is possible. PMID:9082480

  13. Using your shoulder after surgery

    MedlinePlus

    Shoulder surgery - using your shoulder; Shoulder surgery - after ... You had surgery on your shoulder to repair a muscle, tendon, or cartilage tear. The surgeon may have removed damaged tissue. You will need to know how ...

  14. Inflamed shoulder tendons (image)

    MedlinePlus

    Tearing and inflammation of the tendons of the shoulder muscles can occur in sports which require the ... pitching, swimming, and lifting weights. Most often the shoulder will heal if a break is taken from ...

  15. Development of a Finite Element Model of the Human Shoulder to Investigate the Mechanical Responses and Injuries in Side Impact

    NASA Astrophysics Data System (ADS)

    Iwamoto, Masami; Miki, Kazuo; Yang, King H.

    Previous studies in both fields of automotive safety and orthopedic surgery have hypothesized that immobilization of the shoulder caused by the shoulder injury could be related to multiple rib fractures, which are frequently life threatening. Therefore, for more effective occupant protection, it is important to understand the relationship between shoulder injury and multiple rib fractures in side impact. The purpose of this study is to develop a finite element model of the human shoulder in order to understand this relationship. The shoulder model included three bones (the humerus, scapula and clavicle) and major ligaments and muscles around the shoulder. The model also included approaches to represent bone fractures and joint dislocations. The relationships between shoulder injury and immobilization of the shoulder are discussed using model responses for lateral shoulder impact. It is also discussed how the injury can be related to multiple rib fractures.

  16. "Floating shoulder" injuries.

    PubMed

    Heng, Kenneth

    2016-12-01

    "Floating shoulder" is a rare injury complex resulting from high-energy blunt force trauma to the shoulder, resulting in scapulothoracic dissociation. It is commonly associated with catastrophic neurovascular injury. Two cases of motorcyclists with floating shoulder injuries are described. PMID:26961729

  17. Monteggia fracture-dislocations: A Historical Review

    PubMed Central

    Rehim, Shady A.; Maynard, Mallory A.; Sebastin, Sandeep J.; Chung, Kevin C.

    2014-01-01

    The eponym Monteggia fracture-dislocation originally referred to a fracture of the shaft of the ulna accompanied by anterior dislocation of the radial head that was described by Giovanni Battista Monteggia of Italy in 1814. Subsequently, a further classification system based on the direction of the radial head dislocation and associated fractures of the radius and ulna was proposed by Jose Luis Bado of Uruguay in 1958. This article investigates the evolution of treatment, classification, and outcomes of the Monteggia injury and sheds light on the lives and contributions of Monteggia and Bado. PMID:24792923

  18. MRI of the shoulder

    SciTech Connect

    Zlatkin, M.B.; Iannotti, J.P.; Schnall, M.D.

    1991-01-01

    This book reports on the use of magnetic resonance imaging (MRI) in evaluating shoulder disorders. The book gives detailed information on MRI techniques and shoulder anatomy, describes and illustrates MRI findings for a wide range of shoulder disorders, and explains how abnormalities seen on MIR images relate to pathophysiology and clinical signs. Special attention is given to imaging of rotator cuff disease and shoulder instability conditions for which MRI is the imaging procedure of choice. Complementing the text are 365 high-quality scans depicting normal shoulder anatomy and showing the wide variety of pathologic findings encountered in practice.

  19. Restoration of Shoulder Function.

    PubMed

    Boe, Chelsea C; Elhassan, Bassem T

    2016-08-01

    Restoration of shoulder function in patients with brachial plexus injury can be challenging. Initial reported efforts were focused on stabilizing the shoulder, improving inferior subluxation and restoring abduction and flexion of the joint. Recent advancements and improved understanding of coordinated shoulder motion and the biomechanical properties of the muscles around the shoulder applicable to tendon transfer have expanded available surgical options to improve shoulder function, specifically external rotation. Despite the advances in reconstructive options, brachial plexus injury remains a serious problem that requires complex surgical solutions, prolonged recovery, and acceptance of functional loss. PMID:27387074

  20. A rigid body model for the assessment of glenohumeral joint mechanics: Influence of osseous defects on range of motion and dislocation.

    PubMed

    Welsh, Mark F; Willing, Ryan T; Giles, Joshua W; Athwal, George S; Johnson, James A

    2016-02-29

    The purpose of this study was to employ subject-specific computer models to evaluate the interaction of glenohumeral range-of-motion and Hill-Sachs humeral head bone defect size on engagement and shoulder dislocation. We hypothesized that the rate of engagement would increase as defect size increased, and that greater shoulder ROM would engage smaller defects. Three dimensional computer models of 12 shoulders were created. For each shoulder, additional models were created with simulated Hill-Sachs defects of varying severities (XS=15%, S=22.5%, M=30%, L=37.5%, XL=45% and XXL=52.5% of the humeral head diameter, respectively). Rotational motion simulations without translation were conducted. The simulations ended if the defect engaged the anterior glenoid rim with resultant dislocation. The results showed that the rate of engagement was significantly different between defect sizes (0.001

  1. Shoulder pain in primary care: frozen shoulder.

    PubMed

    Cadogan, Angela; Mohammed, Khalid D

    2016-03-01

    BACKGROUND AND CONTEXT Frozen shoulder is a painful condition that follows a protracted clinical course. We aim to review the management of patients with a diagnosis of frozen shoulder who are referred for specialist orthopaedic evaluation against existing guidelines in primary care. ASSESSMENT OF PROBLEM Referrals and clinical records were reviewed for all patients referred for orthopaedic specialist assessment who received a specialist diagnosis of frozen shoulder. Diagnostic, investigation and management practices from a regional primary health care setting in New Zealand were compared with guideline-recommended management. RESULTS Eighty patients with frozen shoulder were referred for orthopaedic evaluation in the 13 month study period, mostly from general practice. Fifteen patients (19%) were identified as having a frozen shoulder in their medical referral. Most (99%) had received previous imaging. Seven patients (12%) had received guideline recommended treatment. STRATEGIES FOR IMPROVEMENT Education of all clinicians involved in patient management is important to ensure an understanding of the long natural history of frozen shoulder and provide reassurance that outcomes are generally excellent. HealthPathways now include more information regarding diagnosis, imaging and evidence-based management for frozen shoulder. LESSONS Frozen shoulder may be under-diagnosed among patients referred for orthopaedic review. Ultrasound imaging is commonly used and may identify occult and unrelated pathology in this age-group. When managed according to clinical guidelines, patients report significant clinical and functional improvement with most reporting 80% function compared with normal after 1 year. KEYWORDS Adhesive capsulitis; bursitis; injections; practice guideline; primary health care; ultrasound. PMID:27477374

  2. The influence of experimentally induced pain on shoulder muscle activity.

    PubMed

    Diederichsen, Louise Pyndt; Winther, Annika; Dyhre-Poulsen, Poul; Krogsgaard, Michael R; Nørregaard, Jesper

    2009-04-01

    Muscle function is altered in painful shoulder conditions. However, the influence of shoulder pain on muscle coordination of the shoulder has not been fully clarified. The aim of the present study was to examine the effect of experimentally induced shoulder pain on shoulder muscle function. Eleven healthy men (range 22-27 years), with no history of shoulder or cervical problems, were included in the study. Pain was induced by 5% hypertonic saline injections into the supraspinatus muscle or subacromially. Seated in a shoulder machine, subjects performed standardized concentric abduction (0 degrees -105 degrees) at a speed of approximately 120 degrees/s, controlled by a metronome. During abduction, electromyographic (EMG) activity was recorded by intramuscular wire electrodes inserted in two deeply located shoulder muscles and by surface-electrodes over six superficially located shoulder muscles. EMG was recorded before pain, during pain and after pain had subsided and pain intensity was continuously scored on a visual analog scale (VAS). During abduction, experimentally induced pain in the supraspinatus muscle caused a significant decrease in activity of the anterior deltoid, upper trapezius and the infraspinatus and an increase in activity of lower trapezius and latissimus dorsi muscles. Following subacromial injection a significantly increased muscle activity was seen in the lower trapezius, the serratus anterior and the latissimus dorsi muscles. In conclusion, this study shows that acute pain both subacromially and in the supraspinatus muscle modulates coordination of the shoulder muscles during voluntary movements. During painful conditions, an increased activity was detected in the antagonist (latissimus), which support the idea that localized pain affects muscle activation in a way that protects the painful structure. Further, the changes in muscle activity following subacromial pain induction tend to expand the subacromial space and thereby decrease the load

  3. The evidenced-based shoulder evaluation.

    PubMed

    O'Kane, John W; Toresdahl, Brett G

    2014-01-01

    The physical examination of the shoulder has been studied extensively, but the quality and statistical power of the published research often is lacking. The initial reports of new shoulder examination techniques commonly describe impressive performance. However recent meta-analyses have found that when the majority of these tests are used in isolation, they lack the ability to rule in or rule out the pathology in question, with few exceptions. The diagnostic accuracy of the physical examination improves when the shoulder tests are evaluated in combination, such as positive passive distraction and active compression identifying a superior labral anterior to posterior (SLAP) lesion. The accuracy also can be improved when the shoulder tests are evaluated in conjunction with specific historical findings, such as age greater than 39 years, history of popping or clicking, and a positive painful arc (pain experienced between 60° and 120° of abduction) identifying rotator cuff tendinopathy. The literature on shoulder imaging demonstrates that rotator cuff tears can be ruled in or ruled out by both ultrasound and magnetic resonance imaging. For SLAP lesions, magnetic resonance arthrography can be used to rule out a tear but may not be as accurate as combined physical examinations to rule in a tear. PMID:25211618

  4. Influence of Field Position on Rugby League Players Requiring Shoulder Reconstruction.

    PubMed

    Bokor, D J; Sundaram, A; Graham, P L

    2016-06-01

    A consecutive series of patients sustaining their index anterior instability while playing Rugby League and requiring shoulder reconstruction was retrospectively reviewed and evaluated. The details of their on-field position and hand dominance at time of injury, the side of injury, and mechanism of injury were collated and statistically analyzed. A total of 173 Bankart repairs were performed on 132 patients, and 102 players had one injury while 30 had 2 or more injuries. Players are more likely to injure their non-dominant side (P=0.009) in the first-time injury. Whereas second and subsequent injuries were not associated with a particular side (P=0.81). Applying a Bonferroni correction to the chi-squared goodness-of-fit test of position at time of injury revealed players on the wing had a significantly lower frequency of injury (P<0.001), whereas the full back had a significantly higher frequency of injury (P<0.001). 30 players sustained 69 re-dislocations with the lock and fullback positions incurring significantly more re-injuries and the wing position fewer re-injuries than expected (P<0.006). Understanding which player positions on the rugby league field are more likely to sustain an anterior instability will assist medical and support staff to optimize the pre-season conditioning and post surgical rehabilitation of players. PMID:26990719

  5. Incidence and Characteristics of Traumatic Shoulder Instability in Japanese Military Cadets.

    PubMed

    Amako, Masatoshi; Sasao, Hiroshi; Matsuhashi, Yusuke; Yato, Yoshiyuki; Yoshihara, Yasuo; Arino, Hiroshi; Sakurai, Yutaka; Nemoto, Koichi

    2016-06-01

    Little is known regarding the incidence of the shoulder instability in Japan. The aim of this study was to evaluate the incidence of traumatic shoulder instability among Japanese military cadets. A prospective cohort study was performed to capture all traumatic shoulder instability events between 2009 and 2012 among cadets in a military educational academy of the Japan Self Defense Forces. The total number of cadets in the cohort was 5,402 (average age 20.6 years). The incidence of instability events, including dislocation or subluxation, was calculated. Chronicity, demographics of participants, mechanism of injury, and athletic events were also evaluated. The incidence of traumatic dislocation was 4.1/1,000 person-years and that of subluxation was 6.1/1,000 person-years. The incidence of primary dislocation or subluxation was 5.4/1,000 person-years and that of recurrent dislocation or subluxation was 4.7/1,000 person-years. Of first dislocations or subluxations, 92% occurred during sports activities, including after-school sports activities, military training, and gym classes. In conclusion, the overall incidence of shoulder instability events among Japanese military cadets was 10.3/1,000 person-years, and was extremely high. Most shoulder instability events occurred during sports activities, and a program to prevent such injuries during sports activities is necessary for young participants. PMID:27244069

  6. Total Shoulder Arthroplasty

    PubMed Central

    Sanchez-Sotelo, Joaquin

    2011-01-01

    Shoulder arthroplasty has been the subject of marked advances over the last few years. Modern implants provide a wide range of options, including resurfacing of the humeral head, anatomic hemiarthroplasty, total shoulder arthroplasty, reverse shoulder arthroplasty and trauma-specific implants for fractures and nonunions. Most humeral components achieve successful long-term fixation without bone cement. Cemented all-polyethylene glenoid components remain the standard for anatomic total shoulder arthroplasty. The results of shoulder arthroplasty vary depending on the underlying diagnosis, the condition of the soft-tissues, and the type of reconstruction. Total shoulder arthroplasty seems to provide the best outcome for patients with osteoarthritis and inflammatory arthropathy. The outcome of hemiarthroplasty for proximal humerus fractures is somewhat unpredictable, though it seems to have improved with the use of fracture-specific designs, more attention to tuberosity repair, and the selective use of reverse arthroplasty, as well as a shift in indications towards internal fixation. Reverse shoulder arthroplasty has become extremely popular for patients with cuff-tear arthropathy, and its indications have been expanded to the field of revision surgery. Overall, shoulder arthroplasty is a very successful procedure with predictable pain relief and substantial improvements in motion and function. PMID:21584206

  7. Dislocations and subgrain boundaries in highly magnesium-doped lithium niobate crystals

    NASA Astrophysics Data System (ADS)

    Kong, Yongfa; Wen, Jinke; Wang, Huafu

    1994-06-01

    The extension and distribution of dislocations and subgrain boundaries in highly magnesium-doped lithium niobate crystals at different stages of growth have been investigated using chemical etching and optical microscopy. The relations between dislocation densities, subgrain boundaries and optical quality of the crystals have been also studied. It was found that there is a core with relatively high dislocation density in the central region of the crystal shoulder. In the shouldering stage, the dislocations gathering in the core extend to its surrounding regions and the dislocation density tends to be homogeneous. Tailing increases the dislocation density in the bottom part of the crystal and causes inhomogeneous distribution of dislocations in that part. Subgrain boundaries are apt to form in high dislocation density regions, and neighbouring multiple subgrain boundaries tend to reform a more stable single subgrain boundary. The extinction ratios and conoscope images of crystals are worst in the dislocation gathering regions around the ends of subgrain boundaries, and dislocations are the basic cause of poor optical quality of crystals.

  8. Dislocation motion and instability

    NASA Astrophysics Data System (ADS)

    Zhu, Yichao; Chapman, Stephen Jonathan; Acharya, Amit

    2013-08-01

    The Peach-Koehler expression for the stress generated by a single (non-planar) curvilinear dislocation is evaluated to calculate the dislocation self stress. This is combined with a law of motion to give the self-induced motion of a general dislocation curve. A stability analysis of a rectilinear, uniformly translating dislocation is then performed. The dislocation is found to be susceptible to a helical instability, with the maximum growth rate occurring when the dislocation is almost, but not exactly, pure screw. The non-linear evolution of the instability is determined numerically, and implications for slip band formation and non-Schmid behavior in yielding are discussed.

  9. An arthroscopic and electromyographic study of painful shoulders in elite gymnasts.

    PubMed

    Caraffa, A; Cerulli, G; Rizzo, A; Buompadre, V; Appoggetti, S; Fortuna, M

    1996-01-01

    Shoulder problems are common in overhead sports like baseball, basketball and volleyball. Although gymnastics also includes overhead activities, there are few reports about shoulder problems in this sports activity. During the time period 1992-1995 we treated five young competitive gymnasts for shoulder pain. Arthroscopy revealed that they were all suffering from SLAP lesions or other labral pathology, although they had never dislocated their shoulders. These injuries have not been described earlier in connection with gymnastics. In a survey of 13 gymnasts in an elite club, we found that six (46%) complained about shoulder pain. Since four of these athletes explained that their shoulder pain started acutely during ring exercises in suspension while one suffered a slower onset with pain also during parallel bar exercises, we undertook an electromyographic study of the shoulder musculature of three normal elite gymnasts during exercises on the parallel bars and rings. We found that during the ring exercises in suspension there was a "critical phase" during which the muscle activity around the shoulder was very low, leading to great articular stresses. This might explain the occurrence of labral lesions like the SLAP lesions in this type of athlete. If shoulder pain in elite gymnasts does not respond to rest and physical therapy over 2-3 months, a shoulder arthroscopy should be considered. PMID:8819062

  10. All arthroscopic stabilization of acute acromioclavicular joint dislocation with fiberwire and endobutton system

    PubMed Central

    Spoliti, Marco; De Cupis, Mauro; Via, Alessio Giai; Oliva, Francesco

    2014-01-01

    Summary Introduction: acromioclavicular (AC) joint dislocation is common in athletes and in contact sports and about 9% of shoulder injuries involves this joint. The majority of these AC lesions can be successfully treated conservatively but high grade dislocation and some cases of type III dislocation need a surgical treatment. Many different operative techniques have been described over the years. The purpose of this study is to evaluate the results of arthroscopic stabilization of AC joint dislocation with TightRope® system. Materials and methods: nineteen patients with acute AC dislocation were treated by arthroscopic fixation with TightRope® system. Any associated lesions were repaired. All patients were assessed before surgery (T0), at 3 months (T1), at 6 months (T2) and at 1 year after the surgery (T3) using a visual analogic scale (VAS) and Constant-Murley Score (CMS). All patients were evaluated with X-ray. Results: six AC-joint dislocations involved the right shoulder and thirteen the left shoulder. Ten were type III dislocation, three were type IV and six were type V dislocation. We found a statistically significant reduction of pain (p< 0.01) at T1 compared to the pretreatment scores. The CMS measures showed an improvement between T1, T2 and T3, but the difference was statistically significant only between T1 and T3 (p= 0.017). The postoperative X-Ray of the shoulder showed a good reduction of the AC joint dislocation. We had 1 case of recurrence and 2 cases of loss of intraoperative reduction. Conclusion: arthroscopic technique for acute AC joint dislocations with the use of the TightRope® device is minimally invasive and it allows an anatomic restoration of the joint. It is a safe and effective procedure ensuring stable AC joint reconstruction and good cosmetic results. PMID:25767774

  11. Constrained fixed-fulcrum reverse shoulder arthroplasty improves functional outcome in epileptic patients with recurrent shoulder instability

    PubMed Central

    Thangarajah, Tanujan; Higgs, Deborah; Bayley, J I L; Lambert, Simon M

    2016-01-01

    AIM: To report the results of fixed-fulcrum fully constrained reverse shoulder arthroplasty for the treatment of recurrent shoulder instability in patients with epilepsy. METHODS: A retrospective review was conducted at a single facility. Cases were identified using a computerized database and all clinic notes and operative reports were reviewed. All patients with epilepsy and recurrent shoulder instability were included for study. Between July 2003 and August 2011 five shoulders in five consecutive patients with epilepsy underwent fixed-fulcrum fully constrained reverse shoulder arthroplasty for recurrent anterior shoulder instability. The mean duration of epilepsy in the cohort was 21 years (range, 5-51) and all patients suffered from grand mal seizures. RESULTS: Mean age at the time of surgery was 47 years (range, 32-64). The cohort consisted of four males and one female. Mean follow-up was 4.7 years (range, 4.3-5 years). There were no further episodes of instability, and no further stabilisation or revision procedures were performed. The mean Oxford shoulder instability score improved from 8 preoperatively (range, 5-15) to 30 postoperatively (range, 16-37) (P = 0.015) and the mean subjective shoulder value improved from 20 (range, 0-50) preoperatively to 60 (range, 50-70) postoperatively (P = 0.016). Mean active forward elevation improved from 71° preoperatively (range, 45°-130°) to 100° postoperatively (range, 80°-90°) and mean active external rotation improved from 15° preoperatively (range, 0°-30°) to 40° (20°-70°) postoperatively. No cases of scapular notching or loosening were noted. CONCLUSION: Fixed-fulcrum fully constrained reverse shoulder arthroplasty should be considered for the treatment of recurrent shoulder instability in patients with epilepsy. PMID:27458554

  12. SHOULDER ARTHROPLASTY RECORDS

    PubMed Central

    Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

    2015-01-01

    The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

  13. Shoulder MRI scan

    MedlinePlus

    ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine . 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ... by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, ...

  14. [The Throwing Shoulder].

    PubMed

    Wieser, Karl; Gerber, Christian; Meyer, Dominik C

    2016-02-01

    Repetitive top-performance of overhead athletes induces a tremendous stress for the throwing shoulder. Throwers reach rotational speed of their arm of more than 7000°/s with joint compression and distraction forces of more than 1000 N. This performance is tributary to adaption of the shoulder muscles and the joint itself. These adaptions may, however lead to two specific problems of the throwing shoulder: 1. The posterosuperior internal impingement of the rotator cuff and labrum between glenoid and humeral head during late cooking phase; 2. A decreased internal rotation of the glenohumeral joint (GIRD) with compensatory problems of the scapula-stabilizing muscles. Precise analysis of kinematics and pathomechanics aims to improve understanding and treatment of those specific problems of the throwing shoulder. PMID:26837325

  15. What Are Shoulder Problems?

    MedlinePlus

    ... between the collarbone and the shoulder blade are torn. The injury is most often caused by a ... others can be very painful. Treatment for a torn rotator cuff depends on age, health, how severe ...

  16. Exercise and Shoulder Pain

    MedlinePlus

    ... of four small muscles (known as the rotator cuff) and another five muscles that stabilize the scapula ( ... Adequate strength and endurance of both the rotator cuff and shoulder blade stabilizing muscles (trapezius, levator scapula, ...

  17. Shoulder MRI scan

    MedlinePlus

    ... an imaging test that uses energy from powerful magnets and to create pictures of the shoulder area. ... in your eyes) Because the MRI contains strong magnets, metal objects are not allowed in the room ...

  18. Frozen shoulder - aftercare

    MedlinePlus

    Adhesive capsulitis - aftercare; Frozen shoulder syndrome - aftercare ... Krabak BJ, Banks NL. Adhesive capsulitis. In: Frontera WR, Silver JK, eds. Essentials of Physical Medicine and Rehabilitation . 2nd ed. Philadelphia, PA: Elsevier Saunders;2008: ...

  19. Common Shoulder Injuries in American Football Athletes.

    PubMed

    Gibbs, Daniel B; Lynch, T Sean; Nuber, Erika D; Nuber, Gordon W

    2015-01-01

    American football is a collision sport played by athletes at high speeds. Despite the padding and conditioning in these athletes, the shoulder is a vulnerable joint, and injuries to the shoulder girdle are common at all levels of competitive football. Some of the most common injuries in these athletes include anterior and posterior glenohumeral instability, acromioclavicular pathology (including separation, osteolysis, and osteoarthritis), rotator cuff pathology (including contusions, partial thickness, and full thickness tears), and pectoralis major and minor tears. In this article, we will review the epidemiology and clinical and radiographic workup of these injuries. We also will evaluate the effectiveness of surgical and nonsurgical management specifically related to high school, collegiate, and professional football athletes. PMID:26359844

  20. An Evaluation of the Responsiveness and Discriminant Validity of Shoulder Questionnaires among Patients Receiving Surgical Correction of Shoulder Instability

    PubMed Central

    Kemp, Kyle A. R.; Sheps, David M.; Beaupre, Lauren A.; Styles-Tripp, Fiona; Luciak-Corea, Charlene; Balyk, Robert

    2012-01-01

    Health-related quality-of-life (HRQL) measures must detect clinically important changes over time and between different patient subgroups. Forty-three patients (32 M, 13 F; mean age  =  26.00  ±  8.19 years) undergoing arthroscopic Bankart repair completed three validated shoulder questionnaires (Western Ontario Shoulder Instability index (WOSI), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment form (ASES), Constant score) preoperatively, and at 6, 12, and 24 months postoperatively. Responsiveness and discriminant validity was assessed between those with a satisfactory outcome and those with (1) a major recurrence of instability, (2) a single episode of subluxation, (3) any postoperative episode of instability. Eight (20%) patients reported recurrent instability. Compared to baseline, the WOSI detected improvement at the 6- (P < 0.001) and 12-month (P = 0.011) evaluations. The ASES showed improvement at 6 months (P = 0.003), while the Constant score did not report significant improvement until 12 months postoperatively (P = 0.001). Only the WOSI detected differential shoulder function related to shoulder instability. Those experiencing even a single episode of subluxation reported a 10% drop in their WOSI score, attaining the previously established minimal clinically important difference (MCID). Those experiencing a frank dislocation or multiple episodes of subluxation reported a 20% decline. The WOSI allows better discrimination of the severity of postoperative instability symptoms following arthroscopic Bankart repair. PMID:23002386

  1. Temporomandibular joint dislocation.

    PubMed

    Sharma, Naresh Kumar; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal; Singh, Shreya

    2015-01-01

    Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation. PMID:26668447

  2. Temporomandibular joint dislocation

    PubMed Central

    Sharma, Naresh Kumar; Singh, Akhilesh Kumar; Pandey, Arun; Verma, Vishal; Singh, Shreya

    2015-01-01

    Temporomandibular joint (TMJ) dislocation is an uncommon but debilitating condition of the facial skeleton. The condition may be acute or chronic. Acute TMJ dislocation is common in clinical practice and can be managed easily with manual reduction. Chronic recurrent TMJ dislocation is a challenging situation to manage. In this article, we discuss the comprehensive review of the different treatment modalities in managing TMJ dislocation. PMID:26668447

  3. Evaluation of arthroscopic treatment of posterior shoulder instability

    PubMed Central

    Garcia, José Carlos; Maia, Lucas Russo; Fonseca, Juliano Rocha; Zabeu, José Luís Amim; Garcia, Jesely Pereira Myrrha

    2015-01-01

    OBJECTIVE: To provide data for the analysis of arthroscopy as a method of surgical treatment for shoulder and discuss its actual indications and preliminary results. METHODS: We evaluated 15 patients submitted to reverse Bankart arthroscopic surgery. We used the UCLA (University of California at Los Angeles) score to measure the results before surgery and 12 months thereafter. RESULTS: The average UCLA score changed from 26.67±0.25 (SD 0.97) before surgery to 34.20±0.53 (SD 2.04) after surgery. The effectiveness of surgery was 93%. In five cases loose bodies were found. A patient undergoing remplissage was evaluated separately. The data did not change after 24 months post-surgery. CONCLUSION: The arthroscopic treatment of posterior shoulder instability and posterior dislocation of the shoulder has been proved feasible and results in our series followed the same trends as in the literature. Level of Evidence III, Transversal Retrospective Study. PMID:26207089

  4. MR evaluation of synovial injury in shoulder trauma.

    PubMed

    Chalian, Majid; Soldatos, Theodoros; Faridian-Aragh, Neda; Andreisek, Gustav; McFarland, Edward G; Carrino, John A; Chhabra, Avneesh

    2011-10-01

    The purpose of this study was to determine magnetic resonance imaging (MRI) findings relevant to synovial injury of the shoulder in patients with and without acute shoulder trauma. Three hundred and nine consecutive shoulder MRI studies (185-male, 124-female, 50 ± 15 years old) were retrospectively evaluated for findings suggestive of synovial injury including rupture and/or diverticulum of the joint capsule, bursa, and biceps tendon sheath (BTS), ganglion/synovial cyst, geyser phenomenon, and sequel of previous shoulder dislocation (Hill-Sachs deformity). Patients with one or more of these findings were included in the MR-positive group, whereas the remaining subjects were used as MR negatives. Based on their medical records, patients were also divided into trauma and non-trauma groups, and statistical analysis was performed to evaluate the association between the aforementioned MRI findings and history of shoulder trauma. Fifty-six patients were included in the MR-positive group and 253 in the MR-negative group. In MR-positive group, the incidence of capsular rupture (CR) and subacromial/subdeltoid (SASD) bursal rupture was higher in trauma patients, whereas the incidence of BTS diverticulum and ganglion cyst was higher in subjects without trauma. Significant association was found between the history of acute trauma and CR, SASD bursal rupture, BTS rupture, and Hill-Sachs deformity. In shoulder MR examination, presence of CR and/or SASD bursal rupture is strongly suggestive of acute shoulder trauma. In addition, BTS rupture and Hill-Sachs deformity are more prevalent in patients with acute shoulder trauma. The presence of these features should alert MRI readers to assess for additional trauma-related internal derangements, if a respective history has not been provided. PMID:21735271

  5. Post-traumatic shoulder movement disorders: A challenging differential diagnosis between organic and functional.

    PubMed

    Pandey, Sanjay; Nahab, Fatta; Aldred, Jason; Nutt, John; Hallett, Mark

    2014-06-01

    Peripheral trauma may be a trigger for the development of various movement disorders though the pathophysiology remains controversial and some of these patients have a functional (psychogenic) disorder. We report 3 cases of shoulder movement disorders following trauma to the shoulder region. Physiology was done in all the patients to extend the physical examination. Two patients had history of recurrent shoulder dislocation and were diagnosed with Ehlers-Danlos syndrome. One patient had shoulder injury following repeated falls while performing as a cheerleader. In two patients there were some clinical features suggesting a functional etiology, but physiological studies in all three failed to produce objective evidence of a functional nature. Shoulder movement following trauma is uncommon. Diagnosis in such cases is challenging considering the complex pathophysiology. The movements can be associated with prolonged pain and handicap, and once established they appear resistant to treatment. PMID:25197686

  6. Post-traumatic shoulder movement disorders: A challenging differential diagnosis between organic and functional

    PubMed Central

    Pandey, Sanjay; Nahab, Fatta; Aldred, Jason; Nutt, John; Hallett, Mark

    2014-01-01

    Peripheral trauma may be a trigger for the development of various movement disorders though the pathophysiology remains controversial and some of these patients have a functional (psychogenic) disorder. We report 3 cases of shoulder movement disorders following trauma to the shoulder region. Physiology was done in all the patients to extend the physical examination. Two patients had history of recurrent shoulder dislocation and were diagnosed with Ehlers-Danlos syndrome. One patient had shoulder injury following repeated falls while performing as a cheerleader. In two patients there were some clinical features suggesting a functional etiology, but physiological studies in all three failed to produce objective evidence of a functional nature. Shoulder movement following trauma is uncommon. Diagnosis in such cases is challenging considering the complex pathophysiology. The movements can be associated with prolonged pain and handicap, and once established they appear resistant to treatment. PMID:25197686

  7. Sternoclavicular dislocation: case report and surgical technique.

    PubMed

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the "figure of eight" technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified "figure of eight" and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case of

  8. Sternoclavicular dislocation: case report and surgical technique☆

    PubMed Central

    Terra, Bernardo Barcellos; Rodrigues, Leandro Marano; Pádua, David Victoria Hoffmann; Martins, Marcelo Giovanini; Teixeira, João Carlos de Medeiros; De Nadai, Anderson

    2015-01-01

    Sternoclavicular dislocations account for less than 5% of all dislocations of the scapular belt. Most cases of anterior dislocation of the sternoclavicular joint do not present symptoms. However, some patients may develop chronic anterior instability and remain symptomatic, and surgical treatment is indicated in these cases. There is a scarcity of reports in the literature relating to reconstruction using the long palmar tendon in cases of traumatic anterior instability. Although rare, these injuries deserve rapid diagnosis and efficient treatment in order to avoid future complications. The aim of this report was to report on a case of a motocross competitor who developed chronic traumatic anterior instability of the sternoclavicular joint and underwent surgical reconstruction using the autogenous long palmar tendon. The patient was a 33-year-old man with a history of anterior dislocation of the sternoclavicular subsequent to a fall during a maneuver in a motocross competition. Conservative treatment was instituted initially, consisting of use of a functional sling to treat the symptoms for 3 weeks, along with physiotherapeutic rehabilitation for 3 months. We chose to use a modification of the “figure of eight” technique based on the studies by Spencer and Kuhn. A longitudinal incision of approximately 10 cm was made at the level of the sternoclavicular joint. The graft from the ipsilateral long palmar tendon was passed through the orifices in the form of a modified “figure of eight” and its ends were sutured together. The patient was immobilized using an American sling for 4 weeks. After 6 months of follow-up, the patient no longer presented pain or instability when movement of the sternoclavicular joint was required. Minor discomfort and slight prominence of the sternoclavicular joint continued to be present but did not affect the patient's activities. Thus, the patient was able to return to racing 6 months after the operation. Our study presented a case

  9. Arytenoid dislocation as a cause of prolonged hoarseness after cervical discectomy and fusion.

    PubMed

    Goz, Vadim; Qureshi, Sheeraz; Hecht, Andrew C

    2013-03-01

    Study Design Case series of two arytenoid dislocations after anterior cervical discectomy. Objective To recognize arytenoid dislocation as a possible cause of prolonged hoarseness in patients after anterior cervical discectomies. Summary of Background Data Prolonged hoarseness is a common postoperative complication after anterior cervical spine surgery. The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve. However, other causes of postoperative hoarseness may be overlooked in this clinical scenario. Other possible etiologies include pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, as well as arytenoid cartilage dislocation. Arytenoid dislocation is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury. Methods We report two cases of arytenoid dislocation and review the literature on this pathology. Results Two patients treated with anterior cervical discectomy and fusion experienced prolonged postoperative hoarseness. Arytenoid dislocation was confirmed by flexible fiber-optic laryngoscopy in both cases. The dislocations experienced spontaneous reduction at 6 weeks and 3 months postsurgery. Conclusions Arytenoid dislocation must be considered in the differential diagnosis of prolonged postoperative hoarseness and evaluated for using direct laryngoscopy, computed tomography, or a laryngeal electromyography. Upon diagnosis, treatment must be considered immediately. Slight dislocations can reduce spontaneously without surgical intervention; however, operative intervention may be required at times. PMID:24436851

  10. Arytenoid Dislocation as a Cause of Prolonged Hoarseness after Cervical Discectomy and Fusion

    PubMed Central

    Goz, Vadim; Qureshi, Sheeraz; Hecht, Andrew C.

    2012-01-01

    Study Design Case series of two arytenoid dislocations after anterior cervical discectomy. Objective To recognize arytenoid dislocation as a possible cause of prolonged hoarseness in patients after anterior cervical discectomies. Summary of Background Data Prolonged hoarseness is a common postoperative complication after anterior cervical spine surgery. The etiology of prolonged postoperative hoarseness is usually related to a paresis of the recurrent laryngeal nerve. However, other causes of postoperative hoarseness may be overlooked in this clinical scenario. Other possible etiologies include pharyngeal and laryngeal trauma, hematoma and edema, injury of the superior laryngeal nerve, as well as arytenoid cartilage dislocation. Arytenoid dislocation is often misdiagnosed as vocal fold paresis due to recurrent or laryngeal nerve injury. Methods We report two cases of arytenoid dislocation and review the literature on this pathology. Results Two patients treated with anterior cervical discectomy and fusion experienced prolonged postoperative hoarseness. Arytenoid dislocation was confirmed by flexible fiber-optic laryngoscopy in both cases. The dislocations experienced spontaneous reduction at 6 weeks and 3 months postsurgery. Conclusions Arytenoid dislocation must be considered in the differential diagnosis of prolonged postoperative hoarseness and evaluated for using direct laryngoscopy, computed tomography, or a laryngeal electromyography. Upon diagnosis, treatment must be considered immediately. Slight dislocations can reduce spontaneously without surgical intervention; however, operative intervention may be required at times. PMID:24436851

  11. Frozen shoulder and other shoulder disturbances in Parkinson's disease.

    PubMed

    Riley, D; Lang, A E; Blair, R D; Birnbaum, A; Reid, B

    1989-01-01

    The frequency of shoulder disturbances, particularly frozen shoulder, has not been assessed previously in Parkinson's disease. In a survey of 150 patients compared with 60 matched control subjects a significantly higher incidence of both a history of shoulder complaints (43% vs. 23%) and frozen shoulder (12.7% vs. 1.7%) was found in the Parkinson's disease population. Those developing a frozen shoulder had initial disease symptoms indicative of akinesia twice as frequently as tremor while the ratio was reversed in those without frozen shoulder. In at least 8% of the patients frozen shoulder was the first symptom of disease, occurring 0-2 years prior to the onset of more commonly recognised features. Parkinson's disease should be added to the list of causes of frozen shoulder, and clinicians must be aware that the latter is often the presenting symptom of Parkinson's disease. PMID:2709037

  12. Thromboembolism Following Shoulder Arthroscopy

    PubMed Central

    Schick, Cameron W.; Westermann, Robert W.; Gao, Yubo; Abboud, Joseph A.; Wolf, Brian R.

    2014-01-01

    Background: Thromboembolism following shoulder arthroscopy is considered an uncommon complication, with fewer than 50 cases reported in the literature. Arthroscopy of the shoulder is one of the most commonly performed orthopaedic procedures, with low associated risks. Purpose: To identify potential risk factors for the development of venous thromboembolism (VTE) following shoulder arthroscopy and to determine the overall incidence of this complication. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective case-control review was performed of patients who developed symptomatic deep venous thrombosis (DVT) or pulmonary embolism (PE) following shoulder arthroscopy. Multiple surgeons from across North America were queried. For every case of DVT or PE identified, 2 control cases of shoulder arthroscopy were analyzed. The incidence of DVT/PE following shoulder arthroscopy was determined. A univariate analysis and a multivariate logistic regression model were conducted to identify any potential risk factors for the development of VTE following shoulder arthroscopy. Results: A total of 17 surgeons participated in this study and had performed a total of 15,033 cases of shoulder arthroscopy from September 2002 through August 2011. Eleven of the 17 participating surgeons had had a patient with a VTE complication during this time frame. The incidence of VTE in the 15,033 cases was 0.15%; 22 patients of the 15,033 patients had a DVT (n = 15) and/or PE (n = 8). Forty-four control cases were also analyzed. Univariate and multivariate analyses were performed. No significant risk factors were identified other than patient positioning. All cases and controls were positioned in the beach-chair position for surgery. Conclusion: The results of this study show that although rare, VTE occurs following shoulder arthroscopy at a rate of 0.15%. The variables analyzed in the cases of VTE compared with the control cases did not show any significant risk factors. All

  13. Using your shoulder after replacement surgery

    MedlinePlus

    Joint replacement surgery - using your shoulder; Shoulder replacement surgery - after ... You have had shoulder replacement surgery to replace the bones of your shoulder joint with artificial parts. The parts include a stem made ...

