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Sample records for anterior shoulder dislocations

  1. BBilateral Neglected Anterior Shoulder Dislocation with Greater Tuberosity Fractures

    PubMed Central

    Upasani, Tejas; Bhatnagar, Abhinav; Mehta, Sonu

    2016-01-01

    Introduction: Shoulder dislocations are a very common entity in routine orthopaedic practice. Chronic unreduced anterior dislocations of the shoulder are not very common. Neurological and vascular complications may occur as a result of an acute anterior dislocation of the shoulder or after a while in chronic unreduced shoulder dislocation. Open reduction is indicated for most chronic shoulder dislocations. We report a case of neglected bilateral anterior shoulder dislocation with bilateral displaced greater tuberosity fracture. To the best of our knowledge, only a handful cases have been reported in literature with bilateral anterior shoulder dislocation with bilateral fractures. Delayed diagnosis/reporting is a scenario which makes the list even slimmer and management all the more challenging. Case Report: We report a case of a 35-year-old male who had bilateral anterior shoulder dislocation and bilateral greater tuberosity fracture post seizure and failed to report it for a period of 30 days. One side was managed conservatively with closed reduction and immobilization and the other side with open reduction. No neurovascular complications pre or post reduction of shoulder were seen. Conclusion: Shoulder dislocations should always be suspected post seizures and if found should be treated promptly. Treatment becomes difficult for any shoulder dislocation that goes untreated for considerable period of time PMID:27703939

  2. Double level arterial injury with neuropraxia following anterior shoulder dislocation

    PubMed Central

    Zaraa, Mourad; Sehli, Heithem; Mahjoub, Sabri; Dridi, Moez; Mbarek, Mondher

    2015-01-01

    Vascular and nervous complications are rare after shoulder dislocation. We report the case of a double level arterial injury with neuropraxia following anterior shoulder dislocation that was diagnosed by MultiDetector-row Computed Tomographic (MDCT) angiography and treated by surgical bypass graft and embolectomy. Our case is original, not only because of the rarity of these complications, but also because of the thromboembolism of brachial artery which could be undiagnosed and could compromise prognosis. PMID:26566344

  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.

  4. Increasing preoperative dislocations and total time of dislocation affect surgical management of anterior shoulder instability

    PubMed Central

    Denard, Patrick J.; Dai, Xuesong; Burkhart, Stephen S.

    2015-01-01

    Purpose: Our purpose was to determine the relationship between number of preoperative shoulder dislocations and total dislocation time and the need to perform bone deficiency procedures at the time of primary anterior instability surgery. Our hypothesis was that need for bone deficiency procedures would increase with the total number and hours of dislocation. Materials and Methods: A retrospective review was performed of primary instability surgeries performed by a single surgeon. Patients with <25% glenoid bone loss were treated with an isolated arthroscopic Bankart repair. Those who also had an engaging Hill-Sachs lesion underwent arthroscopic Bankart repair with remplissage. Patients with >25% glenoid bone loss were treated with Latarjet reconstruction. Number of dislocations and total dislocation time were examined for their relationship with the treatment method. Results: Ten arthroscopic Bankart repairs, 13 arthroscopic Bankart plus remplissage procedures, and 9 Latarjet reconstructions were available for review. Total dislocations (P = 0.012) and total hours of dislocation (P = 0.019) increased from the Bankart, to the remplissage, to the Latarjet groups. Patients with a total dislocation time of 5 h or more were more likely to require a Latarjet reconstruction (P = 0.039). Patients with only 1 preoperative dislocation were treated with an isolated Bankart repair in 64% (7 of 11) of cases, whereas those with 2 or more dislocations required a bone loss procedure in 86% (18 of 21) of cases (P = 0.013). Conclusion: Increasing number of dislocations and total dislocation time are associated with the development of glenoid and humeral head bony lesions that alter surgical management of anterior shoulder instability. The necessity for the addition of a remplissage to an arthroscopic Bankart repair or the use of a Latarjet reconstruction increases with only 1 recurrent dislocation. Level of evidence: Level III, retrospective comparative study. PMID:25709237

  5. Axillary artery transection and bilateral pulmonary embolism after anterior shoulder dislocation: case report

    PubMed Central

    Leclerc, Betty; Loisel, François; Ferrier, Maxime; Al Sayed, Mazen; Rinckenbach, Simon; Obert, Laurent

    2017-01-01

    Introduction: Anterior shoulder dislocation can be associated with vascular and neurological complications. However, axillary artery injury associated with shoulder dislocation is rare and extremely rare without bone fracture. An early diagnosis of these complications allows predicting long-term functional outcomes. Methods: This article reports the case of a 66-year-old patient who presented an anterior shoulder dislocation after a ski fall without any neurological dysfunction or pulse deficit. Results: The first reduction attempts were unsuccessful and during the new attempt, we observed a hematoma. A CT scan showed a disruption of the axillary artery and a bilateral pulmonary embolism. Conclusion: Neurovascular injury must be systematically sought before and after reduction, and a multidisciplinary approach is always necessary. PMID:28074775

  6. A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning.

    PubMed

    McMahon, Patrick J; Chow, Stephen; Sciaroni, Laura; Yang, Bruce Y; Lee, Thay Q

    2003-01-01

    A novel cadaveric model for anterior-inferior shoulder dislocation using forcible apprehension positioning is presented. This model simulates an in vivo mechanism and yields capsulolabral lesions. The scapulae of 14 cadaveric entire upper limbs (82 +/- 9 years, mean +/- standard deviation) were each rigidly fixed to a custom shoulder-testing device. A pneumatic system was used with pulleys and cables to simulate the rotator cuff and the deltoid muscles (anterior and middle portions). The glenohumeral joint was then positioned in the apprehension position of abduction, external rotation, and horizontal abduction. A 6-degree-of-freedom load cell (Assurance Technologies, Garner, North Carolina) measured the joint reaction force that was then resolved into three orthogonal components of compression force, anteriorly directed force, and superiorly directed force. With the use of a thrust bearing, the humerus was moved along a rail with a servomotor-controlled system at 50 mm/s that resulted in horizontal abduction. Force that developed passively in the pectoralis major muscle was recorded with an independent uniaxial load cell. Each of the glenohumeral joints dislocated anterior-inferior, six with avulsion of the capsulolabrum from the anterior-inferior glenoid bone and eight with capsulolabral stretching. Pectoralis major muscle force as well as the joint reaction force increased with horizontal abduction until dislocation. At dislocation, the magnitude of the pectoralis major muscle force, 609.6 N +/- 65.2 N was similar to the compression force, 569.6 N +/- 37.8 N. A cadaveric model yielded an anterior dislocation with a mechanism of forcible apprehension positioning when the appropriate shoulder muscles were simulated and a passive pectoralis major muscle was included. Capsulolabral lesions resulted, similar to those observed in vivo.

  7. Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations.

    PubMed

    Regauer, Markus; Polzer, Hans; Mutschler, Wolf

    2014-01-18

    In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

  8. Neglected anterior dislocation of shoulder with large Hillsach's lesion & deficient glenoid: Treated by autogenous bone graft & modified Latarjet procedure☆

    PubMed Central

    Peshin, Chetan; Jangira, Vivek; Gupta, Ravi Kumar; Jindal, Rohit

    2015-01-01

    Neglected anterior dislocation of shoulder is rare in spite of the fact that the anterior dislocation of the shoulder is seen in around 90% of the acute cases. Most of the series of neglected dislocation describe posterior dislocation to be far more common.1,2 We hereby report a case of the neglected anterior shoulder dislocation in a 15 year old boy who had a history of epilepsy. There was a large Hill Sachs lesion in humeral head which was impacted in glenoid inferiorly and glenoid was eburnated at that margin. The humeral head was reconstructed with a tricortical iliac graft. Glenoid was reconstructed by transfer of coracoids process of scapula to antero-inferior glenoid (modified Latarjet procedure). This case is unique because management of humeral head defect with bone graft is not mentioned in anterior dislocation. PMID:26566343

  9. Dislocated shoulder - aftercare

    MedlinePlus

    ... aftercare; Shoulder subluxation - aftercare; Shoulder reduction - aftercare; Glenohumeral joint dislocation ... that connect bone to bone) of the shoulder joint. All of these tissues help keep your arm ...

  10. Intraarticular lidocaine versus intravenous analgesic for reduction of acute anterior shoulder dislocations. A prospective randomized study.

    PubMed

    Matthews, D E; Roberts, T

    1995-01-01

    We performed a prospective, randomized study to evaluate the use of injected lidocaine as an anesthetic for closed reduction of acute anterior shoulder dislocations. Thirty consecutive patients who presented at the emergency department with acute anterior shoulder dislocations were randomly placed in one of two groups. One group received an intraarticular injection of 20 ml of 1% lidocaine and the other group, intravenous injections of morphine sulfate and midazolam. The groups were compared regarding time of reduction maneuver, difficulty of reduction, subjective pain, complications, and total time spent in the emergency department. The lidocaine provided adequate anesthesia and secondary relief of muscle spasm in 15 of 15 (100%) patients. When compared with the intravenous sedation group, the lidocaine group showed no statistically significant difference in time for reduction maneuver, difficulty of reduction, or subjective pain. The lidocaine group had no complications and had a statistically significant shorter emergency department visit when compared with the intravenous sedation group (mean, 78 minutes versus 186 minutes; P = 0.004). Lidocaine provides excellent anesthesia for patients with uncomplicated anterior shoulder dislocations and can be very beneficial when sedation is contraindicated. Lidocaine injections also proved to be cost effective in our institution, reducing total costs by as much as 62%.

  11. Dislocated Shoulder

    MedlinePlus

    ... gradual rehabilitation program designed to restore range of motion, strength and stability to your shoulder joint. If ... when the pain improves. Maintain the range of motion of your shoulder. After one or two days, ...

  12. RESULTS FROM FILLING “REMPLISSAGE” ARTHROSCOPIC TECHNIQUE FOR RECURRENT ANTERIOR SHOULDER DISLOCATION

    PubMed Central

    Gracitelli, Mauro Emilio Conforto; Helito, Camilo Partezani; Malavolta, Eduardo Angeli; Neto, Arnaldo Amado Ferreira; Benegas, Eduardo; Prada, Flávia de Santis; de Sousa, Augusto Tadeu Barros; Assunção, Jorge Henrique; Sunada, Edwin Eiji

    2015-01-01

    Objective: To evaluate the clinical result from the filling (“remplissage”) technique in association with Bankart lesion repair for treating recurrent anterior shoulder dislocation. Methods: Nine patients (10 shoulders), with a mean follow-up of 13.7 months, presented traumatic recurrent anterior shoulder dislocation. All of them had a Bankart lesion, associated with a Hill-Sachs lesion showing the “engaging” sign. The Hill-Sachs lesion defect was measured and showed an average bone loss of 17.3% (7.7% to 26.7%) in relation to the diameter of the humeral head. All the cases underwent arthroscopic repair of the Bankart lesion, together with filling of the Hill-Sachs lesion by means of tenodesis of the infraspinatus. Results: The Rowe score ranged from 22.5 (10 to 45) before the operation to 80.5 (5 to 100) after the operation (p > 0.001). The UCLA score ranged from 18.0 (8 to 29) to 31.1 (21 to 31) (p > 0.001). The measurements of external and internal rotation at abduction of 90° after the operation were 63.5° (45° to 90°) and 73° (50° to 92°) respectively. Two patients presented recurrence (one with dislocation and the other with subluxation). None of the patients presented pain in the region of the infraspinatus tendon after the operation. Conclusion: Over the short term, the filling (“remplissage”) arthroscopic technique produced improvements in functional scores and a low complication rate when used for treating glenohumeral instability associated with Hill-Sachs lesions. PMID:27027073

  13. 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.

  14. Anterior Dislocation of the Shoulder Due to an Idiopathic Deltoid Contracture-the Report of a Rare Presentation

    PubMed Central

    Vadapalli, Satyadev

    2013-01-01

    Post injection fibrosis leading to muscle contracture is a known complication. Deltoid fibrosis is known to occur following trauma or an intramuscular injection. Idiopathic Deltoid fibrosis leading to abduction contracture and anterior dislocation of the shoulder is a rare entity. Prompt diagnosis and surgery by distal release of fibrosed Deltoid muscle will lead to good functional recovery. PMID:23543744

  15. First-time traumatic anterior dislocation of the shoulder in young adults: the position of the arm during immobilisation revisited.

    PubMed

    De Baere, Tom; Delloye, Christian

    2005-10-01

    In contrast to the surgical treatment of chronic shoulder instability, there are only scarce publications about the management after a first episode of anterior shoulder dislocation and how to prevent the evolution towards chronic instability. We present here a review of the literature on this subject. Particular attention is paid to recent studies about the position of the arm during immobilisation. According to recent views, it may be preferable to immobilise the arm in external rather than internal rotation, but this has to be confirmed by further clinical studies. The issue of early arthroscopic stabilisation after a first dislocation event in young athletic patients is also discussed.

  16. Bilateral four-part anterior fracture dislocation of the shoulder--a case report and review of literature.

    PubMed

    Bachhal, Vikas; Goni, Vijay; Taneja, Ashish; Shashidhar, B K; Bali, Kamal

    2012-01-01

    Although bilateral anterior dislocation of shoulder is not that uncommon, there have been only 12 published reports on bilateral anterior fracture dislocation of shoulder. The associated fractures have mostly been greater tuberosity fractures with bilateral three part fractures being reported in only two cases. To our knowledge, a bilateral four part anterior fracture dislocation of the shoulder has not yet been reported in the English literature. We here report a case of bilateral anterior fracture dislocation with four part fracture of both proximal humeri in a 60-year-old male due to electrocution. Considering the comparatively old age of the patient and excessive comminution of both the fractures, a bilateral hemiarthroplasty was done. At the last follow-up after more than 2 years, the patient was pain free with ability to comfortably carry out most of the activities of daily life. Through our case report, we highlight the rarity of the condition and review the available literature on the subject. We also emphasize the importance of meticulous perioperative planning when dealing with such cases to ensure a satisfactory long-term outcome.

  17. 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

  18. Anterior dislocation of the shoulder associated with Bankart lesion in a patient with Poland's syndrome: a case report and review of the literature.

    PubMed

    Zwolak, P; Schnurr, C; Hackenbroch, M; Eysel, P; Michael, J W-P

    2010-02-01

    Poland's syndrome is a rare congenital entity characterized by unilateral partial or total hypoplasia of the major pectoralis muscle, breast and/or ipsilateral hand abnormalities. It has been reported in association with various structural and functional abnormalities. We report about a 23-year-old male kick-boxer with Poland's syndrome who presented in our department the history of two traumatic anterior shoulder dislocations due to boxing and self-reductions. Physical examination showed an instability of the left shoulder, and the MRI scans demonstrated a Bankart lesion. The patient had been treated with an arthroscopic Bankart repair; reattachment of the detached antero-inferior labrum down to the glenoid and repairing of the inferior gleno-humeral ligament complex. To our knowledge this is a first case report of a patient presenting with traumatic anterior shoulder dislocations due to kick-boxing associated with Poland's syndrome.

  19. Risk factors which predispose first-time traumatic anterior shoulder dislocations to recurrent instability in adults: a systematic review and meta-analysis

    PubMed Central

    Olds, M; Ellis, R; Donaldson, K; Parmar, P; Kersten, P

    2015-01-01

    Background Recurrent instability following a first-time anterior traumatic shoulder dislocation may exceed 26%. We systematically reviewed risk factors which predispose this population to events of recurrence. Methods A systematic review of studies published before 1 July 2014. Risk factors which predispose recurrence following a first-time traumatic anterior shoulder dislocation were documented and rates of recurrence were compared. Pooled ORs were analysed using random-effects meta-analysis. Results Ten studies comprising 1324 participants met the criteria for inclusion. Recurrent instability following a first-time traumatic anterior shoulder dislocation was 39%. Increased risk of recurrent instability was reported in people aged 40 years and under (OR=13.46), in men (OR=3.18) and in people with hyperlaxity (OR=2.68). Decreased risk of recurrent instability was reported in people with a greater tuberosity fracture (OR=0.13). The rate of recurrent instability decreased as time from the initial dislocation increased. Other factors such as a bony Bankart lesion, nerve palsy and occupation influenced rates of recurrent instability. Conclusions Sex, age at initial dislocation, time from initial dislocation, hyperlaxity and greater tuberosity fractures were key risk factors in at least two good quality cohort studies resulting in strong evidence as concluded in the GRADE criteria. Although bony Bankart lesions, Hill Sachs lesions, occupation, physiotherapy treatment and nerve palsy were risk factors for recurrent instability, the evidence was weak using the GRADE criteria—these findings relied on poorer quality studies or were inconsistent among studies. PMID:25900943

  20. Using evidence-based algorithms to improve clinical decision making: the case of a first-time anterior shoulder dislocation.

    PubMed

    Federer, Andrew E; Taylor, Dean C; Mather, Richard C

    2013-09-01

    Decision making in health care has evolved substantially over the last century. Up until the late 1970s, medical decision making was predominantly intuitive and anecdotal. It was based on trial and error and involved high levels of problem solving. The 1980s gave way to empirical medicine, which was evidence based probabilistic, and involved pattern recognition and less problem solving. Although this represented a major advance in the quality of medical decision making, limitations existed. The advantages of the gold standard of the randomized controlled clinical trial (RCT) are well-known and this technique is irreplaceable in its ability to answer critical clinical questions. However, the RCT does have drawbacks. RCTs are expensive and can only capture a snapshot in time. As treatments change and new technologies emerge, new expensive clinical trials must be undertaken to reevaluate them. Furthermore, in order to best evaluate a single intervention, other factors must be controlled. In addition, the study population may not match that of another organization or provider. Although evidence-based medicine has provided powerful data for clinicians, effectively and efficiently tailoring it to the individual has not yet evolved. We are now in a period of transition from this evidence-based era to one dominated by the personalization and customization of care. It will be fueled by policy decisions to shift financial responsibility to the patient, creating a powerful and sophisticated consumer, unlike any patient we have known before. The challenge will be to apply medical evidence and personal preferences to medical decisions and deliver it efficiently in the increasingly busy clinical setting. In this article, we provide a robust review of the concepts of customized care and some of techniques to deliver it. We will illustrate this through a personalized decision model for the treatment decision after a first-time anterior shoulder dislocation.

  1. 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.

  2. 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

  3. Simultaneous shoulder and elbow dislocation.

    PubMed

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

    2014-05-23

    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.

  4. 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

  5. Understanding Preferences for Treatment After Hypothetical First-Time Anterior Shoulder Dislocation: Surveying an Online Panel Utilizing a Novel Shared Decision-Making Tool

    PubMed Central

    Streufert, Ben; Reed, Shelby D.; Orlando, Lori A.; Taylor, Dean C.; Huber, Joel C.; Mather, Richard C.

    2017-01-01

    Background: Although surgical management of a first-time anterior shoulder dislocation (FTASD) can reduce the risk of recurrent dislocation, other treatment characteristics, costs, and outcomes are important to patients considering treatment options. While patient preferences, such as those elicited by conjoint analysis, have been shown to be important in medical decision-making, the magnitudes or effects of patient preferences in treating an FTASD are unknown. Purpose: To test a novel shared decision-making tool after sustained FTASD. Specifically measured were the following: (1) importance of aspects of operative versus nonoperative treatment, (2) respondents’ agreement with results generated by the tool, (3) willingness to share these results with physicians, and (4) association of results with choice of treatment after FTASD. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A tool was designed and tested using members of Amazon Mechanical Turk, an online panel. The tool included an adaptive conjoint analysis exercise, a method to understand individuals’ perceived importance of the following attributes of treatment: (1) chance of recurrent dislocation, (2) cost, (3) short-term limits on shoulder motion, (4) limits on participation in high-risk activities, and (5) duration of physical therapy. Respondents then chose between operative and nonoperative treatment for hypothetical shoulder dislocation. Results: Overall, 374 of 501 (75%) respondents met the inclusion criteria, of which most were young, active males; one-third reported prior dislocation. From the conjoint analysis, the importance of recurrent dislocation and cost of treatment were the most important attributes. A substantial majority agreed with the tool’s ability to generate representative preferences and indicated that they would share these preferences with their physician. Importance of recurrence proved significantly predictive of respondents’ treatment choices

  6. 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

  7. Opposite-direction bilateral fracture dislocation of the shoulders after an electric shock.

    PubMed

    Ozer, Hamza; Baltaci, Gül; Selek, Hakan; Turanli, Sacit

    2005-09-01

    Injuries after an electric shock, such as dermal burns, motor and sensory nerve deficits, fractures and dislocations, are reported in the literature. Posterior dislocation of the shoulder after electric-shock is the common musculoskeletal injury. Bilateral dislocation, either anterior or posterior, is rarely seen and reported. We report a case of bilateral shoulder fracture dislocation in opposite directions following an electric-shock and discuss the mechanism, the diagnosis and the treatment.

  8. Posterior dislocation of the shoulder in athletes.

    PubMed

    Samilson, R L; Prieto, V

    1983-07-01

    Although posterior dislocation of the shoulder is a rare injury in athletes, failure to recognize and properly manage acute dislocation may have serious consequences. The article discusses the incidence, mechanism of injury, classification, pathologic findings, clinical and radiologic diagnosis, and management.