  14. Involuntary inferior and multidirectional instability of the shoulder: etiology, recognition, and treatment.

    PubMed

    Neer, C S

    1985-01-01

    Multidirectional and inferior instability of the shoulder is not rare. Etiological factors include various combinations of (a) repetitive injuries, (b) inherent joint laxity, and (c) one or more major injuries. It is seen in athletic and active patients without generalized joint laxity and as well in sedentary patients with hypermobile joints. Standard operations for unidirectional anterior or posterior dislocations fail to correct multidirectional instability because they do not correct inferior instability and they may displace the head in fixed subluxation to the opposite side leading to severe arthritis ("arthritis of dislocations"). Proper detection depends on suspecting its possibility in all types of patients and in a wide age range as well. Helpful signs include the sulcus sign, positive apprehension test in multiple directions, stress roentgenograms and fluoroscopy, and evaluations under anesthesia. Arthroscopy may be helpful in doubtful cases, but the findings require clinical interpretation. Selection of patients with multidirectional instability for surgery is extremely difficult because it requires not only great care in determining all directions of instability and planning the repair but also determining the motivation of the patient and excluding the possibility of some other condition being present that is causing pain rather than the joint laxity. The results of inferior capsular shift have continued to withstand the test of time and, though it is more difficult than standard procedures, is considered a very helpful procedure in the treatment of these difficult lesions. The principle is to reduce capsular laxity on all three sides by shortening and reinforcing and to reduce the joint volume.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3833944

  15. Shoulder Problems Motivate Innovative Solutions.

    PubMed

    Lubowitz, James H; Brand, Jefferson C; Rossi, Michael J; Provencher, Matthew T

    2016-09-01

    Shoulder arthroscopic and related surgeons may require expertise in use of the 70° arthroscope, biologic patch augmentation, repair of massive rotator cuff tears, the Latarjet procedure and related glenoid bone augmentation, and reverse total shoulder arthroplasty. PMID:27594323

  16. Using your shoulder after surgery

    MedlinePlus

    ... you it is ok. If you had rotator cuff surgery or other ligament or labral surgery, you ... Saunders; 2009:chap 20. Read More Osteoarthritis Rotator cuff problems Rotator cuff repair Shoulder arthroscopy Shoulder pain ...

  17. Shoulder proprioception in baseball pitchers.

    PubMed

    Safran, M R; Borsa, P A; Lephart, S M; Fu, F H; Warner, J J

    2001-01-01

    We examined proprioceptive differences between the dominant and nondominant shoulders of 21 collegiate baseball pitchers without a history of shoulder instability or surgery. A proprioceptive testing device was used to measure kinesthesia and joint position sense. Joint position sense was significantly (P =.05) more accurate in the nondominant shoulder than in the dominant shoulder when starting at 75% of maximal external rotation and moving into internal rotation. There were no significant differences for proprioception in the other measured positions or with kinesthesia testing. Six pitchers with recent shoulder pain had a significant (P =.04) kinesthetic deficit in the symptomatic dominant shoulder compared with the asymptomatic shoulder, as measured in neutral rotation moving into internal rotation. The net effect of training, exercise-induced laxity, and increased external rotation in baseball pitchers does not affect proprioception, although shoulder pain, possibly due to rotator cuff inflammation or tendinitis, is associated with reduced kinesthetic sensation. PMID:11641701

  18. Robotics in shoulder rehabilitation

    PubMed Central

    Sicuri, Chiara; Porcellini, Giuseppe; Merolla, Giovanni

    2014-01-01

    Summary In the last few decades, several researches have been conducted in the field of robotic rehabilitation to meet the intensive, repetitive and task-oriented training, with the goal to recover the motor function. Up to now, robotic rehabilitation studies of the upper extremity have generally focused on stroke survivors leaving less explored the field of orthopaedic shoulder rehabilitation. In this review we analyse the present status of robotic technologies, in order to understand which are the current indications and which may be the future perspective for their application in both neurological and orthopaedic shoulder rehabilitation. PMID:25332937

  19. SHOULDER DISORDERS AND OCCUPATION

    PubMed Central

    Linaker, CH; Walker-Bone, K

    2016-01-01

    Shoulder pain is very common and causes substantial morbidity. Standardised classification systems based upon presumed patho-anatomical origins have proved poorly reproducible and hampered epidemiological research. Despite this, there is evidence that exposure to combinations of physical workplace strains such as overhead working, heavy lifting and forceful work as well as working in an awkward posture increase the risk of shoulder disorders. Psychosocial risk factors are also associated. There is currently little evidence to suggest that either primary prevention or treatment strategies in the workplace are very effective and more research is required, particularly around the cost-effectiveness of different strategies. PMID:26612238

  20. Prosthesis design and placement in reverse total shoulder arthroplasty.

    PubMed

    Ackland, David C; Patel, Minoo; Knox, David

    2015-01-01

    The management of irreparable rotator cuff tears associated with osteoarthritis of the glenohumeral joint has long been challenging. Reverse total shoulder arthroplasty (RSA) was designed to provide pain relief and improve shoulder function in patients with severe rotator cuff tear arthropathy. While this procedure has been known to reduce pain, improve strength and increase range of motion in shoulder elevation, scapular notching, rotation deficiency, early implant loosening and dislocation have attributed to complication rates as high as 62%. Patient selection, surgical approach and post-operative management are factors vital to successful outcome of RSA, with implant design and component positioning having a significant influence on the ability of the shoulder muscles to elevate, axially rotate and stabilise the humerus. Clinical and biomechanical studies have revealed that component design and placement affects the location of the joint centre of rotation and therefore the force-generating capacity of the muscles and overall joint mobility and stability. Furthermore, surgical technique has also been shown to have an important influence on clinical outcome of RSA, as it can affect intra-operative joint exposure as well as post-operative muscle function. This review discusses the behaviour of the shoulder after RSA and the influence of implant design, component positioning and surgical technique on post-operative joint function and clinical outcome. PMID:26135298

  1. Arthroscopic Treatment of Perilunate Dislocations and Fracture Dislocations

    PubMed Central

    Kim, Jong Pil; Lee, Jae Sung; Park, Min Jong

    2015-01-01

    Background The key to a successful result in the treatment of perilunate dislocations (PLDs) and fracture-dislocations (PLFDs) is the restoration of normal alignment of the carpal bones, followed by stable maintenance until healing. This article aimed to assess whether arthroscopic techniques are a reliable surgical option for the treatment of this challenging injury. Materials and Methods Twenty patients with an acute PLD or PLFD were treated by an arthroscopic technique. They were retrospectively reviewed at an average follow-up of 31.2 months (range 18–61 months). Functional outcomes were assessed with the Modified Mayo Wrist Score (MMWS), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, and Patient-Rated Wrist Evaluation (PRWE) score as well as radiographic evaluations. Description of Technique Arthroscopic reduction and percutaneous fixation was performed to the scapholunate and lunotriquetral intervals using Kirschner wires (K-wires) as joysticks as well as to the scaphoid using a cannulated headless screw for transscaphoid-type injuries. The K-wires were removed at 10 weeks postoperation. Results Overall functional outcomes according to the MMWS were rated as excellent in three patients, good in eight, fair in seven, and poor in two. The mean DASH score was 18, and the mean PRWE score was 30. On the basis of radiographic parameters, reduction obtained at the operation was maintained within normal ranges in 15 patients. No patient had developed arthritis by the last follow-up. Conclusions The medium-term results show that arthroscopic treatment can provide proper restoration and stable fixation of carpal alignment and results in satisfactory functional and radiologic outcomes for acute perilunate injuries. Level of Evidence Level IV. PMID:25945291

  2. The Painful Shoulder: Shoulder Impingement Syndrome

    PubMed Central

    Khan, Yousaf; Nagy, Mathias Thomas; Malal, Joby; Waseem, Mohammad

    2013-01-01

    Rotator cuff disorders are considered to be among the most common causes of shoulder pain and disability encountered in both primary and secondary care. The general pathology of subacromial impingment generally relates to a chronic repetitive process in which the conjoint tendon of the rotator cuff undergoes repetitive compression and micro trauma as it passes under the coracoacromial arch. However acute traumatic injuries may also lead to this condition. Diagnosis remains a clinical one, however advances in imaging modalities have enabled clinicians to have an increased understanding of the pathological process. Ultrasound scanning appears to be a justifiable and cost effective assessment tool following plain radiographs in the assessment of shoulder impingment, with MRI scans being reserved for more complex cases. A period of observed conservative management including the use of NSAIDs, physiotherapy with or without the use of subacromial steroid injections is a well-established and accepted practice. However, in young patients or following any traumatic injury to the rotator cuff, surgery should be considered early. If surgery is to be performed this should be done arthroscopically and in the case of complete rotator cuff rupture the tendon should be repaired where possible. PMID:24082973

  3. Comparison of 3-Dimensional Shoulder Complex Kinematics in Individuals With and Without Shoulder Pain, Part 2: Glenohumeral Joint

    PubMed Central

    LAWRENCE, REBEKAH L.; BRAMAN, JONATHAN P.; STAKER, JUSTIN L.; LAPRADE, ROBERT F.; LUDEWIG, PAULA M.

    2015-01-01

    STUDY DESIGN Cross-sectional. OBJECTIVES To compare differences in glenohumeral joint angular motion and linear translations between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation. BACKGROUND Numerous clinical theories have linked abnormal glenohumeral kinematics, including decreased glenohumeral external rotation and increased superior translation, to individuals with shoulder pain and impingement diagnoses. However, relatively few studies have investigated glenohumeral joint angular motion and linear translations in this population. METHODS Transcortical bone pins were inserted into the scapula and humerus of 12 a symptomatic and 10 symptomatic participants for direct bone-fixed tracking using electromagnetic sensors. Glenohumeral joint angular positions and linear translations were calculated during active shoulder flexion, abduction, and scapular plane abduction. RESULTS Differences between groups in angular positions were limited to glenohumeral elevation, coinciding with a reduction in scapulothoracic upward rotation. Symptomatic participants demonstrated 1.4 mm more anterior glenohumeral translation between 90° and 120° of shoulder flexion and an average of 1 mm more inferior glenohumeral translation throughout shoulder abduction. CONCLUSION Differences in glenohumeral kinematics exist between symptomatic and a symptomatic individuals. The clinical implications of these differences are not yet understood, and more research is needed to understand the relationship between abnormal kinematics, shoulder pain, and pathoanatomy. PMID:25103132

  4. Dislocation Formation in Alloys

    NASA Astrophysics Data System (ADS)

    Minami, Akihiko; Onuki, Akira

    2006-05-01

    An interaction between dislocations and phase transitions is studied by a phase field model both in two and three dimensional systems. Our theory is a simple extension of the traditional linear elastic theory, and the elastic energy is a periodic function of local strains which is reflecting the periodicity of crystals. We find that the dislocations are spontaneously formed by quenching. Dislocations are formed from the interface of binary alloys, and slips are preferentially gliding into the soft metals. In three dimensional systems, formation of dislocations under applied strain is studied in two phase state. We find that the dislocation loops are created from the surface of hard metals. We also studied the phase separation above the coexisting temperature which is called as the Cottrell atmosphere. Clouds of metals cannot catch up with the motion of dislocations at highly strained state.

  5. Do normal hips dislocate?

    PubMed

    Alshameeri, Zeiad; Rehm, Andreas

    2014-11-01

    There have been a small number of case reports describing late normal-hip dislocations in children who were later diagnosed with developmental dysplasia of the hip. Here, we contest the assumption that normal hips can dislocate. We argue that (as in our case) the ultrasound scans in all published case reports on late dislocated normal hips did not show results that were entirely normal and therefore, so far, there has been no convincing evidence of a dislocation of a normal hip. We also want to highlight the importance of meticulous ultrasound and clinical assessments of high-risk children by an experienced orthopaedic surgeon. PMID:25144883

  6. Adhesive Capsulitis (Frozen Shoulder)

    MedlinePlus

    ... Reaching: Put things you use every day (shoes, coffee cup, toothbrush) on a high shelf. This way you have to reach up for things more often. The reaching is a good stretch for your shoulder. Do the exercises once or twice a day even after your ...

  7. Functional Analysis of the Primate Shoulder

    PubMed Central

    Hohn, Bianca; Scherf, Heike; Schmidt, Manuela; Krause, Cornelia; Witzel, Ulrich

    2010-01-01

    Studies of the shoulder girdle are in most cases restricted to morphological comparisons and rarely aim at elucidating function in a strictly biomechanical sense. To fill this gap, we investigated the basic functional conditions that occur in the shoulder joint and shoulder girdle of primates by means of mechanics. Because most of nonhuman primate locomotion is essentially quadrupedal walking—although on very variable substrates—our analysis started with quadrupedal postures. We identified the mechanical situation at the beginning, middle, and end of the load-bearing stance phase by constructing force parallelograms in the shoulder joint and the scapulo-thoracal connection. The resulting postulates concerning muscle activities are in agreement with electromyographical data in the literature. We determined the magnitude and directions of the internal forces and explored mechanically optimal shapes of proximal humerus, scapula, and clavicula using the Finite Element Method. Next we considered mechanical functions other than quadrupedal walking, such as suspension and brachiation. Quadrupedal walking entails muscle activities and joint forces that require a long scapula, the cranial margin of which has about the same length as the axillary margin. Loading of the hand in positions above the head and suspensory behaviors lead to force flows along the axillary margin and so necessitate a scapula with an extended axillary and a shorter cranial margin. In all cases, the facies glenoidalis is nearly normal to the calculated joint forces. In anterior view, terrestrial monkeys chose a direction of the ground reaction force requiring (moderate) activity of the abductors of the shoulder joint, whereas more arboreal monkeys prefer postures that necessitate activity of the adductors of the forelimb even when walking along branches. The same adducting and retracting muscles are recruited in various forms of suspension. As a mechanical consequence, the scapula is in a more

  8. Effect of tight clothes on cervical and thoracic spine muscles during shoulder abduction

    PubMed Central

    Kim, Min-hee; Yoo, Won-gyu

    2016-01-01

    [Purpose] The purpose of this study was investigated the effect of tight clothes on cervical and thoracic spine muscles activities during shoulder abduction. [Subjects and Methods] The subjects of this study were 10 healthy males. The subjects performed two shoulder abduction trials for each of two jacket-wearing conditions. The right upper, middle, and lower trapezius and serratus anterior muscles activities were measured using a surface electromyography system during right shoulder abduction. [Results] The upper and middle trapezius muscle activities during shoulder abduction were significantly increased under the tight-jacket conditions compared with the general-jacket conditions. The lower trapezius and serratus anterior muscle activities were significantly decreased under the tight-jacket conditions compared with the general-jacket conditions. [Conclusion] The results of this study suggest that normal scapular movements did not occur sufficiently when wearing a tight jacket. PMID:27313348

  9. Metallurgy: Starting and stopping dislocations

    NASA Astrophysics Data System (ADS)

    Minor, Andrew M.

    2015-09-01

    A comparison of dislocation dynamics in two hexagonal close-packed metals has revealed that dislocation movement can vary substantially in materials with the same crystal structure, associated with how the dislocations relax when stationary.

  10. Acute patellar dislocation with multiple ligament injuries after knee dislocation and single session reconstruction.

    PubMed

    Gormeli, Gokay; Gormeli, Cemile Ayse; Karakaplan, Mustafa; Gurbuz, Sukru; Ozdemir, Zeynep; Ozer, Mustafa

    2016-06-01

    Knee dislocation is a relatively rare condition of all orthopaedic injuries. Accompanying multiple ligament injuries are common after knee dislocations. A 41-year-old male presented to the emergency department suffering from right knee dislocation in June 2013. The patient had anterior cruciate ligament, medial collateral ligament (MCL), medial patellofemoral ligament (MPFL) rupture, and lateral meniscal tear. A single-bundle anatomic reconstruction, medial collateral ligament reconstruction, medial patellofemoral ligament reconstruction and meniscus repair were performed in single session. At twelve months follow-up; there was 160º flexion and 10° extension knee range of motion. Lysholm knee score was 90. Extensive forces can cause both MCL and MPFL injury due to overload and the anatomical relationship between these two structures. Therefore, patients with valgus instability should be evaluated for both MPFL and MCL tears to facilitate successful treatment. PMID:27339584

  11. Dislocation in Spoken French.

    ERIC Educational Resources Information Center

    Calve, Pierre

    1985-01-01

    Discusses dislocation, a construction in which one element, usually a noun, is isolated either at the beginning or at the end of a sentence while being represented in the body of the sentence by a pronoun. Discusses the place of dislocation in linguistic studies and its pedagogical implications. (SED)

  12. Dislocations in yttrium orthovanadate

    NASA Astrophysics Data System (ADS)

    Eakins, D. E.; LeBret, J. B.; Norton, M. G.; Bahr, D. F.

    2004-06-01

    Dislocation structures in single crystals of yttrium orthovanadate have been identified by transmission electron microscopy. Electron diffraction was used to predict possible Burgers vectors for the dislocations. Results suggest vectors of the type {1}/{2}[1 1 1] or {1}/{4}[0 2 1] . Arguments for the likelihood of each possible vector have been presented.

  13. Parallel Dislocation Simulator

    Energy Science and Technology Software Center (ESTSC)

    2006-10-30

    ParaDiS is software capable of simulating the motion, evolution, and interaction of dislocation networks in single crystals using massively parallel computer architectures. The software is capable of outputting the stress-strain response of a single crystal whose plastic deformation is controlled by the dislocation processes.

  14. Anterior Glenoid Rim Fracture Following Use of Resorbable Devices for Glenohumeral Stabilization

    PubMed Central

    Augusti, Carlo Alberto; Paladini, Paolo; Campi, Fabrizio; Merolla, Giovanni; Bigoni, Marco; Porcellini, Giuseppe

    2015-01-01

    Background Resorbable anchors are widely used in arthroscopic stabilization of the shoulder as a means of soft tissue fixation to bone. Their function is to ensure repair stability until they are replaced by host tissue. Complications include inflammatory soft tissue reactions, cyst formation, screw fragmentation in the joint, osteolytic reactions, and enhanced glenoid rim susceptibility to fracture. Purpose To evaluate resorption of biodegradable screws and determine whether they induce formation of areas with poor bone strength that may lead to glenoid rim fracture even with minor trauma. Study Design Case series; Level of evidence, 4. Methods This study evaluated 12 patients with anterior shoulder instability who had undergone arthroscopic stabilization with the Bankart technique and various resorbable anchors and subsequently experienced redislocation. The maximum interval between arthroscopic stabilization and the new dislocation was 52 months (mean, 22.16 months; range, 12-52 months). The mean patient age was 31.6 years (range, 17-61 years). The persistence or resorption of anchor holes; the number, area, and volume of osteolytic lesions; and glenoid erosion/fracture were assessed using computed tomography scans taken after redislocation occurred. Results Complete screw resorption was never documented. Osteolytic lesions were found at all sites (mean diameter, 5.64 mm; mean depth, 8.09 mm; mean area, 0.342 cm2; mean volume, 0.345 cm3), and all exceeded anchor size. Anterior glenoid rim fracture was seen in 9 patients, even without high-energy traumas (75% of all recurrences). Conclusion Arthroscopic stabilization with resorbable devices is a highly reliable procedure that is, however, not devoid of complications. In all 12 patients, none of the different implanted anchors had degraded completely, even in patients with longer follow-up, and all induced formation of osteolytic areas. Such reaction may lead to anterior glenoid rim fracture according to the

  15. Comparison between ultrasound and plain X-ray in evaluating the cause of shoulder pain.

    PubMed

    Salek, K M; Mannan, M; Chowdhury, A Z; Haque, M A; Kaiser, M S; Nabi, S; Ferdousee, R A; Paul, B K; Ahmed, S M; Khan, M; Begum, M

    2011-01-01

    Painful shoulder is a common painful condition among patients. Apart from acute traumatic lesions such as fractures, dislocations, contusions, sprains and ruptured tendons, 85 to 90% of painful shoulders are due to adhesive capsulitis, acute or chronic calcific tendinitis, bursitis, bicipital tendinitis and lesions of the musculotendinous cuff. Arthritis is the cause of less than 5% of painful shoulders. For evaluating conditions of shoulder joint, X-ray has been regarded as only method of choice for long time. Magnetic resonance imaging (MRI) is an alternative procedure but the cost limits its utilization especially in Bangladesh. Ultrasonography is an effective imaging modality in the evaluation of both rotator and non-rotator cuff disorders. Because of low cost and availability, it can be an alternative procedure for the diagnosis of painful shoulder. The present study was conducted to assess ultrasonography as a useful modality in evaluating cases of shoulder pain and to compare the findings with X-ray findings. Thirty two patients with shoulder pain were evaluated by X-ray and Ultrasonography (USG). Clinical diagnosis was done for correlation. To identify the cause of shoulder pain, 100% patients were found normal in plain X-ray. On Ultrasonography (USG) 12.5% patients had displaced long head of biceps, 21.9% had biceps tendinitis, and 3.1% had bursitis. In the assessment of shoulder pathology, USG had a sensitivity of 73.3%, specificity of 88.2%, Positive predictive value (PPV) of 84.6%, Negative predictive value (NPV) of 78.9% and an accuracy of 81.3%. USG is a useful modality for evaluation the shoulder joint in case of painful shoulder even plain X-ray is non conclusive. PMID:21240157

  16. Kneecap dislocation - aftercare

    MedlinePlus

    ... MD, Thompson SR, eds. DeLee and Drez's Orthopaedic Sports Medicine. 4th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap ... by: C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery, ...

  17. Electromechanical simulations of dislocations

    NASA Astrophysics Data System (ADS)

    Skiba, Oxana; Gracie, Robert; Potapenko, Stanislav

    2013-04-01

    Improving the reliability of micro-electronic devices depends in part on developing a more in-depth understanding of dislocations because dislocations are barriers to charge carriers. To this end, the quasi-static simulation of discrete dislocations dynamics in materials under mechanical and electrical loads is presented. The simulations are based on the extended finite element method, where dislocations are modelled as internal discontinuities. The strong and weak forms of the boundary value problem for the coupled system are presented. The computation of the Peach-Koehler force using the J-integral is discussed. Examples to illustrate the accuracy of the simulations are presented. The motion of the network of the dislocations under different electrical and mechanical loads is simulated. It was shown that even in weak piezoelectric materials the effect of the electric field on plastic behaviour is significant.

  18. Electronic properties of dislocations

    NASA Astrophysics Data System (ADS)

    Reiche, M.; Kittler, M.; Uebensee, H.; Pippel, E.; Haehnel, A.; Birner, S.

    2016-04-01

    Dislocations exhibit a number of exceptional electronic properties resulting in a significant increase in the drain current of MOSFETs if defined numbers of these defects are placed in the channel. Measurements on individual dislocations in Si refer to a supermetallic conductivity. A model of the electronic structure of dislocations is proposed based on experimental measurements and tight-binding simulations. It is shown that the high strain level on the dislocation core—exceeding 10 % or more—causes locally dramatic changes in the band structure and results in the formation of a quantum well along the dislocation line. This explains experimental findings (two-dimensional electron gas, single-electron transitions). The energy quantization within the quantum well is most important for supermetallic conductivity.

  19. [Stability versus mobility of the shoulder. Biomechanical aspects in athletes].

    PubMed

    Pastor, M F; Smith, T; Struck, M; Wellmann, M

    2014-03-01

    The demand profile of athletes shoulders is high. On the one hand the shoulder has to provide a maximum active range of motion that allows rapid movements of the arm and on the other hand it has to be sufficiently stabilized to decelerate rapid movements and to neutralize the resulting translational forces. Two general types of instability can be differentiated in athletes shoulders: the macroinstability typically occurring in athletes involved in contact sports and the microinstability occurring in athletes involved in overhead sports.Repetitive abduction and external rotation movements of athletes involved in overhead sports lead to adaptation of the glenohumeral joint capsule and ligaments. The anterior capsule becomes stretched while the posterior capsule develops tightness. These adaptations can result in an anterior microinstability as well as posterosuperior impingement (PSI) which implicates a pathological contact of the posterosuperior rotator cuff with the posterior glenoid and which is also associated with SLAP lesions. In contrast the shoulders of swimmers are prone to anterosuperior impingement because the arm stroke involves a forceful combined anteflexion, adduction and internal rotation of the arm.The macroinstability of contact athletes is caused by sufficient trauma and characterized by a structural lesion of capsulolabral or bony lesion. While the empirical recurrence risk of young contact athletes is already high, it can be further impaired by bony defects of the glenoid. In suspected cases, critical glenoid defects should be quantified by computed tomography (CT) scans and treated by bony augmentation of the glenoid. PMID:24604155

  20. Predictor variables for forward scapular posture including posterior shoulder tightness.

    PubMed

    Lee, Ji-Hyun; Cynn, Heon-seock; Yi, Chung-Hwi; Kwon, Oh-yun; Yoon, Tae-Lim

    2015-04-01

    The purpose of this study was (1) to determine the relationships between the degree of forward scapular posture and the pectoralis minor index, the strength of the serratus anterior, the thoracic spine angle, and posterior shoulder tightness, and (2) to identify predictors of forward scapular posture, including posterior shoulder tightness. The study recruited eighteen subjects with forward scapular posture and objectively measured the acromion distance, the pectoralis minor index, and the strength of the serratus anterior muscle of each participant. The amount of glenohumeral horizontal adduction and internal rotation were evaluated to measure posterior shoulder tightness. There were high intra-rater reliabilities in all measurements. The measurement results showed a statistically strong negative correlation between the degree of forward scapular posture and the pectoralis minor index. They also revealed a moderate positive correlation between the degree of forward scapular posture and the thoracic spine angle and a moderate negative relationship between the degree of forward scapular posture and the amount of the glenohumeral horizontal adduction. A multiple regression analysis indicated that a total multiple regression model explained 93% of the amount of forward scapular posture. All predictor variables, including posterior shoulder tightness, should be considered while assessing, managing, and preventing forward scapular posture. PMID:25892380

  1. Swimmer's Shoulder: Painful Shoulder in the Competitive Swimmer.

    PubMed

    Matzkin, Elizabeth; Suslavich, Kaytelin; Wes, David

    2016-08-01

    Swimmer's shoulder is a broad term often used to diagnose shoulder injury in swimmers. However, research has elucidated several specific shoulder injuries that often are incurred by the competitive swimmer. Hyperlaxity, scapular dyskinesis, subacromial impingement, labral damage, os acromiale, suprascapular nerve entrapment, and glenohumeral rotational imbalances all may be included within a differential diagnosis for shoulder pain in the competitive swimmer. An understanding of the mechanics of the swim stroke, in combination with the complex static and dynamic properties of the shoulder, is essential to the comprehension and identification of the painful swimmer's shoulder. It is important for the athlete, coach, and clinician to be aware of the discerning characteristics among these different injuries to ensure a proper diagnosis and treatment plan to aid the swimmer in his or her return to competition. PMID:27355281

  2. Complete Brachial Artery Transection following closed Posterior Elbow Dislocation: A Rare Case Report

    PubMed Central

    C, JayanthKumar B; Sampath, Deepak; N, Hanumantha Reddy; Motukuru, Vishnu

    2015-01-01

    Introduction: Vascular injury associated withclosed posterior elbow dislocations is rare and it usually occurs along with open dislocation, anterior dislocation, penetrating injuries, dislocations associated with fracture. We report such a case of closed posterior elbow dislocation with complete brachial artery rupture. Case Report: A 58 years old lady sustained posterior dislocation of right elbow following a fall at home. She presented three days later with complaints of severe pain, swelling around the right elbow and numbness of fingers following a closed reduction done elsewhere. Computed graft angiography showed complete transection of brachialartery. Patient was treated with thrombectomy, right great saphenous vein graft interposition repair of brachial artery and forearm fasciotomy. Conclusion: Vascular injuries associated with posterior elbow dislocation are very rare, but high index of suspicion of arterial injury need to be thought off and repeated vascular examination during pre and post reduction stage should be done to prevent complications. PMID:27299092

  3. Short stem shoulder replacement

    PubMed Central

    Bell, Simon N.; Coghlan, Jennifer A.

    2014-01-01

    Context: It is agreed that it is important to anatomically reproduce the proximal humeral anatomy when performing a prosthetic shoulder replacement. This can be difficult with a long stemmed prosthesis, in particular if there is little relationship of the metaphysis to the humeral shaft. The ‘short stem’ prosthesis can deal with this problem. Aims: A prospective study assessed the results of total shoulder arthroplasty using a short stem humeral prosthesis, a ceramic humeral head, and a pegged cemented polyethylene glenoid. Materials and methods: Patients with primary shoulder osteoarthritis were recruited into this prospective trial and pre-operatively had the ASES, Constant, SPADI, and DASH scores recorded. The patients were clinically reviewed at the two weeks, eight weeks, one year, and two year mark with completion of a data form. Radiological evaluation was at the eight week, one year and two year follow-up. At the one and two year follow-up the satisfaction rating, the range of passive and active motion, Constant, ASES, SPADI, DASH and pain results were recorded and analysed with SPPS 20. Results: During the study period 97 short stem, ceramic head total shoulder replacements were carried out. At the time of follow-up 12 were two years from operation and 38 one year from operation. Active elevation was overall mean 160 degrees. Constant scores were 76 at 1 year, and 86 at 2 years, ASES 88 and 93, and satisfaction 96% and 98% respectively at one and 2 year follow up. There were no problems during insertion of the humeral prosthesis, or any radiolucent lines or movement of the prosthesis on later radiographs. Conclusion: The short stem prosthesis had no complications, and on follow up radiographs good bone fixation. These fairly short term clinical results were overall good. PMID:25258497

  4. Tardy ulnar nerve palsy caused by chronic radial head dislocation after Monteggia fracture: a report of two cases.

    PubMed

    Nishimura, Masahiro; Itsubo, Toshiro; Horii, Emiko; Hayashi, Masanori; Uchiyama, Shigeharu; Kato, Hiroyuki

    2016-09-01

    Dislocation of the radial head is often encountered as a result of a pediatric Monteggia fracture. We report two rare cases of tardy ulnar nerve palsy associated with anterior radial head dislocation combined with anterior bowing of the ulna. They had cubitus valgus deformity, valgus instability, and osteoarthritis of the elbow, and had elbow injury more than 40 years back. They were diagnosed with chronic radial head dislocation long after a Bado type 1 Monteggia fracture. Anterior subcutaneous ulnar nerve transposition yielded favorable results. It is important to recognize the possibility of tardy ulnar nerve palsy caused by an improperly treated Monteggia fracture. PMID:26986030

  5. Validity and reliability of the SPORTS score for shoulder instability

    PubMed Central

    BLONNA, DAVIDE; BELLATO, ENRICO; CARANZANO, FRANCESCO; BONASIA, DAVIDE E.; MARMOTTI, ANTONGIULIO; ROSSI, ROBERTO; CASTOLDI, FILIPPO

    2014-01-01

    Purpose athletes affected by shoulder instability cannot be judged solely according to the criteria used for non-athletes. In order to improve the assessment of shoulder instability surgery outcomes, the SPORTS score was tested in a cohort of athletes. Methods ninety-eight athletes at an average follow-up of 4.6 years (range 1–9.2) after open or arthroscopic surgery for recurrent anterior shoulder instability were included in this study. The patients were asked to complete the SPORTS score questionnaire twice, with an interval of 2–3 weeks between the two assessments. The Bland-Altman method and the intra-class correlation coefficient were used to measure reliability. Criterion validity was assessed by calculating the Spearman correlation coefficient between the SPORTS score and the Western Ontario Shoulder Instability Index (WOSI) score, the Rowe score, the Oxford Shoulder Instability Score (OSIS), and the Subjective Shoulder Value (SSV). Results the SPORTS score showed excellent test-retest reliability. The systematic error between the first and the second assessment was 0.3 points (95% upper limit of agreement = 2.3 points). The criterion validity was found to be strong for the SPORTS score, which correlated best with the SSV and the “sport, recreation, and work” component of the WOSI score. The SPORTS score had an acceptable floor effect (8%). The ceiling effect was 46%, which was better than the ceiling effects seen with the Rowe, OSIS and WOSI scores. Conclusions this study suggests that the SPORTS score is a valid score in the assessment of athletes after surgery for shoulder instability and that it adds important information to the currently available scores. Level of evidence Level III, diagnostic study of nonconsecutive patients. PMID:25606544

  6. Does Subacromial Osteolysis Affect Shoulder Function after Clavicle Hook Plating?

    PubMed Central

    Sun, Siwei; Gan, Minfeng; Sun, Han; Wu, Guizhong; Yang, Huilin; Zhou, Feng

    2016-01-01

    Purpose. To evaluate whether subacromial osteolysis, one of the major complications of the clavicle hook plate procedure, affects shoulder function. Methods. We had performed a retrospective study of 72 patients diagnosed with a Neer II lateral clavicle fracture or Degree-III acromioclavicular joint dislocation in our hospital from July 2012 to December 2013. All these patients had undergone surgery with clavicle hook plate and were divided into two groups based on the occurrence of subacromial osteolysis. By using the Constant-Murley at the first follow-up visit after plates removal, we evaluated patients' shoulder function to judge if it has been affected by subacromial osteolysis. Results. We have analyzed clinical data for these 72 patients, which shows that there is no significant difference between group A (39 patients) and group B (33 patients) in age, gender, injury types or side, and shoulder function (the Constant-Murley scores are 93.38 ± 3.56 versus 94.24 ± 3.60, P > 0.05). Conclusion. The occurrence of subacromial osteolysis is not rare, and also it does not significantly affect shoulder function. PMID:27034937

  7. Clinical evaluation of nonarthritic shoulder pain: Diagnosis and treatment.

    PubMed

    Holmes, Robert E; Barfield, William R; Woolf, Shane K

    2015-07-01

    Shoulder pain and dysfunction is a complex problem frequently encountered by primary care physicians. Common nonarthritic conditions seen in the primary care setting include rotator cuff syndrome, impingement, posttraumatic stiffness, adhesive capsulitis, and instability. A thorough history and physical examination can aid in the diagnosis of many common shoulder complaints. Pain and instability are the most common shoulder complaints. Pain that is sharp or burning is commonly radicular in origin, whereas pain caused by tendinitis is often dull, diffuse, and aching. Instability is frequently found in patients with a history of dislocation, but also may occur with no prior history. Imaging modalities such as magnetic resonance imaging can be helpful for more advanced pathology. However, many common shoulder conditions can be diagnosed without imaging, and may be initially treated with a short course of rest, ice, topical analgesics, nonsteroidal anti-inflammatory drugs, directed and supervised physical therapy, and occasionally subacromial corticosteroid injections. As always, a detailed history and a thorough physical exam by a primary care physician are vital for diagnosis. When conservative measures fail, referral to an orthopaedic surgeon may be necessary for further patient management. PMID:25622930

  8. Association Between Serum Relaxin and Subsequent Shoulder Instability.

    PubMed

    Owens, Brett D; Cameron, Kenneth L; Clifton, Kari B; Svoboda, Steven J; Wolf, Jennifer Moriatis

    2016-07-01

    Ligamentous laxity correlates with shoulder instability. Relaxin is a hormone that has been linked to laxity in the knee and has been shown to be a risk factor for anterior cruciate ligament (ACL) injury. This study prospectively evaluated the association between relaxin and acute shoulder instability. A prospective cohort study of 1050 young athletes was performed between 2006 and 2010. The authors conducted a nested case-control analysis within this cohort to evaluate the association between preinjury serum relaxin concentration and the likelihood of subsequent shoulder instability. The study compared 53 patients who had shoulder instability and 53 control subjects who were matched for sex, age, height, and weight. The serum relaxin concentration in preinjury baseline samples was tested with enzyme-linked immunosorbent assay analysis in duplicate. Independent t tests were performed to identify differences in mean serum relaxin concentration between patients with shoulder instability and uninjured control subjects. Logistic regression was used to evaluate whether preinjury baseline serum relaxin concentration was associated with the subsequent likelihood of shoulder instability. Of the 53 patients with instability, 13 (25%) had a detectable serum relaxin concentration compared with 9 (17%) of uninjured control subjects (P=.34). Mean serum relaxin concentration in the injury group was 3.69±1.78 pg/mL and 2.20±0.97 pg/mL in uninjured control subjects (P=.02). Increased serum relaxin concentration was associated with the subsequent likelihood of acute shoulder instability. Subjects were 2.18 times (odds ratio, 2.18; 95% confidence interval, 1.01-4.76) more likely to have acute shoulder instability during the follow-up period for every 1-pg/mL increase in serum relaxin concentration at baseline. The findings suggest that serum relaxin concentration is associated with a risk of subsequent shoulder instability in young athletes. Further research on the role of relaxin

  9. Functional Anatomy of the Shoulder

    PubMed Central

    Terry, Glenn C.; Chopp, Thomas M.

    2000-01-01

    Objective: Movements of the human shoulder represent the result of a complex dynamic interplay of structural bony anatomy and biomechanics, static ligamentous and tendinous restraints, and dynamic muscle forces. Injury to 1 or more of these components through overuse or acute trauma disrupts this complex interrelationship and places the shoulder at increased risk. A thorough understanding of the functional anatomy of the shoulder provides the clinician with a foundation for caring for athletes with shoulder injuries. Data Sources: We searched MEDLINE for the years 1980 to 1999, using the key words “shoulder,” “anatomy,” “glenohumeral joint,” “acromioclavicular joint,” “sternoclavicular joint,” “scapulothoracic joint,” and “rotator cuff.” Data Synthesis: We examine human shoulder movement by breaking it down into its structural static and dynamic components. Bony anatomy, including the humerus, scapula, and clavicle, is described, along with the associated articulations, providing the clinician with the structural foundation for understanding how the static ligamentous and dynamic muscle forces exert their effects. Commonly encountered athletic injuries are discussed from an anatomical standpoint. Conclusions/Recommendations: Shoulder injuries represent a significant proportion of athletic injuries seen by the medical provider. A functional understanding of the dynamic interplay of biomechanical forces around the shoulder girdle is necessary and allows for a more structured approach to the treatment of an athlete with a shoulder injury. PMID:16558636

  10. Editorial Commentary: Multidirectional Shoulder Instability.

    PubMed

    Lubowitz, James H

    2015-12-01

    Multidirectional shoulder instability responds to physical therapy and rehabilitation. For patients who fail rehabilitation, arthroscopic capsular plication seems the treatment of choice. PMID:26652151

  11. GPU accelerated dislocation dynamics

    NASA Astrophysics Data System (ADS)

    Ferroni, Francesco; Tarleton, Edmund; Fitzgerald, Steven

    2014-09-01

    In this paper we analyze the computational bottlenecks in discrete dislocation dynamics modeling (associated with segment-segment interactions as well as the treatment of free surfaces), discuss the parallelization and optimization strategies, and demonstrate the effectiveness of Graphical Processing Unit (GPU) computation in accelerating dislocation dynamics simulations and expanding their scope. Individual algorithmic benchmark tests as well as an example large simulation of a thin film are presented.

  12. Cervical facet joint kinematics during bilateral facet dislocation

    PubMed Central

    Panjabi, Manohar M.; Simpson, Andrew K.; Pearson, Adam M.; Tominaga, Yasuhiro; Yue, James J.

    2007-01-01

    Previous biomechanical models of cervical bilateral facet dislocation (BFD) are limited to quasi-static loading or manual ligament transection. The goal of the present study was to determine the facet joint kinematics during high-speed BFD. Dislocation was simulated using ten cervical functional spinal units with muscle force replication by frontal impact of the lower vertebra, tilted posteriorly by 42.5°. Average peak rotations and anterior sliding (displacement of upper articulating facet surface along the lower), separation and compression (displacement of upper facet away from and towards the lower), and lateral shear were determined at the anterior and posterior edges of the right and left facets and statistically compared (P < 0.05). First, peak facet separation occurred, and was significantly greater at the left posterior facet edge, as compared to the anterior edges. Next, peak flexion rotation and anterior facet sliding occurred, followed by peak facet compression. The highest average facet translation peaks were 22.0 mm for anterior sliding, 7.9 mm for separation, 9.9 mm for compression and 3.6 mm for lateral shear. The highest average rotation of 63° occurred in flexion, significantly greater than all other directions. These events occurred, on average, within 0.29 s following impact. During BFD, the main sagittal motions included facet separation, flexion rotation, anterior sliding, followed by compression, however, non-sagittal motions also existed. These motions indicated that unilateral dislocation may precede bilateral dislocation. PMID:17566792

  13. Acute traumatic patellar dislocation.

    PubMed

    Duthon, V B

    2015-02-01

    Inaugural traumatic patellar dislocation is most often due to trauma sustained during physical or sports activity. Two-thirds of acute patellar dislocations occur in young active patients (less than 20 years old). Non-contact knee sprain in flexion and valgus is the leading mechanism in patellar dislocation, accounting for as many as 93% of all cases. The strong displacement of the patella tears the medial stabilizing structures, and notably the medial patellofemoral ligament (MPFL), which is almost always injured in acute patellar dislocation, most frequently at its femoral attachment. Lateral patellar glide can be assessed with the knee in extension or 20° flexion. Displacement by more than 50% of the patellar width is considered abnormal and may induce apprehension. Plain X-ray and CT are mandatory to diagnose bony risk factors for patellar dislocation, such as trochlear dysplasia or increased tibial tubercle-trochlear groove distance (TT-TG), and plan correction. MRI gives information on cartilage and capsulo-ligamentous status for treatment planning: free bodies or osteochondral fracture have to be treated surgically. If patellar dislocation occurs in an anatomically normal knee and osteochondral fracture is ruled out on MRI, non-operative treatment is usually recommended. PMID:25592052

  14. [A DESTRUCTIVE SHOULDER ARTHROPATHY].

    PubMed

    Ouhadi, L; Gaudreault, M; Mottard, S; Gillet, Ph

    2016-02-01

    Charcot arthropathy is a progressive, chronic and degenerative destruction of one or several joints caused by a central or peripheral neurological disorder. Approximately 25 % of the patients with syringomyelia develop this arthropathy located in the upper limb in 80 % of the cases. An early etiological diagnosis is essential to begin the treatment of the underlying neurological disorder. Afterwards, a conservative treatment of the arthropathy is preferred. We report the story of a patient with an arthropathy of the left shoulder due to Arnold-Chiari's malformation of type I with syringomyelia. PMID:27141649

  15. Three-Dimensional Scapular Kinematics in Patients with Reverse Total Shoulder Arthroplasty during Arm Motion

    PubMed Central

    Lee, Kwang Won; Kim, Ha Yong; Yang, Dae Suk; Lee, Gyu Sang; Choy, Won Sik

    2016-01-01

    Background There have been few reports on altered kinematics of the shoulder after reverse total shoulder arthroplasty (RTSA). We investigated differences in 3-dimensional (3D) scapular motions assessed using an optical tracking system between RTSA treated shoulders and asymptomatic contralateral shoulders during arm motion. Methods Thirteen patients who underwent RTSA were assessed for active arm elevation in 2 distinct elevation planes (sagittal plane flexion and scapular plane abduction). Their mean age was 72 years (range, 69 to 79 years) and the mean follow-up was 24.4 months (range, 13 to 48 months). The dominant side was the right side in all the 13 patients, and it was also the side treated with RTSA. Scapular kinematics was recorded with an optical tracking system. The scapular kinematics and the scapulohumeral rhythm (SHR) of the RTSA shoulders and asymptomatic contralateral shoulders were recorded and analyzed during arm elevation. Results There were no significant differences in internal/external rotation and anterior/posterior tilting of the scapula between shoulders during arm motion (p > 0.05). However, upward rotation of the scapula differed significantly during arm motion (p = 0.035 for sagittal plane flexion; p = 0.046 for scapular plane abduction). There were significant differences in the SHR between the two shoulders (p = 0.016 for sagittal plane flexion; p = 0.021 for scapular plane abduction). Conclusions The shoulder kinematics after RTSA showed significant differences from the contralateral asymptomatic shoulders. Increased upward rotation and decreased SHR after RTSA indicate that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. PMID:27583116

  16. A Simple Population-Based Finite Element Model Eliminates the Need for Patient-Specific Models to Predict Instability of the Shoulder

    PubMed Central

    Jones, Morgan H.; Walia, Piyush; Fening, Stephen D.; Miniaci, Anthony

    2016-01-01

    Objectives: Recurrent shoulder instability can significantly increase in the presence of bony Bankart and Hill-Sachs lesions. Therefore, it is important to understand the changes in shoulder biomechanics due to bony defects. Limitations of using cadaveric model to investigate the effects of combined bony defects on shoulder instability is inability to test all combination in a single specimen. Utilizing the flexibility of computational methodology like finite element (FE) model provides the advantage of testing all combinations at multiple arm positions. The aim of this study was to develop a simple FE model of combined bony lesions and its effect on anterior shoulder instability. In addition, we wanted to determine the need for patient (specimen) specific modeling. We hypothesized that the shoulder instability would be similar for all three models (population-based model, specimen-specific model, and cadaveric model). Methods: Three specimens were randomly selected from specimens tested in our previous study and Computed Tomography (CT) arthrogram images were taken before and after experimentation to develop FE models. We also developed a simple population-based model representing a spherical humeral head, which was developed using the radii values for cartilage and bone from literature. The sizes of humeral head lesions chosen were: 6%, 19%, 31%, and 44% of humeral head diameter and glenoid defect sizes were 10%, 20% and 30% of the glenoid width. All simulations were performed at glenohumeral abduction angles (ABD) of 20°, 40°, and 60° and external rotation of 0°, 40°, and 80°. Each simulation comprised of translating the humeral head leading to an anterior dislocation under a constant 50 N medial load. This compressive load simulated the static load of soft tissue. The percent intact translation (%IT) was computed by normalizing the distance to dislocation value for each defect condition w.r.t intact condition of each specimen. Stability Ratio (SR) was

  17. Biomechanical Comparison of Acute Hill-Sachs Reduction and Remplissage to Treat Complex Anterior Instability

    PubMed Central

    Dines, Joshua S.; Garcia, Grant; McGarry, Michelle H.; Lee, Thay Q.; Degen, Ryan

    2016-01-01

    Objectives: Acute Hill-Sachs (HS) reduction represents a potential alternative method to remplissage for the treatment of an engaging HS lesion. The purpose of this study is to biomechanically compare the stabilizing effects of an acute HS reduction technique and remplissage in a complex instability model. Methods: This was a comparative cadaveric study of 6 shoulders. For the acute HS lesion, a unique model was used to create a 30% defect, compressing the subchondral bone while preserving the articular surface in a more anatomic fashion. In addition, a 15% glenoid defect was made in all specimens. The HS lesion was reduced through a lateral cortical window with a bone tamp, and the subchondral void was filled with Quickset (Arthrex) bone cement to prevent plastic deformation. Five scenarios were tested; intact specimen, bipolar lesion, Bankart repair, remplissage with Bankart repair and HS reduction technique with Bankart repair. Translation, kinematics and dislocation events were recorded. Results: For all 6 specimens no dislocations occurred after either remplissage or the reduction technique. At 90 degrees of abduction and external rotation (ABER), anterior-inferior translation was 11.1 mm (SD 0.9) for the bipolar lesion. This was significantly reduced following both remplissage (5.1±0.7 mm; p<0.001) and HS reduction (4.4 ±0.3 mm; p<0.001). For anterior-inferior translation there was no significant difference in translation between the reduction technique and remplissage (p=0.91). At 90 degrees of ABER, the intact specimens average joint stiffness was 7.0 ±1.0N/mm, which was not significantly different from the remplissage (7.8±0.9 N/mm; p=0.9) and reduction technique (9.1±0.6 N/mm; p=0.50). Compared with an isolated Bankart repair, the average external rotation loss after also performing a remplissage procedure was 4.3 ±3.5 deg (p=0.65), while average ER loss following HS reduction was 1.1 ±3.3 deg (p=0.99). There was no significant difference in

  18. A History of Shoulder Surgery

    PubMed Central

    Iqbal, S; Jacobs, U; Akhtar, A; Macfarlane, R.J; Waseem, M

    2013-01-01

    Shoulder surgery has emerged from being a marginalised sub-speciality to being an area of much research and advancement within the last seventy years. This has been despite the complexity of the joint, and success majorly rests on parallel development of biomedical technology. This article looks at the past and present of shoulder surgery and discusses future directions in the speciality. PMID:24082968

  19. Simulation of dislocation accumulation in ULSI cells with STI structure

    NASA Astrophysics Data System (ADS)

    Ohashi, Tetsuya; Sato, Michihiro; Maruizumi, Takuya; Kitagawa, Isao

    2003-06-01

    Periodic structure of the shallow trench isolation (STI) type ULSI cells is generally used for the latest semiconductor devices. However, dislocations sometimes accumulate in the electron channel when the device size becomes small, and they have an enormous effect on the electronic state and obstruct the device from normal operation. In this paper, we numerically model the periodic structure of the STI type ULSI cells, and analyze the plastic slip that takes place during the oxidation process of oxide film area. The slip deformation is analyzed by a crystal plasticity analysis software, which has been developed on the basis of finite element technique, and we evaluate the accumulation of dislocations that accompany plastic slip. The results show stress concentrations at the shoulder part of the device area and the bottom corners of the trench for the device isolation, and the high stresses at these area cause plastic slip and dislocation accumulation. The direction of these dislocation lines are shown to be mostly parallel to the trench direction and dislocations are approximately 60° mixed type.

  20. Congenital Rhabdomyosarcoma of Shoulder

    PubMed Central

    Khaleghnejad-Tabari, Ahmad; Mirshemirani, Alireza; Rouzrokh, Mohsen; Nariman, Shahin; Hassas-Yeganeh, Shaghayegh; Gharib, Atoosa; Khaleghnejad-Tabari, Nasibeh

    2012-01-01

    A 16-day-old female was referred with congenital swelling on her right shoulder. On examination, there was a hard, round, ecchymotic, nontender, slightly movable, warm and shiny 10x15 cm mass on the right axillary pits which was extended to the right side of neck and chest wall. The mass separated the shoulder from the chest wall causing paralysis of right hand. Chest X-ray, ultrasound and MRI with contrast demonstrated a soft tissue mass suspected to be a hemangioma. The mass rapidly increased in size despite aggressive steroid therapy with rupture and bleeding. On the 45th post natal day the baby was taken to operating room to control the bleeding and if possible total excision of the mass. The mass was separated easily from the surrounding tissue and was excised along with right upper extremity. At the end of surgery the baby had cardiac arrest, and apparently died of Disseminated Intravascular Coagulation (DIC). The final pathology report was Rhabdomyosarcoma (RMS). PMID:25628836

  1. Spontaneous dislocation of lens bag with acrylic lens after uneventful cataract surgery – unusual complication of cataract surgery

    PubMed Central

    Shah, Mehul A.; Shah, Shreya M.; Mehta, Ruchir; Shah, Prerna

    2015-01-01

    Introduction: Spontaneous dislocation of intraocular lens with bag is rare. Methods: We report a case of a 56-year-old male who presented with spontaneous anterior dislocation of an in-the-bag intraocular lens 3 years after manual small incision cataract surgery. He had undergone manual small incision cataract surgery with foldable acrylic intraocular lens implantation, and 18 months after cataract surgery ND: YAG capsulotomy with uneventful post capsulotomy follow-up. 17 months after capsulotomy, the patient presented with sudden decrease of vision. On anterior segment examination, the intraocular lens with bag was dislocated into the anterior chamber. Result: It was managed with intraocular lens explantation with bag, anterior vitrectomy and sclera fixated intraocular lens. Conclusion: Spontaneous intraocular lens dislocation with bag is possible after 1.5 years of uneventful surgery which may be managed using different techniques.

  2. The Anterior Approach for Total Hip Replacement.

    PubMed

    Hochfelder, Jason P; Davidovitch, Roy I

    2016-03-01

    The anterior approach for total hip replacements has recently gained popularity. Some authors report faster recoveries and decreased dislocation rated with no increased risk of complications. However others claim no difference in outcomes when compared to other approaches yet an increase in complication rates. This paper provides a brief history of the approach, discusses various indications and contraindications, preoperative considerations, surgical techniques, and postoperative protocols. PMID:26977549

  3. Statistical characterization of dislocation ensembles

    SciTech Connect

    El-Azab, A; Deng, J; Tang, M

    2006-05-17

    We outline a method to study the spatial and orientation statistics of dynamical dislocation systems by modeling the dislocations as a stochastic fiber process. Statistical measures have been introduced for the density, velocity, and flux of dislocations, and the connection between these measures and the dislocation state and plastic distortion rate in the crystal is explained. A dislocation dynamics simulation model has been used to extract numerical data to study the evolution of these statistical measures numerically in a body-centered cubic crystal under deformation. The orientation distribution of the dislocation density, velocity and dislocation flux, as well as the dislocation correlations have been computed. The importance of the statistical measures introduced here in building continuum models of dislocation systems is highlighted.

  4. Shoulder Musculature Activity and Stabilization During Upper Extremity Weight-Bearing Activities

    PubMed Central

    Pontillo, Marisa; Kremenic, Ian J.; McHugh, Malachy P.; Mullaney, Michael J.; Tyler, Timothy F.

    2007-01-01

    Background Upper extremity weight-bearing exercises are routinely used in physical therapy for patients with shoulder pathology. However, little evidence exists regarding the demand on the shoulder musculature. Objective To examine changes in shoulder muscle activity and center of pressure during upper extremity weight-bearing exercises of increasing difficulty. Methods Electromyographic (EMG) and kinetic data were recorded from both shoulders of 15 healthy subjects (10 male and 5 female). Participants were tested in a modified tripod position under three conditions of increasing difficulty: (1) hand directly on the force plate, (2) on a green Stability Trainer™ and (3) on a blue Stability Trainer™. Ground reaction forces were recorded for each trial. Surface EMG was recorded from the serratus anterior, pectoralis major, upper trapezius, lower trapezius, infraspinatus, anterior deltoid, posterior deltoid, and the lateral head of the triceps muscles. Results Mean deviation from center of pressure significantly increased when using the Stability Trainer™ pads. The activities of the triceps, serratus anterior, and anterior deltoid muscles significantly increased as each trial progressed, irrespective of stability condition. Additionally, activity in the anterior deltoid, lower trapezius, and serratus anterior muscles significantly decreased with increasing difficulty, whereas activity in the triceps muscles significantly increased. Discussion and Conclusion Balancing on a foam pad made it more difficult to maintain the upper extremity in a stable position. However, this activity did not alter the proprioceptive stimulus enough to elicit an increase in shoulder muscle activation. While the results on this study support the use of different level Stability Trainers™ to facilitate neuromuscular re-education, a less compliant unstable surface may produce larger training effects. PMID:21522206

  5. Subtalar dislocation without associated fractures: Case report and review of literature

    PubMed Central

    Giannoulis, Dionisios; Papadopoulos, Dimitrios V; Lykissas, Marios G; Koulouvaris, Panagiotis; Gkiatas, Ioannis; Mavrodontidis, Alexandros

    2015-01-01

    Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed. PMID:25893182

  6. Subtalar dislocation without associated fractures: Case report and review of literature.

    PubMed

    Giannoulis, Dionisios; Papadopoulos, Dimitrios V; Lykissas, Marios G; Koulouvaris, Panagiotis; Gkiatas, Ioannis; Mavrodontidis, Alexandros

    2015-04-18

    Isolated subtalar dislocations are unusual injuries due to the inherent instability of the talus. Subtalar dislocations are frequently associated with fractures of the malleoli, the talus, the calcaneus or the fifth metatarsal. Four types of subtalar dislocation have been described according to the direction of the foot in relation to the talus: medial, lateral posterior and anterior. It has been shown that some of these dislocations may spontaneously reduce. A rare case of a 36-year-old male patient who sustained a closed medial subtalar dislocation without any associated fractures of the ankle is reported. The patient suffered a pure closed medial subtalar dislocation that is hardly reported in the literature. Six months after injury the patient did not report any pain, had a satisfactory range of motion, and no signs of residual instability or early posttraumatic osteoarthritis. The traumatic mechanism, the treatment options, and the importance of a stable and prompt closed reduction and early mobilization are discussed. PMID:25893182

  7. Dislocation following total knee arthroplasty: A report of six cases

    PubMed Central

    Villanueva, Manuel; Ríos-Luna, Antonio; Pereiro, Javier; Fahandez-Saddi, Homid; Pérez-Caballer, Antonio

    2010-01-01

    Background: Dislocation following total knee arthroplasty (TKA) is the worst form of instability. The incidence is from 0.15 to 0.5%. We report six cases of TKA dislocation and analyze the patterns of dislocation and the factors related to each of them. Materials and Methods: Six patients with dislocation of knee following TKA are reported. The causes for the dislocations were an imbalance of the flexion gap (n=4), an inadequate selection of implants (n=1), malrotation of components (n=1) leading to incompetence of the extensor mechanism, or rupture of the medial collateral ligament (MCC). The patients presented complained of pain, giving way episodes, joint effusion and difficulty in climbing stairs. Five patients suffered posterior dislocation while one anterior dislocation. An urgent closed reduction of dislocation was performed under general anaesthesia in all patients. All patients were operated for residual instability by revision arthroplasty after a period of conservative treatment. Results: One patient had deep infection and knee was arthrodesed. Two patients have a minimal residual lag for active extension, including a patient with a previous patellectomy. Result was considered excellent or good in four cases and fair in one, without residual instability. Five out of six patients in our series had a cruciate retaining (CR) TKA designs: four were revised to a posterior stabilized (PS) TKA and one to a rotating hinge design because of the presence of a ruptured MCL. Conclusion: Further episodes of dislocation or instability will be prevented by identifying and treating major causes of instability. The increase in the level of constraint and correction of previous technical mistakes is mandatory. PMID:20924487

  8. Dual Nerve Transfers for Restoration of Shoulder Function After Brachial Plexus Avulsion Injury.

    PubMed

    Chu, Bin; Wang, Huan; Chen, Liang; Gu, Yudong; Hu, Shaonan

    2016-06-01

    The purpose of this study was to investigate the effectiveness of shoulder function restoration by dual nerve transfers, spinal accessory nerve to the suprascapular nerve and 2 intercostal nerves to the anterior branch of the axillary nerve, in patients with shoulder paralysis that resulted from brachial plexus avulsion injury. It was a retrospective analysis to assess the impact of a variety of factors on reanimation of shoulder functions with dual nerve transfers. A total of 19 patients were included in this study. Most of these patients sustained avulsions of C5, C6, and C7 nerve roots (16 patients). Three of them had avulsions of C5 and C6 roots only. Through a posterior approach, direct coaptation of the intercostal nerves and the anterior branch of the axillary nerve was performed, along with accessory nerve transfer to the suprascapular nerve. Satisfactory shoulder function recovery (93.83° of shoulder abduction and 54.00° of external rotation on average) was achieved after a 62-month follow-up. This dual nerve transfer procedure provided us with a reliable and effective method for shoulder function reconstruction after brachial plexus root avulsion, especially C5/C6/C7 avulsion. The level of evidence is therapeutic IV. PMID:26835823

  9. Recurrent anterior instability of the radial head: case report.

    PubMed

    Itadera, Eichi; Ueno, Keisuke

    2014-02-01

    We present a case of recurrent anterior instability of the radial head presenting 4 weeks after injury. A 16-year-old girl injured the right upper extremity while playing volleyball. Thereafter, she felt a recurrent click associated with pain in the elbow when rotating the forearm. Image intensifier findings implied that the radial head would anteriorly dislocate with contraction of the biceps brachii. Annular ligament reconstruction using the palmaris longus tendon graft relieved the instability. PMID:24332619

  10. How much does inferior capsular shift reduce shoulder volume?

    PubMed

    Lubowitz, J; Bartolozzi, A; Rubinstein, D; Ciccotti, M; Schweitzer, M; Nazarian, L; Lombardi, J; Dellose, S; Landsdorf, A; Miller, L

    1996-07-01

    The purpose of this study was to quantitate the effect of inferior capsular shift on shoulder volume. Four fresh frozen cadaveric shoulders were analyzed. Volume before and after shift was determined using 3 techniques: (1) Magnetic resonance imaging sequences were digitized to computer and analyzed for volume via a 35-mm camera using Cue 2 software. The capsule was delineated by contrast between light and dark regions. Volume was calculated by summing the total area of respective slices. (2) Ultrasound images, obtained after surgical exposure of the capsule, were digitized. Volume was calculated using the formula for a prolate ellipsoid. (3) An 18-gauge needle was used to inject and evacuate saline via an anterior approach. Quantity of aspirated fluid provided a direct measure of volume. Inferior capsular shift was performed. After the operation, measurements were repeated. Inferior capsular shift reduced volume in all shoulders with each technique. On average, inferior capsular shift reduced joint volume by 57 %). A measurable reduction in shoulder joint volume is an effect of capsular shift. This measurement may have clinical application if volume is an indicator of instability or laxity. PMID:8653983

  11. Types of Traumatic Lens Dislocations at Larkana.

    PubMed

    Shah, Syed Imtiaz Ali; Shah, Shujaat Ali; Rai, Partab; Siddiqui, Shahid Jamal; Abbasi, Safdar Ali; Katpar, Naeem Akhtar

    2016-08-01

    The objective of this study was to determine the pattern of traumatic lens dislocations presenting at our institute. This may help develop the preventive strategies. The number of cases of traumatic lens dislocations, presented at the Department of Ophthalmology, Chandka Medical College, Larkana, Pakistan, from January 2002 to June 2015, were 59 including 61.02% (n=36) males and 38.98% (n=23) females. Cause of trauma was wood or plant impalement in 35.6% (n=21) cases, cracker blast in 13.55% (n=8) cases, fall on ground in 11.86% (n=7) cases, penetrating injuries with needle, scissors or knife in 10.16% (n=6) cases, road traffic accidents in 10.16% (n=6) cases, sports injuries (cricket ball and gulle danda) in 8.47% (n=5) cases, firearm injuries in 5.1% (n=3) cases, and fist hitting in 5.1% (n=3) cases. Lens was dislocated posteriorly in 33.90% (n=20) cases, anteriorly in 25.42% (n=15) cases, inferiorly in 11.86% (n=7) cases, medially in 10.17% (n=6) cases, laterally in 10.17% (n=6) cases, superiorly in 6.78% (n=4) cases, and a single (1.69%) case of lenticele was seen. PMID:27539772

  12. Dislocation of the hip (image)

    MedlinePlus

    A dislocation is an injury in which a bone is displaced from its proper position. Unless there are accompanying fractures or tissue damage, a simple dislocation may be manipulated back into place. Recovery may ...

  13. Supersonic Dislocation Bursts in Silicon

    DOE PAGESBeta

    Hahn, E. N.; Zhao, S.; Bringa, E. M.; Meyers, M. A.

    2016-06-06

    Dislocations are the primary agents of permanent deformation in crystalline solids. Since the theoretical prediction of supersonic dislocations over half a century ago, there is a dearth of experimental evidence supporting their existence. Here we use non-equilibrium molecular dynamics simulations of shocked silicon to reveal transient supersonic partial dislocation motion at approximately 15 km/s, faster than any previous in-silico observation. Homogeneous dislocation nucleation occurs near the shock front and supersonic dislocation motion lasts just fractions of picoseconds before the dislocations catch the shock front and decelerate back to the elastic wave speed. Applying a modified analytical equation for dislocation evolutionmore » we successfully predict a dislocation density of 1.5 x 10(12) cm(-2) within the shocked volume, in agreement with the present simulations and realistic in regards to prior and on-going recovery experiments in silicon.« less

  14. Supersonic Dislocation Bursts in Silicon.

    PubMed

    Hahn, E N; Zhao, S; Bringa, E M; Meyers, M A

    2016-01-01

    Dislocations are the primary agents of permanent deformation in crystalline solids. Since the theoretical prediction of supersonic dislocations over half a century ago, there is a dearth of experimental evidence supporting their existence. Here we use non-equilibrium molecular dynamics simulations of shocked silicon to reveal transient supersonic partial dislocation motion at approximately 15 km/s, faster than any previous in-silico observation. Homogeneous dislocation nucleation occurs near the shock front and supersonic dislocation motion lasts just fractions of picoseconds before the dislocations catch the shock front and decelerate back to the elastic wave speed. Applying a modified analytical equation for dislocation evolution we successfully predict a dislocation density of 1.5 × 10(12) cm(-2) within the shocked volume, in agreement with the present simulations and realistic in regards to prior and on-going recovery experiments in silicon. PMID:27264746

  15. Supersonic Dislocation Bursts in Silicon

    PubMed Central

    Hahn, E. N.; Zhao, S.; Bringa, E. M.; Meyers, M. A.

    2016-01-01

    Dislocations are the primary agents of permanent deformation in crystalline solids. Since the theoretical prediction of supersonic dislocations over half a century ago, there is a dearth of experimental evidence supporting their existence. Here we use non-equilibrium molecular dynamics simulations of shocked silicon to reveal transient supersonic partial dislocation motion at approximately 15 km/s, faster than any previous in-silico observation. Homogeneous dislocation nucleation occurs near the shock front and supersonic dislocation motion lasts just fractions of picoseconds before the dislocations catch the shock front and decelerate back to the elastic wave speed. Applying a modified analytical equation for dislocation evolution we successfully predict a dislocation density of 1.5 × 1012 cm−2 within the shocked volume, in agreement with the present simulations and realistic in regards to prior and on-going recovery experiments in silicon. PMID:27264746

  16. Supersonic Dislocation Bursts in Silicon

    NASA Astrophysics Data System (ADS)

    Hahn, E. N.; Zhao, S.; Bringa, E. M.; Meyers, M. A.

    2016-06-01

    Dislocations are the primary agents of permanent deformation in crystalline solids. Since the theoretical prediction of supersonic dislocations over half a century ago, there is a dearth of experimental evidence supporting their existence. Here we use non-equilibrium molecular dynamics simulations of shocked silicon to reveal transient supersonic partial dislocation motion at approximately 15 km/s, faster than any previous in-silico observation. Homogeneous dislocation nucleation occurs near the shock front and supersonic dislocation motion lasts just fractions of picoseconds before the dislocations catch the shock front and decelerate back to the elastic wave speed. Applying a modified analytical equation for dislocation evolution we successfully predict a dislocation density of 1.5 × 1012 cm‑2 within the shocked volume, in agreement with the present simulations and realistic in regards to prior and on-going recovery experiments in silicon.

  17. Dislocation dynamics in confined geometry

    NASA Astrophysics Data System (ADS)

    Gómez-García, D.; Devincre, B.; Kubin, L.

    1999-05-01

    A simulation of dislocation dynamics has been used to calculate the critical stress for a threading dislocation moving in a confined geometry. The optimum conditions for conducting simulations in systems of various sizes, down to the nanometer range, are defined. The results are critically compared with the available theoretical and numerical estimates for the problem of dislocation motion in capped layers.

  18. Behavior of dislocations in silicon

    SciTech Connect

    Sumino, Koji

    1995-08-01

    A review is given of dynamic behavior of dislocations in silicon on the basis of works of the author`s group. Topics taken up are generation, motion and multiplication of dislocations as affected by oxygen impurities and immobilization of dislocations due to impurity reaction.

  19. Multibody system of the upper limb including a reverse shoulder prosthesis.

    PubMed

    Quental, C; Folgado, J; Ambrósio, J; Monteiro, J

    2013-11-01

    The reverse shoulder replacement, recommended for the treatment of several shoulder pathologies such as cuff tear arthropathy and fractures in elderly people, changes the biomechanics of the shoulder when compared to the normal anatomy. Although several musculoskeletal models of the upper limb have been presented to study the shoulder joint, only a few of them focus on the biomechanics of the reverse shoulder. This work presents a biomechanical model of the upper limb, including a reverse shoulder prosthesis, to evaluate the impact of the variation of the joint geometry and position on the biomechanical function of the shoulder. The biomechanical model of the reverse shoulder is based on a musculoskeletal model of the upper limb, which is modified to account for the properties of the DELTA® reverse prosthesis. Considering two biomechanical models, which simulate the anatomical and reverse shoulder joints, the changes in muscle lengths, muscle moment arms, and muscle and joint reaction forces are evaluated. The muscle force sharing problem is solved for motions of unloaded abduction in the coronal plane and unloaded anterior flexion in the sagittal plane, acquired using video-imaging, through the minimization of an objective function related to muscle metabolic energy consumption. After the replacement of the shoulder joint, significant changes in the length of the pectoralis major, latissimus dorsi, deltoid, teres major, teres minor, coracobrachialis, and biceps brachii muscles are observed for a reference position considered for the upper limb. The shortening of the teres major and teres minor is the most critical since they become unable to produce active force in this position. Substantial changes of muscle moment arms are also observed, which are consistent with the literature. As expected, there is a significant increase of the deltoid moment arms and more fibers are able to elevate the arm. The solutions to the muscle force sharing problem support the

  20. Shoulder Joint For Protective Suit

    NASA Technical Reports Server (NTRS)

    Kosmo, Joseph J.; Smallcombe, Richard D.

    1994-01-01

    Shoulder joint allows full range of natural motion: wearer senses little or no resisting force or torque. Developed for space suit, joint offers advantages in protective garments for underwater work, firefighting, or cleanup of hazardous materials.

  1. Posterior dislocation of the sternoclavicular joint leading to mediastinal compression.

    PubMed

    Jougon, J B; Lepront, D J; Dromer, C E

    1996-02-01

    Dislocations of the sternoclavicular joint are uncommon, and the posterior variety have a potential for considerable morbidity. We report a case with compression of the vital structures within the superior mediastinum. It was a rugby player getting run over by the scrum. The mechanism was an indirect force exerted forward and laterally against the shoulder. The patient complained of pain and dysphagia. A systolic right cervical murmur was heard. Angiography was normal and esophagography showed extrinsic esophageal compression. Surgical reduction was performed because there was a slight pneumomediastinum on the computed tomography. This case report demonstrates the mechanism, complications, and treatment of such a lesion. PMID:8572795

  2. Congenital hip dislocation (image)

    MedlinePlus

    ... by a blow, fall, or other trauma, a dislocation can also occur from birth. The cause is unknown but genetic factors may play a role. Problems resulting from very mild developmental dysplasia of the hip may not become apparent until the person is ...

  3. Dislocated Worker Project.

    ERIC Educational Resources Information Center

    1988

    Due to the severe economic decline in the automobile manufacturing industry in southeastern Michigan, a Dislocated Workers Program has been developed through the partnership of the Flint Area Chamber of Commerce, three community colleges, the National Center for Research in Vocational Education, the Michigan State Department of Education, the…

  4. The overlooked side of convulsion: bilateral posterior fracture and dislocation of proximal humerus.

    PubMed

    Yigit, Mehmet; Yaman, Asli; Yigit, Eda; Turkdogan, Kenan Ahmet

    2016-05-01

    Injuries after an epileptic convulsion have been seen commonly such as burns, head injury and dislocation of the extremities. But fractures of the extremities due to convulsion are rare. External trauma mechanism is not necessary for extremity fractures. Muscle contractions can cause increased load on the skeleton and it can be complicated by dislocation andor fracture of extremities. Almost 1-4% of all the shoulder dislocations are posterior. In this case report we present a 32 year old male patient who had bilateral posterior fracture and dislocation of proximal humerus after convulsion. We would like to emphasize that it is so important to make systemic examination and evaluation of the patients who were admitted to emergency department after epileptic convulsion. PMID:27183951

  5. Submicron Plasticity: Yield Stress, Dislocation Avalanches, and Velocity Distribution

    NASA Astrophysics Data System (ADS)

    Ispánovity, Péter Dusán; Groma, István; Györgyi, Géza; Csikor, Ferenc F.; Weygand, Daniel

    2010-08-01

    The existence of a well-defined yield stress, where a macroscopic crystal begins to plastically flow, has been a basic observation in materials science. In contrast with macroscopic samples, in microcrystals the strain accumulates in random bursts, which makes controlled plastic formation difficult. Here we study by 2D and 3D simulations the plastic deformation of submicron objects under increasing stress. We show that, while the stress-strain relation of individual samples exhibits jumps, its average and mean deviation still specify a well-defined critical stress. The statistical background of this phenomenon is analyzed through the velocity distribution of dislocations, revealing a universal cubic decay and the appearance of a shoulder due to dislocation avalanches.

  6. Frozen shoulder: a sympathetic dystrophy?

    PubMed

    Müller, L P; Müller, L A; Happ, J; Kerschbaumer, F

    2000-01-01

    Diagnostic and clinical features of the frozen shoulder syndrome and the Sudeck syndrome are similar in many aspects. Radioisotope bone scan shows an increased uptake in affected areas in both diseases, while native radiographs show a progressive demineralisation. Measurement of bone mineral density (BMD) by quantitative digital radiography objectified these local decalcification processes in an early stage of the frozen shoulder syndrome; 10 of 12 patients with primary frozen shoulder had BMD decreases greater 21% in the humeral head of the affected shoulder compared to the non-affected side. In the immobilised control group with degenerative changes of the rotator cuff, calcifying tendinitis and shoulder instability (n = 12) and in the group of healthy probands (n = 20), the difference between the affected and non-affected side (left and right humerus of the healthy probands) was only more than 21% in one case each. There are several references in the literature that assume frozen shoulder to be an algoneurodystrophic process; our observations support this hypothesis, possibly leading to earlier diagnoses and extended therapeutic management. PMID:10653111

  7. Arthroscopic Shoulder Surgery in Female Professional Tennis Players

    PubMed Central

    Young, Simon W.; Safran, Marc R.; Dakic, Jodie; Nguyen, Michael L.; Stroia, Kathleen

    2013-01-01

    Objectives: Recent publications have highlighted the relatively poor outcome of other overhead athletes, particularly baseball players, with regard to return to sports at the same or higher level after shoulder surgery. However, true assessment of their ability when returning to sport is not as clear. Further, ability to return to other overhead sports has not been reported. Our objective was to assess outcome and time to return to previous level of function following shoulder surgery in professional tennis players. Methods: The records of all female tennis players on the Women’s Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Details of the surgery including date, procedures performed, and complications were recorded. The primary outcomes were ability and time to return to professional play, and if they were able to return to their previous level of function, as determined by singles ranking. Pre and post-operative singles rankings were used to determine rate and completeness of return to preoperative function. Their highest ranking pre-injury, post operatively, and the time to return to pre-injury ranking were evaluated. Results: During the study period eight professional women tennis players from the WTA underwent shoulder surgery on their dominant arm. All surgery was performed arthroscopically, 7 out of 8 players had more than one procedure performed during the surgery. In total, 3 players underwent debridement of a partial rotator cuff tear and 2 players underwent repair of a complete supraspinatus tear. Three players had an anterior labral repair or reconstruction for anterior instability, and one player underwent repair of a SLAP lesion. Two players underwent neurolysis of a suprascapular nerve, and three players in total underwent a subacromial decompression. All players (100%) returned to professional play. The mean

  8. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation

    PubMed Central

    Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  9. Coracoid Process Avulsion Fracture at the Coracoclavicular Ligament Attachment Site in an Osteoporotic Patient with Acromioclavicular Joint Dislocation.

    PubMed

    Onada, Yoshihiro; Umemoto, Takahisa; Fukuda, Kimitaka; Kajino, Tomomichi

    2016-01-01

    Coracoid fractures are uncommon, mostly occur at the base or neck of the coracoid process (CP), and typically present with ipsilateral acromioclavicular joint (ACJ) dislocation. However, CP avulsion fractures at the coracoclavicular ligament (CCL) attachment with ACJ dislocation have not been previously reported. A 59-year-old woman receiving glucocorticoid treatment fell from bed and complained of pain in her shoulder. Radiographs revealed an ACJ dislocation with a distal clavicle fracture. Three-dimensional computed tomography (3D-CT) reconstruction showed a small bone fragment at the medial apex of the CP. She was treated conservatively and achieved a satisfactory outcome. CP avulsion fractures at the CCL attachment can occur in osteoporotic patients with ACJ dislocations. Three-dimensional computed tomography is useful for identifying this fracture type. CP avulsion fractures should be suspected in patients with ACJ dislocations and risk factors for osteoporosis or osteopenia. PMID:27493819

  10. [Impingement syndrome following direct injuries of the shoulder joint].