  9. Incidence of Posttraumatic Shoulder Dislocation in Poland

    PubMed Central

    Szyluk, Karol J.; Jasiński, Andrzej; Mielnik, Michał; Koczy, Bogdan

    2016-01-01

    Background The incidence of shoulder joint dislocation has been estimated at 11–26 per 100 000 population per year. In our opinion, basic epidemiological data need to be continually updated in studies of large populations. To study the incidence of posttraumatic dislocation of the shoulder joint in the Polish population. Material/Methods We retrospectively investigated the entire Polish population between 1 January 2010 and 1 January 2015. To identify the study group, data collected in the electronic database of the National Health Fund were used. The study group was divided into subgroups to detect possible differences in the incidence of shoulder dislocation with regard to age, sex, and season of the year (month) when the dislocation occurred. Results The cumulative size of the study sample was 192.72 million over the 5 years of the study. We identified 51 409 patients with first posttraumatic shoulder dislocation, at a mean age of 50.83 years (SD 21.12), from 0 to 104 years. The incidence of traumatic shoulder dislocations for the entire study group ranged from 24.75/100 000/year (number of posttraumatic shoulder dislocations per 100 000 persons per year) to 29.09/100 000/year, for a mean of 26.69/100 000/year. Conclusions In this study, the overall incidence of first-time posttraumatic shoulder dislocations in the Polish general population was 26.69 per 100 000 persons per year. These results are higher than estimates presented by other authors. It is necessary to study, regularly update, and monitor this problem in the general population. PMID:27777396

  10. Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review.

    PubMed

    Behr, Ian; Blint, Andy; Trenhaile, Scott

    2013-12-01

    Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome.

  11. Ipsilateral fracture dislocation of the shoulder and elbow: A case report and literature review

    PubMed Central

    Behr, Ian; Blint, Andy; Trenhaile, Scott

    2013-01-01

    Ipsilateral dislocation of the shoulder and elbow is an uncommon injury. A literature review identified nine previously described cases. We are reporting a unique case of ipsilateral posterior shoulder dislocation and anterior elbow dislocation along with concomitant intra-articular fractures of both joints. This is the first report describing this combination of injuries. Successful treatment generally occurs with closed reduction of ipsilateral shoulder and elbow dislocations, usually reducing the elbow first. When combined with a fracture at one or both locations, closed reduction of the dislocations in conjunction with appropriate fracture management can result in a positive functional outcome. PMID:26403884

  12. Clinical Outcomes Following Revision Anterior Shoulder Stabilization

    PubMed Central

    Frank, Rachel M.; Mellano, Chris; Shin, Jason J.; Feldheim, Terrence F.; Mascarenhas, Randhir; Yanke, Adam Blair; Cole, Brian J.; Nicholson, Gregory P.; Romeo, Anthony A.; Verma, Nikhil N.

    2015-01-01

    Objectives: The purpose of this study was to determine the clinical outcomes following revision anterior shoulder stabilization performed either via all-arthroscopic soft tissue repair or via Latarjet coracoid transfer. Methods: A retrospective review of prospectively collected data on 91 shoulders undergoing revision anterior shoulder stabilization was performed. All patients underwent prior soft tissue stabilization; those with prior open bone grafting procedures were excluded. For patients with 25% glenoid bone loss, Latarjet was performed (n=28). Patients were queried regarding recurrent instability (subluxation or dislocation). Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), visual analog scale (VAS) for pain, and Western Ontario Shoulder Instability Index (WOSI). Results: A total of 63 shoulders in 62 patients (46 males, 16 females) with an average age of 23.2 ± 6.9 years were included in the revision arthroscopy group. At an average follow-up of 46.9 ± 16.8 months (range, 15 to 78), the mean WOSI score was 80.1 (range, 15.0 to 100), and there were significant improvements (p<0.001) in ASES (63.7 to 85.1), SST (6.2 to 9.1), and VAS pain scores (2.89 to 0.81). Recurrent instability occurred in 12 of 63 shoulders (19%); the number of prior surgeries and baseline hyperlaxity were significant risk factors for failure (p<0.001 and p=0.04, respectively). No patients developed clinical or radiographic evidence of arthritis. A total of 28 shoulders in 28 patients (21 male, 7 female) with an average age of 27.5 years (range 14 to 45) were included in the Latarjet group. Thirteen (46%) had more than one previous stabilization attempt. ), the average WOSI score was 71.9, and there were significant improvements (p<0.001) in ASES (65.7 to 87.0), SST (7.2 to 10.3), and VAS (3.1 to 1.1). Recurrent instability occurred in 2 of 28 shoulders

  13. Arthroscopic Findings in Anterior Shoulder Instability

    PubMed Central

    Hantes, Michael; Raoulis, Vasilios

    2017-01-01

    Background: In the last years, basic research and arthroscopic surgery, have improved our understanding of shoulder anatomy and pathology. It is a fact that arthroscopic treatment of shoulder instability has evolved considerably over the past decades. The aim of this paper is to present the variety of pathologies that should be identified and treated during shoulder arthroscopy when dealing with anterior shoulder instability cases. Methods: A review of the current literature regarding arthroscopic shoulder anatomy, anatomic variants, and arthroscopic findings in anterior shoulder instability, is presented. In addition, correlation of arthroscopic findings with physical examination and advanced imaging (CT and MRI) in order to improve our understanding in anterior shoulder instability pathology is discussed. Results: Shoulder instability represents a broad spectrum of disease and a thorough understanding of the pathoanatomy is the key for a successful treatment of the unstable shoulder. Patients can have a variety of pathologies concomitant with a traditional Bankart lesion, such as injuries of the glenoid (bony Bankart), injuries of the glenoid labrum, superiorly (SLAP) or anteroinferiorly (e.g. anterior labroligamentous periosteal sleeve avulsion, and Perthes), capsular lesions (humeral avulsion of the glenohumeral ligament), and accompanying osseous-cartilage lesions (Hill-Sachs, glenolabral articular disruption). Shoulder arthroscopy allows for a detailed visualization and a dynamic examination of all anatomic structures, identification of pathologic findings, and treatment of all concomitant lesions. Conclusion: Surgeons must be well prepared and understanding the normal anatomy of the glenohumeral joint, including its anatomic variants to seek for the possible pathologic lesions in anterior shoulder instability during shoulder arthroscopy. Patient selection criteria, improved surgical techniques, and implants available have contributed to the enhancement of

  14. The epidemiology of shoulder dislocation in a state-hospital: a review of 106 cases.

    PubMed

    Hazmy, C H Wan; Parwathi, A

    2005-07-01

    This retrospective study was conducted in a state hospital set-up and aimed at identifying the magnitude of shoulder dislocations and their demographic data, characteristics of the injury, mechanism and predisposing factors, and the instituted treatment. Patients with radiographic evidence of shoulder dislocation admitted to the hospital from January 1999 to December 2002 were included. Data were recorded from the case notes. There were 105 shoulder dislocations with male predomination in 77% cases and age ranged between 11 and 90 years (average 30.9 years). The right shoulder was affected in 68% of the cases. The contributing events were fall in 37% of cases, road traffic accident 23%, sports 17% and pathological conditions 13%. Anterior dislocation occurred in 96.2% of the cases. Posterior and inferior dislocations encountered in two patients for each type. Twelve dislocations were associated fracture of the greater tuberosity, two each with humeral neck fracture and cerebral injuries. First time dislocation occurred in 73.6% of the cases. The recurrences ranged between 2 to 6 times (average 3.4 times). Closed manipulative reduction and strapping was the definitive treatment in 92.4% of the cases and the remaining needed surgical reconstruction. Four patients had open reduction and internal fixation of the associated fractures while another four had arthroscopic Bankart's repair. In conclusion, shoulder dislocation represents the most common shoulder problems. It afflicted young adults of reproductive age (21-40 years) and participation in sports was a risk factor in men. Women over 40 years and fall were at risk to develop shoulder dislocation.

  15. 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.

  16. 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

  17. FUNCTIONAL ASSESSMENT OF ARTHROSCOPIC REPAIR FOR RECURRENT ANTERIOR SHOULDER INSTABILITY

    PubMed Central

    de Almeida Filho, Ildeu Afonso; de Castro Veado, Marco Antônio; Fim, Márcio; da Silva Corrêa, Lincoln Vargas; de Carvalho Junior, Antônio Enéas Rangel

    2015-01-01

    Objective: To clinically and radiologically evaluate patients who underwent arthroscopic surgical treatment for anterior shoulder instability by means of the Bankart technique, using metal anchors. Methods: This was a retrospective study on 49 patients who underwent arthroscopic repair of anterior shoulder instability between 2002 and 2007. The patients were evaluated using the Carter-Rowe score and the Samilson and Prieto classification. The mean age at the time of surgery was 30 years. The mean length of follow-up was 42.7 months (ranging from 18 to 74). 85% of the patients were male. Results: The mean Carter-Rowe score was 83 points (ranging from 30 to 100) including 31 excellent results, 7 good, 3 fair and 8 poor. Recurrent dislocation was observed in 16% (8 patients), and 37.5% of them were of traumatic origin. Joint degeneration was present in 32.5% of the cases, including 5 cases of grade 1, 6 cases of grade 2 and 2 cases of grade 3. The average loss of external rotation was 12° and the loss of anterior elevation was 8°. There was a statistically significant relationship (p < 0.05) between arthritis and age at first dislocation, age at surgery and crackling. 92% of the patients reported high degrees of satisfaction after the procedure. Among the complications, there were two cases of stiff shoulder, one patient with prominence of the synthesis material and one case of anchor loosening. Conclusion: Arthroscopic repair of anterior shoulder instability using metal anchors was shown to be effective, with a low complication rate. PMID:27042624

  18. Posterior shoulder dislocation while lifting weights: a missed diagnosis

    PubMed Central

    Cuffolo, Giulio; Coomber, Ross; Burtt, Simon; Gray, Jim

    2014-01-01

    Summary We present a case of a 24-year-old man who suffered acute shoulder pain and subsequent inability to move his arm while lifting weights in the bench-press position. He attended A&E where he was examined and X-rays were performed. He was diagnosed with presumed pectoralis major tendon rupture and was discharged to fracture clinic the following day with analgesia. On review in clinic he was found to have a posterior shoulder dislocation and was taken to theatre for relocation under anaesthesia. This case report examines the mechanism, investigations and management of posterior shoulder dislocation. PMID:24557475

  19. A prevalence study of recurrent shoulder dislocations in young adults.

    PubMed

    Milgrom, C; Mann, G; Finestone, A

    1998-01-01

    The computerized database of the Israeli Defence Forces Medical Corps monitors recurrent shoulder dislocations before citizens are eligible for military induction, during the years of regular military service, and during the time of eligibility for reserve army service. With the computerized database of the Israeli Defence Forces Medical Corps, between the years of 1978 to 1995 the prevalence rate of subjects with recurrent shoulder dislocations less than or equal to 21 years of age was found to be 19.7 of 10,000 for men and 5.01 of 10,000 for women. The prevalence rate of subjects with a history of shoulder dislocations in the male population between the ages of 22 and 33 years was 42.4 of 10,000. Forty-four percent were judged to be sufficiently unstable to warrant surgery, but only 55% of these actually underwent surgery. These epidemiologic data may be important if arthroscopic shoulder surgery is being considered after a first shoulder dislocation.

  20. Treatment of Locked Posterior Shoulder Dislocation With Bone Defect.

    PubMed

    Khira, Yousuf M; Salama, Adel M

    2017-03-14

    Locked posterior shoulder dislocation is an uncommon condition and is associated with a reverse Hill-Sachs lesion in 50% of cases. The condition is likely to occur in cases of violent trauma, seizures, or electric shock. Unrecognized dislocation with humeral head fracture affects joint function and humeral head vascularity and may lead to chronic instability, osteonecrosis, and osteoarthritis. A group of 12 patients, including 10 men and 2 women, with neglected locked posterior shoulder dislocation with a reverse Hill-Sachs lesion were treated with the modified McLaughlin technique. The added bone graft from the iliac crest was impacted in the defect and fixed with screws. Mean follow-up was 30 months (range, 24-48 months). The range of forward flexion was 150˚ to 175˚ (average, 165˚), external rotation ranged from 60˚ to 80˚ (average, 75˚), internal rotation ranged from 40˚ to 60˚ (average, 50˚), and average abduction was 150˚ (range, 145˚-160˚). The modified University of California Los Angeles (UCLA) scoring system was used for postoperative clinical evaluation. Total UCLA scores immediately postoperatively ranged from 22 to 28 points (average, 26.5 points) and averaged 30 points (range, 28-33 points) at last follow-up. No recurrence of dislocation occurred during the follow-up period. Of the study patients, 10 returned to their previous job and 2 modified their manual work. The modified McLaughlin technique with added iliac crest bone graft to fill the defect and prevent humeral head deformity is a successful technique for the treatment of patients with chronic locked posterior shoulder dislocation. [Orthopedics. 201x; xx(x):xx-xx.].

  1. Arthroscopic stabilization procedures for recurrent anterior shoulder instability.

    PubMed

    Yahiro, M A; Matthews, L S

    1989-11-01

    Anterior shoulder instability is a common and functionally disabling problem in young athletes. The goal in treatment of this condition is a stable, yet mobile, joint. Current methods now being utilized in the arthroscopic stabilization of the anterior shoulder include staple capsulorrhaphy, removable rivet capsulorrhaphy, cannulated screw fixation, and the transglenoid suture technique. These techniques and the clinical experience with each are reviewed, with an emphasis on providing stability, improving function, and allowing earlier rehabilitation in the unstable shoulder of the athlete.

  2. One step arthroscopically assisted Latarjet and posterior bone-block, for recurrent posterior instability and anterior traumatic dislocation

    PubMed Central

    D’Ambrosi, Riccardo; Perfetti, Carlo; Garavaglia, Guido; Taverna, Ettore

    2015-01-01

    This case presents the challenges of the surgical management for a patient with a history of recurrent posterior shoulder instability and subsequently traumatic anterior dislocation. The patient was already on the waiting list for an arthroscopic posterior stabilization with anchors, when a car accident caused an additional anterior shoulder dislocation. This traumatic anterior dislocation created a bone loss with a glenoid fracture and aggravated the preexisting posterior instability. In order to address both problems, we decided to perform an arthroscopically assisted Latarjet procedure for anterior instability and to stabilize with a bone graft for posterior instability. To our best knowledge, this type of surgical procedure has so far never been reported in the literature. The purpose of this report is to present the surgical technique and to outline the decision making process. PMID:26288539

  3. 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.

  4. Long head of the biceps pathology as a cause of anterior shoulder pain after shoulder arthroplasty.

    PubMed

    Tuckman, David V; Dines, David M

    2006-01-01

    The use of shoulder arthroplasty has been increasing over the last decade, with nearly 20,000 shoulder arthroplasties being performed each year. Although many patients have excellent results, there exists a subset of patients in whom anterior catching shoulder pain develops after arthroplasty. The purpose of this study was to examine this group of patients and explore treatment options and outcomes for this condition. We undertook a review of 8 shoulders in 7 patients who were treated for anterior shoulder pain radiating into the biceps muscle after shoulder arthroplasty. Three patients had a hemiarthroplasty for fracture, and five had a total shoulder arthroplasty. All patients had anterior shoulder pain with physical examination findings consistent with biceps tendon pathology. Definitive diagnosis and treatment consisted of either arthroscopy, in 7 of 8 shoulders, or an open procedure, in 1 of 8 shoulders. The range of motion improved in all shoulders. The hemiarthroplasty group showed an increase in flexion of 36 degrees (range, 68 degrees -104 degrees ), external rotation of 23 degrees (range, 11 degrees -34 degrees ), and internal rotation to L4. The total shoulder group demonstrated an increase in flexion of 50 degrees (range, 66 degrees -166 degrees ), external rotation of 27 degrees (range, 22 degrees -39 degrees ), and internal rotation to L3. The Hospital for Special Surgery score improved in all shoulders, with all patients being satisfied with their final outcome. Pain scores improved from a mean of 6.9 (range, 4-9) preoperatively to 1.4 (range, 0.5-2) postoperatively on a scale of 1 to 10, with 10 indicating the most pain. The role of the biceps tendon in the pathology of anterior shoulder pain after shoulder arthroplasty appears to be consistent with fibrosis and inflammation. Initial results, achieved with arthroscopic debridement or tenodesis, were encouraging.

  5. Pathologic dislocation of the shoulder secondary to septic arthritis: a case report

    PubMed Central

    2009-01-01

    Septic arthritis of the shoulder is uncommon in adults, and complete dislocation of the glenohumeral joint following septic arthritis is extremely rare. We report a case of pathologic shoulder dislocation secondary to septic arthritis in an intravenous drug abuser. PMID:20062648

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

    PubMed

    Iosifidis, Michael I; Giannoulis, Ioannis; Traios, Stavros; Giantsis, Georgios

    2006-08-01

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

  7. Recurrent anterior shoulder instability: a review of the Latarjet procedure and its postoperative rehabilitation.

    PubMed

    Fedorka, Catherine J; Mulcahey, Mary K

    2015-02-01

    The shoulder is the most common joint to dislocate in the human body, with the dislocation often occurring in the anterior direction. This injury frequently results in soft tissue injury (eg, labral tear, capsular stretching) or bone injury (eg, glenoid or humeral head bone loss), which commonly leads to persistent deficits of shoulder function and a high risk of subsequent instability episodes in young, active patients. Patients with a significant degree of glenoid bone loss (> 25%) may require surgical intervention using the Latarjet procedure, which is an open bony augmentation of the glenoid. This procedure involves transferring the tip of the coracoid to the anteroinferior glenoid, creating a bony block and musculotendinous sling to prevent instability. Rehabilitation after the procedure is a slow progression over 4 to 6 months to regain range of motion and strength, while protecting the bony augmentation. Recent reports have shown success with the Latarjet procedure, as indicated by patient satisfaction scores and a low rate of recurrent instability.

  8. [How I Treat. An Anterior Temporomandibular Joint Dislocation].

    PubMed

    Gilon, Y; Johnen, J; Nizet, J L

    2015-09-01

    Anterior dislocation of the temporomandibular joint is not uncommon and requires prompt management. A defect of dislocation reduction can lead to severe functional impairment of a complex, and often active joint. The diagnosis is clinical and relatively obvious. It is made by the frontline medical team, general practitioner or emergency doctor. Recurrent cases are a matter for maxillofacial surgeons. This article describes a conventional technique for anterior dislocation reduction, to achieve urgently. The second part of the article deals with the specialized surgical treatment of relapsing forms.

  9. Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult.

    PubMed

    Kumar, Sunil; Rathi, Akhilesh; Sehrawat, Sunil; Gupta, Vikas; Talwar, Jatin; Arora, Sumit

    2014-01-01

    Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

  10. 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

  11. Minimally Invasive Modified Latarjet Procedure in Patients With Traumatic Anterior Shoulder Instability

    PubMed Central

    Ebrahimzadeh, Mohammad Hossein; Moradi, Ali; Zarei, Ahmad Reza

    2015-01-01

    Background: Despite recent advances in arthroscopic soft tissue repair and reconstruction for shoulder instability, Latarjet procedure is continuously a method of choice for many cases of unstable shoulders. Objectives: To evaluate the clinical results of minimally invasive modified Latarjet technique in recurrent, traumatic anterior shoulder instability associated with obvious Hill-Sachs and Bankart lesions. Patients and Methods: Between 2007 and 2013, 36 consequent patients with traumatic anterior shoulder instability who underwent modified Latarjet operation were enrolled in this prospective study. The MRI studies revealed labrum detachment and Hill-Sachs lesion in all shoulders. For all patients, demographic and injury data were obtained and Constant Shoulder score, Rowe score, and UCLA scores were completed by related surgeon. Stability of the shoulder was assessed with the Jobe’s relocation test preoperatively. The patients were followed up at two weeks, one month, three months, and six months from the date of the surgery and evaluated for probable complications. Above mentioned assessments were completed again at the time of the final follow-up. Results: The average age of the enrolled patients was 24.6 (ranging from 18 to 33 years) and 35 patients out of the total of 36 patients were males. Motor-vehicle accidents were the major cause of the injuries (52%) with the average interval between the injury and operation of 3.1 ± 1.2 years (Ranging from 1 to 5 years). The average number of incidents of dislocations between the injury date and the surgery was 7.2 ± 2.1 (Ranging from 4 to 20). The average follow-up period was 37 months (Ranging from 12 to 65 months). All patients had Jobe’s relocation test (Apprehension sign) pre-operatively and negative Jobe’s relocation test post-operation. Significant improvements in functional scores were demonstrated postoperatively compared to preoperational assessment in all cases. Final follow up radiographs showed

  12. Traumatic shoulder dislocation with combined bankart lesion and humeral avulsion of the glenohumeral ligament in a professional basketball player: three-year follow-up of surgical stabilization.

    PubMed

    Shah, Aakash A; Selesnick, F Harlan

    2010-10-01

    Traumatic anterior shoulder instability has been well documented to have associated lesions such as a Bankart tear, humeral avulsion of the glenohumeral ligament (HAGL), Hill-Sachs lesion, fracture, and nerve injury. To our knowledge, the combined Bankart and HAGL injury in a single acute anterior shoulder dislocation has not yet been reported. We describe a traumatic first-time anterior-inferior shoulder dislocation in a professional basketball player with a combined Bankart and HAGL lesion. The patient underwent arthroscopic Bankart repair followed by open repair of the HAGL lesion with an open capsular shift reconstruction. At 3 years' follow-up, the patient had returned to an elite level of play, with an excellent outcome.