    PubMed

    Volpin, G; Stahl, S; Stein, H

    1996-02-15

    Impingement is the most common cause of pain and limitation of movement in the shoulder, with painful arc syndrome its major clinical sign. It usually becomes manifest at between 70 degrees-120 degrees of abduction, but in severe cases, this may be reduced to only 50 degrees-70 degrees. We studied 22 patients who had developed shoulder impingement following direct injuries and who had been treated by anterior acromioplasty and decompression, with an average follow-up of 32 months. 5 had sustained fractures of the greater tuberosity of the humerus at the time of injury, 14 had tears of the rotator cuff of various sizes (1 in both shoulders) and 3 had developed fibrotic scars of the subacromial bursa. Excellent or good results were achieved in 86.6%. Healing time was shorter, and there was return of full range of shoulder movement in those with subacromial scars, undisplaced fractures of the greater tuberosity, or those with a small tear of the rotator cuff. Recovery took longer in those with larger tears of the rotator cuff and in those with displaced fractures of the greater tuberosity. Recovery time was proportional to the size of the rotator cuff tear. It is concluded that direct trauma to the shoulder bears a direct relationship to the development of impingement syndrome, and that at surgery a concomitant tear in the rotator cuff is seen more than 2/3. Because of the high rate of success in surgical treatment of this syndrome, operation is indicated when a few months of physical therapy and analgesics fail to provide relief. In the presence of fractures, decompression surgery should be postponed until the fracture has united. PMID:8675117

  11. Neglected dislocation in sub-axial cervical spine: Case series and a suggested treatment protocol

    PubMed Central

    Srivastava, Sudhir Kumar; Aggarwal, Rishi Anil; Bhosale, Sunil Krishna; Nemade, Pradip Sharad

    2016-01-01

    Context: Approaches suggested for treatment of neglected dislocations in the subaxial cervical spine (SACS) include only anterior approach (a), only posterior approach (b), posterior-anterior approach, posterior-anterior-posterior approach, and anterior-posterior-anterior-posterior approach. No protocol is suggested in literature to guide surgeons treating neglected dislocations. Aim: To describe a protocol for the treatment of neglected dislocation in the SACS. Settings and Designs: Retrospective case series and review of literature. Materials and Methods: Six consecutive patients of neglected dislocation (presenting to us more than 3 weeks following trauma) of the SACS were operated as per the protocol suggested in this paper. A retrospective review of the occupational therapy reports, patient records, and radiographs was performed. Only cases with time lapse of more than 3 weeks between the time of injury and initial management have been included in the review. Results: Closed reduction (CR) was achieved in three patients following cervical traction and these were managed by anterior cervical discectomy and fusion (ACDF). Open reduction via posterior approach and soft tissue release was required to achieve reduction in two patients. Following reduction posterior instrumented fusion was done in them. One patient with preoperative neurological deficit needed a facetectomy to achieve reduction. Following short-segment fixation, ACDF was also performed in this patient. None of the patients deteriorated neurologically following surgery. Fusion was achieved in all patients. Conclusions: Preoperative and intraoperative traction have a role in the management of neglected dislocations in the cervical spine. If CR is achieved the patient may be managed by ACDF. If CR is not achieved, posterior soft tissue release may be done to achieve reduction and partial facetectomy must be reserved for cases in which reduction is not achieved after soft tissue release. A treatment

  12. Ankle dislocation without accompanying malleolar fracture. A case report.

    PubMed

    Hatori, Masahito; Kotajima, Satoshi; Smith, Richard A; Kokubun, Shoichi

    2006-01-01

    Dislocation of the tibiotalar joint without associated fracture is rare. We present here a 21-year-old man who sustained open posteromedial dislocation of the left ankle without malleolar facture when he jumped and sprained his right ankle while playing basketball. The most likely mechanism is forced flexion applied to the ankle joint leading to a rupture of the anterior capsule and lateral structures of the ankle followed by an accelerating inversion stress leading to a posteromedial dislocation of the talus from the tibial condyle. Transient paresthesia was noted in the area of the superficial peroneal nerve. At surgery, the anterior part of the tibiotalar joint capsule and anterior talofibular ligament were detached from their original sites. The calcaneofibular ligament was also detached with its associated periosteum and a tiny avulsed bony fragment. The articular facets of the tibia and talus were intact. The treatment consisted of wound irrigation, debridement, reduction and capsular suture followed by immobilization with a short leg cast. About 10 degrees of loss in the range of dorsiflexion was observed. The patient achieved good long-term functional results. PMID:16961183

  13. The Effects of Vibration Stimuli Applied to the Shoulder Joint on the Activity of the Muscles Around the Shoulder Joint

    PubMed Central

    Lee, Su-kyoung

    2013-01-01

    [Purpose] The present study compared the muscle activity of the upper trapezius with those of the serratus anterior and the lower trapezius when slings, unstable surfaces, were laterally vibrated, to examine the effects of vibration during sling exercises on shoulder stabilization muscles. [Methods] The subjects performed push-up exercises on a sling and maintained isometric contraction in the final stage, while vibration was manually administered to the rope of the sling during the isometric-contraction stage. Vibration within a range of 10 cm was delivered for five seconds at a frequency of 1 Hz in time with a metronome. Vibrations were applied for five seconds at 3 Hz and 3.5 Hz, respectively. [Results] The serratus anterior showed a significant differences between isometric contraction with vibration of 3 Hz and isometric contraction with vibration of 3.5 Hz. [Conclusion] The upper trapezius and the lower trapezius showed prominent changes in muscle activity at 3.5 Hz, and the serratus anterior showed prominent changes in muscle activity at 3 Hz and 3.5 Hz. Therefore, as vibration frequency increased, making the load-bearing surface more unstable, the recruitment of the upper trapezius, the lower trapezius, and the serratus anterior increased. To perform exercises that selectively strengthen the serratus anterior, the exercises should be performed at a vibration frequency of 3 Hz. PMID:24396199

  14. Shoulder Injuries in US Astronauts Related to EVA Suit Design

    NASA Technical Reports Server (NTRS)

    Scheuring, Rick; McCulloch, Pat; Van Baalen, Mary; Watson, Richard; Bowen, Steve; Blatt, Terri

    2012-01-01

    There are multiple factors associated with the mechanism of injury that leads to shoulder injury requiring surgical repair. Despite the injury prevention measures taken from the 2003 Shoulder Tiger Team recommendations, shoulder injuries and subsequent shoulder surgeries remain relatively unchanged.

  15. Elastodynamic image forces on dislocations

    PubMed Central

    Gurrutxaga-Lerma, Beñat; Balint, Daniel S.; Dini, Daniele; Sutton, Adrian P.

    2015-01-01

    The elastodynamic image forces on edge and screw dislocations in the presence of a planar-free surface are derived. The explicit form of the elastodynamic fields of an injected, quiescent screw dislocation are also derived. The resulting image forces are affected by retardation effects: the dislocations experience no image force for a period of time defined by the arrival and reflection at the free surface of the dislocation fields. For the case of injected, stationary dislocations, it is shown that the elastodynamic image force tends asymptotically to the elastotatic prediction. For the case of injected, moving dislocations, it is shown that the elastodynamic image force on both the edge and the screw dislocations is magnified by inertial effects, and becomes increasingly divergent with time; this additional effect, missing in the elastostatic description, is shown to be substantial even for slow moving dislocations. Finally, it is shown that the elastodynamic image force of an edge dislocation moving towards the surface at the Rayleigh wave speed becomes repulsive, rather than attractive; this is suggestive of instabilities at the core of the dislocation, and likely resonances with the free surface. PMID:26528080

  16. Phacoemulsification in anterior megalophthalmos.

    PubMed

    Lee, Graham A; Hann, Joshua V; Braga-Mele, Rosa

    2006-07-01

    This case outlines the phacoemulsification technique used to overcome the challenge of the hyperdeep anterior chamber, weak zonules, abnormal anterior capsule, and large capsular bag. Key steps included trypan blue staining of the anterior capsule, a large capsulorhexis, prolapse of the nucleus into the anterior chamber with phacoemulsification anterior to the capsulorhexis, and a posterior chamber-placed iris-clip intraocular lens. Successful visual rehabilitation is achievable in these anatomically challenging eyes. PMID:16857490

  17. Thermodynamically consistent continuum dislocation dynamics

    NASA Astrophysics Data System (ADS)

    Hochrainer, Thomas

    2016-03-01

    Dislocation based modeling of plasticity is one of the central challenges at the crossover of materials science and continuum mechanics. Developing a continuum theory of dislocations requires the solution of two long standing problems: (i) to represent dislocation kinematics in terms of a reasonable number of variables and (ii) to derive averaged descriptions of the dislocation dynamics (i.e. material laws) in terms of these variables. The kinematic problem (i) was recently solved through the introduction of continuum dislocation dynamics (CDD), which provides kinematically consistent evolution equations of dislocation alignment tensors, presuming a given average dislocation velocity (Hochrainer, T., 2015, Multipole expansion of continuum dislocations dynamics in terms of alignment tensors. Philos. Mag. 95 (12), 1321-1367). In the current paper we demonstrate how a free energy formulation may be used to solve the dynamic closure problem (ii) in CDD. We do so exemplarily for the lowest order CDD variant for curved dislocations in a single slip situation. In this case, a thermodynamically consistent average dislocation velocity is found to comprise five mesoscopic shear stress contributions. For a postulated free energy expression we identify among these stress contributions a back-stress term and a line-tension term, both of which have already been postulated for CDD. A new stress contribution occurs which is missing in earlier CDD models including the statistical continuum theory of straight parallel edge dislocations (Groma, I., Csikor, F.F., Zaiser, M., 2003. Spatial correlations and higher-order gradient terms in a continuum description of dislocation dynamics. Acta Mater. 51, 1271-1281). Furthermore, two entirely new stress contributions arise from the curvature of dislocations.

  18. Dynamic Three-Dimensional Shoulder Mri during Active Motion for Investigation of Rotator Cuff Diseases

    PubMed Central

    Tempelaere, Christine; Pierrart, Jérome; Lefèvre-Colau, Marie-Martine; Vuillemin, Valérie; Cuénod, Charles-André; Hansen, Ulrich; Mir, Olivier; Skalli, Wafa; Gregory, Thomas

    2016-01-01

    Background MRI is the standard methodology in diagnosis of rotator cuff diseases. However, many patients continue to have pain despite treatment, and MRI of a static unloaded shoulder seems insufficient for best diagnosis and treatment. This study evaluated if Dynamic MRI provides novel kinematic data that can be used to improve the understanding, diagnosis and best treatment of rotator cuff diseases. Methods Dynamic MRI provided real-time 3D image series and was used to measure changes in the width of subacromial space, superior-inferior translation and anterior-posterior translation of the humeral head relative to the glenoid during active abduction. These measures were investigated for consistency with the rotator cuff diseases classifications from standard MRI. Results The study included: 4 shoulders with massive rotator cuff tears, 5 shoulders with an isolated full-thickness supraspinatus tear, 5 shoulders with tendinopathy and 6 normal shoulders. A change in the width of subacromial space greater than 4mm differentiated between rotator cuff diseases with tendon tears (massive cuff tears and supraspinatus tear) and without tears (tendinopathy) (p = 0.012). The range of the superior-inferior translation was higher in the massive cuff tears group (6.4mm) than in normals (3.4mm) (p = 0.02). The range of the anterior-posterior translation was higher in the massive cuff tears (9.2 mm) and supraspinatus tear (9.3 mm) shoulders compared to normals (3.5mm) and tendinopathy (4.8mm) shoulders (p = 0.05). Conclusion The Dynamic MRI enabled a novel measure; ‘Looseness’, i.e. the translation of the humeral head on the glenoid during an abduction cycle. Looseness was better able at differentiating different forms of rotator cuff disease than a simple static measure of relative glenohumeral position. PMID:27434235

  19. Dislocation lines in indium-doped GaAs crystals observed by infrared light scattering tomography of about 1 μm wavelength radiation

    NASA Astrophysics Data System (ADS)

    Ogawa, Tomoya

    1988-05-01

    Decorated dislocation lines in GaAs crystals are remarkably well observed by scattering of an infrared laser beam in the 1 μm wavelength range. Some of these dislocation lines are also observed by absorption imaging in the same wavelength region but others are only detected by light scattering. Furthermore, the former lines correspond to the pits etched by molten KOH. Dislocation lines in In-doped GaAs crystals grown by the LEC method from nearly stoichiometric melts are studied in connection with their growth history, where grown-in dislocation lines are bent at growth interfaces to react with each other and then their density is decreased. At the shoulder part of the ingots, many slip dislocations are found, where most dislocation lines are so isolated that they are clearly and individually observed by light scattering tomography without etching.

  20. Arthritis at the shoulder joint.

    PubMed

    Sankaye, Prashant; Ostlere, Simon

    2015-07-01

    The shoulder is a complex joint with numerous structures contributing to mobility and stability. Shoulder pain is a common clinical complaint that may be due to a wide spectrum of disorders including rotator cuff disease, instability, and arthropathy. Primary osteoarthritis of the shoulder joint is uncommon because it is a non-weight-bearing joint. Significant osteoarthritis of the glenohumeral joint is unusual in the absence of trauma, and the detection of advanced degenerative changes in patients without a known history of trauma should alert the clinician to search for other disorders. This article reviews the pathogenesis, clinical manifestations, and key imaging findings of the common categories of the arthritis affecting the glenohumeral joint. PMID:26021591

  1. Painful Shoulder in Swimmers: A Diagnostic Challenge.

    ERIC Educational Resources Information Center

    McMaster, William C.

    1986-01-01

    This article discusses the incidence, diagnosis, and treatment of painful shoulder in swimmers, including: regional problems that can cause shoulder pain; physical, clinical, and laboratory tests for diagnostic use; and approaches to management of the problem. (Author/CB)

  2. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... cemented prosthesis. 888.3680 Section 888.3680 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket)...

  3. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... uncemented prosthesis. 888.3690 Section 888.3690 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as...

  4. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... uncemented prosthesis. 888.3690 Section 888.3690 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as...

  5. Strength Training and Shoulder Proprioception

    PubMed Central

    Salles, José Inácio; Velasques, Bruna; Cossich, Victor; Nicoliche, Eduardo; Ribeiro, Pedro; Amaral, Marcus Vinicius; Motta, Geraldo

    2015-01-01

    Context: Proprioception is essential to motor control and joint stability during daily and sport activities. Recent studies demonstrated that athletes have better joint position sense (JPS) when compared with controls matched for age, suggesting that physical training could have an effect on proprioception. Objective: To evaluate the result of an 8-week strength-training program on shoulder JPS and to verify whether using training intensities that are the same or divergent for the shoulder's dynamic-stabilizer muscles promote different effects on JPS. Design: Randomized controlled clinical trial. Setting: We evaluated JPS in a research laboratory and conducted training in a gymnasium. Patients or Other Participants: A total of 90 men, right handed and asymptomatic, with no history of any type of injury or shoulder instability. Intervention(s): For 8 weeks, the participants performed the strength-training program 3 sessions per week. We used 4 exercises (bench press, lat pull down, shoulder press, and seated row), with 2 sets each. Main Outcome Measure(s): We measured shoulder JPS acuity by calculating the absolute error. Results: We found an interaction between group and time. To examine the interaction, we conducted two 1-way analyses of variance comparing groups at each time. The groups did not differ at pretraining; however, a difference among groups was noted posttraining. Conclusions: Strength training using exercises at the same intensity produced an improvement in JPS compared with exercises of varying intensity, suggesting that the former resulted in improvements in the sensitivity of muscle spindles and, hence, better neuromuscular control in the shoulder. PMID:25594912

  6. Design rules for dislocation filters

    SciTech Connect

    Ward, T.; Sánchez, A. M.; Beanland, R.; Tang, M.; Wu, J.; Liu, H.; Dunstan, D. J.

    2014-08-14

    The efficacy of strained layer threading dislocation filter structures in single crystal epitaxial layers is evaluated using numerical modeling for (001) face-centred cubic materials, such as GaAs or Si{sub 1−x}Ge{sub x}, and (0001) hexagonal materials such as GaN. We find that threading dislocation densities decay exponentially as a function of the strain relieved, irrespective of the fraction of threading dislocations that are mobile. Reactions between threading dislocations tend to produce a population that is a balanced mixture of mobile and sessile in (001) cubic materials. In contrast, mobile threading dislocations tend to be lost very rapidly in (0001) GaN, often with little or no reduction in the immobile dislocation density. The capture radius for threading dislocation interactions is estimated to be approximately 40 nm using cross section transmission electron microscopy of dislocation filtering structures in GaAs monolithically grown on Si. We find that the minimum threading dislocation density that can be obtained in any given structure is likely to be limited by kinetic effects to approximately 10{sup 4}–10{sup 5 }cm{sup −2}.

  7. Dislocation dynamics in nanocrystalline nickel.

    PubMed

    Shan, Z W; Wiezorek, J M K; Stach, E A; Follstaedt, D M; Knapp, J A; Mao, S X

    2007-03-01

    It is believed that the dynamics of dislocation processes during the deformation of nanocrystalline materials can only be visualized by computational simulations. Here we demonstrate that observations of dislocation processes during the deformation of nanocrystalline Ni with grain sizes as small as 10 nm can be achieved by using a combination of in situ tensile straining and high-resolution transmission electron microscopy. Trapped unit lattice dislocations are observed in strained grains as small as 5 nm, but subsequent relaxation leads to dislocation recombination. PMID:17359167

  8. Dynamic transitions in dislocation motion

    NASA Astrophysics Data System (ADS)

    Bulatov, Vasily; Cai, Wei; Marian, Jaime

    2003-03-01

    In a series of Molecular Dynamics simulations, we observe that, depending on stress, temperature and line length, screw dislocations in BCC iron move in three strikingly different regimes. Under low stress, the dislocations move smoothly via formation and migration of atomic-sized kinks; although widely believed, such motion mechanism has never been directly observed in full dynamic detail. Then, at a higher stress, dislocation motion suddenly becomes rough: the line becomes rugged and its motion becomes jerky producing in its wake a large amount of debris in the form of lattice vacancies and interstitial clusters. Remarkably, this bizarre behavior is not caused by any external factors, such as dislocation interaction with other crystal defects: the roughening transition is intrinsic to the dislocation itself. Under increasing stress the line raggedness and the amount of debris its motion produces continue to increase until, at some point, another dynamic transition takes place. The dislocation is now seen to cease at once its turbulent motion through the lattice and to initiate a thin plate of sheared crystal, a twin. The twin plate picks up where the dislocation just left off - it extends very fast in the same direction as dislocation motion and increases, gradually, in thickness. Notably, no more debris is produced during the twinning motion. The origin of these dynamic transitions, the underlying atomistic mechanisms of dislocation motion in all three regimes and their implication for strength of shocked materials are discussed.

  9. Smectic Edge Dislocations under Shear

    NASA Astrophysics Data System (ADS)

    Chen, Peilong; Lu, Chun-Yi David

    2011-09-01

    Layer structures around an edge dislocation in a smectic phase under shear are studied with both phase field and order parameter models. It is shown that, contrast to a crystal solid, the conventional picture of the Peach--Koehler force experienced by dislocations when the sample is under a shear stress cannot be readily applied to the smectic phases. Under a uniform shear flow, we obtain the phase field and order parameter solutions around an edge dislocation. The solutions elucidate properties such as the layer distortion range around the dislocation and scaling of inter-dislocation interaction on dislocation separation. Calculations on energy dissipation indicate the extreme shear-thinning behavior that an edge dislocation induces a shear stress independent of the shear rate. Finally in a bulk sample with dislocation forming loops and networks, we argue that the uniform flow component around the dislocation is important to the energy dissipation and we show that its scaling exponent with the shear rate is very close to results from many previous rheology measurements.

  10. Gimbaled-shoulder friction stir welding tool

    NASA Technical Reports Server (NTRS)

    Carter, Robert W. (Inventor); Lawless, Kirby G. (Inventor)

    2010-01-01

    A gimbaled-shoulder friction stir welding tool includes a pin and first and second annular shoulders coupled to the pin. At least one of the annular shoulders is coupled to the pin for gimbaled motion with respect thereto as the tool is rotated by a friction stir welding apparatus.

  11. Shoulder Impingement/Rotator Cuff Tendinitis

    MedlinePlus

    .org Shoulder Impingement/Rotator Cuff Tendinitis Page ( 1 ) One of the most common physical complaints is shoulder pain. Your shoulder is made up of several ... is vulnerable to many different problems. The rotator cuff is a frequent source of pain in the ...

  12. Homo floresiensis and the evolution of the hominin shoulder.

    PubMed

    Larson, Susan G; Jungers, William L; Morwood, Michael J; Sutikna, Thomas; Jatmiko; Saptomo, E Wahyu; Due, Rokus Awe; Djubiantono, Tony

    2007-12-01

    The holotype of Homo floresiensis, diminutive hominins with tiny brains living until 12,000 years ago on the island of Flores, is a partial skeleton (LB1) that includes a partial clavicle (LB1/5) and a nearly complete right humerus (LB1/50). Although the humerus appears fairly modern in most regards, it is remarkable in displaying only 110 degrees of humeral torsion, well below modern human average values. Assuming a modern human shoulder configuration, such a low degree of humeral torsion would result in a lateral set to the elbow. Such an elbow joint would function more nearly in a frontal than in a sagittal plane, and this is certainly not what anyone would have predicted for a tool-making Pleistocene hominin. We argue that Homo floresiensis probably did not have a modern human shoulder configuration: the clavicle was relatively short, and we suggest that the scapula was more protracted, resulting in a glenoid fossa that faced anteriorly rather than laterally. A posteriorly directed humeral head was therefore appropriate for maintaining a normally functioning elbow joint. Similar morphology in the Homo erectus Nariokotome boy (KNM-WT 15000) suggests that this shoulder configuration may represent a transitional stage in pectoral girdle evolution in the human lineage. PMID:17692894

  13. Atlanto-occipital dislocation

    PubMed Central

    Hall, Graham C; Kinsman, Michael J; Nazar, Ryan G; Hruska, Rob T; Mansfield, Kevin J; Boakye, Maxwell; Rahme, Ralph

    2015-01-01

    Atlanto-occipital dislocation (AOD) is being increasingly recognized as a potentially survivable injury as a result of improved prehospital management of polytrauma patients and increased awareness of this entity, leading to earlier diagnosis and more aggressive treatment. However, despite overall improved outcomes, AOD is still associated with significant morbidity and mortality. The purpose of this paper is to review the biomechanical aspects, clinical features, radiologic criteria, and treatment strategies of AOD. Given that the diagnosis of AOD can be very challenging, a high degree of clinical suspicion is essential to ensure timely recognition and treatment, thus preventing neurological decline or death. PMID:25793163

  14. A Rare Unusual Case Presentation of the Tuberculosis of the Shoulder Joint

    PubMed Central

    Deshmukh, Ashwin; Deo, Sanjay; Salgia, Anil Kumar; Agarwal, Tushar

    2013-01-01

    Introduction: Afflictions of shoulder by tuberculosis is rare and when it occurs its more commonly a dry lesion (caries sicca). Wet lesions in shoulder are rare and we report this case for the rarity of its occurrence. Case Report: A 55yrs old female patient presented with a painful swelling with restriction of movements of the right shoulder since six months. Patient had taken various treatments without any relief; there was no history of trauma, weight loss, recent infection in the past or any history of tuberculosis in family or contact with tubercular patient. Right shoulder revealed restricted movements with no local rise in temperature. Tenderness was present over anterior and posterior aspect of the right shoulder diffusely. External rotation and abduction movements were restricted while adduction and flexion were not restricted. Power of the muscles was unaffected with no neurological deficit. Antero-posterior and axial X-rays of the right shoulder showed no bony involvement however, ultrasonography showed lipoma. Serological investigations showed a markedly raised erythrocyte sedimentation rate (73mm / hr) and a positive C-reactive protein. Surgical excision of the mass revealed rice bodies. DNA PCR was positive for tuberculosis and patient was started on anti-tubercular treatment(Category I) for six months. Conclusion: Any patient coming with the complaints of long standing painful restriction of the movements of the shoulder associated with or without complaints swelling, shall be evaluated to rule out skeletal tuberculosis along with other differential diagnosis of periarthritis of shoulder and adhesive capsulitis. Most of the patients with skeletal tuberculosis may not necessarily present with the constitutional symptoms of fever, weight loss, etc and also because of the widespread prevalence of the organism in India. PMID:27298926

  15. Throwing Injuries of the Shoulder.

    ERIC Educational Resources Information Center

    McCue, Frank C., III; and Others

    The majority of shoulder injuries occurring in throwing sports involve the soft tissue structures. Injuries often occur when the unit is overstretched to a point near its greatest length, involving the elastic tissues. The other injury mechanism involves the contractural unit of the muscle, which occurs near the midpoint of contractions, involving…

  16. [Shoulder dystocia: an obstetrical emergency].

    PubMed

    Marques, Joana Borges; Reynolds, Ana

    2011-01-01

    Shoulder dystocia is one of the most feared obstetric emergencies due to related maternal and neonatal complications and therefore, the growing of medico-legal litigation that it entails. Although associated with risk factors such as fetal macrossomia, gestacional diabetes and instrumented delivery, the majority of cases are unpredictable. The lack of a consensus on shoulder dystocia diagnosis causes variations on its incidence and hampers a more comprehensive analysis. Management guidelines described for its resolution include several manoeuvres but the ideal sequence of procedures is not clearly defined in more severe cases. Hands-on and team training, through simulation-based techniques applied to medicine, seems to be a promising method to learn how to deal with shoulder dystocia having in mind a reduction in related maternal or neonatal morbidity and mortality. The main goal of this paper is to provide a comprehensive revision of shoulder dystocia highlighting its relevance as an obstetric emergency. A reflection on the management is presented emphasising the importance of simulation-based training. PMID:22521019

  17. Shoulder muscle firing patterns during the windmill softball pitch.

    PubMed

    Maffet, M W; Jobe, F W; Pink, M M; Brault, J; Mathiyakom, W

    1997-01-01

    The purpose of this study was to describe the activity of eight shoulder muscles during the windmill fast-pitch softball throw. Ten collegiate female pitchers were analyzed with intramuscular electromyography, high-speed cinematography, and motion analysis. The supraspinatus muscle fired maximally during arm elevation from the 6 to 3 o'clock position phase, centralizing the humeral head within the glenoid. The posterior deltoid and teres minor muscles acted maximally from the 3 to 12 o'clock position phase to continue arm elevation and externally rotate the humerus. The pectoralis major muscle accelerated the arm from the 12 o'clock position to ball release phase. The serratus anterior muscle characteristically acted to position the scapula for optimal glenohumeral congruency, and the subscapularis muscle functioned as an internal rotator and to protect the anterior capsule. Although the windmill softball pitch is overtly different from the baseball pitch, several surprising similarities were revealed. The serratus anterior and pectoralis major muscles work in synchrony and seem to have similar functions in both pitches. Although the infraspinatus and teres minor muscles are both posterior cuff muscles, they are characteristically uncoupled during the 6 to 3 o'clock position phase, with the infraspinatus muscle acting more independently below 90 degrees. Subscapularis muscle activity seems important in dynamic anterior glenohumeral stabilization and as an internal rotator in both the baseball and softball throws. PMID:9167819

  18. Anterior muscle sparing approach for total hip arthroplasty

    PubMed Central

    Moskal, Joseph T; Capps, Susan G; Scanelli, John A

    2013-01-01

    The purpose of this review is to examine the validity of positive claims regarding the direct anterior approach (DAA) with a fracture table for total hip arthroplasty. Recent literature regarding the DAA was searched and specific claims investigated including improved early outcomes, speed of recovery, component placement, dislocation rates, and complication rates. Recent literature is positive regarding the effects of total hip arthroplasty with the anterior approach. While the data is not definitive at present, patients receiving the anterior approach for total hip arthroplasty tend to recover more quickly and have improved early outcomes. Component placement with the anterior approach is more often in the “safe zone” than with other approaches. Dislocation rates tend to be less than 1% with the anterior approach. Complication rates vary widely in the published literature. A possible explanation is that the variance is due to surgeon and institutional experience with the anterior approach procedure. Concerns remain regarding the “learning curve” for both surgeons and institutions. In conclusion, it is not a matter of should this approach be used, but how should it be implemented. PMID:23362470

  19. Anterior vaginal wall repair

    MedlinePlus

    ... Cystocele Anterior vaginal wall repair (surgical treatment of urinary incontinence) - series References Lentz GM. Anatomic defects of the ... 72. Read More Anterior Inflatable artificial sphincter Stress urinary incontinence Urinary catheters Urinary incontinence - injectable implant Urinary incontinence - ...

  20. Functional treatment versus plaster for simple elbow dislocations (FuncSiE): a randomized trial

    PubMed Central

    2010-01-01

    Background Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures. After reduction of a simple dislocation, treatment options include immobilization in a static plaster for different periods of time or so-called functional treatment. Functional treatment is characterized by early active motion within the limits of pain with or without the use of a sling or hinged brace. Theoretically, functional treatment should prevent stiffness without introducing increased joint instability. The primary aim of this randomized controlled trial is to compare early functional treatment versus plaster immobilization following simple dislocations of the elbow. Methods/Design The design of the study will be a multicenter randomized controlled trial of 100 patients who have sustained a simple elbow dislocation. After reduction of the dislocation, patients are randomized between a pressure bandage for 5-7 days and early functional treatment or a plaster in 90 degrees flexion, neutral position for pro-supination for a period of three weeks. In the functional group, treatment is started with early active motion within the limits of pain. Function, pain, and radiographic recovery will be evaluated at regular intervals over the subsequent 12 months. The primary outcome measure is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford elbow score, pain level at both sides, range of motion of the elbow joint at both sides, rate of secondary interventions and complication rates in both groups (secondary dislocation, instability, relaxation), health-related quality of life (Short-Form 36 and EuroQol-5D), radiographic appearance of the elbow joint (degenerative changes and heterotopic ossifications), costs, and cost-effectiveness. Discussion The successful completion of this trial will

  1. [Classification of periprosthetic shoulder fractures].

    PubMed

    Kirchhoff, C; Kirchhoff, S; Biberthaler, P

    2016-04-01

    The key targets in the treatment of periprosthetic humeral fractures (PHF) are the preservation of bone, successful bony consolidation and provision of a stable anchoring of the prosthesis with the major goal of restoring the shoulder-arm function. A substantial problem of periprosthetic shoulder fractures is the fact that treatment is determined not only by the fracture itself but also by the implanted prosthesis and its function. Consequently, the exact preoperative shoulder function and, in the case of an implanted anatomical prosthesis, the status and function of the rotator cuff need to be assessed in order to clarify the possibility of a secondarily occurring malfunction. Of equal importance in this context is the type of implanted prosthesis. The existing classification systems of Wright and Cofield, Campbell et al., Groh et al. and Worland et al. have several drawbacks from a shoulder surgeon's point of view, such as a missing reference to the great variability of the available prostheses and the lack of an evaluation of rotator cuff function. The presented 6‑stage classification for the evaluation of periprosthetic fractures of the shoulder can be considered just as simple or complex to understand as the classification of the working group for osteosynthesis problems (AO, Arbeitsgemeinschaft für Osteosynthesefragen), depending on the viewpoint. From our point of view the classification presented here encompasses the essential points of the existing classification systems and also covers the otherwise missing points, which should be considered in the assessment of such periprosthetic fractures. The classification presented here should provide helpful assistance in the daily routine to find the most convenient form of therapy. PMID:26992712

  2. Asymmetric Bilateral Hip Dislocations: A Case Report and Historical Review of the Literature

    PubMed Central

    Buckwalter, Joseph; Westerlind, Brian; Karam, Matthew

    2015-01-01

    Background Asymmetric bilateral hip dislocations are a rare injury pattern in which one hip dislocates posteriorly, and the contralateral hip dislocates anteriorly. We report a case of bilateral asymmetric hip dislocations and provide a comprehensive review of all available reports, identifying 104 total cases, which is 70 more than previously reported. Purpose To review and evaluate the total body of literature regarding bilateral asymmetric hip dislocations. Methods Comprehensive literature review and analysis of all reports of bilateral asymmetric hip dislocations with concurrent case report. Results and Conclusions Bilateral, asymmetric represent approximately 0.01%–0.02% of all joint dislocations. There has been a substantial increase in the number of case reports in the literature in the last 10 years. Males are more likely than females to incur this injury pattern and the most common mode of injury is motor vehicle accident Urgent closed reduction should be attempted in an efficient and safe manner to avoid potential complications, and open reduction should be considered in irreducible dislocations. Post reduction management should include stability assessment and CT to assess for associated injuries and intraarticular fragments; although no clear guidelines for post-reduction treatment emerged. Common complications include: nerve palsies, AVN and heterotopic ossification. PMID:26361448

  3. Current Concepts for Patellar Dislocation

    PubMed Central

    Petri, Maximilian; Ettinger, Max; Stuebig, Timo; Brand, Stephan; Krettek, Christian; Jagodzinski, Michael; Omar, Mohamed

    2015-01-01

    Context: Patellar dislocation usually occurs to the lateral side, leading to ruptures of the Medial Patellofemoral Ligament (MPFL) in about 90% of the cases. Even though several prognostic factors are identified for patellofemoral instability after patellar dislocation so far, the appropriate therapy remains a controversial issue. Evidence Acquisition: Authors searched the Medline library for studies on both surgical and conservative treatment for patellar dislocation and patellofemoral instability. Additionally, the reference list of each article was searched for additional studies. Results: A thorough analysis of the anatomical risk factors with a particular focus on patella alta, increased Tibial Tuberosity-Trochlear Groove (TT-TG) distance, trochlear dysplasia as well as torsional abnormalities should be performed early after the first dislocation to allow adequate patient counseling. Summarizing the results of all published randomized clinical trials and comparing surgical and conservative treatment after the first-time patellar dislocation until today indicated no significant evident difference for children, adolescents, and adults. Therefore, nonoperative treatment was indicated after a first-time patellar dislocation in the vast majority of patients. Conclusions: Surgical treatment for patellar dislocation is indicated primarily in case of relevant concomitant injuries such as osteochondral fractures, and secondarily for recurrent dislocations. PMID:26566512

  4. Stemless shoulder arthroplasty: a literature review

    PubMed Central

    PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

    2015-01-01

    The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis of the shoulder and deformities in the metaphyseal region. To avoid stem-related complications while retaining the advantages of the fourth generation of shoulder implants, different stemless implants have been developed. The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. The authors review the indications, surgical technique, clinical and radiological midterm results, and complications of these humeral implants. PMID:26151038

  5. POSTEROSUPERIOR SURGICAL ACCESS ROUTE FOR TREATMENT OF ACROMIOCLAVICULAR DISLOCATIONS: RESULTS FROM 84 SURGICAL CASES

    PubMed Central

    Dal Molin, Danilo Canesin; Ribeiro, Fabiano Rebouças; Filho, Rômulo Brasil; Filardi, Cantídio Salvador; Tenor, Antonio Carlos; Stipp, Willian Nandi; Petros, Rodrigo Souto Borges

    2015-01-01

    Objective: To evaluate the results from surgical treatment of 84 cases of acute acromioclavicular dislocation, using a posterosuperior access route. Methods: Eighty-four cases of acute acromioclavicular dislocation (grade III in the Allman-Tossy classification) operated between November 2002 and May 2010 were evaluated. The patients’ mean age was 34 years. The diagnoses were made using clinical and radiographic evaluations. The patients were operated by the same surgical team, within three weeks of the date of the trauma, using a posterosuperior approach to the shoulder to access the top of the base of the coracoid process for placement of two anchors, which were used in reducing the dislocation. The minimum follow-up was 12 months. The postoperative clinical-radiographic evaluation was done using the modified Karlsson criteria and the University of California at Los Angeles (UCLA) score. Results: 92.8% of the 84 patients treated presented good or excellent results, and 7.2% presented fair or poor results, using the UCLA assessment score. According to the modified Karlsson criteria, 76.2% were assessed as grade A, 17.9% as grade B and 5.9% as grade C. Conclusion: The posterosuperior access route to the shoulder is a new option for accessing the coracoid process and treating acromioclavicular dislocation, with clinical and radiographic results equivalent to those in the literature. PMID:27047866

  6. Double-button Fixation System for Management of Acute Acromioclavicular Joint Dislocation

    PubMed Central

    Torkaman, Ali; Bagherifard, Abolfazl; Mokhatri, Tahmineh; Haghighi, Mohammad Hossein Shabanpour; Monshizadeh, Siamak; Taraz, Hamid; Hasanvand, Amin

    2016-01-01

    Background: Surgical treatments for acromioclavicular (AC) joint dislocation present with some complications. The present study was designed to evaluate the double-button fixation system in the management of acute acromioclavicular joint dislocation. Methods: This cross sectional study, done between February 2011 to June 2014, consisted of 28 patients who underwent surgical management by the double-button fixation system for acute AC joint dislocation. Age, sex, injury mechanism, dominant hand, side with injury, length of follow up, time before surgery, shoulder and hand (DASH), constant and visual analogue scale (VAS) scores, and all complications of the cases during the follow up were recorded. Results: The mean age of patients was 33.23±6.7 years. Twenty four patients (85.71%) were male and four (14.28%) were female. The significant differences were observed between pre-operation VAS, constant shoulder scores and post-operation measurements. There were not any significant differences between right and left coracoclavicular, but two cases of heterotrophic ossifications were recorded. The mean follow-up time was 16.17±4.38 months. Conclusion: According to the results, the double-button fixation system for management of acute acromioclavicular joint dislocation has suitable results and minimal damage to the soft tissues surrounding the coracoclavicular ligaments. PMID:26894217

  7. Dislocation Mechanics Under Extreme Pressures

    NASA Astrophysics Data System (ADS)

    Armstrong, Ronald; Arnold, Werner; Zerilli, Frank

    2007-06-01

    The shock-induced plasticity of copper, Armco iron, and tantalum materials is attributed to strain rate control by a substantial dislocation density being generated at the shock front. A thermal activation type constitutive equation is employed for the dislocation generation based on achievement of a limiting small activation volume for the process. A linear dependence of the equivalent compressive stress on logarithm of the plastic strain rate is predicted. The prediction compares favorably with Swegle-Grady and Meyers measurements previously fitted to a power law relationship. For Armco iron and tantalum, control is matched with a dislocation description of deformation twinning at the shock front. By comparison, the uniform shock-less loading in an isentropic compression experiment (ICE) provides for plastic strain rate control by the drag-resisted movement of mobile dislocations within the resident dislocation density.

  8. Relationship Between Hand Contact Angle and Shoulder Loading During Manual Wheelchair Propulsion by Individuals with Paraplegia

    PubMed Central

    Mulroy, Sara J.; Ruparel, Puja; Hatchett, Patricia E.; Haubert, Lisa Lighthall; Eberly, Valerie J.; Gronley, JoAnne K.