  13. True congenital dislocation of shoulder: A case report and review of the literature

    PubMed Central

    Sudesh, Pebam; Rangdal, Sushil; Bali, Kamal; Kumar, Vishal; Gahlot, Nitesh; Patel, Sandeep

    2010-01-01

    The dislocation of a shoulder joint in infancy is extremely rare and is usually the result of traumatic birth injuries, a sequel to brachial plexus injury, or a true congenital dislocation of shoulder. With more advanced obstetric care, the incidence of first two types has drastically decreased. We report a case of true congenital dislocation of shoulder, second of its kind, in a child who was delivered by cesarean section thereby negating any influence of trauma. We report the case because of its rarity, and review the available literature on this topic. We also discuss the management options when encountered with such a rare case scenario. PMID:21655006

  14. Irreducible anterior dislocation of the elbow without associated fracture.

    PubMed

    Gyawali, Gopal Prasad; Pokharel, Bishnu; Pokharel, Rohit Kumar

    2013-01-01

    Anterior dislocation of the elbow joint is a rare entity and is usually associated with injuries to surrounding bony and soft tissues. Simple dislocation of the joint is managed conservatively. An eight years old girl had traumatic anterior dislocation of the elbow joint with intact distal neurovascular status. X-rays showed no associated bony injury. Close reductions failed. Per operative findings showed no intra-articular fracture and the radial head was button holed into the anterior joint capsule. Reduction was achieved openly and maintained in a posterior slab for four weeks. Active and assisted mobilization started after removal of the slab. At ten month follow-up there was almost full range of movement of the joint.

  15. Low-energy anterior hip dislocation in a dancer.

    PubMed

    Stein, Drew A; Polatsch, Daniel B; Gidumal, Ramesh; Rose, Donald J

    2002-10-01

    In this article, we report the case of a healthy young woman who sustained an anterior hip dislocation while participating in a noncontact activity (ballet dancing). The patient's atraumatic dislocation failed closed reduction secondary to interposition of anterior capsule and rectus femoris muscle. Open reduction using a Smith-Petersen approach was concentric and stable. Postinjury femoral nerve neuropraxia resolved within 6 weeks. At 2-year follow-up, the patient was without complications of the injury-including avascular necrosis and posttraumatic arthritis. She returned to dancing and is now asymptomatic.

  16. TREATMENT OF ANTERIOR SHOULDER SUBLUXATION USING THE MULLIGAN CONCEPT AND REFLEX NEUROMUSCULAR STABILIZATION: A CASE REPORT

    PubMed Central

    Baker, Russell T.; Nasypany, Alan; Reordan, Don

    2017-01-01

    Background and Purpose Shoulder instability, a common issue among athletes who engage in contact sports, may lead to recurrent subluxations, or partial dislocations of the shoulder. Young athletic patients generally respond poorly to the nonsurgical treatments for shoulder instability that are commonly utilized. The purpose of this case report is to describe the effects of the treatment guided by the Mulligan Concept (MC) coupled with reflex neuromuscular stabilization (RNS) also known as reactive neuromuscular training (RNT), on an adolescent football player with glenohumeral joint (GHJ) instability who sustained a traumatic anterior subluxation. Case Description The MC shoulder Mobilization with Movement (MWM) and RNS were applied in the treatment of an anterior shoulder subluxation injury sustained by a competitive adolescent football player. The Numeric Pain Rating Scale (NPRS), the Disability in the Physically Active (DPA) scale, the Patient specific Functional Scale (PSFS) and the Shoulder Pain and Disability Index (SPADI), were administered in order to identify patient-reported outcomes. Outcomes The shoulder MWM and RNS provided immediate relief of all of the patient's pain and increased ROM after the first treatment. The use of the coupled treatments resulted in a resolution of pain, an increase in range of motion (ROM) and improvement in perceived stability. A minimal clinically important difference (MCID) was reported on the NPRS and minimal detectable changes (MDC) were reported on the NRS and PSFS, after the first treatment. Equally important, MCIDs were reported on the DPA scale and SPADI scale over the course of treatment. Discussion In this case report, the MC shoulder MWM, coupled with RNS, was an effective treatment for this patient and provided a short time to resolution (6 treatments; 19 days) compared to other descriptions of recovery in the literature. Clinicians treating patients who display anterior shoulder instability can consider this as

  17. 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

  18. 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

  19. Anterior elbow dislocation with potential compartment syndrome: a case report.

    PubMed

    Queipo-de-Llano Temboury, Alfonso; Lara, Jorge Mariscal; Fernadez-de-Rota, Antonio; Queipo-de-Llano, Enrique

    2007-03-01

    Anterior elbow dislocation is an infrequent lesion, usually produced by direct trauma to the proximal ulna after a fall on the elbow in flexion, and is often associated with soft tissue injuries. The authors report a case of a complex injury produced by a high-energy trauma in the right arm of a 65-year-old patient. His limb was trapped inside an industrial spin-dryer, resulting in a closed anterior elbow dislocation, diaphyseal ulnar shaft, radial styloid process fractures, and an associated compartment syndrome. The injury mechanism and its treatment are described to better manage the soft tissue injury and early elbow mobilization using the FEARM hinged external fixator. A good result was achieved, with almost complete restoration of the patient's arm functions, and he has returned to his previous working activities.

  20. [Anterior dislocation of the elbow joint without peri-articular fracture in an adult].

    PubMed

    Chbani, B; Lahrach, K; Amar, M-F; Ibnlkadi, K; Elmoubaker, S; Bennani, A; Marzouki, A; Boutayeb, F

    2012-12-01

    In view of the comparative frequency of posterior dislocations of the elbow, it is rather remarkable that anterior dislocations of that joint should be among the rarest of injuries [1]. Our case is one of the first cases of anterior dislocation of the elbow without any periarticular fracture or pre-existing deformities around the elbow [2].

  1. Anterior dislocation of an empty capsular bag in a pseudophakic eye: A rare case report

    PubMed Central

    Hwang, Hyung Bin; Yim, Hye Bin; Kim, Hyun Seung

    2015-01-01

    Spontaneous intraocular lens (IOL) dislocation is uncommon in the absence of any ocular areas with zonular weakness or trauma. There have been no reports of spontaneous capsular bag dislocation into the anterior chamber without an IOL. We report a rare, interesting case of spontaneous capsular bag anterior dislocation, without an IOL, into the anterior chamber with no history of genetic disease, ocular trauma, or pseudoexfoliation that might predispose to a zonular abnormality. PMID:25971181

  2. 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

  3. Treatment of osseous defects associated with anterior shoulder instability.

    PubMed

    Lynch, Joseph R; Clinton, Jeremiah M; Dewing, Christopher B; Warme, Winston J; Matsen, Frederick A

    2009-01-01

    Bone loss of the glenoid and/or humerus is a common consequence of traumatic anterior shoulder instability and can be a cause of recurrent instability after a Bankart repair. Accurate characterization of the size and location of osseous defects associated with traumatic instability is important when planning treatment. Open or arthroscopic soft tissue repairs are usually sufficient when less than 25% of the width of the glenoid bone has been lost. Bone replacement techniques may be necessary when glenoid bone loss is greater than 25% of the glenoid width. Glenoid bone restoration techniques include the use of a tricortical iliac crest graft or the transfer of the coracoid process to the area of glenoid deficiency. Bone grafting becomes a strong consideration when soft tissue repairs have failed to restore stability. Treatment of these severe defects may be followed by osteoarthritis. The destabilizing effects of anterior glenoid bone defects are compounded by concurrent defects of the posterior-lateral humeral head, commonly known as Hill-Sachs lesions, which can engage the glenoid defect. Large humeral head defects can be treated by transhumeral bone grafting techniques or osteoarticular allograft reconstruction. Prosthetic replacement of the proximal humerus is considered for humeral head defects involving more than 40% of the articular surface. Understanding the importance of humeral and glenoid bone deficiencies may help guide the treatment of recurrent anterior glenohumeral instability.

  4. Osseous Defects Seen in Patients with Anterior Shoulder Instability

    PubMed Central

    Itoi, Eiji

    2015-01-01

    Shoulder surgeons need to be aware of the critical size of the glenoid or humeral osseous defects seen in patients with anterior shoulder instability, since the considerable size of osseous defect is reported to cause postoperative instability. Biomechanical studies have identified the size of the osseous defect which affects stability. Since engagement always occurs between a Hill-Sachs lesion and the glenoid rim, when considering the critical size of the Hill-Sachs lesion, we have to simultaneously consider the size of the glenoid osseous defect. With the newly developed concept of the glenoid track, we are able to evaluate whether a large Hill-Sachs lesion is an "on-track" or "off-track" lesion, and to consider both osseous defects together. In case of an off-track Hill-Sachs lesion, if the glenoid defect is less than 25%, no treatment is required. In this case, the Latarjet procedure or arthroscopic remplissage procedure can be a treatment option. However, if the glenoid defect is more than 25%, treatment such as bone grafting is required. This will convert an off-track lesion to an on-track lesion. After the bone graft or Latarjet procedure, if the Hill-Sachs lesion persists as off-track, then further treatment is necessitated. In case with an on-track Hill-Sachs lesion and a less than 25% glenoid defect, arthroscopic Bankart repair alone is enough. PMID:26640623

  5. RECURRENT SHOULDER DISLOCATION: ASPECTS BETWEEN THE FIRST EPISODE AND SURGICAL TREATMENT

    PubMed Central

    Ikemoto, Roberto Yukio; Murachovsky, Joel; Strose, Eric; Nascimento, Luís Gustavo Prata; Bueno, Rogério Serpone; Almeida, Luís Henrique Oliveira

    2015-01-01

    Objective: To determine: 1) whether the patients had been oriented to use immobilization for at least four weeks and which type of immobilization was prescribed, 2) how many dislocations occurred until the patient received information about the need of surgery, 3) How long it takes for patients to have an appointment with a shoulder surgeon, 4) How many dislocations the patient had at the time of surgery. Material and Methods: Of the 100 patients surgically treated or waiting for surgery at outpatient facilities, we interviewed 61 patients with questions related to the mechanism of dislocation, emergency service sites, guidelines for acute event treatment and follow-up, time elapsed until surgery and follow-up. Collected data were submitted to analysis. Results: Only 13 patients (22%) had received correct information about their lesion, prognosis concerning recurrence, and about the need of surgery and expert follow-up in recurrent cases. None of our patients received proper information about type and duration of immobilization. Conclusion: None of our patients had received proper orientation to remain immobilized for four weeks, and the types of immobilization vary from a handmade sling to a manufactured Velpeau. Most of our patients (78%) did not receive proper orientation about specialized follow-up and surgery after their second episode of dislocation. The time for a specialized appointment with shoulder surgeon ranges from four to six months, with 1-100 dislocation episodes at the moment of surgery. PMID:27077064

  6. 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

  7. Anterior Dislocation of Elbow Joint-Case Report of A Rare Injury

    PubMed Central

    Kumar, Rakesh; Sekhawat, Vishal; Sankhala, SS; Bijarnia, Isha

    2014-01-01

    Introduction: In view of the comparative frequency of posterior dislocations of the elbow, it is rather remarkable that anterior dislocations of that joint should be among the rarest of injuries. Authors report a case of acute anterior dislocation with old fracture of medial epicondyle. Case Report: 22 years old male presented with acute pain and tenderness with deformity of right elbow joint and inability to move the elbow joint after he fell down during an episode of seizure. There was no neurovascular deficit. Radiological examination confirmed anterior dislocation of elbow joint with an ununited medial epicondyle fracture. Elbow was reduced under general anesthesia in emergency operation theatre. Conclusion: Anterior dislocation of elbow is very rare. Early diagnosis and proper reduction of dislocation is key of normal functioning of elbow joint. PMID:27298973

  8. 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

  9. Management of mid-season traumatic anterior shoulder instability in athletes.

    PubMed

    Owens, Brett D; Dickens, Jonathan F; Kilcoyne, Kelly G; Rue, John-Paul H

    2012-08-01

    Shoulder dislocation and subluxation injuries are common in young athletes and most frequently occur during the competitive season. Controversy exists regarding optimal treatment of an athlete with an in-season shoulder dislocation, and limited data are available to guide treatment. Rehabilitation may facilitate return to sport within 3 weeks, but return is complicated by a moderate risk of recurrence. Bracing may reduce the risk of recurrence, but it restricts motion and may not be tolerated in patients who must complete certain sport-specific tasks such as throwing. Surgical management of shoulder dislocation or subluxation with arthroscopic or open Bankart repair reduces the rate of recurrence; however, the athlete is unable to participate in sport for the remainder of the competitive season. When selecting a management option, the clinician must consider the natural history of shoulder instability, pathologic changes noted on examination and imaging, sport- and position-specific demands, duration of treatment, and the athlete's motivation.