    2015-01-01

    Background: Shoulder loading during manual wheelchair propulsion (WCP) contributes to the development of shoulder pain in individuals with spinal cord injury (SCI). Objective: To use regression analysis to investigate the relationships between the hand contact angle (location of the hand on the pushrim at initial contact and release during the push phase of the WCP cycle) with propulsion characteristics, pushrim forces, and shoulder kinetics during WCP in individuals with paraplegia. Methods: Biomechanical data were collected from 222 individuals (198 men and 24 women) with paraplegia from SCI during WCP on a stationary ergometer at a self-selected speed. The average age of participants was 34.7 years (±9.3), mean time since SCI was 9.3 years (±6.1), and average body weight was 74.4 kg (±15.9). The majority (n = 127; 56%) of participants had lower level paraplegia (T8 to L5) and 95 (42%) had high paraplegia (T2 to T7). Results: Increased push arc (mean = 75.3°) was associated with greater velocity (R = 0.384, P < .001) and cycle distance (R = 0.658, P < .001) and reduced cadence (R = -0.419, P < .001). Initial contact angle and hand release angles were equally associated with cycle distance and cadence, whereas a more anterior release angle was associated with greater velocity (R = 0.372, P < .001). When controlling for body weight, a more posterior initial contact angle was associated with greater posterior shoulder net joint force (R = 0.229, P = .001) and greater flexor net joint moment (R = 0.204, P = .002), whereas a more anterior hand release angle was significantly associated with increased vertical (R = 0.270, P < .001) and greater lateral (R = .293, P < .001) pushrim forces; greater shoulder net joint forces in all 3 planes — posterior (R = 0.164, P = .015), superior (R = 0.176, P = .009), and medial (R = 0.284, P < .001); and greater external rotator (R = 0.176, P = .009) and adductor (R = 0.259, P = .001) net joint moments. Conclusions: Current

  9. Effect of backpack load on the head, cervical spine and shoulder postures in children during gait termination.

    PubMed

    Mo, Shi Wei; Xu, Dong-Qing; Li, Jing Xian; Liu, Meng

    2013-01-01

    Twelve boys with an average age of 9.9 years were instructed to carry backpacks that weighed 0%, 10% and 15% of their body weights (BWs) to complete planned and unplanned gait termination experiments. The craniohorizontal, craniovertebral and sagittal shoulder posture angles at the sagittal plane as well as the anterior head alignment and coronal shoulder posture angles at the coronal plane were analysed. Results revealed significantly smaller craniohorizontal and sagittal shoulder posture angles during planned gait termination and a significantly smaller sagittal shoulder posture angle during unplanned gait termination under loaded conditions compared with those at 0% BW backpacks. Furthermore, the coronal shoulder posture angles at 10% and 15% BW during planned and unplanned gait terminations were significantly larger than those at 0% BW. Therefore, subjects were more likely to have a forward head posture, rounded shoulder posture and increased lateral tilting of the shoulders during gait termination as backpack loads were increased. However, gait termination, whether planned or unplanned, did not elicit a remarkable effect on posture. PMID:24206277

  10. Anterior Longitudinal Osteotomy of the Greater Trochanter in Total Hip Arthroplasty.

    PubMed

    Surace, Michele F; Regazzola, Gianmarco M V; Vulcano, Ettore; Monestier, Luca; Cherubino, Paolo

    2015-08-01

    The extra-articular impingement of the greater trochanter against the ileum is an underrated cause of early dislocation in total hip arthroplasty. In this preliminary study, the authors assess the effectiveness of an anterior longitudinal osteotomy of the greater trochanter for preventing dislocation. A total of 115 patients underwent a total hip arthroplasty through a posterolateral approach. All patients underwent clinical and radiological follow-up at 1, 3, and 6 months. No dislocation was reported. All patients demonstrated fast recovery of range of motion and walking. No trochanter fractures were observed. The osteotomy of the greater trochanter is an effective surgical technique that decreases anterior impingement and consequently lowers the dislocation rate in primary total hip arthroplasty. [Orthopedics. 2015; 38(8):490-493.]. PMID:26313167

  11. Management of Neglected Traumatic Bilateral Cervical Facet Dislocations Without Neurological Deficit

    PubMed Central

    Farooque, Kamran; Khatri, Kavin; Gupta, Babita; Sharma, Vijay

    2015-01-01

    Introduction: Sub axial cervical spine dislocations are common and managing these cases by closed reduction is successful in the majority of cases. However, treatment of old and neglected cases is difficult and the results may vary in terms of neurological and functional outcomes. Case Presentation: We present two cases of traumatic bilateral cervical facet dislocation with no neurological deficit (ND) who referred four months after the injury. They were managed via single stage anterior discectomy, posterior facet reduction, instrumentation, and then anterior reconstruction with bone graft and cervical plate. The patients had no ND in the postoperative period and returned to work. Discussion: Patients presenting with neck pain after a history of trauma should be evaluated thoroughly with radiographs and computed tomography. The management of old neglected facet dislocations is difficult, lengthy, and fraught with potential neurological complications; operative intervention can substantially improve the quality of life in these patients. PMID:26543838

  12. Spontaneous dislocation of intraocular lens as a late complication of uncomplicated cataract surgery: a case series.

    PubMed

    Lam, Hee Hong; Visvaraja, Subrayan

    2012-01-01

    Five patients having uncomplicated phacoemulsification were implanted with CT-Asphina 603P intraocular lenses into the capsular bag. After a few months, three of the patients had haptic flexion anterior to the optic despite minimal capsular fibrosis. One patient had spontaneous dislocation of the intraocular lens into the anterior chamber with only minimal capsular fibrosis. Another patient had one haptic dislocated out of the bag. Late intraocular lens dislocation is also seen in newly designed preloaded intraocular lenses despite the absence of significant capsular fibrosis. Haptic-optic junction design and intraocular lens material play important roles in such complication. A slightly large capsulorhexis might be a deterrent for implantation of this intraocular lens. PMID:21954950

  13. An electromyographic analysis of shoulder function in tennis players.

    PubMed

    Ryu, R K; McCormick, J; Jobe, F W; Moynes, D R; Antonelli, D J

    1988-01-01

    Shoulder injuries in tennis players are common because of the repetitive, high-magnitude forces generated around the shoulder during the various tennis strokes. An understanding of the complex sequences of muscle activity in this area may help reduce injury, enhance performance, and assist the rapid rehabilitation of the injured athlete. The supraspinatus, infraspinatus, subscapularis, middle deltoid, pectoralis major, latissimus dorsi, biceps brachii, and serratus anterior muscles were studied in six uninjured male Division II collegiate tennis players using dynamic electromyography (EMG) and synchronized high-speed photography. Each subject performed the tennis serve and the forehand and backhand groundstrokes, and each stroke was divided into stages. The tennis serve contains four stages. Three stages characterize the forehand and backhand groundstrokes. Our results indicate that the subscapularis, pectoralis major, and serratus anterior display the greatest activity during the serve and forehand. The middle deltoid, supraspinatus, and infraspinatus are most active in the acceleration and follow-through stages of the backhand. The biceps brachii increases its activity during cocking and follow-through in the serve with a similar pattern noted in the acceleration and follow-through stages of the forehand and backhand. The serratus anterior demonstrates intense activity in the serve and forehand, thus providing a stable platform for the humeral head and assisting in gleno-humeral-scapulothoracic synchrony. The tennis serve and forehand and backhand groundstrokes are accomplished by complex sequences of muscle activity that incorporate contributions from the lower extremities and trunk into smooth, coordinated patterns.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3189681

  14. Ipsilateral obturator type of hip dislocation with fracture shaft femur in a child: a case report and literature review.

    PubMed

    Arjun, R H H; Kumar, Vishal; Saibaba, Balaji; John, Rakesh; Guled, Uday; Aggarwal, Sameer

    2016-09-01

    The incidence of traumatic hip dislocations in children is rising in this fast developing world along with increasing numbers of high-velocity road traffic accidents. Anterior dislocation of the hip has a lower incidence compared with posterior dislocation of the hip. We encountered a rare case of the obturator type of anteriorly dislocated hip associated with ipsilateral fracture of the shaft femur in an 11-year-old child. This is a highly unusual injury combination and the mechanism of injury is obscure. Only two similar cases have been reported in the English literature to date. Closed reduction of the hip using a hitherto undescribed technique and an intramedullary interlocking nail was performed in this case. At 6 months of follow-up, the fracture shaft femur has united and the child is bearing full weight on the limb. PMID:27128394

  15. Surgical Treatment for Significant Fracture-dislocation of the Thoracic or Lumbar Spine without Neurologic Deficit: A Case Series

    PubMed Central

    Enishi, Tetsuya; Katoh, Shinsuke; Sogo, Toshiharu

    2014-01-01

    Introduction: Fracture-dislocation of the thoracic or lumbar spine often results in severe neurologic deficits if dislocation is significant. However, cases of fracture-dislocation of the thoracic or lumbar spine without neurologic deficits are rarely reported in the literature, and the choice of the treatment has been controversial. Case Report: Two female patients, aged 27 and 35 years, were injured in motor vehicle accidents and did not have neurological deficits except for slight numbness in the thighs in one case. Radiologic examinations showed nearly complete fracture-dislocations at T7-8 and L1-2, respectively. In both cases, subtotal corpectomies and anterior reconstructions using Kaneda devices were performed after laminectomy in the lateral decubitus position. No neurological deterioration was observed after surgery. Conclusion: Anterior subtotal corpectomy and reconstruction combined with posterior decompression is a good option for these cases to restore the alignment and the stability of the spine. PMID:27298981

  16. Perilunate Injuries, Not Dislocated (PLIND)

    PubMed Central

    Herzberg, Guillaume

    2013-01-01

    Purpose We reviewed a series of equivalents of perilunate dislocations and fracture-dislocations (PLDs–PLFDs) in which there was no dislocation of the capitate from the lunate on the initial radiographs. We propose to include these injuries as a variant of perilunate dislocations that we have termed a perilunate injury, not dislocated (PLIND) lesion in a modified classification of perilunate injuries. Methods A review of the records of all acute perilunate injuries and displaced carpal fractures was done in a single-center university hospital wrist surgery unit over a 5-year period. All cases presenting at the acute stage with displaced fractures of scaphoid, lunate, triquetrum, or capitate along with scapholunate and/or lunotriquetral dissociation but no dislocation of the capitate from the lunate in the sagittal or coronal plane were reviewed and considered as PLIND lesions. Results We identified 11 patients with PLIND lesions. Three cases with clinical and radiological follow-up are presented. Discussion Equivalents of PLDs–PLFDs presenting without dislocation of the capitate from the lunate do exist. These injuries may be overlooked despite their severity. They require both osseous and ligamentous repair. Including them into an existing perilunate injuries classification highlights their recognition and enables a better understanding and treatment of both acute and chronic nondislocated perilunate injuries. Level of Evidence Level IV, retrospective case series. PMID:24436839

  17. Infection Prevention in Shoulder Surgery.

    PubMed

    Hackett, Daniel J; Crosby, Lynn A

    2015-12-01

    The microbiome of the shoulder demonstrates distinctive differences to other orthopaedic surgical sites. Recent studies have demonstrated that the most common organisms found in deep shoulder infections are coagulase-negative staph lococcal species and Propionibacterium acnes . Many studies support diligent hand washing, decreasing operative time, routine glove changing, minimizing operating room traffic, and covering instruments as means for decreasing the risk of deep infection. On the other hand, hair clipping and the use of adhesive drapes may have little effect on decreasing the incidence of deep infection. Although generally considered the most efficacious skin preparation solution, chlorhexidine gluconate has minimal effect on eradication of P. acnes from the surgical site; however, the addition of preoperative topical applications of benzoyl peroxide to standard surgical preparation has shown promise in decreasing the rate of P . acnes culture positivity. Additionally, the use of local antibiotic formulations seems to be an effective means of preventing deep infection. PMID:26631211

  18. Patellar Dislocations and Reduction Procedure.

    PubMed

    Ramponi, Denise

    2016-01-01

    Acute patellar dislocations are a common injury occurring in adolescents involved in sports and dancing activities. This injury usually occurs when the knee is in full extension and sustains a valgus stress on the knee. The medial patellofemoral ligament is the medial restraint that assists in stabilizing the patella from lateral dislocations. The patella usually dislocates laterally and is usually not difficult to reduce after patient evaluation and prereduction radiographs. After postreduction radiographs confirm proper position of the patella postreduction and the absence of fractures, the patient is usually treated conservatively with initial immobilization, orthopedic referral, and physical therapy. PMID:27139130

  19. Moving Dislocations in Disordered Alloys.

    SciTech Connect

    Marian, J; Caro, A

    2006-11-18

    Using atomistic simulations of dislocation motion in Ni and Ni-Au alloys we report a detailed study of the mobility function as a function of stress, temperature and alloy composition. We analyze the results in terms of analytic models of phonon radiation and their selection rules for phonon excitation. We find a remarkable agreement between the location of the cusps in the {sigma}-v relation and the velocity of waves propagating in the direction of dislocation motion. We identify and characterize three regimes of dissipation whose boundaries are essentially determined by the direction of motion of the dislocation, rather than by its screw or edge character.

  20. Shoulder injuries from attacking motion

    NASA Astrophysics Data System (ADS)

    Yanagi, Shigeru; Nishimura, Tetsu; Itoh, Masaru; Wada, Yuhei; Watanabe, Naoki

    1997-03-01

    Sports injuries have bothered professional players. Although many medical doctors try to treat injured players, to prevent sports injuries is more important. Hence, it is required to clear a kinematic mechanism of the sport injuries. A shoulder of volleyball attacker or baseball pitcher is often inured by playing motion. The injuries are mainly caused at the end of long head tendon, which is located in the upper side of scapula. Generally, a muscle and tendon have enough strength against tensile force, however, it seems that they are sometimes defeated by the lateral force. It is imagined that the effect of the lateral force has a possibility of injuring the tendon. If we find the influence of the lateral force on the injured portion, the mechanism of injuries must be cleared. In our research, volleyball attacking motion is taken by high speed video cameras. We analyze the motion as links system and obtain an acceleration of an arm and a shoulder from video image data. The generated force at a shoulder joint is calculated and resolved into the lateral and longitudinal forces. Our final goal is to discuss a possibility that the lateral force causes the injuries.

  1. Assessment of Correlation Between MRI and Arthroscopic Pathologic Findings in the Shoulder Joint

    PubMed Central

    Momenzadeh, Omid R; Gerami, Mohamad H; Sefidbakht, Sepideh; Dehghani, Sakineh

    2015-01-01

    Background: The objective of this study was to determine the diagnostic value of magnetic resonance imaging for shoulder joint pathologies and then compare the results with arthroscopy, the standard for joint diagnosis. Methods: In this cross-sectional study, 80 patients with shoulder joint disorders, who underwent final arthroscopy, were studied. Based on patients’ medical history and physical examinations, shoulder MRI was requested if paraclinical investigations were. If non-surgical therapies failed, arthroscopy of the affected shoulder was done and the same structures were inspected. Subsequently, sensitivity, specificity, and positive and negative predictive values (PPV) and (NPV) of MRI were determined by arthroscopy comparisons. Results: The highest sensitivity, specificity, PPV and NPV were found in MRI pathology reports that included: Hill-Sach lesion (0.910), infraspinatus tendon (0.985), supraspinatus tendon (0.930), and biceps tendon (0.954), respectively. Rotator interval (0.250), biceps labrum complex (0.805), subscapularis tendon (0.538) and anterior labrum lesions (0.604) had the lowest sensitivity, specificity, PPV and NPV, respectively. Conclusion: The results showed that MRI can be a useful tool in ruling out possible abnormalities in the shoulder and to give clues to the most probable diagnosis. Although knowing some practical skills in order to successfully perform the procedure and experience of the radiologist with suitable feedback by surgeon is necessary. PMID:26550595

  2. Abdominal Access for Shoulder Dystocia as a Last Resort – a Case Report

    PubMed Central

    Enekwe, A.; Rothmund, R.; Uhl, B.

    2012-01-01

    Shoulder dystocia is the term used to describe failure to progress in labour after the head has been delivered due to insufficient rotation of the shoulders. It is unpredictable and cannot be prevented by the midwife or the obstetrician. We report here on a severe case of shoulder dystocia, where delivery of the shoulder was finally achieved through direct pressure on the anterior shoulder after laparotomy and uterotomy with concurrent vaginal Woods screw manoeuvre and was followed by vaginal delivery. The patient presented risk factors like maternal obesity and administration of labour-inducing drugs. After different manoeuvres like McRoberts manoeuvre and several manoeuvres for internal rotation were carried out unsuccessfully, an emergency laparotomy was performed. The newborn was in need for reanimation and artifical ventilation postpartum but recovered fast during the following days. An Erbʼs palsy of the posterior arm improved during the hospital stay. The German Guideline of the DGGG 8 recommends a risk management plan and regular training to all birth attendants for obstetric clinics. Beside the vaginal manoeuvres one should have at least theoretical expertise in operative manoeuvres to be able to perform them in emergency cases. PMID:25264378

  3. Arthroscopically Assisted Mini-Invasive Management of Perilunate Dislocations

    PubMed Central

    Liu, Bo; Chen, Shan-Lin; Zhu, Jin; Wang, Zhi-Xin; Shen, Jie

    2015-01-01

    Purpose The purpose of this study was to evaluate the outcomes of perilunate dislocations and fracture-dislocations treated with arthroscopically assisted mini-invasive reduction and fixation. Methods Between June 2012 and May 2014, 24 patients who had a dorsal perilunate dislocation or fracture-dislocation were treated with arthroscopically assisted reduction and percutaneous fixation. The mean follow-up was 14.8 months (range 6–32 months). Clinical outcomes were evaluated on the basis of range of motion; grip strength; Mayo Wrist Score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire; and Patient-Rated Wrist Evaluation (PRWE) score. Radiographic evaluations included time to scaphoid union, carpal alignments, and any development of arthritis. Results The range of flexion-extension motion of the injured wrist averaged 86% of the values for the contralateral wrist. The grip strength of the injured wrist averaged 83% of the values for the contralateral wrists. The mean QuickDASH score was 6, and the mean PRWE score was 10. According to the Mayo Wrist Scores, overall functional outcomes were rated as excellent in 13 patients (54%), good in 6 (25%), fair in 4 (17%), and poor in 1 (4%). Scaphoid nonunion developed in one patient. Reduction obtained during the operation was maintained within normal ranges in all patients. Arthritis had not developed in any patient at final follow-up. Conclusions Arthroscopically assisted mini-invasive reduction with percutaneous fixation is a reliable and favorable alternative in the treatment of perilunate injuries according to our early follow-up results. Level of Evidence: Level IV, Therapeutic. PMID:25945293

  4. Kinematics of chiropteran shoulder girdle in flight.

    PubMed

    Panyutina, A A; Kuznetsov, A N; Korzun, L P

    2013-03-01

    New data on the mechanisms of movements of the shoulder girdle and humerus of bats are described; potential mobility is compared to the movements actually used in flight. The study was performed on the basis of morphological and functional analysis of anatomical specimens of 15 species, high speed and high definition filming of two species and X-ray survey of Rousettus aegyptiacus flight. Our observations indicate that any excursions of the shoulder girdle in bats have relatively small input in the wing amplitude. Shoulder girdle movements resemble kinematics of a crank mechanism: clavicle plays the role of crank, and scapula-the role of connecting rod. Previously described osseous "locking mechanisms" in shoulder joint of advanced bats do not affect the movements, actually used in flight. The wing beats in bats are performed predominantly by movements of humerus relative to shoulder girdle, although these movements occupy the caudal-most sector of available shoulder mobility. PMID:23381941

  5. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... made of alloys, such as cobalt-chromium-molybdenum, or alloys with ultra-high molecular weight... equivalent to a shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis that was in...

  6. How to treat a frozen shoulder? A survey among shoulder specialists in the Netherlands and Belgium.

    PubMed

    Kraal, Tim; Visser, Cornelis; Sierevelt, Inger; Beimers, Lijkele

    2016-03-01

    A frozen shoulder is a common cause of a painful and stiff shoulder. A web-based survey was conducted to obtain insight in the current preferences about the diagnosis and treatment of a frozen shoulder. A response rate of 54% was reached among shoulder specialized orthopaedic surgeons from the Netherlands and Belgium. Non-steroidal anti-inflammatory drugs and intra-articular corticosteroid injections are used frequently in the first phase of the condition. Physiotherapy is assumed to be more important in the final phase. The results of the survey indicate a wide variety of treatment strategies in the different phases of a frozen shoulder. Three out of four respondents considered that the management of a frozen shoulder could benefit from a written guideline. The development of a written guideline should lead to an improved level of consensus and a more standardized approach in the treatment of a frozen shoulder among shoulder specialists in the Netherlands and Belgium. PMID:26984658

  7. Shoulder Symptoms and Function in Geriatric Patients

    PubMed Central

    Burner, Todd; Abbott, Daniel; Huber, Karri; Stout, Monica; Fleming, Raymond; Wessel, Bambi; Massey, Ellen; Rosenthal, Ann; Burns, Edith

    2015-01-01

    Background and Purpose Musculoskeletal problems including shoulder pain are common in the general population and are often cited as reasons for physician visits. Although many risk factors for shoulder pain are postulated, the effects of shoulder pain on functional level and perceived quality of life are poorly characterized in older adults. In this study, we set out to determine the prevalence and impact of shoulder symptoms and dysfunction in an older adult veteran population. Methods A chart review, cross-sectional survey, and examination were performed. A sample of 93 individuals, age >60, were recruited from a primary clinic outpatient waiting room at the Clement J. Zablocki VA Medical Center in Milwaukee, WI. Patients were asked about shoulder symptoms and self-assessed health (SAH), and completed the Stanford Modified Health Assessment Questionnaire (MHAQ). A series of 3 shoulder maneuvers were used to assess shoulder mobility and pain. The presence of diabetes and statin use was documented. A more thorough chart review was performed on individuals who reported shoulder pain and disability. Results Severe shoulder pain was common in the study group, reported by 31% of all participants. Functional limitation measured by the MHAQ and answering “yes” to greater difficulty performing daily tasks was associated with reduced internal rotation, which was present in almost 36% of all participants. Symptoms were often bilateral. No statistically significant risk factors emerged in this small sample, but suggestive trends were apparent. Interestingly, few patients reported discussing these problems with their providers, and shoulder-related problems were documented in only 10% of corresponding problem lists of symptomatic patients. Conclusions With an aging population, the high prevalence of shoulder pain may have considerable impact on public health. It will become increasingly important to define risk factors, delineate etiologies, and devise new management

  8. Gimballed Shoulders for Friction Stir Welding

    NASA Technical Reports Server (NTRS)

    Carter, Robert; Lawless, Kirby

    2008-01-01

    In a proposed improvement of tooling for friction stir welding, gimballed shoulders would supplant shoulders that, heretofore, have been fixedly aligned with pins. The proposal is especially relevant to self-reacting friction stir welding. Some definitions of terms, recapitulated from related prior NASA Tech Briefs articles, are prerequisite to a meaningful description of the proposed improvement. In friction stir welding, one uses a tool that includes (1) a rotating shoulder on top (or front) of the workpiece and (2) a pin that rotates with the shoulder and protrudes from the shoulder into the depth of the workpiece. In conventional friction stir welding, the main axial force exerted by the tool on the workpiece is reacted through a ridged backing anvil under (behind) the workpiece. When conventional friction stir welding is augmented with an auto-adjustable pin-tool (APT) capability, the depth of penetration of the pin into the workpiece is varied in real time by a position- or forcecontrol system that extends or retracts the pin as needed to obtain the desired effect. In self-reacting (also known as self-reacted) friction stir welding as practiced heretofore, there are two shoulders: one on top (or front) and one on the bottom (or back) of the workpiece. In this case, a threaded shaft protrudes from the tip of the pin to beyond the back surface of the workpiece. The back shoulder is held axially in place against tension by a nut on the threaded shaft. Both shoulders rotate with the pin and remain aligned coaxially with the pin. The main axial force exerted on the workpiece by the tool and front shoulder is reacted through the back shoulder and the threaded shaft into the friction-stir-welding machine head, so that a backing anvil is no longer needed. A key transmits torque between the bottom shoulder and the threaded shaft, so that the bottom shoulder rotates with the shaft. This concludes the prerequisite definitions of terms.

  9. Shoulder Injury Incidence Rates in NASA Astronauts

    NASA Technical Reports Server (NTRS)

    Laughlin, Mitzi S.; Murray, Jocelyn D.; Foy, Millennia; Wear, Mary L.; Van Baalen, Mary

    2014-01-01

    Evaluation of the astronaut shoulder injury rates began with an operational concern at the Neutral Buoyancy Laboratory (NBL) during Extravehicular Activity (EVA) training. An astronaut suffered a shoulder injury during an NBL training run and commented that it was possibly due to a hardware issue. During the subsequent investigation, questions arose regarding the rate of shoulder injuries in recent years and over the entire history of the astronaut corps.

  10. Linguatula serrata in the anterior chamber of the eye

    PubMed Central

    Bhende, Muna; Abhishek; Biswas, Jyotirmoy; Raman, M; Bhende, Pramod S

    2014-01-01

    We report a case of intraocular Linguatula in healthy young female who presented with a history of trivial trauma, dislocated lens, inflammation and secondary glaucoma. A mobile worm was seen in the anterior chamber. Pars plana lensectomy and vitrectomy was planned to remove both the cataractous lens and the parasite during which the worm disappeared from view but was later recovered from the cassette fluid. It was identified as the nymphal form of Linguatula serrata (tongue worm). PMID:25579362

  11. Posttraumatic focal dystonia of the shoulder.

    PubMed

    Vasileiadis, Georgios I; Sakellariou, Vasileios I; Papagelopoulos, Panayiotis J; Zoubos, Aristeides B

    2012-06-01

    Focal posttraumatic shoulder dystonia is a rare and not easily identifiable entity. Its true pathophysiologic nature, predisposing factors, and disease course remain debatable.This article describes a rare case of a 40-year-old man with late symptoms of focal shoulder dystonia after peripheral trauma of his left shoulder girdle. The shoulder was indirectly injured from the impact of a fall off his motorbike 3 years earlier. He was referred to the authors' institution because remarkable reduction of arm abduction, muscle spasms, and circumscribed hypertrophy of the trapezius muscle were noted while his head and neck were in neutral position and had a full range of motion. The left shoulder had a fixed elevated posture compared with the contralateral shoulder. A continuous burning pain was localized over the area of the hypertrophied trapezius muscle, radiating to the ipsilateral side of the head and neck. Dystonic movements of the trapezius, rhomboid, and supraspinatus muscles were observed. The abduction of the shoulder was significantly decreased, and any repetitive effort for arm abduction induced an exaggeration of his movement disorder, leading to a more pronounced shoulder elevation.Plain radiographs and magnetic resonance imaging of the left shoulder revealed a suprascapular tendinitis with no other abnormalities. Repeated needle electromyography of the left trapezius muscle and neurography of the accessory nerve on both sides were normal. Injections of botulinum toxin A were effective in the resolution of muscle hypertrophy and abnormal posture. PMID:22691679

  12. Biomechanics of reverse total shoulder arthroplasty.

    PubMed

    Berliner, Jonathan L; Regalado-Magdos, Ashton; Ma, C Benjamin; Feeley, Brian T

    2015-01-01

    Reverse total shoulder arthroplasty is an effective procedure for treatment of glenohumeral joint disease among patients with severe rotator cuff deficiency. Improvements in prosthetic design are the result of an evolved understanding of both shoulder and joint replacement biomechanics. Although modern generations of the reverse shoulder prosthesis vary in specific design details, they continue to adhere to Grammont's core principles demonstrated by his original Delta III prosthesis. This review article discusses the biomechanics of reverse total shoulder arthroplasty with a focus on elements of implant design and surgical technique that may affect stability, postoperative complications, and functional outcomes. PMID:25441574

  13. Dislocation sources in ordered intermetallics

    SciTech Connect

    Yoo, M.H.; Appel, F.; Wagner, R.; Mecking, H.

    1996-09-01

    An overview on the current understanding of dislocation sources and multiplication mechanisms is made for ordered intermetallic alloys of the L1{sub 2}, B2, and D0{sub 19} structures. In L1{sub 2} alloys, a large disparity of edge/screw segments in their relative mobility reduces the efficiency of a Frank-Read Type multiplication mechanism. In Fe-40%Al of the B2 structure, a variety of dislocation sources are available for <111> slip, including ones resulting from condensation of thermal vacancies. In NiAl with the relatively high APB energy, <100> dislocations may result from the dislocation decomposition reactions, the prismatic punching out from inclusion particles, and/or steps and coated layers of the surface. Internal interfaces often provide sites for dislocation multiplication, e.g., grain boundaries, sub-boundaries in Ni{sub 3}Ga, NiAl and Ti{sub 3}Al, and antiphase domain boundaries in Ti{sub 3}Al. As for the crack tip as a dislocation source, extended SISFs trailed by super-Shockley partials emanating form the cracks in Ni{sub 3}Al and Co{sub 3}Ti are discussed in view of a possible toughening mechanism.

  14. [The value of anterior plate fixation without bone graft in simple luxation and various fracture-luxations of the lower cervical spine].

    PubMed

    Loembe, P M; Chouteau, Y; Dukuly, L; Ndong-Launay, M; Bouger, D

    1990-01-01

    In comparison to posterior fixation by Roy-Camille plates which does not require bone grafting, the authors present 9 cases of anterior plate fixation, also without bone grafting (6 dislocations and 3 fracture-dislocations of the lower cervical spine). The results and indications of this technique are discussed. PMID:2267047

  15. The effect of shoulder supporting banding and shoulder pulling banding using elastic bands on shoulder pain and scapular position of a scapular dyskinesis patient with shoulder depression and scapular downward rotation

    PubMed Central

    Yoo, Won-gyu

    2016-01-01

    [Purpose] This study developed methods of shoulder supporting banding and shoulder pulling banding using elastic bands for scapular dyskinesis patients with shoulder depression and scapular downward rotation and investigated the effect on shoulder pain and scapular position. [Subject] The subject was a scapular dyskinesis patient with shoulder depression and scapular downward rotation and shoulder pain. [Methods] This study compared the scapular position and upper trapezius pressure pain between before and after applying the shoulder supporting banding and shoulder pulling banding for one month. [Results] The results showed that the acromion depression distance and scapular inferior downward distance decreased and that the pressure pain threshold of the upper trapezius increased after using shoulder supporting banding and shoulder pulling banding for one month. [Conclusion] Therefore, the shoulder banding methods using elastic bands showed positive effect in a scapular dyskinesis patient with shoulder depression and scapular downward rotation. PMID:27064562

  16. Editorial Commentary: Glenoid Bone Reconstruction for Recurrent Shoulder Instability-Risk or Benefit?

    PubMed

    Verma, Nikhil N

    2016-09-01

    Bone reconstruction for management of glenohumeral instability to reduce postoperative recurrence rates is increasingly emphasized in our literature. Unfortunately, significant complication rates are associated with these procedures, particularly in the United States where training in bony glenoid reconstruction may be limited. The alternative of early intervention, specifically surgical treatment of first-time shoulder dislocation, could result in glenoid bone preservation and overall improvement in the results of soft-tissue stabilization procedures. Avoidance of future glenohumeral bone loss may diminish the need for more complicated surgery. PMID:27594329

  17. Dislocations in Monolayers and Semiconductors.

    NASA Astrophysics Data System (ADS)

    Ren, Qiang

    1995-01-01

    Four different aspects of the properties of dislocations in monolayer and semiconductors have been investigated: (i) Using atomic relaxation techniques, dislocation dipoles of various sizes and orientations have been studied for monolayers with the Lennard-Jones potential (LJP) and the nearest-neighbour piecewise linear force (PLF) interactions. In the WP system the lower energy vacancy dipoles have over a wide range of angles an energy which is mainly a function of the vacancy content of the dipole. There is a competition between the elastic forces and the topological constraints which favour a five-fold coordinate vacancy (FCV) at the centre of each core. For the short range PLF system the lattice usually compresses upon the introduction of a dislocation, a consequence of the soft core of the interaction potential, and interstitial dipoles are lower in energy. For the long range LJP system the dislocations are mobile whereas for the PLF system they are pinned. The relevance of these results to existing theories of melting are discussed. (ii) Using generalized stacking-fault (GSF) energies obtained from first-principles density-functional calculations, a zero-temperature model for dislocations in silicon is constructed within the framework of a Peierls-Nabarro (PN) model. Core widths, core energies, PN pinning energies, and stresses are calculated for various possible perfect and imperfect dislocations. Both shuffle and glide sets are considered. 90^circ partials are shown to have a lower Peierls stress (PS) than 30 ^circ partials in accord with experiment. (iii) We have also studied by atomic relaxation techniques the properties of dislocations in silicon, modelled by the empirical potential of Stillinger and Weber. In order to compare with the preceding calculation no reconstruction is allowed. We find no evidence of dissociation in the shuffle dislocations. Within this model shuffle dislocations glide along their slipping planes. On the other hand, glide sets

  18. Shoulder arthropathy in primary hyperparathyroidism

    SciTech Connect

    Nussbaum, A.J.; Doppman, J.L.

    1982-12-01

    An erosive arthropathy of the hands and wrists has been recognized in patients with primary and secondary hyperparathyroidism. Recently, intra-articular erosions of the humeral head were described in six patients who had been on chronic long-term hemodialysis with secondary hyperparathyroidism. We would like to present the finding of shoulder erosions in four patients with primary hyperparathyroidism and one patient with renal osteodystrophy and suggest that the humeral erosion can occur in both an intra-articular and peri-articular location.

  19. Sternoclavicular joint dislocation and its management: A review of the literature

    PubMed Central

    Morell, Daniel J; Thyagarajan, David S

    2016-01-01

    Dislocations of the sternoclavicular joint (SCJ) occur with relative infrequency and can be classified into anterior and posterior dislocation, with the former being more common. The SCJ is inherently unstable due to its lack of articular contact and therefore relies on stability from surrounding ligamentous structures, such as the costoclavicular, interclavicular and capsular ligaments. The posterior capsule has been shown in several studies to be the most important structure in determining stability irrespective of the direction of injury. Posterior dislocation of the SCJ can be associated with life threatening complications such as neurovascular, tracheal and oesophageal injuries. Due to the high mortality associated with such complications, these injuries need to be recognised acutely and managed promptly. Investigations such as X-ray imaging are poor at delineating anatomy at the level of the mediastinum and therefore CT imaging has become the investigation of choice. Due to its rarity, the current guidance on how to manage acute and chronic dislocations is debatable. This analysis of historical and recent literature aims to determine guidance on current thinking regarding SCJ instability, including the use of the Stanmore triangle. The described methods of reduction for both anterior and posterior dislocations and the various surgical reconstructive techniques are also discussed. PMID:27114931

  20. Changes in upper-extremity muscle activities due to head position in subjects with a forward head posture and rounded shoulders

    PubMed Central

    Kwon, Jung Won; Son, Sung Min; Lee, Na Kyung

    2015-01-01

    [Purpose] This study investigated upper-extremity muscle activities in natural, ideal, and corrected head positions. [Subjects and Methods] Forty subjects with a forward head posture and rounded shoulder were recruited and randomly assigned to the natural head position group (n = 13), ideal head position group (n = 14), or corrected head position group (n = 13). Muscle activities were measured using a four-channel surface electromyography system at the sternocleidomastoideus, upper and lower trapezius, and serratus anterior muscles on the right side during an overhead reaching task. [Results] The muscle activities of the upper trapezius and serratus anterior differed significantly among head positions. Post hoc tests revealed significant differences between natural and ideal head positions, and natural and ideal head positions for both the upper trapezius and serratus anterior. [Conclusion] Recovery of normal upper trapezius and serratus anterior muscle functions plays an important role in correcting forward head posture and rounded shoulders. PMID:26180310

  1. Dislocation Multi-junctions and Strain Hardening

    SciTech Connect

    Bulatov, V; Hsiung, L; Tang, M; Arsenlis, A; Bartelt, M; Cai, W; Florando, J; Hiratani, M; Rhee, M; Hommes, G; Pierce, T; Diaz de la Rubia, T

    2006-06-20

    At the microscopic scale, the strength of a crystal derives from the motion, multiplication and interaction of distinctive line defects--dislocations. First theorized in 1934 to explain low magnitudes of crystal strength observed experimentally, the existence of dislocations was confirmed only two decades later. Much of the research in dislocation physics has since focused on dislocation interactions and their role in strain hardening: a common phenomenon in which continued deformation increases a crystal's strength. The existing theory relates strain hardening to pair-wise dislocation reactions in which two intersecting dislocations form junctions tying dislocations together. Here we report that interactions among three dislocations result in the formation of unusual elements of dislocation network topology, termed hereafter multi-junctions. The existence of multi-junctions is first predicted by Dislocation Dynamics (DD) and atomistic simulations and then confirmed by the transmission electron microscopy (TEM) experiments in single crystal molybdenum. In large-scale Dislocation Dynamics simulations, multi-junctions present very strong, nearly indestructible, obstacles to dislocation motion and furnish new sources for dislocation multiplication thereby playing an essential role in the evolution of dislocation microstructure and strength of deforming crystals. Simulation analyses conclude that multi-junctions are responsible for the strong orientation dependence of strain hardening in BCC crystals.

  2. 49 CFR 572.184 - Shoulder assembly.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 100 ±5 mm. The length of the elastic shoulder cord (175-3015) shall be adjusted so that a force... shoulder at 4.3±0.1 m/s. (c) Performance criteria. The peak acceleration of the impactor is between 7.5...

  3. 49 CFR 572.184 - Shoulder assembly.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... ±5 mm. The length of the elastic shoulder cord (175-3015) shall be adjusted so that a force between... shoulder at 4.3±0.1 m/s. (c) Performance criteria. The peak acceleration of the impactor is between 7.5...

  4. 49 CFR 572.184 - Shoulder assembly.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 100 ±5 mm. The length of the elastic shoulder cord (175-3015) shall be adjusted so that a force... shoulder at 4.3±0.1 m/s. (c) Performance criteria. The peak acceleration of the impactor is between 7.5...

  5. Current Concepts in Anaesthesia for Shoulder Surgery

    PubMed Central

    Sulaiman, Lutfi; MacFarlane, Robert J; Waseem, Mohammad

    2013-01-01

    There has been an exponential growth in the volume of shoulder surgery in the last 2 decades and a very wide variety of anaesthetic techniques have emerged to provide anaesthesia and post-operative analgesia. In this article we examine current opinion, risks, benefits and practicalities of anaesthetic practice and the provision of post-operative analgesia for shoulder surgery. PMID:24082970

  6. [Prediction, prevention and management of shoulder dystocia].

    PubMed

    Csorba, Roland

    2012-05-20

    Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2-0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4-16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia. PMID:22580502

  7. 49 CFR 572.194 - Shoulder.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Shoulder. 572.194 Section 572.194 Transportation Other Regulations Relating to Transportation (Continued) NATIONAL HIGHWAY TRAFFIC SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) ANTHROPOMORPHIC TEST DEVICES IIsD Side Impact Crash Test Dummy, Small Adult Female § 572.194 Shoulder....

  8. 49 CFR 572.184 - Shoulder assembly.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... the plane of motion of the impactor at contact with the shoulder. The arms are oriented forward at 50... ±5 mm. The length of the elastic shoulder cord (175-3015) shall be adjusted so that a force between... clavicle in the same plane as the clavicle movement, is required to initiate a forward motion of 1 to 5...

  9. Effects of mop handle height on shoulder muscle activity and perceived exertion during floor mopping using a figure eight method

    PubMed Central

    WALLIUS, Mari-Anne; RISSANEN, Saara M.; BRAGGE, Timo; VARTIAINEN, Paavo; KARJALAINEN, Pasi A.; RÄSÄNEN, Kimmo; JÄRVELIN-PASANEN, Susanna

    2015-01-01

    The aim of this study was to investigate effects of mop handle height on electromyographic (EMG) activities of the shoulder muscles and perceived exertion for the shoulder area during floor mopping using a figure eight method. An experimental study with 13 cleaners was conducted using surface EMG and category ratio (CR-10) scale. EMG activity was recorded unilaterally from the upper trapezius, infraspinatus, anterior and middle deltoid muscles. Each subject performed four trials of mopping and each trial consisted of using a different mop handle height (mop adjustment at the level of shoulder, chin, nose and eye) in randomized order. EMG data were normalized to a percentage of maximal voluntary contraction (%MVC). The muscle activities were assessed by estimating the 10th, 50th and 90th percentiles of the amplitude probability distribution function (APDF) of the EMG signals and analysed by linear mixed model analysis. Results showed that shoulder muscle activity was significantly lower when the mop handle height was adjusted to shoulder level or chin level as compared to eye level. These findings were supported by subjective ratings of exertion. It seems that mop handle height adjustment between shoulder and chin level may be recommended as a basis for figure eight mopping. PMID:26423328

  10. Effects of mop handle height on shoulder muscle activity and perceived exertion during floor mopping using a figure eight method.