  10. 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

  11. 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.

  12. Simultaneous shoulder and hip dislocation in a 12-year-old girl with Hutchinson-Gilford progeria syndrome.

    PubMed

    Espandar, Ramin; Eraghi, Amir Sobhani; Mardookhpour, Shirin

    2012-01-01

    Hutchinson-Gilford progeria syndrome (HGPS) is a rare premature ageing disorder that is characterized by accelerated degenerative changes of the cutaneous, musculoskeletal and cardiovascular systems. Mean age at diagnosis is 2.9 years and generally leading to death at approximately 13 years of age due to myocardial infarction or stroke. Orthopedic manifestations of HGPS are multiple and shoulder dislocation is a rare skeletal trauma in progeria syndrome. Our patient had simultaneous shoulder and hip dislocation associated with a low energy trauma. This subject has not been reported. Treatment accomplished as close reduction under general anesthesia and immobilization.

  13. Bilateral sacroiliac joint dislocation (anterior and posterior) with triradiate cartilage injury: a case report.

    PubMed

    Lee, Dae-Hee; Jeong, Woong-Kyo; Inna, Prashanth; Noh, Won; Lee, Dong-Ki; Lee, Soon-Hyuck

    2011-12-01

    Pediatric sacroiliac joint injuries are uncommon. Significant pelvis ring disruptions in children are rare, and their management is complicated by patient size, differences in bony architecture, and future growth and remodeling potential. We present a rare case of anterior sacroiliac joint dislocation associated with triradiate cartilage injury with a posterior sacroiliac dislocation on the contralateral side. This appears to be the first such case reported in the literature.

  14. [Elbow dislocation].

    PubMed

    de Pablo Márquez, B; Castillón Bernal, P; Bernaus Johnson, M C; Ibañez Aparicio, N M

    2017-03-09

    Elbow dislocation is the most frequent dislocation in the upper limb after shoulder dislocation. Closed reduction is feasible in outpatient care when there is no associated fracture. A review is presented of the different reduction procedures.

  15. 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. PMID:27582973

  16. 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

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

    PubMed

    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.

  18. Dislocation

    MedlinePlus

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

  19. 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

  20. 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

  1. 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

  2. Mean Glenoid Defect Size and Location Associated With Anterior Shoulder Instability

    PubMed Central

    Gottschalk, Lionel J.; Bois, Aaron J.; Shelby, Marcus A.; Miniaci, Anthony; Jones, Morgan H.

    2017-01-01

    Background: There is a strong correlation between glenoid defect size and recurrent anterior shoulder instability. A better understanding of glenoid defects could lead to improved treatments and outcomes. Purpose: To (1) determine the rate of reporting numeric measurements for glenoid defect size, (2) determine the consistency of glenoid defect size and location reported within the literature, (3) define the typical size and location of glenoid defects, and (4) determine whether a correlation exists between defect size and treatment outcome. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Ovid, and Cochrane databases were searched for clinical studies measuring glenoid defect size or location. We excluded studies with defect size requirements or pathology other than anterior instability and studies that included patients with known prior surgery. Our search produced 83 studies; 38 studies provided numeric measurements for glenoid defect size and 2 for defect location. Results: From 1981 to 2000, a total of 5.6% (1 of 18) of the studies reported numeric measurements for glenoid defect size; from 2001 to 2014, the rate of reporting glenoid defects increased to 58.7% (37 of 63). Fourteen studies (n = 1363 shoulders) reported defect size ranges for percentage loss of glenoid width, and 9 studies (n = 570 shoulders) reported defect size ranges for percentage loss of glenoid surface area. According to 2 studies, the mean glenoid defect orientation was pointing toward the 3:01 and 3:20 positions on the glenoid clock face. Conclusion: Since 2001, the rate of reporting numeric measurements for glenoid defect size was only 58.7%. Among studies reporting the percentage loss of glenoid width, 23.6% of shoulders had a defect between 10% and 25%, and among studies reporting the percentage loss of glenoid surface area, 44.7% of shoulders had a defect between 5% and 20%. There is significant variability in the way glenoid bone loss is measured, calculated

  3. Shoulder problems in high level swimmers--impingement, anterior instability, muscular imbalance?

    PubMed

    Rupp, S; Berninger, K; Hopf, T

    1995-11-01

    The objective was to study prevalence and underlying pathology of "swimmer's shoulder". Twenty-two competitive swimmers of national "D-Kader" (elite development swimmers) were evaluated by means of questionnaire, clinical examination and isokinetic testing of external rotation and internal rotation. At the examination current interfering pain necessitating a cessation or reduction of practice was found in 5 (23%) athletes. At isokinetic testing 8 (36%) athletes complained of shoulder pain. Any history of pain was seen in 14 (64%) swimmers. A positive impingement sign was noted in 11 (50%) athletes. Apprehension sign which is indicative of anterior instability was found in 11 (50%) swimmers. Clinical equivalents of dysfunction of scapulothoracic muscles such as scapular winging (5 athletes) and shoulder protraction (12 athletes) were noted. For comparison of results of isokinetic testing a control group of non-swimmers was selected matching the group of swimmers exactly in terms of age, sex and dominant side. External rotation/internal rotation ratio of peak torque and total work at 60 deg/sec and 180 deg/sec was significantly lower in swimmers than in controls. The ratio was independent of sex, dominant side, history of pain and pain at examination. During internal rotation competitive swimmers produced significantly higher peak torques and total work than controls. There was no significant difference in external rotation. In conclusion there are several different abnormalities of function contributing to the pathology of "swimmer's shoulder":--Laxity of anterior-inferior capsuloligamentous structures with atruamatic anterior instability due to repetitive overload.--Impingement with rotator cuff tendinitis.--Muscular imbalance of the rotator cuff muscles and scapulothoracic dysfunction.

  4. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) in anterior shoulder instability

    PubMed Central

    Vedova, Franco Della; Ibáñez, Maximiliano; Alvarez, Victoria; Lépore, Salvador; Sulzle, Vanina Ojeda; Galan, Hernán; Slullitel, Daniel

    2015-01-01

    Introduction: Bankart lesion is the anterior glenohumeral instability most common associated injury. Tears at glenohumeral ligaments can be intra substance or at humeral insertion, this location may be the cause of instability. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) can be an isolated or associated cause of instability and it is usually related to the posterior glenohumeral instability. The aim of this article is to report the clinical assessment and postoperative outcomes of 6 patients with PHAGL with anterior shoulder instability. Materials and Methods: We evaluated six patients with PHAGL due to anterior glenohumeral instability arthroscopically repaired. All 6 patients developed the lesion after a sports-related trauma. Sixty six per cent of patients had associated intra-articular shoulder pathologies. The diagnosis with MRI arthrogram (with gadolinium) was performed preoperatively in 50% of patients. Postoperative evaluation was made with Rowe, ASES and WOSI scores. Results: All patients returned to their previous sports level. One patient had a recurrence. Postoperative scores results are WOSI: 13.13%, Rowe 83.33 and ASES 95.83. Discussion: Humeral avulsions of glenohumeral ligaments represent 25% of capsulolabral injuries. PHAGL injury was initially described as a cause of posterior instability, but according to two other series, our study shows that this lesion may also cause anterior instability. It is critical to have a high index of suspicion and make a correct arthroscopic examination to diagnose this injury, because arthroscopic repair of PHAGL has good postoperative outcomes.

  5. Anterior dislocation of the ulnar‐humeral joint in a so‐called ‘pulled elbow'

    PubMed Central

    Venkatram, N; Wurm, V; Houshian, S

    2006-01-01

    We describe an unusual case of a missed anterior dislocation of the elbow joint in a 1 year old girl who presented with a pulled elbow. To our knowledge, this is the first report of anterior dislocation as a result of a pulled elbow in the literature. We would like to highlight the rarity of this presentation and the importance of chronological assessment and management in the accident and emergency department. PMID:16714491

  6. [A case of traumatic anterior dislocation of C4 recovered from complete tetraplegia].

    PubMed

    Okada, K; Tasaki, T; Komatsu, S; Asakura, K

    1985-07-01

    A case of traumatic anterior dislocation of C4 is presented. A 65-year-old man who was beastly drunken fell down backward and severely struck occipital region against the door and immediately developed tetraplegia. Neurological examination 12 hours after the trauma revealed complete flaccid tetraplegia, abdominal respiration, bladder-bowel disturbance, anesthesia below C5 and hyperpathia in C3 and C4 dermatomes. Plain films of the cervical spine disclosed anterior dislocation of C4 upon C5 approximately 6 mm and possible disc herniation of C4/5. On Amipaque cervical myelography via C1C2 lateral puncture, there was almost complete block of the dye at C4/5 level. With diagnosis of acute cervical spinal cord injury on C4/5 caused by pincer mechanism and herniated disc material, the patient was operated on 19 hours after the trauma by anterior discectomy of C4/5 and fusion under Crutchfield skull traction. Neurological recovery began with the right leg from the day after the operation and it's recovery pattern showed the syndrome of acute central cervical spinal cord injury reported by Schneider. The patient discharged on March '84 four months after the trauma walking by himself with tetraparesis especially weakness of the hands and hypesthesia of glove and stocking type. We emphasized importance of Amipaque cervical myelography via C1C2 lateral puncture and anterior approach on the treatment of acute cervical spinal cord injury to be done as soon as possible.

  7. 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

  8. 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 ...

  9. 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

  10. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

    PubMed Central

    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

  11. 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

  12. Arthroscopic Remplissage for Engaging Hill-Sachs Lesions in Patients With Anterior Shoulder Instability

    PubMed Central

    Camp, Christopher L.; Dahm, Diane L.; Krych, Aaron J.

    2015-01-01

    Anterior shoulder instability is often accompanied by a Hill-Sachs defect on the humeral head that can contribute to recurrent instability if not addressed at the time of surgery. We describe a method of performing arthroscopic remplissage to treat engaging Hill-Sachs lesions in patients with glenohumeral instability. It has the benefits of being an efficient procedure that can be performed with minimal technical difficulty and can be used to augment other stabilization procedures such as labral repair. The indications for this technique include the presence of an engaging Hill-Sachs defect in patients will little or no glenoid bone loss. In appropriately selected patients, arthroscopic remplissage has shown reduced rates of recurrent instability. PMID:26697311

  13. Imaging of superior labral anterior to posterior (SLAP) tears of the shoulder.

    PubMed

    Simoni, P; Scarciolla, L; Kreutz, J; Meunier, B; Beomonte Zobel, B

    2012-12-01

    Superior labral anterior to posterior (SLAP) tears include a number of abnormal changes of the superior glenoid labrum. SLAP tears have been first reported in elite young atlete and are caused by repetitive overhead motion or by a fall on an outstretched arm. SLAP can lead to chronic pain and instability of shoulder. A diagnosis of SLAP may be difficult on the basis of clinical tests. Hence, modern imaging, including computed tomography arthrography (CTA), magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA) play a key role in the diagnosis of SLAP. The large number of normal anatomic variants of the superior labrum and the surrounding structures make the interpretation of SLAP challenging on imaging and at arthroscopy. In this article the imaging of SLAP are discussed in detail along with relevant anatomy, anatomic variants and biomechanics.

  14. 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.

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

    PubMed Central

    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

  16. Clinical assessment of external rotation for the diagnosis of anterior shoulder hyperlaxity.

    PubMed

    Ropars, M; Fournier, A; Campillo, B; Bonan, I; Delamarche, P; Crétual, A; Thomazeau, H

    2010-12-01

    The aim of this study was to evaluate two methods of clinical assessment for external rotation of the shoulder to optimise the diagnosis of hyperlaxity in patients being selected for surgery for stabilisation of chronic anterior instability. External rotation was evaluated in 70 healthy student volunteers by two examiners (intertester study) using two methods of assessment at 15-day intervals (intratester study). The first method used was the protocol described for the Instability Severity Index Score (ISIS). In this case, the subject was evaluated in the sitting position, bilaterally with passive range of motion movements. The shoulder was considered hyperlax if ER1 was greater than 85°. With the second, so-called "elbow on the table" (EOT) method, the subject was evaluated in the decubitus dorsal position, unilaterally with passive range of motion. The subject was considered to be hyperlax if ER1 was greater than 90°. Kappa values for intra- and intertester agreement with the ISIS method were average, while they were satisfactory with the intraclass coefficient (ICC). Kappa values for inter- and intratester agreement with the EOT method were average and good, respectively. This tendency was confirmed by the ICC which went from good to excellent for the two examiners in both series of measurements using the EOT method, showing better reproducibility with this method. Our study confirms that the most reproducible method for assessing external rotation is obtained by unilateral assessment of the patient in the decubitus dorsal position, with passive range of motion. An ER1 of 90° is the necessary threshold for hyperlaxity because of elbow retropulsion with this method, which provides immediate and visual evaluation and eliminates the necessity of goniometry.

  17. Deltoid contracture mimicking shoulder dislocation in a 7-year-old boy.

    PubMed

    Lian, L Y; Zhang, L J; Zhao, Q

    2010-09-01

    Contracture of the deltoid muscle, a relatively uncommon disorder in children, can be caused by repeated intramuscular injection, trauma, or congenital disease. The typical clinical manifestations of deltoid contracture (i.e., a palpable fibrous cord within the deltoid muscle, abduction contracture of the shoulder, winged scapula, and skin dimpling over the fibrous bands), however, may be atypical or even lacking, thus, leading to misdiagnosis. The procedure going from misdiagnosis to recognition of the correct diagnosis is reviewed in a 7-year-old boy with deltoid contracture.

  18. Long-term follow-up of allograft reconstruction of segmental defects of the humeral head associated with posterior dislocation of the shoulder.

    PubMed

    Martinez, Angel Antonio; Navarro, Evelio; Iglesias, Daniel; Domingo, Javier; Calvo, Angel; Carbonel, Ignacio

    2013-04-01

    The purpose of this study is to report the long-term follow-up result of allograft reconstruction of segmental defect of the humeral head associated with posterior dislocation of the shoulder. Six men underwent operative management of defects of the humeral head involving 40% of the articular surface, following posterior dislocation of the humeral head. The period of time between dislocation and surgery ranged from 7 to 8 weeks. The defect in the head was filled with an allogeneic segment of humeral head contoured to restore the spherical shape. All the patients returned to their occupation 4 months later. All the cases were evaluated clinically and by radiographs and computed tomography (CT) scan at a mean of 122 (96-144) months after the operative procedure. Three men had no complaints of pain, instability, clicking or catching, whereas three had pain, clicking, catching and stiffness. The three patients with good clinical result showed also good radiographic result. The computed tomography (CT) confirmed incorporation of the allograft and no osteoarthrosis. Another patient had a good clinical and radiographic result until the eighth postoperative year. At 8-year follow-up examination, this patient developed shoulder osteoarthrosis and he had pain and stiffness. He needed an arthroplasty 10 years after the operation. The other two patients developed collapse of the graft and osteoarthrosis that were yet evident at 4-year follow-up. These patients required a shoulder arthroplasty 8 years after the procedure. We conclude that the treatment of segmental defects of the humeral head associated with posterior dislocations of the shoulder by allograft reconstruction has a good long-term follow-up result in 50% of the patients.

  19. Anterior knee dislocation with ipsilateral open tibial shaft fracture: a 5-year clinical follow-up of a professional athlete.

    PubMed

    Aydın, Adem; Atmaca, Halil; Müezzinoğlu, Ümit Sefa

    2013-08-01

    Traumatic dislocation of the knee joint is an uncommon complex, multiple ligamentous injury resulting from a high-energy trauma. Significant lack of functions can be seen because of both early and late complications of these injuries such as popliteal artery disruption, peroneal nerve injury, persistent instability and posttraumatic arthritis. Therefore, the emergency surgery is necessary due to possibility of neurovascular compromise and limb loss. Controversies over operative versus closed immobilization of traumatic complex, multiple ligamentous knee injury are still debated. We report a case of traumatic anterior dislocation of the right knee with an ipsilateral tibial shaft fracture in association with right popliteal artery occlusion of a professional athlete who was returned to his sports activity by surgical treated tibia fracture and conservative treatment of the knee dislocation.

  20. 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.…

  1. Inferior capsular shift operation for multidirectional instability of the shoulder in players of contact sports

    PubMed Central

    Choi, C; Ogilvie-Harris, D

    2002-01-01

    Objectives: To assess the results of inferior capsular shift for multidirectional instability of the shoulder in athletes. Methods: Multidirectional instability was surgically corrected in 53 shoulders in 47 athletes who engaged in contact sports. A history of major trauma was found in eight patients, the others having had minor episodes. Before surgery, all patients had complex combinations of instabilities. The surgical approach was selected according to the predominant direction of instability. Results: Anterior inferior capsular shift was carried out in 37 shoulders, and anterior dislocation recurred in three. In one of these, it was anterior alone, one was anterior and inferior, and one was unstable in all three directions. After posterior inferior capsular shift in 16 shoulders, one dislocation occurred anteriorly and one posteriorly. With the anterior approach, four athletes could not return to sport. Two patients treated with the posterior approach could not return to sport. Of these six failures, five patients had had bilateral repairs. Successful repair based on the criteria of the American Shoulder and Elbow Association was achieved in 92% of anterior repairs and 81% of posterior repairs. Successful return to sport was noted in 82% of patients with anterior repairs, 75% with posterior repairs, and 17% with bilateral repairs. Overall, there were five subsequent dislocations, three in the anterior repair group (8%), and two in the posterior repair group (12%). Conclusions: Inferior capsular shift can successfully correct multidirectional instability in most players of contact sports, but the results in bilateral cases are poor. PMID:12145120

  2. 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

    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.

  3. Shoulder Injuries and Disorders

    MedlinePlus

    ... injured. Common problems include Sprains and strains Dislocations Separations Tendinitis Bursitis Torn rotator cuffs Frozen shoulder Fractures Arthritis Health care providers diagnose shoulder problems by using your medical history, a physical exam, and imaging tests. Often, the first treatment ...

  4. Arthroscopic Repair of Inferior Labrum From Anterior to Posterior Lesions Associated With Multidirectional Instability of the Shoulder

    PubMed Central

    Burt, David M.

    2014-01-01

    Multidirectional instability (MDI) of the shoulder may arise spontaneously; however, recent evidence suggests that traumatic events may play a role in this syndrome. Variable degrees of injury around the circumference of the glenoid have been reported, ranging from Bankart and Kim lesions to 270° of injury and even 360° of injury. Hyperabduction injury may cause inferior subluxation of the shoulder and result in traumatic isolated injury to the inferior labrum from anterior to posterior. This particular lesion spans approximately 180° of the inferior hemisphere and may lead to symptomatic MDI. In contrast to open or arthroscopic plication procedures for atraumatic MDI without labral injury, the goal in these cases is anatomic arthroscopic repair of the inferior labrum tear without the need for capsular plication, volume reduction, or rotator interval closure. PMID:25685683

  5. Axillary shoulder with exaggerated rotation: the Hill-Sachs defect.

    PubMed

    Rafert, J A; Long, B W; Hernandez, E M; Kreipke, D L

    1990-01-01

    One of the most common fractures of the humeral head resulting from an anterior dislocation is the Hill-Sachs defect. Other special radiographic positions to demonstrate this injury may prove difficult for the patient to assume and maintain. An axillary shoulder projection with exaggerated external rotation is easy to position and clearly demonstrates the Hill-Sachs defect.

  6. Arthroscopic Latarjet and Capsular Shift (ALCS) procedure: a new "freehand" technique for anterior shoulder instability associated with significant bone defects.

    PubMed

    Bhatia, Deepak N

    2015-03-01

    Anterior shoulder instability associated with significant bone loss has been described as "bony-instability," and this condition is usually treated with an anterior glenoid bone grafting procedure (Latarjet procedure). The Latarjet procedure involves transfer of the horizontal limb of the coracoid process along with the conjoint tendon to the anterior glenoid rim, and is traditionally performed as an open surgical procedure. Recently, an arthroscopic technique for the Latarjet procedure has been described; the technique necessitates the use of specialized instrumentation and involves excision of the entire anterior capsule to facilitate coracoid fixation. We describe a new "freehand" arthroscopic technique for the Latarjet procedure, and, in addition, a simultaneous capsular shift to further optimize mid and end range stability. This technique eliminates the use of additional instrumentation and can be done using routine arthroscopic instruments. Preliminary experience with this technique suggests that the arthroscopic Latarjet and capsular shift is a technically demanding procedure. Glenohumeral capsule can be preserved, and this should be attempted wherever possible to optimize stability. Additional specialized instrumentation would probably reduce surgical time; however, the procedure can be performed with routine instruments.