    PubMed

    Wallius, Mari-Anne; Rissanen, Saara M; Bragge, Timo; Vartiainen, Paavo; Karjalainen, Pasi A; Räsänen, Kimmo; Järvelin-Pasanen, Susanna

    2016-01-01

    The aim of this study was to investigate effects of mop handle height on electromyographic (EMG) activities of the shoulder muscles and perceived exertion for the shoulder area during floor mopping using a figure eight method. An experimental study with 13 cleaners was conducted using surface EMG and category ratio (CR-10) scale. EMG activity was recorded unilaterally from the upper trapezius, infraspinatus, anterior and middle deltoid muscles. Each subject performed four trials of mopping and each trial consisted of using a different mop handle height (mop adjustment at the level of shoulder, chin, nose and eye) in randomized order. EMG data were normalized to a percentage of maximal voluntary contraction (%MVC). The muscle activities were assessed by estimating the 10th, 50th and 90th percentiles of the amplitude probability distribution function (APDF) of the EMG signals and analysed by linear mixed model analysis. Results showed that shoulder muscle activity was significantly lower when the mop handle height was adjusted to shoulder level or chin level as compared to eye level. These findings were supported by subjective ratings of exertion. It seems that mop handle height adjustment between shoulder and chin level may be recommended as a basis for figure eight mopping. PMID:26423328

  11. Frozen shoulder--an algoneurodystrophic process?

    PubMed

    Müller, L P; Rittmeister, M; John, J; Happ, J; Kerschbaumer, F

    1998-12-01

    The frozen shoulder syndrome and the Sudeck syndrome are clinically in many aspects similar. Radioisotope bone scan shows an increased uptake in the affected areas in both diseases, while standard radiographs show a progressive demineralization. With measurement of bone-mineral density by quantitative digital radiography these local decalcification processes were diagnosed in an early stage of the frozen shoulder syndrome: of 12 patients with primary frozen shoulder 10 had a bone-mineral density decrease of more than 21% in the humeral head of the affected shoulder compared to the unaffected side. In the control groups (n = 32) the difference between affected and unaffected side (left and right humerus of the healthy probands) was in only one case each above 21%. There are several indications in the literature assuming the frozen shoulder to be an algoneurodystrophic process. Our observation supports this hypothesis, and may possibly lead to earlier diagnosis and improved therapeutic management. PMID:9922549

  12. Shoulder Ultrasonography: Performance and Common Findings

    PubMed Central

    Gaitini, Diana

    2012-01-01

    Ultrasound (US) of the shoulder is the most commonly requested examination in musculoskeletal US diagnosis. Sports injuries and degenerative and inflammatory processes are the main sources of shoulder pain and functional limitations. Because of its availability, low cost, dynamic examination process, absence of radiation exposure, and ease of patient compliance, US is the preferred mode for shoulder imaging over other, more sophisticated, and expensive methods. Operator dependence is the main disadvantage of US examinations. Use of high range equipment with high resolution transducers, adhering to a strict examination protocol, good knowledge of normal anatomy and pathological processes and an awareness of common pitfalls are essential for the optimal performance and interpretation of shoulder US. This article addresses examination techniques, the normal sonographic appearance of tendons, bursae and joints, and the main pathological conditions found in shoulder ultrasonography. PMID:22919552

  13. Dislocations and other topological oddities

    NASA Astrophysics Data System (ADS)

    Pieranski, Pawel

    2016-03-01

    We will show that the book Dislocations by Jacques Friedel, published half a century ago, can still be recommended, in agreement with the author's intention, as a textbook "for research students at University and for students at engineering schools as well as for research engineers". Indeed, today dislocations are known to occur not only in solid crystals but also in many other systems discovered more recently such as colloidal crystals or liquid crystals having periodic structures. Moreover, the concept of dislocations is an excellent starting point for lectures on topological defects occurring in systems equipped with order parameters resulting from broken symmetries: disclinations in nematic or hexatic liquid crystals, dispirations in chiral smectics or disorientations in lyotropic liquid crystals. The discussion of dislocations in Blue Phases will give us an opportunity to call on mind Sir Charles Frank, friend of Jacques Friedel since his Bristol years, who called these ephemeral mesophases "topological oddities". Being made of networks of disclinations, Blue Phases are similar to Twist Grain Boundary (TGB) smectic phases, which are made of networks of screw dislocations and whose existence was predicted by de Gennes in 1972 on the basis of the analogy between smectics and superconductors. We will stress that the book by Jacques Friedel contains seeds of this analogy.

  14. A hinged external fixator for complex elbow dislocations: A multicenter prospective cohort study

    PubMed Central

    2011-01-01

    Background Elbow dislocations can be classified as simple or complex. Simple dislocations are characterized by the absence of fractures, while complex dislocations are associated with fractures of the radial head, olecranon, or coronoid process. The majority of patients with these complex dislocations are treated with open reduction and internal fixation (ORIF), or arthroplasty in case of a non-reconstructable radial head fracture. If the elbow joint remains unstable after fracture fixation, a hinged elbow fixator can be applied. The fixator provides stability to the elbow joint, and allows for early mobilization. The latter may be important for preventing stiffness of the joint. The aim of this study is to determine the effect of early mobilization with a hinged external elbow fixator on clinical outcome in patients with complex elbow dislocations with residual instability following fracture fixation. Methods/Design The design of the study will be a multicenter prospective cohort study of 30 patients who have sustained a complex elbow dislocation and are treated with a hinged elbow fixator following fracture fixation because of residual instability. Early active motion exercises within the limits of pain will be started immediately after surgery under supervision of a physical therapist. Outcome will be evaluated at regular intervals over the subsequent 12 months. The primary outcome is the Quick Disabilities of the Arm, Shoulder, and Hand score. The secondary outcome measures are the Mayo Elbow Performance Index, Oxford Elbow Score, pain level at both sides, range of motion of the elbow joint at both sides, radiographic healing of the fractures and formation of periarticular ossifications, rate of secondary interventions and complications, and health-related quality of life (Short-Form 36). Discussion The outcome of this study will yield quantitative data on the functional outcome in patients with a complex elbow dislocation and who are treated with ORIF and

  15. Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation

    PubMed Central

    Joukainen, Antti; Kröger, Heikki; Niemitukia, Lea; Mäkelä, E. Antero; Väätäinen, Urho

    2014-01-01

    Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in

  16. Clavicle length, throwing performance and the reconstruction of the Homo erectus shoulder.

    PubMed

    Roach, Neil T; Richmond, Brian G

    2015-03-01

    Powerful, accurate throwing may have been an important mode of early hunting and defense. Previous work has shown that throwing performance is functionally linked to several anatomical shifts in the upper body that occurred during human evolution. The final shift to occur is the inferior reorientation of the shoulder. Fossil scapulae show the earliest evidence of a more inferior glenoid in Homo erectus. However, where the scapula rests on the thorax is uncertain. The relative length of the clavicle, the only skeletal attachment of the scapula to the torso, is quite variable. Depending on which fossils or skeletal measures are used to reconstruct the H. erectus shoulder, either a novel, anteriorly facing shoulder configuration or a modern human-like lateral orientation is possible. These competing hypotheses have led to very different conclusions regarding the throwing ability and hunting behavior of early Homo. Here, we evaluate competing models of H. erectus shoulder morphology and examine how these models relate to throwing performance. To address these questions, we collected skeletal measures from fossil and extant taxa, as well as anthropometric (N = 36) and kinematic (N = 27) data from Daasanach throwers from northwestern Kenya. Our data show that all H. erectus fossil clavicles fall within the normal range of modern human variation. We find that a commonly used metric for normalizing clavicle length, the claviculohumeral ratio, poorly predicts shoulder position on the torso. Furthermore, no significant relationship between clavicle length and any measure of throwing performance was found. These data support reconstructing the H. erectus shoulder as modern human-like, with a laterally facing glenoid, and suggest that the capacity for high speed throwing dates back nearly two million years. PMID:25439706

  17. Multiscale Theory of Dislocation Climb

    NASA Astrophysics Data System (ADS)

    Geslin, Pierre-Antoine; Appolaire, Benoît; Finel, Alphonse

    2015-12-01

    Dislocation climb is a ubiquitous mechanism playing a major role in the plastic deformation of crystals at high temperature. We propose a multiscale approach to model quantitatively this mechanism at mesoscopic length and time scales. First, we analyze climb at a nanoscopic scale and derive an analytical expression of the climb rate of a jogged dislocation. Next, we deduce from this expression the activation energy of the process, bringing valuable insights to experimental studies. Finally, we show how to rigorously upscale the climb rate to a mesoscopic phase-field model of dislocation climb. This upscaling procedure opens the way to large scale simulations where climb processes are quantitatively reproduced even though the mesoscopic length scale of the simulation is orders of magnitude larger than the atomic one.

  18. Multiscale Theory of Dislocation Climb.

    PubMed

    Geslin, Pierre-Antoine; Appolaire, Benoît; Finel, Alphonse

    2015-12-31

    Dislocation climb is a ubiquitous mechanism playing a major role in the plastic deformation of crystals at high temperature. We propose a multiscale approach to model quantitatively this mechanism at mesoscopic length and time scales. First, we analyze climb at a nanoscopic scale and derive an analytical expression of the climb rate of a jogged dislocation. Next, we deduce from this expression the activation energy of the process, bringing valuable insights to experimental studies. Finally, we show how to rigorously upscale the climb rate to a mesoscopic phase-field model of dislocation climb. This upscaling procedure opens the way to large scale simulations where climb processes are quantitatively reproduced even though the mesoscopic length scale of the simulation is orders of magnitude larger than the atomic one. PMID:26765003

  19. [Traumatic hip dislocation in childhood].

    PubMed

    Stachel, P; Hofmann-v Kap-herr, S; Schild, H

    1989-06-01

    The article reports on eight cases of traumatic dislocation of the hip in children. Six of these were genuine dislocations and two dislocation fractures. The children were between 5 and 13 years of age at the time of injury. Seven of these 8 children could be followed up one to 21 years after the accident. All 7 children were free from complaints at the time of follow-up examination; in one case only we found a moderate loss of function in the injured hip joint. In this patient the x-ray film showed deformation of the head of the femur after partial necrosis of the femoral head, as well as initial signs of coxarthrosis. Prognosis of this rare injury in children is favourable if repositioning is performed in time and if relief of the hip is effected for the proper period of time, depending on the individual case. PMID:2665382

  20. Incidence, Causes and Predictors of 30-Day Readmission After Shoulder Arthroplasty

    PubMed Central

    Westermann, Robert W; Anthony, Chris A.; Duchman, Kyle R.; Pugely, Andrew J.; Gao, Yubo; Hettrich, Carolyn M.

    2016-01-01

    Background The Center for Medicare and Medicaid Service has identified several quality metrics, including unplanned readmission within 30 days of surgery, to assess and compare surgeons and hospitals. The purpose of this study was to identify the incidence, causes and risk factors for unplanned 30-day readmission after total shoulder arthroplasty. Methods We identified patients undergoing primary elective shoulder arthroplasty performed at American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) participating hospitals in 2013. Cases were stratified by readmission status. Univariate and multivariate analyses were employed to assess patient demographics, comorbidities and operative variables predicting unplanned readmission. Results 2779 patients undergoing shoulder arthroplasty were identified, with 74 (2.66%) requiring unplanned readmissions within 30 days of surgery. The most common surgical causes for unplanned readmission were surgical site infections (18.6%), dislocations (16.3%) and venous thromboembolism (14.0%). Medical causes for readmission were responsible for 51% of unplanned readmissions. Multivariate analysis identified patient age >75 (OR 2.62, 95% CI: 1.27 - 5.41), and ASA class of 3 (OR 1.79, 95% CI: 1.01 - 3.18) or 4 (OR 3.63, 95% CI: 1.31 - 10.08) as independent risk factors for unplanned readmission. Predictive modeling estimated that patients with ASA class of 4 and age >75 are 17.4 times more likely (95% CI 1.77-171.09) to be readmitted within 30 days of shoulder arthroplasty. Conclusion Unplanned readmission after shoulder arthroplasty is infrequent and medical complications account for more than 50% of occurrences. The risk of readmission exponentially increases when age and preoperative comorbidity burden are increased. PMID:27528839

  1. [Isolated anterior cervical hypertrichosis].

    PubMed

    Monteagudo, B; Cabanillas, M; de las Heras, C; Cacharrón, J M

    2009-01-01

    Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding. PMID:19268113

  2. [Retrosternal luxation of the clavicle. Apropos of 4 cases surgically treated using a temporary screwed anterior plate and review of the literature].

    PubMed

    Asfazadourian, H; Kouvalchouk, J F

    1997-01-01

    The authors report 4 new cases of retrosternal dislocation of the clavicle operated by capsular and ligament restoration, and temporary stabilization by anterior plating. The 4 patients were men with a mean age of 17.5 years. The lesion was caused by a sports injury (football, rugby) in 3 out of 4 cases and was related to an indirect mechanism. Clinical examination allowed the diagnosis, was related to based on painful palpation of a dip over the joint, supported by radiology and computed tomography. CT did not reveal the epiphyseal separation present in two cases. Complications were frequent: 1 case of tracheal compression, 2 cases of temporary paresthesia of the upper limb, 2 cases of venous compression with one case of subclavian and medial jugularis venous thrombosis, 1 hemopneumothorax. Surgical reduction was performed in all 4 cases after 2 failures of attempted orthopedic treatment under general anesthesia. All patients recovered a full range of movement, a painless shoulder and no recurrence has been observed. All complications resolved after reduction. Venous thrombosis responded favourably after 6 months of anticoagulant therapy. One plate breakage was observed with no clinical implications. On the basis of an extensive review of the literature, the authors discuss the epidemiology, pathology and the importance of associated injuries, which are frequent and sometimes serious, justifying urgent reduction. Computed tomography is the most useful radiologic modality, both for diagnosis and for investigation of complications. Orthopedic treatment must be attempted first (especially in children) according to a well systematized technique. One third of attempts fail, and cases of delayed diagnosis and serious vascular complications, then require surgical treatment. The costoclavicular ligament is repaired either by Burrows's ligamentoplasty or by bone suture; the clavicle is stabilized by bone suture or by anterior plating. The authors do not advocate either

  3. Sideline Management of Joint Dislocations.

    PubMed

    Schupp, Christian M; Rand, Scott E; Hanson, Travis W; Lee, Bryan M; Jafarnia, Korsh; Jia, Yuhang; Moseley, J Bruce; Seaberg, John P; Seelhoefer, Gregory M

    2016-01-01

    Athletes can sustain a large variety of injuries from simple soft tissue sprains to complex fractures and joint dislocations. This article reviews and provides the most recent information for sports medicine professionals on the management of simple and complex joint dislocations, i.e., irreducible and/or associated with a fracture, from the sidelines without the benefit of imaging. For each joint, the relevant anatomy, common mechanisms, sideline assessment, reduction techniques, initial treatment, and potential complications will be discussed, which allow for the safe and prompt return of athletes to the field of play. PMID:27172077

  4. Observing implantable collamer lens dislocation by panoramic ultrasound biomicroscopy

    PubMed Central

    Shi, M; Kong, J; Li, X; Yan, Q; Zhang, J

    2015-01-01

    Purpose Observe the image characteristics and dislocation of implantable collamer lenses (ICL) following their use to correct high myopia. Methods A total of 127 patients (242 eyes); 64 females (50.3%) and 63 males (49.7%) were included in this retrospective study with ICL V4 implantation and mean spherical equivalent −9.08±2.04 diopters (D). Panoramic ultrasound biomicroscopy (UBM) was utilized to observe anterior segment morphology and ICL location at various follow-up periods (1 week preoperative, followed by 1, 3, 6, and yearly postoperative). Results Twenty-eight ICL eyes (11.2%) were noted to have abnormal postoperative positioning. The central vault of 12 eyes was too high with ICL decentration, mean central vault 1.14±0.39 mm; 10 eyes were too low but without ICL decentration, mean central vault 0.13±0.11 mm. The remaining subjects were only ICL decentration without abnormal central vault, mean central vault was 0.54±0.28 mm. Conclusions This study shows the abnormal characteristics regarding ICL locations. The ICL dislocation closely correlates with the central vault. The ICL dislocation is the primary cause of several postoperative complications. Panoramic UBM is one of the most effective imaging means to observe the ICL positioning and its stability after implantable surgery. PMID:25613840

  5. Anterior Herniation of Partially Calcified and Degenerated Cervical Disc Causing Dysphagia.

    PubMed

    Ozdol, Cagatay; Turk, Cezmi Cagri; Yildirim, Ali Erdem; Dalgic, Ali

    2015-08-01

    We report a rare case of anterior cervical disc herniation associated with dysphagia. A 32-year-old man presented with complaints of dysphagia and concomitant pain in the right arm resistant to conservative therapy. On physical examination with respect to the muscle strength, the right shoulder abduction and flexion of the forearm were 3/5. Lateral X-ray revealed calcified osteophytes at the anterior C4-5 level. Magnetic resonance imaging showed soft disc herniation involving the right C6 root at the C5-6 level and anterior herniation of the C4-5 cervical disc. Anterior discectomies for C4-5 and C5-6 levels stabilized and ameliorated the dysphagia and pain. Cervical disc herniation usually presents with radicular findings. However, dysphagia may be an uncommon presentation. Anterior cervical disc herniation should be considered in a patient presenting with dysphagia. PMID:26240723

  6. Current Trends in Management of Atlantoaxial Dislocation.

    PubMed

    Yin, Qing-shui; Wang, Jian-hua

    2015-08-01

    Atlantoaxial dislocation (AAD), often caused by trauma, tumors or congenital malformations, is a challenging disorder of the craniocervical junction. Because of its deep location and intricate anatomic structure, the craniocervical junction is always a difficult region for spine surgery. With recent developments in medical science, great progress has been made in the diagnosis and treatment of AAD such that more instructive clinical classifications and efficacious treatment strategies, various novel operation techniques including innovative posterior or transoral anterior reduction, and novel fixation instruments are now widely used in clinical practice for managing AAD. However, surgeons continue to face more special characteristics and difficulty in carrying out upper cervical surgery than they encounter in other regions of the spine. Consequently, this high risk surgery should only be performed by extremely skilled and experienced surgeons and only when stringent indications have been met. Therefore, the aim of this course is to assist surgeons who are dealing with AAD by providing comprehensive information about AAD, including related anatomy, classification, clinical manifestations and diagnosis, imaging examinations and surgical techniques, thus decreasing the occurrence of complications and improving the level of diagnosis and treatment. PMID:26311092

  7. Electromyographic Analysis of the Shoulder Girdle Musculature During External Rotation Exercises

    PubMed Central

    Alizadehkhaiyat, Omid; Hawkes, David H.; Kemp, Graham J.; Frostick, Simon P.

    2015-01-01

    Background: Implementation of overhead activity, a key component of many professional sports, requires an effective and balanced activation of the shoulder girdle muscles, particularly during forceful external rotation (ER) motions. Purpose: To identify activation strategies of 16 shoulder girdle muscles/muscle segments during common shoulder ER exercises. Study Design: Descriptive laboratory study. Method: Thirty healthy subjects were included in this study, and 16 shoulder girdle muscles/muscle segments were investigated (surface electrode: anterior, middle, and posterior deltoid; upper, middle, and lower trapezius; serratus anterior; teres major; upper and lower latissimus dorsi; and upper and lower pectoralis major; fine wire electrodes: supraspinatus, infraspinatus, subscapularis, and rhomboid major) using a telemetric electromyography (EMG) system. Five ER exercises (standing ER at 0° and 90° of abduction, with underarm towel roll, prone ER at 90° of abduction, side-lying ER with underarm towel) were studied. Exercise EMG amplitudes were normalized to EMG at maximum ER force in a standard position. Univariate analysis of variance and post hoc analysis applied on EMG activity of each muscle were used to assess the main effect of the exercise condition. Results: Muscular activity differed significantly among the ER exercises (P < .05 to P < .001). The greatest activation for anterior and middle deltoid, supraspinatus, upper trapezius, and serratus anterior occurred during standing ER at 90° of abduction; for posterior deltoid, middle trapezius, and rhomboid during side-lying ER with underarm towel; for lower trapezius, upper and lower latissimus dorsi, subscapularis, and teres major during prone ER at 90° of abduction; and for the clavicular and sternal part of the pectoralis major during standing ER with underarm towel. Conclusion: Key glenohumeral and scapular muscles can be optimally activated during specific ER exercises, particularly in positions that

  8. Design and evaluation of prosthetic shoulder controller

    PubMed Central

    Barton, Joseph E.; Sorkin, John D.

    2015-01-01

    We developed a 2-degree-of-freedom (DOF) shoulder position transducer (sensing shoulder protraction-retraction and elevation-depression) that can be used to control two of a powered prosthetic humerus' DOFs. We also developed an evaluation protocol based on Fitts' law to assess the performance of our device. The primary motivation for this work was to support development of powered prosthetic shoulder joints of a new generation of prosthetic arms for people with shoulder disarticulation and very high-level transhumeral amputation. We found that transducers that provided resistance to shoulder movement performed better than those providing no resistance. We also found that a position control scheme, where effector position is proportional to shoulder position, performed better than a velocity control scheme, where effector velocity is proportional to shoulder position. More generally, our transducer can be used to control motion along any two DOFs. It can also be used in a more general 4-DOF control scheme by sequentially controlling two DOFs at a time. The evaluation protocol has general applicability for researchers and practitioners. Researchers can employ it to compare different prosthesis designs and control schemes, while practitioners may find the evaluation protocol useful in evaluating and training people with amputation in the use of prostheses. PMID:25357185

  9. Shouldering the load, maximising value.

    PubMed

    Baillie, Jonathan

    2015-02-01

    In mid-November last year Ryhurst signed what it dubbed 'a ground-breaking strategic estates partnership' agreement with the Isle of Wight NHS Trust (HEJ - January 2015). Under the Wight Life Partnership, the two organisations will work in partnership 'to comprehensively review the estate across all the Trust's sites to ensure that buildings and grounds are being fully utilised, and suitable for modern healthcare'. This is Ryhurst's third such 'whole estate' joint-venture agreement with the NHS, and the first with a non-Foundation Trust, harnessing an approach that sees the company shoulder a considerable part of the burden of making optimum use of, and deriving 'maximum value' from, large healthcare estates. HEJ editor, Jonathan Baillie, reports. PMID:26268015

  10. Drift of dislocation tripoles under ultrasound influence.

    PubMed

    Murzaev, R T; Bachurin, D V; Nazarov, A A

    2016-01-01

    Numerical simulations of dynamics of different stable dislocation tripoles under influence of monochromatic standing sound wave were performed. The basic conditions necessary for the drift and mutual rearrangements between dislocation structures were investigated. The dependence of the drift velocity of the dislocation tripoles as a function of the frequency and amplitude of the external influence was obtained. The results of the work can be useful in analysis of motion and self-organization of dislocation structure under ultrasound influence. PMID:26278625

  11. Light scattering from dislocations in silicon

    NASA Astrophysics Data System (ADS)

    Monier, Vanessa; Capello, Luciana; Kononchuk, Oleg; Pichaud, Bernard

    2010-11-01

    Nondecorated glide dislocations in Czochralski grown silicon have been studied by laser scattering tomography technique. Dependence of intensity of scattered light on polarization of the incident light has been measured for different orientations of the dislocation line and Burgers vector. Detailed theory of light scattering by dislocation in silicon crystals is presented. It is shown that by combination of polarization and tomography measurements it is possible to determine slip system of nondecorated mixed dislocation in Si.

  12. Navigating the Alphabet Soup of Labroligamentous Pathology of the Shoulder.

    PubMed

    Fitzpatrick, Darren; Grubin, Jeremy

    2016-02-01

    Because of the widespread use of eponyms and acronyms to describe labroligamentous findings in the shoulder, interpreting shoulder magnetic resonance imaging reports can be challenging. A summary of the appearance of these lesions on shoulder magnetic resonance images can help the orthopedic surgeon to understand these entities as imaging findings and to determine the appropriate treatment for patients with shoulder injuries. PMID:26866313

  13. Nerve Transfers to Restore Shoulder Function.

    PubMed

    Leechavengvongs, Somsak; Malungpaishorpe, Kanchai; Uerpairojkit, Chairoj; Ng, Chye Yew; Witoonchart, Kiat

    2016-05-01

    The restoration of shoulder function after brachial plexus injury represents a significant challenge facing the peripheral nerve surgeons. This is owing to a combination of the complex biomechanics of the shoulder girdle, the multitude of muscles and nerves that could be potentially injured, and a limited number of donor options. In general, nerve transfer is favored over tendon transfer, because the biomechanics of the musculotendinous units are not altered. This article summarizes the surgical techniques and clinical results of nerve transfers for restoration of shoulder function. PMID:27094888

  14. 14 CFR 314.6 - Qualifying dislocation.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 14 Aeronautics and Space 4 2010-01-01 2010-01-01 false Qualifying dislocation. 314.6 Section 314.6 Aeronautics and Space OFFICE OF THE SECRETARY, DEPARTMENT OF TRANSPORTATION (AVIATION PROCEEDINGS) PROCEDURAL REGULATIONS EMPLOYEE PROTECTION PROGRAM General § 314.6 Qualifying dislocation. A qualifying dislocation is...

  15. Shoulder injuries in soccer goalkeepers: review and development of a FIFA 11+ shoulder injury prevention program

    PubMed Central

    Ejnisman, Benno; Barbosa, Gisele; Andreoli, Carlos V; de Castro Pochini, A; Lobo, Thiago; Zogaib, Rodrigo; Cohen, Moises; Bizzini, Mario; Dvorak, Jiri

    2016-01-01

    In the last years, shoulder injuries have represented an increasing health problem in soccer players. The goalkeepers are more exposed to shoulder disorders than other field players. Injury prevention exercises for upper limbs were cited in few studies involving throwing athletes, but we know that goalkeepers need a specific program. The purpose of this study is to describe the development of an adapted Fédération Internationale de Football Association (FIFA) 11+ program, namely the FIFA 11+ shoulder, which targets the prevention of shoulder injuries in soccer goalkeepers. The FIFA 11+ shoulder program is structured into three parts: general warming-up exercises, exercises to improve strength and balance of the shoulder, elbow, wrist, and finger muscles, and advanced exercises for core stability and muscle control. The exercises were selected based on recommendations from studies demonstrating high electromyographic activity. PMID:27563262

  16. Shoulder injuries in soccer goalkeepers: review and development of a FIFA 11+ shoulder injury prevention program.

    PubMed

    Ejnisman, Benno; Barbosa, Gisele; Andreoli, Carlos V; de Castro Pochini, A; Lobo, Thiago; Zogaib, Rodrigo; Cohen, Moises; Bizzini, Mario; Dvorak, Jiri

    2016-01-01

    In the last years, shoulder injuries have represented an increasing health problem in soccer players. The goalkeepers are more exposed to shoulder disorders than other field players. Injury prevention exercises for upper limbs were cited in few studies involving throwing athletes, but we know that goalkeepers need a specific program. The purpose of this study is to describe the development of an adapted Fédération Internationale de Football Association (FIFA) 11+ program, namely the FIFA 11+ shoulder, which targets the prevention of shoulder injuries in soccer goalkeepers. The FIFA 11+ shoulder program is structured into three parts: general warming-up exercises, exercises to improve strength and balance of the shoulder, elbow, wrist, and finger muscles, and advanced exercises for core stability and muscle control. The exercises were selected based on recommendations from studies demonstrating high electromyographic activity. PMID:27563262

  17. Hemiarthroplasty versus Total Shoulder Arthroplasty For Shoulder Osteoarthritis

    PubMed Central

    Sinatro, Alec; Liu, Joseph N.; Mahony, Gregory Thomas; Wu, Hao-Hua; Warren, Russell F.; Dines, David M.; Craig, Edward V.; Gulotta, Lawrence Vincent; Garcia, Grant

    2016-01-01

    Objectives: Return to activity is a commonly used indication for shoulder hemiarthroplasty (HA) in comparison to total shoulder arthroplasty (TSA). Despite clinical studies demonstrating better functional outcomes after TSA, the literature has failed to show a difference in return to sport. The purpose of this study was to compare rates of return to sports in a matched cohort of TSA and HA patients with a preoperative diagnosis of glenohumeral osteoarthritis (OA). Methods: A prospectively collected registry was queried retrospectively for consecutive patients who underwent HA. Inclusion criteria were preoperative diagnosis of OA and > 2 years of follow up. After inclusion criteria, all HA were statistically matched to a TSA patient by preoperative diagnosis, age (+/- 5 yrs), sex, and follow up period (+/- 6 months). At final follow up both cohorts completed a questionnaire regarding physical fitness and sporting activities. Results: 40 HA and 40 TSA were available at final follow up. Average age at surgery was 65.7 years for HA and 66.2 year for TSA (p=0.06). Average follow up was 62.0 months for HA and 61.1 months for TSA (p=0.52). Average ASES scores improved for HA from 36.3 to 70.2 (p<0.001) and for TSA they improved from 34.0 to 78.5 (p<0.001). Final ASES scores were not significantly different between groups (p=0.21). Average VAS scores improved for HA from 6.3 to 2.2 (p<0.001), while TSA improved from 6.1 to 0.6 (p<0.001). HA patients had significantly worse final VAS scores compared to the TSA group (p=0.002). 70% (28) of HA patients compared to 15% (6) of TSA patients complained of postoperative problems with their shoulder (p<0.001). Significantly more TSA were satisfied with their surgery (p=0.01). 65.5% (19/29) of HA patients returned to at least one sport postoperatively compared to 97.3% (36/37) of TSA patients (p<0.001). Average timing for return to full sports was 5.5±4.2 months for HA and 5.4±3.1 months for TSA (p=0.92). Significantly more TSA

  18. Does a SLAP lesion affect shoulder muscle recruitment as measured by EMG activity during a rugby tackle?

    PubMed Central

    2010-01-01

    Background The study objective was to assess the influence of a SLAP lesion on onset of EMG activity in shoulder muscles during a front on rugby football tackle within professional rugby players. Methods Mixed cross-sectional study evaluating between and within group differences in EMG onset times. Testing was carried out within the physiotherapy department of a university sports medicine clinic. The test group consisted of 7 players with clinically diagnosed SLAP lesions, later verified on arthroscopy. The reference group consisted of 15 uninjured and full time professional rugby players from within the same playing squad. Controlled tackles were performed against a tackle dummy. Onset of EMG activity was assessed from surface EMG of Pectorialis Major, Biceps Brachii, Latissimus Dorsi, Serratus Anterior and Infraspinatus muscles relative to time of impact. Analysis of differences in activation timing between muscles and limbs (injured versus non-injured side and non injured side versus matched reference group). Results Serratus Anterior was activated prior to all other muscles in all (P = 0.001-0.03) subjects. In the SLAP injured shoulder Biceps was activated later than in the non-injured side. Onset times of all muscles of the non-injured shoulder in the injured player were consistently earlier compared with the reference group. Whereas, within the injured shoulder, all muscle activation timings were later than in the reference group. Conclusions This study shows that in shoulders with a SLAP lesion there is a trend towards delay in activation time of Biceps and other muscles with the exception of an associated earlier onset of activation of Serratus anterior, possibly due to a coping strategy to protect glenohumeral stability and thoraco-scapular stability. This trend was not statistically significant in all cases PMID:20184752

  19. Superior labrum anterior to posterior tears in throwing athletes.

    PubMed

    Lintner, David M

    2013-01-01

    Superior labrum anterior to posterior (SLAP) tears and partial undersurface tears of the rotator cuff are common in experienced throwers, may be adaptive, and are only occasionally symptomatic. Pain in the shoulder of a throwing athlete with an MRI-documented SLAP tear or partial undersurface tear of the rotator cuff can be managed nonsurgically, with attention to posterior capsular contracture, scapular dyskinesia, and rotator cuff strength. The results of the surgical repair of SLAP lesions in the throwing athlete, with or without rotator cuff repair, are inferior to those of nonsurgical treatment. The cause of pain in the throwing athlete must be accurately diagnosed without reliance on MRI findings. PMID:23395053

  20. Interaction of <1 0 0> dislocation loops with dislocations studied by dislocation dynamics in α-iron

    NASA Astrophysics Data System (ADS)

    Shi, X. J.; Dupuy, L.; Devincre, B.; Terentyev, D.; Vincent, L.

    2015-05-01

    Interstitial dislocation loops with Burgers vector of <1 0 0> type are formed in α-iron under neutron or heavy ion irradiation. As the density and size of these loops increase with radiation dose and temperature, these defects are thought to play a key role in hardening and subsequent embrittlement of iron-based steels. The aim of the present work is to study the pinning strength of the loops on mobile dislocations. Prior to run massive Dislocation Dynamics (DD) simulations involving experimentally representative array of radiation defects and dislocations, the DD code and its parameterization are validated by comparing the individual loop-dislocation reactions with those obtained from direct atomistic Molecular Dynamics (MD) simulations. Several loop-dislocation reaction mechanisms are successfully reproduced as well as the values of the unpinning stress to detach mobile dislocations from the defects.

  1. Trunk and Shoulder Kinematic and Kinetic and Electromyographic Adaptations to Slope Increase during Motorized Treadmill Propulsion among Manual Wheelchair Users with a Spinal Cord Injury

    PubMed Central

    Champagne, Audrey

    2015-01-01

    The main objective was to quantify the effects of five different slopes on trunk and shoulder kinematics as well as shoulder kinetic and muscular demands during manual wheelchair (MWC) propulsion on a motorized treadmill. Eighteen participants with spinal cord injury propelled their MWC at a self-selected constant speed on a motorized treadmill set at different slopes (0°, 2.7°, 3.6°, 4.8°, and 7.1°). Trunk and upper limb movements were recorded with a motion analysis system. Net shoulder joint moments were computed with the forces applied to the handrims measured with an instrumented wheel. To quantify muscular demand, the electromyographic activity (EMG) of the pectoralis major (clavicular and sternal portions) and deltoid (anterior and posterior fibers) was recorded during the experimental tasks and normalized against maximum EMG values obtained during static contractions. Overall, forward trunk flexion and shoulder flexion increased as the slope became steeper, whereas shoulder flexion, adduction, and internal rotation moments along with the muscular demand also increased as the slope became steeper. The results confirm that forward trunk flexion and shoulder flexion movement amplitudes, along with shoulder mechanical and muscular demands, generally increase when the slope of the treadmill increases despite some similarities between the 2.7° to 3.6° and 3.6° to 4.8° slope increments. PMID:25793200

  2. The reverse shoulder prosthesis (Delta III) in acute shoulder fractures: technical considerations with respect to stability.

    PubMed

    Van Seymortier, Peter; Stoffelen, Daniel; Fortems, Yves; Reynders, Piet

    2006-08-01

    The reverse shoulder prosthesis reverses the relationship between the scapular and humeral component, resulting in a mechanical advantage as the deltoid muscle is able to compensate for the rotator cuff deficiency. Based on this mechanical advantage, the reverse shoulder prosthesis has become an accepted alternative for the treatment of complex proximal humeral fractures. The purpose of this article is to discuss technical considerations related to stability in the use of the reverse shoulder prosthesis in acute shoulder fractures, based on clinical experience. PMID:17009830

  3. Cervical facet dislocation adjacent to the fused motion segment

    PubMed Central

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation. PMID:26933361

  4. Cervical facet dislocation adjacent to the fused motion segment.

    PubMed

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kuroiwa, Toshihiko

    2016-01-01

    This study reports on a case that forces re-examination of merits and demerits of anterior cervical fusion. A 79-year-old male was brought to the emergency room (ER) of our hospital after he fell and struck the occipital region of his head following excessive alcohol consumption. Four years prior, he had undergone anterior cervical discectomy and fusion of C5/6 and a magnetic resonance imaging (MRI) performed 3 years after this surgery indicated that he was suffering from degeneration of C6/7 intervertebral discs. After arriving at the ER, he presented motor impairment at level C7 and lower of manual muscle testing grade 1 as well as moderate loss of physical sensation from the trunk and peripheries of both upper limbs to the peripheries of both lower limbs (Frankel B). Cervical computed tomography (CT) indicated anterior dislocation of C6/7, and MRI indicated severe spinal cord edema. We performed manipulative reduction of C6/7 with the patient under general anesthesia. Next, we performed laminectomy on C5-T1 and posterior fusion on C6/7. Postoperative CT indicated that cervical alignment had improved, and MRI indicated that the spinal cord edema observed prior to surgery had been mitigated. Three months after surgery, motor function and sensory impairment of the lower limbs had improved, and the patient was ambulatory upon discharge from the hospital (Frankel D). In the present case, although C5 and 6 were rigidly fused, degeneration of the C6/7 intervertebral disc occurred and stability was compromised. As a result, even slight trauma placed a severe dynamic burden on the facet joint of C6/7, which led to dislocation. PMID:26933361

  5. Scapular and rotator cuff muscle activity during arm elevation: A review of normal function and alterations with shoulder impingement

    PubMed Central

    Phadke, V; Camargo, PR; Ludewig, PM

    2009-01-01

    Objective The purpose of this manuscript is to review current knowledge of how muscle activation and force production contribute to shoulder kinematics in healthy subjects and persons with shoulder impingement. Results The middle and lower serratus anterior muscles produce scapular upward rotation, posterior tilting, and external rotation. Upper trapezius produces clavicular elevation and retraction. The middle trapezius is primarily a medial stabilizer of the scapula. The lower trapezius assists in medial stabilization and upward rotation of the scapula. The pectoralis minor is aligned to resist normal rotations of the scapula during arm elevation. The rotator cuff is critical to stabilization and prevention of excess superior translation of the humeral head, as well as production of glenohumeral external rotation during arm elevation. Alterations in activation amplitude or timing have been identified across various investigations of subjects with shoulder impingement as compared to healthy controls. These include decreased activation of the middle or lower serratus anterior and rotator cuff, delayed activation of middle and lower trapezius, and increased activation of the upper trapezius and middle deltoid in impingement subjects. In addition, subjects with a short resting length of the pectoralis minor exhibit altered scapular kinematic patterns similar to those found in persons with shoulder impingement. Conclusion These normal muscle functional capabilities and alterations in patient populations should be considered when planning exercise approaches for the rehabilitation of these patients. PMID:20411160

  6. Rehabilitation of the shoulder in tennis players.

    PubMed

    Plancher, K D; Litchfield, R; Hawkins, R J

    1995-01-01

    The tennis player places unique demands on the shoulder by creating a high risk for overuse and overloading of the soft tissues. Tennis requires concentric work to position and move the arm, eccentric work to stabilize the shoulder, effective depression of the humeral head to avoid impingement in the overhead position, and normal stability to prevent secondary impingement. The tennis serve produces enormous angular velocities about the shoulder joint. A comprehensive rehabilitation program has been described in which the therapist, trainer, player, and physician alike need to have an understanding of the basic biomechanics of this sport. This program can be used to treat the painful shoulder, prevent injury, and enhance performance. PMID:7712546

  7. 14 CFR 91.521 - Shoulder harness.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... inertia load factors established under the certification basis of the airplane. (b) No person may operate... used; and (2) Safety belt and shoulder harness restraint systems may be designed to the inertia...

  8. 14 CFR 91.521 - Shoulder harness.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... inertia load factors established under the certification basis of the airplane. (b) No person may operate... used; and (2) Safety belt and shoulder harness restraint systems may be designed to the inertia...

  9. 14 CFR 91.521 - Shoulder harness.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... inertia load factors established under the certification basis of the airplane. (b) No person may operate... used; and (2) Safety belt and shoulder harness restraint systems may be designed to the inertia...

  10. 14 CFR 91.521 - Shoulder harness.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... inertia load factors established under the certification basis of the airplane. (b) No person may operate... used; and (2) Safety belt and shoulder harness restraint systems may be designed to the inertia...

  11. 14 CFR 91.521 - Shoulder harness.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... inertia load factors established under the certification basis of the airplane. (b) No person may operate... used; and (2) Safety belt and shoulder harness restraint systems may be designed to the inertia...

  12. Nonfatal air embolism during shoulder arthroscopy.

    PubMed

    Pandey, Vivek; Varghese, Elsa; Rao, Madhu; Srinivasan, Nataraj M; Mathew, Neethu; Acharya, Kiran K V; Rao, P Sripathi

    2013-06-01

    An air embolism is a rare but potentially fatal complication of shoulder arthroscopy. In this article, we report the case of a patient who developed a nonfatal air embolism during shoulder arthroscopy for an acute bony Bankart lesion and a greater tuberosity avulsion fracture. The venous air embolism occurred immediately after the joint was insufflated with air for diagnostic air arthroscopy. The diagnosis was based on a drop in end-tidal carbon dioxide and blood pressure and presence of mill wheel (waterwheel) murmur over the right heart. Supportive treatment was initiated immediately. The patient recovered fully and had no further complications of air embolism. This patient's case emphasizes the importance of being aware that air embolisms can occur during shoulder arthroscopy performed for acute intra-articular fractures of the shoulder. Monitoring end tidal carbon dioxide can be very useful in early detection of air embolisms. PMID:23805421

  13. Anaesthetic management of shoulder arthroscopic repair in Parkinson's disease with deep brain stimulator

    PubMed Central

    Gandhi, Ranju; Chawla, Reeta

    2014-01-01

    We describe the anaesthetic management of arthroscopic repair for complete rotator cuff tear of shoulder in a 59-year-old female with Parkinson's disease (PD) with deep brain stimulator (DBS) using a combination of general anaesthesia with interscalene approach to brachial plexus block. The DBS consists of implanted electrodes in the brain connected to the implantable pulse generator (IPG) normally placed in the anterior chest wall subcutaneously. It can be programmed externally from a hand-held device placed directly over the battery stimulator unit. In our patient, IPG with its leads was located in close vicinity of the operative site with potential for DBS malfunction. Implications of DBS in a patient with PD for shoulder arthroscopy for anaesthesiologist are discussed along with a brief review of DBS. PMID:25024475

  14. Judo-related traumatic posterior sternoclavicular joint dislocation in a child.

    PubMed

    Galanis, Nikiforos; Anastasiadis, Prodromos; Grigoropoulou, Foteini; Kirkos, John; Kapetanos, George

    2014-05-01

    Judo is a combat sport with high risk of injury. We present a rare case of traumatic left posterior sternoclavicular (SC) joint dislocation, inflicted to a 12-year-old boy during a judo contest. An extensive literature review did not reveal any case of posterior SC joint dislocation in judo. The patient was treated with closed reduction under general anesthesia. At 2-year follow-up, his left upper extremity had full range of motion, and he did not complain of any residual symptoms. He decided to discontinue judo training; however, he participates in other physically demanding sports. Although not often encountered, posterior SC joint dislocation is a challenging and critical medical problem that can be fatal if not promptly diagnosed and treated on time and should be considered in the differential diagnosis of trauma-related anterior chest pain. PMID:24172655

  15. Throwing, the Shoulder, and Human Evolution.

    PubMed

    Kuhn, John E

    2016-01-01

    Throwing with accuracy and speed is a skill unique to humans. Throwing has many advantages and the ability to throw has likely been promoted through natural selection in the evolution of humans. There are many unsolved questions regarding the anatomy of the human shoulder. The purpose of this article is to review many of these mysteries and propose that the answer to these questions can be understood if one views the shoulder as a joint that has evolved to throw. PMID:26991561

  16. Shoulder ultrasound: What you need to know

    PubMed Central

    Singh, Jatinder Pal

    2012-01-01

    Shoulder ultrasound is consistently used in the assessment of rotator cuff and is as accurate as magnetic resonance imaging in the detection of rotator cuff tear. It can be used as a focused examination providing rapid, real-time diagnosis, and treatment in desired clinical situations. This article presents a simplified approach to scanning and image-guided intervention, and discusses common sonographically apparent shoulder pathologies. PMID:23833420

  17. Severe refractory hypertension during shoulder arthroscopy

    PubMed Central

    Abrons, RO; Ellis, SE

    2016-01-01

    The use of epinephrine-containing saline irrigating solutions during arthroscopic shoulder surgery gained popularity after it was reported that the addition of epinephrine reduced bleeding and improved visualization without adverse cardiovascular effects. We share a case of a patient undergoing shoulder arthroscopy who received a standard intra-articular infusion of epinephrine-containing normal saline (1 mcg/mL) and experienced severe hemodynamic consequences. PMID:27051380

  18. THROMBOEMBOLIC COMPLICATION AFTER ARTHROSCOPIC SHOULDER SURGERY

    PubMed Central

    Dal Molin, Fabio Farina; Dal Molin, Siluê Franzoni

    2015-01-01

    Although thromboembolic phenomena are frequent complications in lower-limb surgery, there are only two cases of pulmonary thromboembolism following shoulder arthroscopy in the literature. We describe the case of a 76-year-old patient with pulmonary embolism in both lungs after shoulder arthroscopy. No vascular abnormalities were found and no origin for the thrombus was detected. The exact cause of the thromboembolism remains unknown. PMID:27022559

  19. Solute drag on perfect and extended dislocations

    NASA Astrophysics Data System (ADS)

    Sills, R. B.; Cai, W.

    2016-04-01

    The drag force exerted on a moving dislocation by a field of mobile solutes is studied in the steady state. The drag force is numerically calculated as a function of the dislocation velocity for both perfect and extended dislocations. The sensitivity of the non-dimensionalized force-velocity curve to the various controlling parameters is assessed, and an approximate analytical force-velocity expression is given. A non-dimensional parameter S characterizing the strength of the solute-dislocation interaction, the background solute fraction ?, and the dislocation character angle ?, are found to have the strongest influence on the force-velocity curve. Within the model considered here, a perfect screw dislocation experiences no solute drag, but an extended screw dislocation experiences a non-zero drag force that is about 10 to 30% of the drag on an extended edge dislocation. The solutes can change the spacing between the Shockley partials in both stationary and moving extended dislocations, even when the stacking fault energy remains unaltered. Under certain conditions, the solutes destabilize an extended dislocation by either collapsing it into a perfect dislocation or causing the partials to separate unboundedly. It is proposed that the latter instability may lead to the formation of large faulted areas and deformation twins in low stacking fault energy materials containing solutes, consistent with experimental observations of copper and stainless steel containing hydrogen.

  20. Successful osteosynthesis of an unstable mesoacromion in 6 shoulders: a new technique.

    PubMed

    Satterlee, C C

    1999-01-01

    Six patients with impingement syndrome associated with an unstable mesoacromion underwent successful acromial fusion performed with a new technique. Preoperative symptoms included pain from a combination of 3 sources: movement at the mesoacromial cleft, junction of the medial cleft with the distal clavicle, and dynamic impingement of the unstable anterior acromion on the underlying rotator cuff. Two patients reported the onset of pain after a blow to the top of the acromion that supposedly rendered the mesoacromion unstable. Three patients had a tear of the supraspinatus tendon. The operative technique utilized 4.5-mm cannulated Herbert screws for fixation, a dorsal wedge osteotomy of the nonunion site, a dorsal bone graft fashioned from an anterior acromion cut, a figure-of-eight suture, and a postoperative abduction brace. Tilting the anterior acromial fragment up and fusing it together worked to relieve impingement. An acromioplasty was not performed. The 3 rotator cuff tears were repaired. After 3 to 6 years of follow-up, all 6 shoulders were rated as excellent according to criteria similar to that of the American Shoulder and Elbow Surgeons. PMID:10226963

  1. Discrete dislocation dynamics simulations in a cylinder

    NASA Astrophysics Data System (ADS)

    Li, Maosheng; Gao, Chan; Xu, Jianing

    2015-02-01

    Mechanical properties of material are closely related to the motion of dislocations, and predicting the interactions and resulting collective motion of dislocations is a major task in understanding and modelling plastically deforming materials. A discrete dislocation dynamics model is used to describe the orientation substructure within the microstructure. Discrete dislocation dynamics simulations in three dimensions have been used to examine the role of dislocation multiplication and mobility on the plasticity in small samples under uniaxial compression. In this paper we describe the application of the dislocation dynamics simulations in a cylindrical geometry. The boundary conditions for the simulation were estimated from the distribution of the geometrically necessary dislocation density which was obtained from the orientation map. Numerical studies benchmark could validate the accuracy of the algorithms and the importance of handling the singularity correctly. The results of the simulation explain the formation of the experimentally observed substructure.

  2. Dislocation boundaries and active slip systems

    SciTech Connect

    Wert, J.A.; Hansen, N.

    1995-11-01

    Part of the dislocations which have participated in the plastic deformation of a polycrystalline metal are stored in dislocation boundaries in a two- or three-dimensional arrangement. The dislocation in such boundaries can be analyzed by determining the misorientation between neighboring crystallites and the boundary orientation. Information about the dislocations in the boundaries can also be obtained by an analysis of active slip systems based on the crystallite orientation and the imposed stress or strain state in combination with appropriate constraint conditions. In the present paper an analysis of the boundary dislocation structure and of the slip systems has been conducted for pure aluminium cold-rolled to a von Mises strain of 0.41. The results show that a substantial majority of dislocations in different types of dislocation boundaries are from the primary and conjugate slip system in the adjoining crystallites. A basis is therefore provided for integrating deformation structure observations with plastic deformation behavior.

  3. Theory of interacting dislocations on cylinders

    NASA Astrophysics Data System (ADS)

    Amir, Ariel; Paulose, Jayson; Nelson, David R.

    2013-04-01

    We study the mechanics and statistical physics of dislocations interacting on cylinders, motivated by the elongation of rod-shaped bacterial cell walls and cylindrical assemblies of colloidal particles subject to external stresses. The interaction energy and forces between dislocations are solved analytically, and analyzed asymptotically. The results of continuum elastic theory agree well with numerical simulations on finite lattices even for relatively small systems. Isolated dislocations on a cylinder act like grain boundaries. With colloidal crystals in mind, we show that saddle points are created by a Peach-Koehler force on the dislocations in the circumferential direction, causing dislocation pairs to unbind. The thermal nucleation rate of dislocation unbinding is calculated, for an arbitrary mobility tensor and external stress, including the case of a twist-induced Peach-Koehler force along the cylinder axis. Surprisingly rich phenomena arise for dislocations on cylinders, despite their vanishing Gaussian curvature.

  4. Scapular Contribution for the End-Range of Shoulder Axial Rotation in Overhead Athletes

    PubMed Central

    Ribeiro, Andrea; Pascoal, Augusto Gil

    2012-01-01

    The aim of this study was to analyze the relative contribution of the scapular motion on the extreme range-of-motion of shoulder external and internal rotation, in overhead athletes. An electromagnetic tracking device (Flock of Birds) was used to record humeral and scapular kinematics. The dominant arm of 26 male subjects (13 athletes and 13 non-athletes) was studied while subjects actively reached end-range of internal and external rotation. Humeral and scapular angles were calculated and compared across groups by means of a t-test for independent samples. A bivariate correlation approach was used to describe the relationship between humeral angles and scapular variables. The range-of-motion of the thoracohumeral angles, during shoulder external rotation was significantly less (p < 0.05) on the athletes group, athletes also positioned their dominant scapula more retracted and posteriorly tilted. A positive correlation was found between glenohumeral angles and scapular tilt (r = 0.6777; p < 0.05). Concerning internal rotation; athletes showed significantly greater (highest) thoracohumeral angles (p < 0.05). Scapula assumed a position more in retraction and anterior tilt. Based on these findings, it is suggested that differences found in athletes seem to reveal an eventual shoulder adaptation to the throwing mechanics. Key points In external rotation end-range, athletes positioned their scapula more in retraction and posterior tilt. In internal rotation end-range, athletes positioned their scapula more in retraction and anterior tilt. Results seem to reveal a sport-related shoulder adaptation. PMID:24150078

  5. The centre of rotation of the shoulder complex and the effect of normalisation.

    PubMed

    Amabile, Celia; Bull, Anthony M J; Kedgley, Angela E

    2016-06-14

    Shoulder motions consist of a composite movement of three joints and one pseudo-joint, which together dictate the humerothoracic motion. The purpose of this work was to quantify the location of the centre of rotation (CoR) of the shoulder complex as a whole. Dynamic motion of 12 participants was recorded using optical motion tracking during coronal, scapular and sagittal plane elevation. The instantaneous CoR was found for each angle of elevation using helical axes projected onto the three planes of motion. The location of an average CoR for each plane was evaluated using digitised and anthropometric measures for normalisation. When conducting motion in the coronal, scapular, and sagittal planes, respectively, the coefficients for locating the CoRs of the shoulder complex are -61%, -61%, and -65% of the anterior-posterior dimension - the vector between the midpoint of the incisura jugularis and the xiphoid process and the midpoint of the seventh cervical vertebra and the eighth thoracic vertebra; 0%, -1%, and -2% of the superior-inferior dimension - the vector between the midpoint of the acromioclavicular joints and the midpoint of the anterior superior iliac spines; and 57%, 57%, and 78% of the medial-lateral dimension -0.129 times the height of the participant. Knowing the location of the CoR of the shoulder complex as a whole enables improved participant positioning for evaluation and rehabilitation activities that involve movement of the hand with a fixed radius, such as those that employ isokinetic dynamometers. PMID:27048984

  6. Capsule repair may reduce dislocation following hip hemiarthroplasty through a direct lateral approach: a cadaver study.

    PubMed

    Hughes, A W; Clark, D; Carlino, W; Gosling, O; Spencer, R F

    2015-01-01

    Reported rates of dislocation in hip hemiarthroplasty (HA) for the treatment of intra-capsular fractures of the hip, range between 1% and 10%. HA is frequently performed through a direct lateral surgical approach. The aim of this study is to determine the contribution of the anterior capsule to the stability of a cemented HA through a direct lateral approach. A total of five whole-body cadavers were thawed at room temperature, providing ten hip joints for investigation. A Thompson HA was cemented in place via a direct lateral approach. The cadavers were then positioned supine, both knee joints were disarticulated and a digital torque wrench was attached to the femur using a circular frame with three half pins. The wrench applied an external rotation force with the hip in extension to allow the hip to dislocate anteriorly. Each hip was dislocated twice; once with a capsular repair and once without repairing the capsule. Stratified sampling ensured the order in which this was performed was alternated for the paired hips on each cadaver. Comparing peak torque force in hips with the capsule repaired and peak torque force in hips without repair of the capsule, revealed a significant difference between the 'capsule repaired' (mean 22.96 Nm, standard deviation (sd) 4.61) and the 'capsule not repaired' group (mean 5.6 Nm, sd 2.81) (p < 0.001). Capsular repair may help reduce the risk of hip dislocation following HA. PMID:25568428

  7. Superior Dislocation of the Patella in a Young Woman without Osteophytes: A Case Report.

    PubMed

    Kataoka, Tatsunori; Iizawa, Norishige; Takai, Shinro

    2016-01-01

    Superior dislocation of the patella without patellar ligament injury is an extremely rare condition. A review of the English-language literature found only 23 reported cases. In addition, the primary factor for dislocation in most of these cases was considered to be osteophytes in the inferior pole of the patella and the anterior surface of the femoral condyle; only 1 case had no osteophytes. We treated a 19-year-old woman who sustained a painful locking of the left knee after colliding with a friend. Plain radiography and computed tomography showed superior-lateral dislocation of the patella and an interlocking between notches in the inferior pole of the patella and the anterior surface of the femoral condyle. Closed reduction without sedation was performed without difficulty, and the patient was able to walk home without pain. After 1 week, the knee was without problems. The patient had no osteophytes in the knee and had no other common risk factors, such as patella alta, ligamentous laxity, genu recurvatum, and paralytic disorders. After a comparison with previously reported cases of superior patella dislocation, we concluded that the primary factor in the present case might have been a different condition. PMID:26960585

  8. Normal shoulder muscular activation and co-ordination during a shoulder elevation task based on activities of daily living: an electromyographic study.

    PubMed

    Hawkes, David H; Alizadehkhaiyat, Omid; Fisher, Anthony C; Kemp, Graham J; Roebuck, Margaret M; Frostick, Simon P

    2012-01-01

    Studies of normal shoulder function have often failed to consider the inter-relationship between different muscle groups in activities relevant to daily life. Upper limb functional status was assessed in 12 healthy male volunteers using the Functional Impairment Test-Hand, Neck, Shoulder and Arm test (FIT-HaNSA). Electromyography was then used to study the activity and coordination of 13 muscles (10 by surface electrodes, 3 by fine-wire intramuscular electrodes) around the shoulder during a dynamic movement task based on the shelf-lifting task in FIT-HaNSA. Muscles were grouped for analysis into deltoid (anterior, middle, and posterior divisions), adductors (latissimus dorsi and teres major), rotator cuff (supraspinatus, infraspinatus, and subscapularis), and elbow flexor (brachioradialis, biceps brachii) groups. There were no significant inter-session effects. Using cross-correlation analysis to investigate the whole time-course of activation, there were highly significant positive correlations (p < 0.001) between the deltoid and rotator cuff, the deltoid and adductor and the adductor and rotator cuff groups, and a significant negative correlation between the deltoid and elbow flexor groups (p = 0.031). We conclude that the deltoid, adductor, and rotator cuff muscles all contribute to the muscular component of glenohumeral joint stability. Muscular stability can be adapted as required to meet task-specific demands. PMID:21674607

  9. Shoulder muscle recruitment patterns and related biomechanics during upper extremity sports.

    PubMed

    Escamilla, Rafael F; Andrews, James R

    2009-01-01

    Understanding when and how much shoulder muscles are active during upper extremity sports is helpful to physicians, therapists, trainers and coaches in providing appropriate treatment, training and rehabilitation protocols to these athletes. This review focuses on shoulder muscle activity (rotator cuff, deltoids, pectoralis major, latissimus dorsi, triceps and biceps brachii, and scapular muscles) during the baseball pitch, the American football throw, the windmill softball pitch, the volleyball serve and spike, the tennis serve and volley, baseball hitting, and the golf swing. Because shoulder electromyography (EMG) data are far more extensive for overhead throwing activities compared with non-throwing upper extremity sports, much of this review focuses on shoulder EMG during the overhead throwing motion. Throughout this review shoulder kinematic and kinetic data (when available) are integrated with shoulder EMG data to help better understand why certain muscles are active during different phases of an activity, what type of muscle action (eccentric or concentric) occurs, and to provide insight into the shoulder injury mechanism. Kinematic, kinetic and EMG data have been reported extensively during overhead throwing, such as baseball pitching and football passing. Because shoulder forces, torques and muscle activity are generally greatest during the arm cocking and arm deceleration phases of overhead throwing, it is believed that most shoulder injuries occur during these phases. During overhead throwing, high rotator cuff muscle activity is generated to help resist the high shoulder distractive forces approximately 80-120% bodyweight during the arm cocking and deceleration phases. During arm cocking, peak rotator cuff activity is 49-99% of a maximum voluntary isometric contraction (MVIC) in baseball pitching and 41-67% MVIC in football throwing. During arm deceleration, peak rotator cuff activity is 37-84% MVIC in baseball pitching and 86-95% MVIC in football

  10. Cerec anterior crowns: restorative options with monolithic ceramic materials.

    PubMed

    Reich, Sven; Fiedlar, Kurt

    2013-01-01

    The aim of this article is to discuss the different types of monolithic ceramic crowns that can be placed on anterior teeth with existing shoulder preparations. Anterior crowns were indicated for the teeth 12 to 22 in the present case. The patient, a 65-year-old male, had received all-ceramic crowns 20 years earlier, which had started to develop cracks and palatal fractures over the last few years. The patient's teeth were prepared and four sets of crowns were fabricated using different monolithic ceramic materials: IPS e.max CAD, Cerec Blocs C In, VITABLOCS Real Life, and ENAMIC. Both shade characterization and crystallization firing were performed on the monolithic lithium disilicate glass ceramic crowns. The silicate ceramic crowns received glaze firing alone. The crowns made of hybrid ceramic (ENAMIC) were treated with a polymer sealant. PMID:24555406

  11. Surface Electromygraphic Analysis of the Lower Trapezius Muscle During Exercises Performed Below Ninety Degrees of Shoulder Elevation in Healthy Subjects

    PubMed Central

    Orishimo, Karl F.; McHugh, Malachy P.; Nicholas, Stephen J.

    2007-01-01

    Background The lower trapezius is an important muscle for normal arthrokinematics of the scapula. In the early stages of rehabilitation, it is generally accepted to perform exercises with the shoulder kept below 90° of elevation in order to minimize risk for shoulder impingement. Few exercises for the lower trapezius have been studied which maintain the shoulder below 90° of humeral elevation. Objective To identify therapeutic exercises performed below 90° of humeral elevation that activate marked levels of lower trapezius electromyographic (EMG) activity. Methods Surface EMG activity of the lower, middle, upper trapezius, and serratus anterior was collected bilaterally on fifteen healthy subjects during four exercises: the press-up, unilateral scapular retraction with the shoulder positioned at 80° of shoulder flexion, bilateral shoulder external rotation, and unilateral scapular depression. Results The press-up exercise elicited marked lower trapezius EMG activity, moderate upper trapezius EMG activity, and a high ratio of lower trapezius to upper trapezius EMG activity. Scapular retraction produced marked EMG activity of both the lower and upper trapezius and moderate activity of the middle trapezius. Bilateral shoulder external rotation generated moderate lower trapezius EMG activity, minimal upper trapezius activity, and the highest ratio of lower trapezius to upper trapezius EMG activity. Scapular depression produced moderate lower trapezius EMG activity, mimimal upper trapezius EMG activity, and a moderately high ratio of lower trapezius to upper trapezius EMG activity. Discussion and Conclusions This study identified two exercises performed below 90° of humeral elevation that markedly activated the lower trapezius: the press-up and scapular retraction. PMID:21522201

  12. Congenital anterior urethral diverticulum.

    PubMed

    Singh, Sanjeet Kumar; Ansari, Ms

    2014-09-01

    Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair. PMID:26328174

  13. Dislocation creep of dry quartz

    NASA Astrophysics Data System (ADS)

    Kilian, Rüdiger; Heilbronner, Renée.; Holyoke, Caleb W.; Kronenberg, Andreas K.; Stünitz, Holger

    2016-05-01

    Small-scale shear zones within the Permian Truzzo meta-granite developed during the Alpine orogeny at amphibolite facies conditions. In these shear zones magmatic quartz deformed by dislocation creep and recrystallized dynamically by grain boundary migration with minor subgrain rotation recrystallization to a grain size of around 250-750 µm, consistent with flow at low differential stresses. Fourier transform infrared (FTIR) spectroscopy reveals very low water contents in the interior of recrystallized grains (in the form of discrete OH peaks, ~20 H/106Si and very little broad band absorption, <100 H/106Si). The spectral characteristics are comparable to those of dry Brazil quartz. In FTIR spectra, magmatic quartz grains show a broad absorption band related with high water concentrations only in those areas where fluid inclusions are present while other areas are dry. Drainage of fluid inclusions and synkinematic growth of hydrous minerals indicates that a hydrous fluid has been available during deformation. Loss of intragranular water during grain boundary migration recrystallization did not result in a microstructure indicative of hardening. These FTIR measurements provide the first evidence that quartz with extremely low intragranular water contents can deform in nature by dislocation creep at low differential stresses. Low intragranular water contents in naturally deformed quartz may not be necessarily indicative of a high strength, and the results are contrary to implications taken from deformation experiments where very high water contents are required to allow dislocation creep in quartz. It is suggested that dislocation creep of quartz in the Truzzo meta-granite is possible to occur at low differential stresses because sufficient amounts of intergranular water ensure a high recovery rate by grain boundary migration while the absence of significant amounts of intragranular water is not crucial at natural conditions.

  14. Shoulder-to-Shoulder Research "with" Children: Methodological and Ethical Considerations

    ERIC Educational Resources Information Center

    Griffin, Krista M.; Lahman, Maria K. E.; Opitz, Michael F.

    2016-01-01

    This paper presents a methodological study with children where two different interview methods were utilized: the "walk-around" (a form of mobile interview) and the "shoulder-to-shoulder." The paper reviews the methodological aspects of the study then provides a brief review of the history of methods employed in research with…

  15. Misfit dislocation nucleation in heteroepitaxy

    NASA Astrophysics Data System (ADS)

    Trushin, Oleg; Ying, See Chen; Granato, Enzo; Ala-Nissila, Tapio

    2001-03-01

    We have studied atomic mechanisms of misfit dislocation nucleation in heteroepitaxy with semiempirical potentials. Many-body mechanisms of stress relaxation are systematically investigated with Lennard-Jones potential in 2D and 3D cases. Energy barriers for dislocation nucleation are estimated using modern methods for saddle point search (Nudged Elastic Band [1], Eigenvector Following [2] and others). Moreover, new simple and effective method for transition paths searching is proposed. Based on the data the critical thickness of film is estimated as a function of film-substrate lattice misfit. Moreover, to make the study more realistic we used EAM [3] potentials in simulations of Pd/Cu and Cu/Pd systems. We show that the dislocations nucleate more easily in compressive than tensile strained films, and in fcc(111) orientation rather than in fcc(100). These findings are in agreement with recent experimental and theoretical works. 1. H. Jonsson, G. Mills and K. W. Jacobsen, in Classical and Quantum Dynamics in Condensed Phase Simulations, ed. by B. J. Berne, G. Ciccotti, and D. F. Coker (World Scientific, Singapore, 1998). 2. L. J. Munro and D. J. Wales, Phys. Rev. B v59, 3969 (1999), and references therein. 3. S. M. Foiles, M. I. Baskes, and M. S. Daw, Phys. Rev. B v33, 7983 (1986).

  16. Visualization of dislocation dynamics in colloidal crystals.

    PubMed

    Schall, Peter; Cohen, Itai; Weitz, David A; Spaepen, Frans

    2004-09-24

    The dominant mechanism for creating large irreversible strain in atomic crystals is the motion of dislocations, a class of line defects in the crystalline lattice. Here we show that the motion of dislocations can also be observed in strained colloidal crystals, allowing detailed investigation of their topology and propagation. We describe a laser diffraction microscopy setup used to study the growth and structure of misfit dislocations in colloidal crystalline films. Complementary microscopic information at the single-particle level is obtained with a laser scanning confocal microscope. The combination of these two techniques enables us to study dislocations over a range of length scales, allowing us to determine important parameters of misfit dislocations such as critical film thickness, dislocation density, Burgers vector, and lattice resistance to dislocation motion. We identify the observed dislocations as Shockley partials that bound stacking faults of vanishing energy. Remarkably, we find that even on the scale of a few lattice vectors, the dislocation behavior is well described by the continuum approach commonly used to describe dislocations in atomic crystals. PMID:15448265

  17. Three-dimensional formulation of dislocation climb

    NASA Astrophysics Data System (ADS)

    Gu, Yejun; Xiang, Yang; Quek, Siu Sin; Srolovitz, David J.

    2015-10-01

    We derive a Green's function formulation for the climb of curved dislocations and multiple dislocations in three-dimensions. In this new dislocation climb formulation, the dislocation climb velocity is determined from the Peach-Koehler force on dislocations through vacancy diffusion in a non-local manner. The long-range contribution to the dislocation climb velocity is associated with vacancy diffusion rather than from the climb component of the well-known, long-range elastic effects captured in the Peach-Koehler force. Both long-range effects are important in determining the climb velocity of dislocations. Analytical and numerical examples show that the widely used local climb formula, based on straight infinite dislocations, is not generally applicable, except for a small set of special cases. We also present a numerical discretization method of this Green's function formulation appropriate for implementation in discrete dislocation dynamics (DDD) simulations. In DDD implementations, the long-range Peach-Koehler force is calculated as is commonly done, then a linear system is solved for the climb velocity using these forces. This is also done within the same order of computational cost as existing discrete dislocation dynamics methods.

  18. EVALUATION OF PAINFUL SHOULDER IN BASEBALL PLAYERS

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; do Val Sella, Guilherme; Junior, Adriano Fernando Mendes; Soares, André Lopes; Aihara, Leandro Jun; Checchia, Sérgio Luiz

    2015-01-01

    Objective: To assess the relationship between shoulder mobility and strength and the presence of pain among baseball players. Methods: Between April and July 2009, 55 baseball players were assessed by the Shoulder and Elbow Group of the School of Medical Sciences, Santa Casa de Misericórdia, São Paulo. They were all males, aged between 15 and 33 years (mean of 21); they attended an average of three training sessions per week and had been doing this sport for a mean of 10 years. Results: 14 of the 55 players evaluated were pitchers, and 20 reported pain during the pitching motion. The mean values for lateral and medial rotation and range of motion (ROM) in the dominant shoulder were, respectively, 110 °, 61 ° and 171 °, with a statistically significant difference in relation to the non-dominant limb. Pitchers had greater gains in lateral rotation and deficits in medial rotation than did non-pitchers. Pain presented a statistically significant correlation with diminished ROM, greater length of time playing the sport and situations of “shoulder at risk”. Conclusions: Statistically significant differences in dominant shoulder mobility were found, with increased lateral rotation, diminished medial rotation and smaller ROM, in relation to the contralateral limb. There was a statistically significant relationship between the pitcher's position and greater gain in lateral rotation and diminished medial rotation. There were statistically significant correlations between pain and diminished ROM, greater length of time playing the sport and situations of “shoulder at risk”. There was a statistical tendency suggesting that players with diminished medial rotation of the dominant shoulder presented a relationship with pain. PMID:27028320

  19. Analysis of complications of reverse total shoulder arthroplasty

    PubMed Central

    RUSSO, RAFFAELE; ROTONDA, GIUSEPPE DELLA; CICCARELLI, MICHELE; CAUTIERO, FABIO

    2015-01-01

    Purpose the aim of this study was to analyze complications of reverse total shoulder arthroplasty (RTSA) used to treat different shoulder diseases. Methods from March 2000 to March 2013, 195 RTSA were implanted by the senior Author. The indications for reverse prosthesis surgery were secondary osteoarthritis (OA) in 49 cases, irreparable rotator cuff tear (RCT) in 48 cases, and complex humeral fractures in 75 cases, while 19 were patients requiring surgical revision for first prosthesis implant. We used different prostheses with different designs. Results the clinical and radiological results of all the patients were analyzed retrospectively at an average follow-up of 7 years. The cases were divided into four groups on the basis of the diagnosis and complications were classified as perioperative, postoperative, or late. The mean total Constant score improved from 28 to 69 points in the OA group; from 21 to 70.8 points in the irreparable RCT group, to 76.4 in the fracture group, and from 16.6 to 59.8 points in the revision group. Scapular notching was observed in 59 cases (30.2%). Thirty-three other complications (16.9%) were observed, namely: hematomas (n=3), instability of the humeral component (n=1), scapular spine fractures (n=2), ulnar nerve deficit (n=2), long thoracic nerve palsy (n=2), deep infections (n=2), periprosthetic fractures (n=6), glenoid fractures (n=2), implant loosening (n=2), anterior deltoid muscle deficiency (n=2) and periarticular heterotopic calcifications (n=9). Conclusions the rates of complications, especially fractures, reported in the present study were lower than those reported in the current literature. Level of evidence Level IV, therapeutic case series. PMID:26605252

  20. The primer for sports medicine professionals on imaging: the shoulder.

    PubMed

    Farshad-Amacker, Nadja A; Jain Palrecha, Sapna; Farshad, Mazda

    2013-01-01

    Because of its inherent superior soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging (MRI) is highly suited to study the complex anatomy of the shoulder joint, particularly when assessing the relatively high incidence of shoulder injuries in young, athletic patients. This review aims to serve as a primer for understanding shoulder MRI in an algorithmical approach, including MRI protocol and technique, normal anatomy and anatomical variations of the shoulder, pathologic conditions of the rotator cuff tendons and muscles, the long head of the biceps tendon, shoulder impingement, labral and glenohumeral ligament pathology, MR findings in shoulder instability, adhesive capsulitis, and osteoarthritis. PMID:24381700

  1. [Toxic anterior segment syndrome].

    PubMed

    Cornut, P-L; Chiquet, C

    2011-01-01

    Toxic anterior segment syndrome (TASS) is a general term used to describe acute, sterile postoperative inflammation due to a non-infectious substance that accidentally enters the anterior segment at the time of surgery and mimics infectious endophthalmitis. TASS most commonly occurs acutely following anterior segment surgery, typically 12-72h after cataract extraction. Anterior segment inflammation is usually quite severe with hypopyon. Endothelial cell damage is common, resulting in diffuse corneal edema. No bacterium is isolated from ocular samples. The causes of TASS are numerous and difficult to isolate. Any device or substance used during the surgery or in the immediate postoperative period may be implicated. The major known causes include: preservatives in ophthalmic solutions, denatured ophthalmic viscosurgical devices, bacterial endotoxin, and intraocular lens-induced inflammation. Clinical features of infectious and non-infectious inflammation are initially indistinguishable and TASS is usually diagnosed and treated as acute endophthalmitis. It usually improves with local steroid treatment but may result in chronic elevation of intraocular pressure or irreversible corneal edema due to permanent damage of trabecular meshwork or endothelial cells. PMID:21176994

  2. The Results of Adductor Magnus Tenodesis in Adolescents with Recurrent Patellar Dislocation

    PubMed Central

    Malecki, Krzysztof; Fabis, Jaroslaw; Flont, Pawel; Niedzielski, Kryspin Ryszard

    2015-01-01

    Recurrent dislocation of the patella is a common orthopaedic problem which occurs in about 44% of cases after first-time dislocation. In most cases of first-time patellar dislocation, the medial patellofemoral ligament (MPFL) becomes damaged. Between 2010 and 2012, 33 children and adolescents (39 knees) with recurrent patellar dislocation were treated with MPFL reconstruction using the adductor magnus tendon. The aim of our study is to assess the effectiveness of this surgical procedure. The outcomes were evaluated functionally (Lysholm knee scale, the Kujala Anterior Knee Pain Scale, and isokinetic examination) and radiographically (Caton index, sulcus angle, congruence angle, and patellofemoral angle). Four patients demonstrated redislocation with MPFL graft failure, despite the fact that patellar tracking was found to be normal before the injury, and the patients had not reported any symptoms. Statistically significant improvements in Lysholm and Kujala scales, in patellofemoral and congruence angle, were seen (P < 0.001). A statistically significant improvement in the peak torque of the quadriceps muscle and flexor was observed for 60°/sec and 180°/sec angular velocities (P = 0.01). Our results confirm the efficacy of MPFL reconstruction using the adductor magnus tendon in children and adolescents with recurrent patellar dislocation. PMID:25785271

  3. [Not Available].

    PubMed

    Gadsbøll, Eva; Johannesson, Dan

    2016-01-01

    Shoulder dislocations are not rare in a radiology department working with emergency radiology. The majority are anteriorly dislocated and easy to diagnose. The posteriorly dislocated shoulders are more rare and often more difficult to spot on plain X-ray films. This case report describes a very rare condition with bilateral posterior fracture dislocations in a healthy man following generalized seizures of unknown cause. In spite of complaints of discomfort in the shoulders, two days passed by before the shoulder dislocations were diagnosed. PMID:27003521

  4. The Western Ontario Shoulder Instability Index (WOSI): validity, reliability, and responsiveness retested with a Swedish translation

    PubMed Central

    Ahlström, Susanne; Dalén, Nils; Lillkrona, Ulf

    2009-01-01

    Background and purpose The WOSI score questionnaire is a tool designed for self-assessment of shoulder function for patients with instability problems. We made a translation into Swedish and retested the score by analyzing the psychometric properties validity, reliability, and responsiveness. Patients and methods 3 patient materials were used for the assessment: (A) a follow-up on a group of 32 patients more than 8 years after having primary posttraumatic shoulder dislocation. Evaluation of Pearson’s correlation coefficient between WOSI and Rowe score and for test-retest reliability was made; (B) 22 patients, treated with a surgical stabilization of the shoulder at our department, were evaluated with Pearson’s correlation coefficient between WOSI and EQ-5D, and between WOSI and a VAS-scale of general shoulder function. Also, Cronbach’s alpha, effect size, and floor, and ceiling effects were analyzed; (C) 45 students with healthy shoulders (reference group) had their WOSI score determined. Results The construct validity (Pearson’s correlation coefficient) was adequate (0.59) between the WOSI score and the Rowe score. The agreement with an ICC value (test-retest) for the WOSI score was excellent (0.94). Cronbach’s alpha (internal consistency) was satisfactory, with 0.89 preoperatively and 0.95 postoperatively. All 22 patients in group B reported improvement in the WOSI score (mean 29%). Responsiveness was excellent, with an effect size of 1.67 for the WOSI score. There were no floor or ceiling effects for the Swedish WOSI score. The mean WOSI score from group C with 45 normal healthy shoulders was 96%, with no floor but high ceiling effects. Interpretation WOSI score does not require an examination of the patient and can be administered by mail. The high ICC and sensitivity makes it able to monitor an individual patient’s progress. At this retest, the WOSI score has good validity, a high degree of reliability, and a high degree of responsiveness, all at

  5. Posterior instability caused by batter's shoulder.

    PubMed

    Kang, Richard W; Mahony, Gregory T; Harris, Thomas C; Dines, Joshua S

    2013-10-01

    In summary, batter’s shoulder is a rare and only recently recognized entity. This condition is posterior shoulder instability caused by a missed attempt at hitting a pitch, especially with an outside pitch. The lack of counterforce from hitting a ball produces increased forces imparted on the posterior capsulolabral complex of the lead shoulder during batting. If the player fails conservative management, she or he can undergo an arthroscopic posterior labral repair instead of debridement. After treatment, the player can expect to return to play after approximately 6 to 7 months. Initial results from a small, retrospective series demonstrate greater than 90% excellent results. These findings are similar to current literature for arthroscopic treatment of posterior instability, which reports success rates that range from 75% to 91%. Longer-term follow-up will be needed to determine the natural history and prognosis or batter’s shoulder. Based on initial results, the authors predict good to excellent results for most players with batter’s shoulder who undergo proper treatment. Additionally, with the exception of switch hitters, the nonthrowing arm is affected. This can also improve the athlete’s return to play. PMID:24079435

  6. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release.

    PubMed

    Arce, Guillermo

    2015-12-01

    Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery. PMID:26870652

  7. Functional outcomes assessment in shoulder surgery

    PubMed Central

    Wylie, James D; Beckmann, James T; Granger, Erin; Tashjian, Robert Z

    2014-01-01

    The effective evaluation and management of orthopaedic conditions including shoulder disorders relies upon understanding the level of disability created by the disease process. Validated outcome measures are critical to the evaluation process. Traditionally, outcome measures have been physician derived objective evaluations including range of motion and radiologic evaluations. However, these measures can marginalize a patient’s perception of their disability or outcome. As a result of these limitations, patient self-reported outcomes measures have become popular over the last quarter century and are currently primary tools to evaluate outcomes of treatment. Patient reported outcomes measures can be general health related quality of life measures, health utility measures, region specific health related quality of life measures or condition specific measures. Several patients self-reported outcomes measures have been developed and validated for evaluating patients with shoulder disorders. Computer adaptive testing will likely play an important role in the arsenal of measures used to evaluate shoulder patients in the future. The purpose of this article is to review the general health related quality-of-life measures as well as the joint-specific and condition specific measures utilized in evaluating patients with shoulder conditions. Advances in computer adaptive testing as it relates to assessing dysfunction in shoulder conditions will also be reviewed. PMID:25405091

  8. Shoulder injuries in adolescent rugby players

    PubMed Central

    Hodhody, Ghazal; Mackenzie, Tanya A

    2016-01-01

    Background Rugby is a high-intensity contact sport, frequently causing shoulder injuries. Between the ages of 12 years to 18 years, academy and county level players are being selected for professional contracts, making this is a critical stage of their career. The present study aimed to describe the patterns of injury in adolescent rugby players with shoulder injuries. Methods Academy and county level rugby players in the target age group, over a 7-year period, were included in the present study. Data collected included the mechanism of injury, position and level of play, radiology and surgical findings, and recurrence rate at a minimum of 2 years post-surgery. Results One hundred and sixty-nine cases adhered to the inclusion criteria, with most cases involving two or more pathologies in the shoulder (54%). Forwards sustained more shoulder injuries than backs, incurring more labral injuries. By contrast, backs had a higher incidence of bony pathology. The mechanism of injury frequently correlated with player positions. There was a 21% injury recurrence rate, with forwards (7%) and higher level academy players (11%) most likely to suffer a recurrence. Conclusions Shoulder injury patterns in this important group of adolescent contact athletes are complex, with recurrence rates being higher than those in older rugby players. PMID:27583014

  9. Primary Frozen Shoulder Syndrome: Arthroscopic Capsular Release

    PubMed Central

    Arce, Guillermo

    2015-01-01

    Idiopathic adhesive capsulitis, or primary frozen shoulder syndrome, is a fairly common orthopaedic problem characterized by shoulder pain and loss of motion. In most cases, conservative treatment (6-month physical therapy program and intra-articular steroid injections) improves symptoms and restores shoulder motion. In refractory cases, arthroscopic capsular release is indicated. This surgical procedure carries several advantages over other treatment modalities. First, it provides precise and controlled release of the capsule and ligaments, reducing the risk of traumatic complications observed after forceful shoulder manipulation. Second, release of the capsule and the involved structures with a radiofrequency device delays healing, which prevents adhesion formation. Third, the technique is straightforward, and an oral postoperative steroid program decreases pain and allows for a pleasant early rehabilitation program. Fourth, the procedure is performed with the patient fully awake under an interscalene block, which boosts the patient's confidence and adherence to the physical therapy protocol. In patients with refractory primary frozen shoulder syndrome, arthroscopic capsular release emerges as a suitable option that leads to a faster and long-lasting recovery. PMID:26870652

  10. Kinetics of a Fast Moving Partial Dislocation

    NASA Astrophysics Data System (ADS)

    Daphalapurkar, Nitin; Ramesh, K. T.

    2013-03-01

    Plastic deformation in materials under extreme stresses requires a kinetic description of moving dislocations. The velocities with which the partial dislocations can propagate under an applied stress has implications for plasticity at high strain rates, specifically, the rate of plastic deformation and the rate-sensitivity. In this work, we focus our attention on motion of a twinning partial dislocation in a face-centered cubic (FCC) material, Ni. We use molecular dynamics simulations to simulate the velocity of a propagating twinning partial dislocation and investigate the effect of applied shear stress. Results suggest a limiting value for the speeds of a propagating partial dislocation. The material speeds based on the nonlinear part (under high stresses) of the stress-strain curve are shown to have an influence on the velocity with which a partial dislocation can propagate. Predicted velocities from simulations will be related to observations from high rate impact experiments. Supported by Hopkins Extreme Materials Institute

  11. Computational reverse shoulder prosthesis model: Experimental data and verification.

    PubMed

    Martins, A; Quental, C; Folgado, J; Ambrósio, J; Monteiro, J; Sarmento, M

    2015-09-18

    The reverse shoulder prosthesis aims to restore the stability and function of pathological shoulders, but the biomechanical aspects of the geometrical changes induced by the implant are yet to be fully understood. Considering a large-scale musculoskeletal model of the upper limb, the aim of this study is to evaluate how the Delta reverse shoulder prosthesis influences the biomechanical behavior of the shoulder joint. In this study, the kinematic data of an unloaded abduction in the frontal plane and an unloaded forward flexion in the sagittal plane were experimentally acquired through video-imaging for a control group, composed of 10 healthy shoulders, and a reverse shoulder group, composed of 3 reverse shoulders. Synchronously, the EMG data of 7 superficial muscles were also collected. The muscle force sharing problem was solved through the minimization of the metabolic energy consumption. The evaluation of the shoulder kinematics shows an increase in the lateral rotation of the scapula in the reverse shoulder group, and an increase in the contribution of the scapulothoracic joint to the shoulder joint. Regarding the muscle force sharing problem, the musculoskeletal model estimates an increased activity of the deltoid, teres minor, clavicular fibers of the pectoralis major, and coracobrachialis muscles in the reverse shoulder group. The comparison between the muscle forces predicted and the EMG data acquired revealed a good correlation, which provides further confidence in the model. Overall, the shoulder joint reaction force was lower in the reverse shoulder group than in the control group. PMID:26206550

  12. Coupled dislocation and martensitic phase transformation dynamics

    NASA Astrophysics Data System (ADS)

    Barros, Kipton; Acharya, Amit; Lookman, Turab

    2013-03-01

    We present a field theoretic model that couples dislocation dynamics and plasticity with martensitic phase transformation. Dislocations produce long-range stress via incompatibility of the elastic-distortion field. Phase transformations are modeled with a non-convex elastic potential that contains the crystal symmetries of austenite and martensite phases. We discuss the effects of dislocation dynamics on material microstructure produced under extreme conditions.

  13. A biomechanical analysis of anterior load carriage.

    PubMed

    Anderson, A M; Meador, K A; McClure, L R; Makrozahopoulos, D; Brooks, D J; Mirka, G A

    2007-12-01

    Front load carriage is a common occupational task in some industries (e.g. agriculture, construction), but, as compared to lifting tasks, relatively little research has been conducted on the biomechanical loading during these activities. The focus of this study was to explore the low back biomechanics during these activities and, specifically, to examine the effects of load height and walking speed on trunk muscle activity and trunk posture. Eleven male participants participated in two separate front load-carriage experiments. The first experiment called for carrying a barbell (with weight corresponding to 20% of elbow flexion strength) at three heights (knuckle height, elbow height and shoulder height) at a constant horizontal distance from the spine. The second experiment called for participants to carry a bucket of potatoes weighing 14 kg at the same three heights, but with no further restrictions in technique. In both experiments, the participants performed this task while either standing still or walking at a self-selected speed. As they performed these tasks, the activity levels of the right-side muscle of the rectus abdominis, external oblique, biceps brachii, anterior deltoid and three levels (T9, T12 and L3) of the erector spinae were sampled. Mid-sagittal plane trunk posture was also quantified using three magnetic field-based motion sensors at T9, T12 and L3. The results showed a significant effect of both walking speed and load height on trunk posture and trunk muscle activity levels in both the barbell and bucket experiments. In the barbell experiment, the walking trials generated 43% more trunk muscle activity than the standing trials. Trials at shoulder height produced 11% more muscle activity than trials at elbow height in the T9 erector spinae muscles and 71% more muscle activity in the anterior deltoid. In the bucket experiment, trunk muscle activity responded in a similar fashion, but the key result here was the quantification of the natural

  14. Robust atomistic calculation of dislocation line tension

    NASA Astrophysics Data System (ADS)

    Szajewski, B. A.; Pavia, F.; Curtin, W. A.

    2015-12-01

    The line tension Γ of a dislocation is an important and fundamental property ubiquitous to continuum scale models of metal plasticity. However, the precise value of Γ in a given material has proven difficult to assess, with literature values encompassing a wide range. Here results from a multiscale simulation and robust analysis of the dislocation line tension, for dislocation bow-out between pinning points, are presented for two widely-used interatomic potentials for Al. A central part of the analysis involves an effective Peierls stress applicable to curved dislocation structures that markedly differs from that of perfectly straight dislocations but is required to describe the bow-out both in loading and unloading. The line tensions for the two interatomic potentials are similar and provide robust numerical values for Al. Most importantly, the atomic results show notable differences with singular anisotropic elastic dislocation theory in that (i) the coefficient of the \\text{ln}(L) scaling with dislocation length L differs and (ii) the ratio of screw to edge line tension is smaller than predicted by anisotropic elasticity. These differences are attributed to local dislocation core interactions that remain beyond the scope of elasticity theory. The many differing literature values for Γ are attributed to various approximations and inaccuracies in previous approaches. The results here indicate that continuum line dislocation models, based on elasticity theory and various core-cut-off assumptions, may be fundamentally unable to reproduce full atomistic results, thus hampering the detailed predictive ability of such continuum models.

  15. Dislocation-driven surface dynamics on solids.

    PubMed

    Kodambaka, S; Khare, S V; Swiech, W; Ohmori, K; Petrov, I; Greene, J E

    2004-05-01

    Dislocations are line defects that bound plastically deformed regions in crystalline solids. Dislocations terminating on the surface of materials can strongly influence nanostructural and interfacial stability, mechanical properties, chemical reactions, transport phenomena, and other surface processes. While most theoretical and experimental studies have focused on dislocation motion in bulk solids under applied stress and step formation due to dislocations at surfaces during crystal growth, very little is known about the effects of dislocations on surface dynamics and morphological evolution. Here we investigate the near-equilibrium dynamics of surface-terminated dislocations using low-energy electron microscopy. We observe, in real time, the thermally driven nucleation and shape-preserving growth of spiral steps rotating at constant temperature-dependent angular velocities around cores of dislocations terminating on the (111) surface of TiN in the absence of applied external stress or net mass change. We attribute this phenomenon to point-defect migration from the bulk to the surface along dislocation lines. Our results demonstrate that dislocation-mediated surface roughening can occur even in the absence of deposition or evaporation, and provide fundamental insights into mechanisms controlling nanostructural stability. PMID:15129275

  16. Arthroscopic Treatment of Traumatic Hip Dislocation.

    PubMed

    Begly, John P; Robins, Bryan; Youm, Thomas

    2016-05-01

    Traumatic hip dislocations are high-energy injuries that often result in considerable morbidity. Although appropriate management improves outcomes, associated hip pathology may complicate the recovery and lead to future disability and pain. Historically, open reduction has been the standard of care for treating hip dislocations that require surgical intervention. The use of hip arthroscopy to treat the sequelae and symptoms resulting from traumatic hip dislocations recently has increased, however. When used appropriately, hip arthroscopy is a safe, effective, and minimally invasive treatment option for intra-articular pathology secondary to traumatic hip dislocation. PMID:27007728

  17. Superior Labrum Anterior Posterior Lesions and Associated Injuries

    PubMed Central

    Beyzadeoglu, Tahsin; Circi, Esra

    2015-01-01

    Background: Superior labrum anterior posterior (SLAP) lesions often cause shoulder pain, dysfunction, and instability. Professional athletes require a high level of shoulder function for competition and overhead activities. Purpose: To evaluate elite athletes who had arthroscopic surgery for common shoulder pathologies and SLAP lesions with a follow-up of more than 3 years. The associated intra-articular pathologies and return to play were documented. Study Design: Case series; Level of evidence, 4. Methods: Thirty-five shoulders in 34 elite athletes (4 women and 30 men; mean age, 25 years [range, 18-32 years]) had arthroscopic repair of SLAP lesions and accompanying Bankart or rotator cuff tears between January 2008 and November 2011. The documentation included patient symptoms, physical examination, radiological analysis with radiographs, and magnetic resonance imaging. Shoulder function was evaluated preoperatively and at follow-up using American Shoulder and Elbow Surgeons (ASES) and Kerlan Jobe Orthopaedic Clinic (KJOC) scores. The mean follow-up was 52 months. Results: Isolated SLAP lesions were seen in 17.1% of patients, SLAP lesions and partial cuff tear occurred in 25.7%, associated Bankart lesions in 37.1%, full-thickness rotator cuff tears in 8.6%, Bankart and posterior labrum lesions in 8.6%, and Bankart and full-thickness rotator cuff tears in 2.9%. Return to play was a mean 6.4 ± 1.5 months. The mean postoperative ASES and KJOC scores were 89.6 ± 4.6 and 80.9 ± 6.8, respectively, compared with preoperative scores of 64.0 ± 7.2 and 50.5 ± 10.3 (t test, P < .01). Conclusion: The majority (88.2%) of professional athletes returned to their preinjury levels. SLAP lesions may frequently occur with Bankart lesions and rotator cuff tears. A high rate of return to sport at the same level of athletic performance can be achieved by anatomic repair and effective rehabilitation. PMID:26665050

  18. Axillary nerve neurotization with the anterior deltopectoral approach in brachial plexus injuries.

    PubMed

    Jerome, J Terrence Jose; Rajmohan, Bennet

    2012-09-01

    Combined neurotization of both axillary and suprascapular nerves in shoulder reanimation has been widely accepted in brachial plexus injuries, and the functional outcome is much superior to single nerve transfer. This study describes the surgical anatomy for axillary nerve relative to the available donor nerves and emphasize the salient technical aspects of anterior deltopectoral approach in brachial plexus injuries. Fifteen patients with brachial plexus injury who had axillary nerve neurotizations were evaluated. Five patients had complete avulsion, 9 patients had C5, six patients had brachial plexus injury pattern, and one patient had combined axillary and suprascapular nerve injury. The long head of triceps branch was the donor in C5,6 injuries; nerve to brachialis in combined nerve injury and intercostals for C5-T1 avulsion injuries. All these donors were identified through the anterior approach, and the nerve transfer was done. The recovery of deltoid was found excellent (M5) in C5,6 brachial plexus injuries with an average of 134.4° abduction at follow up of average 34.6 months. The shoulder recovery was good with 130° abduction in a case of combined axillary and suprascapular nerve injury. The deltoid recovery was good (M3) in C5-T1 avulsion injuries patients with an average of 64° shoulder abduction at follow up of 35 months. We believe that anterior approach is simple and easy for all axillary nerve transfers in brachial plexus injuries. PMID:22434572

  19. A navigation system for shoulder arthroscopic surgery.

    PubMed

    Tyryshkin, K; Mousavi, P; Beek, M; Ellis, R E; Pichora, D R; Abolmaesumi, P

    2007-10-01

    The general framework and experimental validation of a novel navigation system designed for shoulder arthroscopy are presented. The system was designed to improve the surgeon's perception of the three-dimensional space within the human shoulder. Prior to surgery, a surface model of the shoulder was created from computed tomography images. Intraoperatively, optically tracked arthroscopic instruments were calibrated. The surface model was then registered to the patient using tracked freehand ultrasound images taken from predefined landmark regions on the scapula. Three-dimensional models of the surgical instruments were displayed, in real time, relative to the surface model in a user interface. Laboratory experiments revealed only small registration and calibration errors, with minimal time needed to complete the intraoperative tasks. PMID:18019466

  20. Ten questions on prosthetic shoulder infection.

    PubMed

    Pinder, Elizabeth M; Ong, Joshua Cy; Bale, R Stephen; Trail, Ian A

    2016-07-01

    Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes. PMID:27583013

  1. Resuscitating the Baby after Shoulder Dystocia.

    PubMed

    Menticoglou, Savas; Schneider, Carol

    2016-01-01

    Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1) the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2) the neonatal resuscitators give volume much sooner. PMID:27493815

  2. Kinetic chain abnormalities in the athletic shoulder.

    PubMed

    Sciascia, Aaron; Thigpen, Charles; Namdari, Surena; Baldwin, Keith

    2012-03-01

    Overhead activities require the shoulder to be exposed to and sustain repetitive loads. The segmental activation of the body's links, known as the kinetic chain, allows this to occur effectively. Proper muscle activation is achieved through generation of energy from the central segment or core, which then transfers the energy to the terminal links of the shoulder, elbow, and hand. The kinetic chain is best characterized by 3 components: optimized anatomy, reproducible efficient motor patterns, and the sequential generation of forces. However, tissue injury and anatomic deficits such as weakness and/or tightness in the leg, pelvic core, or scapular musculature can lead to overuse shoulder injuries. These injuries can be prevented and maladaptations can be detected with a thorough understanding of biomechanics of the kinetic chain as it relates to overhead activity. PMID:22311288

  3. Evaluation and treatment of shoulder pain.

    PubMed

    Greenberg, Deborah L

    2014-05-01

    Shoulder pain is a common symptom in the adult population. The most common cause of shoulder pain is SIS, reflecting a problem with the rotator cuff or subacromial bursa. Determining the cause of a patient’s pain is usually a clinical diagnosis based on careful history taking and physical examination. Limited use of imaging studies will be needed in the setting of trauma, possible glenohumeral arthritis, or when a complete tendon tear is suspected. Therapy is based on pain control and therapeutic exercises in almost all cases. Despite the prevalence of shoulder pain, there is no consensus on the best way to achieve pain control or on the type of exercise most likely to achieve speedy recovery. PMID:24758957

  4. Resuscitating the Baby after Shoulder Dystocia

    PubMed Central

    2016-01-01

    Background. To propose hypovolemic shock as a possible explanation for the failure to resuscitate some babies after shoulder dystocia and to suggest a change in clinical practice. Case Presentation. Two cases are presented in which severe shoulder dystocia was resolved within five minutes. Both babies were born without a heartbeat. Despite standard resuscitation by expert neonatologists, no heartbeat was obtained until volume resuscitation was started, at 25 minutes in the first case and 11 minutes in the second. After volume resuscitation circulation was restored, there was profound brain damage and the babies died. Conclusion. Unsuspected hypovolemic shock may explain some cases of failed resuscitation after shoulder dystocia. This may require a change in clinical practice. Rather than immediately clamping the cord after the baby is delivered, it is proposed that (1) the obstetrician delay cord clamping to allow autotransfusion of the baby from the placenta and (2) the neonatal resuscitators give volume much sooner. PMID:27493815

  5. Ten questions on prosthetic shoulder infection

    PubMed Central

    Pinder, Elizabeth M; Ong, Joshua CY; Bale, R Stephen

    2016-01-01

    Prosthetic shoulder infection can cause significant morbidity secondary to pain and stiffness. Symptoms may be present for years before diagnosis because clinical signs are often absent and inflammatory markers may be normal. An emerging common culprit, Propionibacterium acnes, is hard to culture and so prolonged incubation is necessary. A negative culture result does not always exclude infection and new synovial fluid biochemical markers such as α defensin are less sensitive than for lower limb arthroplasty. A structured approach is necessary when assessing patients for prosthetic shoulder joint infection. This includes history, examination, serum inflammatory markers, plain radiology and aspiration and/or biopsy. A classification for the likelihood of prosthetic shoulder infection has been described based on culture, pre-operative and intra-operative findings. Treatment options include antibiotic suppression, debridement with component retention, one-stage revision, two-stage revision and excision arthroplasty. Revision arthroplasty is associated with the best outcomes. PMID:27583013

  6. Simultaneous dislocation of radiocapitellar and distal radioulnar joint.

    PubMed

    Nishi, Tomio; Suzuki, Noriyuki; Tani, Takayuki; Aonuma, Hiroshi

    2013-01-01

    A 45-year-old male presented to the emergency room of our institution complaining of severe pain around the left elbow. While playing volleyball, he slipped down with his left arm hit between the floor and his body. He complaind of strong pain from left elbow to hand, and active motion of elbow and wrist joint was impossible. His forearm was held in supinated position. On X-ray examination, radius head was deviated to anterior lateral side, and distal end of radius was dislocated to dorsal side. Tenderness was prominent at the site of radial head and distal radioulnar joint. Surgical treatment was performed using triceps tendon strip. Good functional recovery was gained. PMID:24194995

  7. Multiscale modeling of dislocation-precipitate interactions in Fe: From molecular dynamics to discrete dislocations

    NASA Astrophysics Data System (ADS)

    Lehtinen, Arttu; Granberg, Fredric; Laurson, Lasse; Nordlund, Kai; Alava, Mikko J.

    2016-01-01

    The stress-driven motion of dislocations in crystalline solids, and thus the ensuing plastic deformation process, is greatly influenced by the presence or absence of various pointlike defects such as precipitates or solute atoms. These defects act as obstacles for dislocation motion and hence affect the mechanical properties of the material. Here we combine molecular dynamics studies with three-dimensional discrete dislocation dynamics simulations in order to model the interaction between different kinds of precipitates and a 1/2 <111 > {110 } edge dislocation in BCC iron. We have implemented immobile spherical precipitates into the ParaDis discrete dislocation dynamics code, with the dislocations interacting with the precipitates via a Gaussian potential, generating a normal force acting on the dislocation segments. The parameters used in the discrete dislocation dynamics simulations for the precipitate potential, the dislocation mobility, shear modulus, and dislocation core energy are obtained from molecular dynamics simulations. We compare the critical stresses needed to unpin the dislocation from the precipitate in molecular dynamics and discrete dislocation dynamics simulations in order to fit the two methods together and discuss the variety of the relevant pinning and depinning mechanisms.

  8. Elbow Dislocations: A Review Ranging from Soft Tissue Injuries to Complex Elbow Fracture Dislocations

    PubMed Central

    Zellner, Johannes; Koller, Michael; Nerlich, Michael; Lenich, Andreas

    2013-01-01

    This review on elbow dislocations describes ligament and bone injuries as well as the typical injury mechanisms and the main classifications of elbow dislocations. Current treatment concepts of simple, that is, stable, or complex unstable elbow dislocations are outlined by means of case reports. Special emphasis is put on injuries to the medial ulnar collateral ligament (MUCL) and on posttraumatic elbow stiffness. PMID:24228180

  9. Multiscale modeling of dislocation-precipitate interactions in Fe: From molecular dynamics to discrete dislocations.

    PubMed

    Lehtinen, Arttu; Granberg, Fredric; Laurson, Lasse; Nordlund, Kai; Alava, Mikko J

    2016-01-01

    The stress-driven motion of dislocations in crystalline solids, and thus the ensuing plastic deformation process, is greatly influenced by the presence or absence of various pointlike defects such as precipitates or solute atoms. These defects act as obstacles for dislocation motion and hence affect the mechanical properties of the material. Here we combine molecular dynamics studies with three-dimensional discrete dislocation dynamics simulations in order to model the interaction between different kinds of precipitates and a 1/2〈111〉{110} edge dislocation in BCC iron. We have implemented immobile spherical precipitates into the ParaDis discrete dislocation dynamics code, with the dislocations interacting with the precipitates via a Gaussian potential, generating a normal force acting on the dislocation segments. The parameters used in the discrete dislocation dynamics simulations for the precipitate potential, the dislocation mobility, shear modulus, and dislocation core energy are obtained from molecular dynamics simulations. We compare the critical stresses needed to unpin the dislocation from the precipitate in molecular dynamics and discrete dislocation dynamics simulations in order to fit the two methods together and discuss the variety of the relevant pinning and depinning mechanisms. PMID:26871192

  10. Acroplate--a modern solution for the treatment of acromioclavicular joint dislocation.

    PubMed

    Cîrstoiu, C; Rădulescu, R; Popescu, D; Ene, R; Circotă, G; Bădiceanu, Corina

    2009-01-01

    Two main ways to fix the reduction were imposed in surgical treatment of the acromioclavicular joint dislocations: fixation with trans acromioclavicular pin (Phemister method) and fixation with plate and screws type acroplate. The purpose of the present paper work is to compare immediate and later postoperative results between the two types of surgical interventions. During 2005-2007, 37 surgical reductions and fixation of acromioclavicular joint dislocations were performed in the Orthopedic-Traumatology Clinic of SUUB. In 17 cases a fixation with screws and plates type acroplate has been performed and in 20 cases with pins using the Phemister method. Sex ratio: 31 men and 8 women. Patients were aged between 17 and 56 years old. Follow up at 6 weeks, 3, 6, 12 and 18 post-operatory months. Osteosintesis material removing was done postoperatively, at 4 weeks in case of acroplate's and at 6 weeks in case of the pins. All patients treated of fixation with plate and screws acroplate type had a favorable evolution/development, starting with the shoulder joint mobilization at 24 hours postoperatively, with a complete recovery 4 weeks after the operation, at the same time with the ablation, and without immediate other late complications. As far as the patients treated by using the Phemister method are concerned, they were applied an immobilization, postoperatively. Desault bandage or the scarf for a period between 1 and 3 weeks, beginning with the shoulder joint mobilization later on and a full recovery after a minimum of 6 weeks. However, 3 of the cases showed a migration of one or both pins. Following the study, a more rapid recovery resulted, complete, and without complications of mobility in the shoulder joint, when using plate type acroplate vs pin. PMID:20108536

  11. Shoulder Muscular Demand During Lever-Activated Vs Pushrim Wheelchair Propulsion in Persons With Spinal Cord Injury

    PubMed Central

    Requejo, Philip Santos; Lee, Sharon E; Mulroy, Sara J; Haubert, Lisa Lighthall; Bontrager, Ernest L; Gronley, JoAnne K; Perry, Jacquelin

    2008-01-01

    Background/Objective: The high demand on the upper limbs during manual wheelchair (WC) use contributes to a high prevalence of shoulder pathology in people with spinal cord injury (SCI). Lever-activated (LEVER) WCs have been presented as a less demanding alternative mode of manual WC propulsion. The objective of this study was to evaluate the shoulder muscle electromyographic activity and propulsion characteristics in manual WC users with SCI propelling a standard pushrim (ST) and LEVER WC design. Methods: Twenty men with complete injuries (ASIA A or B) and tetraplegia (C6, n = 5; C7, n = 7) or paraplegia (n = 8) secondary to SCI propelled ST and LEVER WCs at 3 propulsion conditions on a stationary ergometer: self-selected free, self-selected fast, and simulated graded resistance. Average velocity, cycle distance, and cadence; median and peak electromyographic intensity; and duration of electromyography of anterior deltoid, pectoralis major, supraspinatus, and infraspinatus muscles were compared between LEVER and ST WC propulsion. Results: Significant decreases in pectoralis major and supraspinatus activity were recorded during LEVER compared with ST WC propulsion. However, anterior deltoid and infraspinatus intensities tended to increase during LEVER WC propulsion. Participants with tetraplegia had similar or greater anterior deltoid, pectoralis major, and infraspinatus activity for both ST and LEVER WC propulsion compared with the men with paraplegia. Conclusions: Use of the LEVER WC reduced and shifted the shoulder muscular demands in individuals with paraplegia and tetraplegia. Further studies are needed to determine the impact of LEVER WC propulsion on long-term shoulder function. PMID:19086715

  12. Identifying foot fractures and dislocations.

    PubMed

    Caswell, Fiona; Brown, Craig

    2014-10-01

    As the roles of emergency nurse practitioners expand, more patients with minor injuries are being managed independently by nursing staff. Injuries to the foot and ankle are common among such patients, and X-rays are frequently performed to aid their diagnoses. Some of these fractures and dislocations are subtle and difficult to identify, so practitioners must adopt a structured approach to reading X-rays. This article describes some of these injuries and offers advice, including X-ray illustrations, on how to identify them. PMID:25270819

  13. Anterior mandibular ameloblastoma

    PubMed Central

    Bhandarwar, Ajay H.; Bakhshi, Girish D.; Borisa, Ashok D.; Wagh, Amol; Kapoor, Rajat; Kori, Channabasappa G.

    2012-01-01

    Ameloblastoma is a benign odontogenic tumor. These are usually asymptomatic until a large size is attained. Ameloblastoma has tendency to spread locally and has a high recurrence rate. Majority of ameloblastomas (80%) arise from the mandible. Ameloblastoma arising from anterior mandibular region (symphysis-menti) is rare. Very few cases of midline anterior ameloblastomas are reported in the literature. They often require wide local excision. Reconstruction of mandible in these cases is challenging. We present a case of mandibular ameloblastoma arising from symphysis-menti. Patient underwent wide surgical excision of the tumor followed by immediate reconstruction using free fibular vascular flap, stabilized with titanium reconstructive plates. A brief case report ands review of literature is presented. PMID:24765429

  14. Anterior urethral stricture review

    PubMed Central

    Stein, Marshall J.

    2013-01-01

    Male anterior urethral stricture disease is a commonly encountered condition that presents to many urologists. According to a National Practice Survey of Board Certified Urologist in the United States most urologists treat on average 6-20 urethral strictures yearly. Many of those same urologists surveyed treat with repeated dilation or internal urethrotomy, despite continual recurrence of the urethral stricture. In point of fact, the urethroplasty despite its high success rate, is underutilized by many practicing urologists. Roughly half of practicing urologist do not perform urethroplasty in the United States. Clearly, the reconstructive ladder for urethral stricture management that was previously described in the literature may no longer apply in the modern era. The following article reviews the etiology, diagnosis, management and comparisons of treatment options for anterior urethral strictures. PMID:26816721

  15. Treatments for Shoulder Impingement Syndrome

    PubMed Central

    Dong, Wei; Goost, Hans; Lin, Xiang-Bo; Burger, Christof; Paul, Christian; Wang, Zeng-Li; Zhang, Tian-Yi; Jiang, Zhi-Chao; Welle, Kristian; Kabir, Koroush

    2015-01-01

    Abstract Many treatments for shoulder impingement syndrome (SIS) are available in clinical practice; some of which have already been compared with other treatments by various investigators. However, a comprehensive treatment comparison is lacking. Several widely used electronic databases were searched for eligible studies. The outcome measurements were the pain score and the Constant–Murley score (CMS). Direct comparisons were performed using the conventional pair-wise meta-analysis method, while a network meta-analysis based on the Bayesian model was used to calculate the results of all potentially possible comparisons and rank probabilities. Included in the meta-analysis procedure were 33 randomized controlled trials involving 2300 patients. Good agreement was demonstrated between the results of the pair-wise meta-analyses and the network meta-analyses. Regarding nonoperative treatments, with respect to the pain score, combined treatments composed of exercise and other therapies tended to yield better effects than single-intervention therapies. Localized drug injections that were combined with exercise showed better treatment effects than any other treatments, whereas worse effects were observed when such injections were used alone. Regarding the CMS, most combined treatments based on exercise also demonstrated better effects than exercise alone. Regarding surgical treatments, according to the pain score and the CMS, arthroscopic subacromial decompression (ASD) together with treatments derived from it, such as ASD combined with radiofrequency and arthroscopic bursectomy, showed better effects than open subacromial decompression (OSD) and OSD combined with the injection of platelet-leukocyte gel. Exercise therapy also demonstrated good performance. Results for inconsistency, sensitivity analysis, and meta-regression all supported the robustness and reliability of these network meta-analyses. Exercise and other exercise-based therapies, such as kinesio taping

  16. Exposures of the shoulder and upper humerus.

    PubMed

    Hoyen, Harry; Papendrea, Rick

    2014-11-01

    Extensile and adequate exposures of the shoulder and upper humerus are important in trauma surgery. The standard deltopectoral approach can be extended distally to expose the whole humerus if necessary. Often, wide exposures of the upper humerus are necessary to reduce complex fractures and apply the plate on the lateral aspect of the humerus. A thorough knowledge of the anatomy as well as strategies of nerve mobilization is necessary for achieving adequate exposures in this area. This article details the many exposure methods for the shoulder, upper humerus, and their extensile extensions. PMID:25440068

  17. Anterior perineal sinus.

    PubMed

    Oliver, G C; Rubin, R J; Salvati, E P; Eisenstat, T E; Lott, J

    1991-09-01

    Each year we treat several patients with an anterior perineal sinus tract. They do not conform to commonly encountered perineal problems such as pilonidal disease, epidermal cysts, hidradenitis, fistulous abscess, or inflammatory bowel disease. In an effort to improve understanding of the problem and its clinical significance, we reviewed our practice records for the period from 1968 through 1988. Fifty-six patients underwent surgery for an anterior perineal sinus tract. In 31 patients, the clinical and pathologic condition defied classical diagnostic categorization. We have termed these lesions "anterior perineal sinuses." Their clinical characteristics, treatment, and pathologic assessment from the body of this report. Male predominance (87 percent) and midlife presentation (average age, 44 years) characterized this group. Local symptoms were present from several weeks to several years prior to treatment. Local anesthesia (74 percent) and limited surgery (100 percent) resulted in complete healing in all patients (average, 7 weeks). A 15 percent recurrence rate was noted. The pathologic evaluation demonstrated acute and chronic dermal and subcutaneous inflammation. The etiology of this process remains uncertain. Its predominance along the median raphe suggests a congenital midline inclusion disorder. PMID:1914743

  18. Total hip arthroplasty in paralytic dislocation from poliomyelitis.

    PubMed

    Laguna, Rafael; Barrientos, Jesús

    2008-02-01

    This article presents a case of a patient with degenerative hip disease in paralytic dislocation by poliomyelitis. Poliomyelitis is an acute infection disease caused by a group of neurotrophic viruses, which has a special affinity by the anterior horns cells of the spinal cord and for certain motor nuclei of the brain stem. Paralysis is a flaccid type and characteristically paralysis is asymmetrical. It is said that the joints of the affected limb by poliomyelitis are protected from the development of osteoarthritis. Hip dislocation in poliomyelitis is an acquired deformity caused by flaccid paralysis and the resulting muscular imbalance. In young children, when the gluteus maximus and medius muscles are paralyzed and the hip flexors and adductors are of normal strength, eventual luxation of the hip is almost inevitable. Hip osteoarthritis in a limb with poliomyelitis is an unusual entity because these limbs do not support excessive loads. In patients who present with the residual effects of poliomyelitis including degenerative disease and hip dysplastic, surgery is one of the most difficult challenges faced by reconstructive surgeons. In such cases, surgeons should attempt to optimize the component position and choice, surgical approach, and soft tissue tensioning because stability of the prosthesis can be problematic. PMID:19292189

  19. Quantum dislocations in solid Helium-4

    NASA Astrophysics Data System (ADS)

    Aleinikava, Darya

    In this thesis the following problems on properties of solid 4He are considered: (i) the role of long-range interactions in suppression of dislocation roughening at T = 0; (ii) the combined effect of 3He impurities and Peierls potential on shear modulus softening; (iii) the dislocation superclimb and its connection to the phenomenon of "giant isochoric compressibility"; (iv) non-linear dislocation response to the applied stress and stress-induces dislocation roughening as a I-order phase transition in 1D at finite temperature. First we investigate the effect of long-range interactions on the state of edge dislocation at T = 0. Such interactions are induced by elastic forces of the solid. We found that quantum roughening transition of a dislocation at T = 0 is completely suppressed by arbitrarily small long-range interactions between kinks. A heuristic argument is presented and the result has been verified by numerical Monte-Carlo simulations using Worm Algorithm in J-current model. It was shown that the Peierls potential plays a crucial role in explaining the elastic properties of dislocations, namely shear modulus softening phenomenon. The crossover from T = 0 to finite temperatures leads to intrinsic softening of the shear modulus and is solely controlled by kink typical energy. It was demonstrated that the mechanism, involving only the binding of 3He impurities to the dislocations, requires an unrealistically high concentrations of defects (or impurities) in order to explain the shear modulus phenomenon and therefore an inclusion of Peierls potential in consideration is required. Superclimbing dislocations, that is the edge dislocations with the superfluidity along the core, were investigated. The theoretical prediction that superclimb is responsible for the phenomenon of "giant isochoric compressibility" was confirmed by Monte-Carlo simulations. It was demonstrated that the isochoric compressibility is suppressed at low temperatures. The dependence of

  20. The Effects of Shoulder Slings on Balance in Patients With Hemiplegic Stroke

    PubMed Central

    Sohn, Min Kyun; Jee, Sung Ju; Hwang, Pyoungsik; Jeon, Yumi

    2015-01-01

    Objective To investigate the effects of a shoulder sling on balance in patients with hemiplegia. Methods Twenty-seven hemiplegic stroke patients (right 13, left 14) were enrolled in this study. The subjects' movement in their centers of gravity (COGs) during their static and dynamic balance tests was measured with their eyes open in each sling condition-without a sling, with Bobath's axillary support (Bobath sling), and with a simple arm sling. The percent times in quadrant, overall, anterior/posterior, and medial/lateral stability indexes were measured using a posturography platform (Biodex Balance System SD). Functional balance was evaluated using the Berg Balance Scale and the Trunk Impairment Scale. All balance tests were performed with each sling in random order. Results The COGs of right hemiplegic stroke patients and all hemiplegic stroke patients shifted to, respectively, the right and posterior quadrants during the static balance test without a sling (p<0.05). This weight asymmetry pattern did not improve with either the Bobath or the simple arm sling. There was no significant improvement in any stability index during either the static or the dynamic balance tests in any sling condition. Conclusion The right and posterior deviations of the hemiplegic stroke patients' COGs were maintained during the application of the shoulder slings, and there were no significant effects of the shoulder slings on the patients' balance in the standing still position. PMID:26798614