  7. 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.

  8. “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

  9. Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations

    PubMed Central

    Yang, Baohui; Lu, Teng

    2017-01-01

    For patients with AS and lower cervical spine fractures, surgical methods have mainly included the single anterior approach, single posterior approach, and combined anterior-posterior approach. However, various surgical procedures were utilized because the fractures have not been clearly classified according to presence of displacement in these previous studies. Consequently, controversies have been raised regarding the selection of the surgical procedure. This study retrospective analysis was conducted in 12 patients with AS and lower cervical spine fractures and dislocations and explored single-session combined anterior-posterior approach for the treatment of AS with obvious displaced lower cervical spine fractures and dislocations which has demonstrated advantages such as good stabilization, satisfied fracture healing, and easy postoperative cares. However, to some extent, the difficulty and risk of this approach should be considered. Attention should be paid to the prevention of perioperative complications. PMID:28133616

  10. Single-Session Combined Anterior-Posterior Approach for Treatment of Ankylosing Spondylitis with Obvious Displaced Lower Cervical Spine Fractures and Dislocations.

    PubMed

    Yang, Baohui; Lu, Teng; Li, Haopeng

    2017-01-01

    For patients with AS and lower cervical spine fractures, surgical methods have mainly included the single anterior approach, single posterior approach, and combined anterior-posterior approach. However, various surgical procedures were utilized because the fractures have not been clearly classified according to presence of displacement in these previous studies. Consequently, controversies have been raised regarding the selection of the surgical procedure. This study retrospective analysis was conducted in 12 patients with AS and lower cervical spine fractures and dislocations and explored single-session combined anterior-posterior approach for the treatment of AS with obvious displaced lower cervical spine fractures and dislocations which has demonstrated advantages such as good stabilization, satisfied fracture healing, and easy postoperative cares. However, to some extent, the difficulty and risk of this approach should be considered. Attention should be paid to the prevention of perioperative complications.

  11. Anterior pre-tensioned external fixator for pelvic fractures and dislocations. Initial clinical series.

    PubMed

    Queipo-de-Llano, A; Lombardo-Torre, M; Leiva-Gea, A; Delgado-Rufino, F B; Luna-González, F

    2016-12-01

    In the treatment of unstable pelvic ring fractures, external fixators have the limitation of not adequately stabilizing the injured posterior elements. This article presents a novel and simple technique of temporary external fixation of the pelvic ring, able to produce compression of both the anterior and posterior pelvic elements. A curved flexible carbon-fiber rod is used, pre-tensioned before attachment to supra-acetabular Schanz screws. Although more extensive clinical experience is required, favorable preliminary results in a series of 13 patients with unstable pelvic fracture were encouraging: the aim of closing the posterior and anterior elements of the pelvic ring was achieved in all cases treated with this technique, and 12 patients survived. Radiological results were excellent in 3 cases and good in 9 cases. No major complications, such as secondary displacement, vertical re-displacement or deep infection, were observed. Mean operative time was 25min, compatible with emergency management.

  12. 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

  13. 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

  14. [Sterno-clavicular plasty in anterior dislocation in child. The new surgical technic and review literature].

    PubMed

    Jiménez, Juan Matus; Guerrero, José Suárez; León, Raúl Torres

    2007-01-01

    The sternoclavicle joint takes part in stability and normal rotation of clavicle in shoulder movement. Its injury infrequent and the luxation in children is more rare. It is classified in previous and retrosternal. The most common causes are by sport trauma and car accidents. In children differential diagnosis includes proximal epiphyseal displacement of clavicle. The clinical picture is pain, sternum or thorax deformity and limitation in range of motion of the arm. The treatment is conservative or surgical, and indications to surgical treatment are pain when moving, range of motion limitation or concomitant complications. In the surgical treatment, the reduction of the clavicle is made with a percutaneous clamp and then protecting the position with a bandage in "eight". Other options are open reduction of the clavicle and subclavian plasty, reduction open and to make plastias with grafts of subclavio,fascia latae or proximal third clavicle resection and cerclage with wire. We present a clinical case and surgical treatment with a novel surgical technique.

  15. 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

  16. Questions and Answers About Shoulder Problems

    MedlinePlus

    ... the dislocation using a traditional open surgery approach. Separation A shoulder separation occurs where the collarbone (clavicle) meets the shoulder ... acromioclavicular or AC joint) are signs that a separation may have occurred. Diagnosis. Doctors may diagnose a ...

  17. 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.

  18. The Sheffield bone block procedure: a new operation for the treatment of glenoid bone loss in patients with anterior traumatic shoulder instability

    PubMed Central

    Storey, Phil; Macinnes, Scott J; Ali, Amjid; Potter, David

    2015-01-01

    Background The purpose of the present study was to evaluate the results of the Sheffield bone block procedure for anteroinferior bone loss in traumatic shoulder instability. In this modified open technique, the medial half of coracoid process without its soft tissue attachments is used to provide congruent augmentation of the anteroinferior glenoid and secured with two screws. Methods In this retrospective consecutive case series (2007–11), all patients having recurrent traumatic instability with glenoid bone loss > 20% and/or a large Hill–Sachs lesion were included. The shoulder function was evaluated clinically and by Oxford Shoulder Instability Score (OSIS; by post/telephone). Results There were 84 patients in this series with a large proportion engaged in contact sports. Mean (range) age was 33 years (16 years to 45 years); male : female, 59 : 8; mean (range) follow-up period was 48 months (36 months to 84 months) and the response rate 89% (75/84). Mean postoperative OSIS was 43 (33 to 46) and one patient had re-dislocation (1.3%). No neurovascular complications/hardware failure/non-union/infections were noted. By 6 months, 85% patients had returned to pre-injury sport and 93% had returned to pre-injury work. Conclusions The Sheffield bone block procedure provides reliable and satisfactory results in patients having recurrent instability with glenoid bone loss and/or a large Hill–Sachs lesion with minimal complications and an excellent chance of returning to original sport and occupation. PMID:27583007

  19. 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

  20. 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.

  1. 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

  2. The minimal invasive direct anterior approach in combination with large heads in total hip arthroplasty - is dislocation still a major issue? a case control study

    PubMed Central

    2014-01-01

    Background There have been increasing numbers of publications in recent years on minimally invasive surgery (MIS) for total hip arthroplasty (THA), reporting results with the use of different head sizes, tribologic and functional outcomes. This study presents the results and early complication rates after THA using the direct anterior approach (DAA) in combination with head sizes ≥ 36 mm. Methods A total of 113 patients with THA were included in the study. The Harris Hip Score (HHS) was determined, a radiographic evaluation was carried out, and complications were recorded. The minimum follow-up period was 2 years (means 35 ± 7 months). Results The HHS improved from 43.6 (± 12) to 88.2 (± 14; P < 0.01). One early infection occurred, one periprosthetic fracture, and three cases of aseptic stem loosening. No incorrect positioning of the implants was observed, and there were no dislocations. Conclusion THA with the minimally invasive DAA in combination with large heads is associated with good to very good functional results in the majority of cases. The complication rates are not increased. The rate of dislocation mainly as an complication of the first two years can be markedly reduced in particular. PMID:24621189

  3. Functional shoulder radiography with use of a dynamic flat panel detector.

    PubMed

    Sakuda, Keita; Sanada, Shigeru; Tanaka, Rie; Kitaoka, Katsuhiko; Hayashi, Norio; Matsuura, Yukihiro

    2014-07-01

    Our purpose in this study was to develop a functional form of radiography and to perform a quantitative analysis for the shoulder joint using a dynamic flat panel detector (FPD) system. We obtained dynamic images at a rate of 3.75 frames per second (fps) using an FPD system. Three patients and 5 healthy controls were studied with a clinically established frontal projection, with abduction of the arms. The arm angle, glenohumeral angle (G-angle), and scapulothoracic angle (S-angle) were measured on dynamic images. The ratio of the G-angle to the S-angle (GSR) was also evaluated quantitatively. In normal subjects, the G-angle and S-angle changed gradually along with the arm angle. The G-angle was approximately twice as large as the S-angle, resulting in a GSR of 2 throughout the abduction of the shoulder. Changes in G-angle and S-angle tended to be irregular in patients with shoulder disorders. The GSR of the thoracic outlet syndrome, recurrent dislocation of the shoulder joint, and anterior serratus muscle paralysis were 3-7.5, 4-9.5, and 3.5-7.5, respectively. The GSR of the anterior serratus muscle paralysis improved to approximately 2 after orthopedic treatment. Our preliminary results indicated that functional radiography by FPD and computer-aided quantitative analysis is useful for diagnosis of some shoulder disorders, such as the thoracic outlet syndrome, recurrent dislocation of the shoulder joint, and anterior serratus muscle paralysis. The technique and procedures described comprise a simple, functional shoulder radiographic method for evaluation of the therapeutic effects of surgery and/or rehabilitation.

  4. Separated Shoulder

    MedlinePlus

    Separated shoulder Overview By Mayo Clinic Staff A separated shoulder is an injury to the ligaments that hold your collarbone (clavicle) to your shoulder blade. In a mild separated shoulder, the ligaments ...

  5. Proptosis and Anterior Dislocation as a Late Noninflammatory Complication of Failure of Tissue Integration in the Alphasphere Implant.

    PubMed

    Neimkin, Michael G; Reggie, Sara; Holds, John B

    2016-01-04

    A 57-year-old healthy female underwent enucleation for choroidal melanoma with primary implantation of a 2-hydroxyethyl methacrylate sphere (AlphaSphere, Addition Technology, Des Plaines, IL). Her course was uneventful, with successful prosthetic fitting 6 weeks postoperatively. She returned 2 years later, with anterior displacement of the implant, poor implant movement, and poor prosthetic fit. There was no defect in the conjunctiva, Tenon's layer or evidence of inflammation. Successful orbital implant exchange was performed, replacing the AlphaSphere with an eyebank-scleral wrapped acrylic implant. Intraoperative findings revealed dissolution of the scaffolding aspect of the anterior implant, with loss of extraocular muscle attachments and no fibrovascular ingrowth. This case demonstrates late AlphaSphere failure in an otherwise unremarkable course; further review of similar cases or a larger study is warranted to examine the efficacy of this relatively new implant.

  6. Modified axillary radiograph of the shoulder: a new position.

    PubMed

    Senna, Luís Filipe; Pires E Albuquerque, Rodrigo

    2017-01-01

    Obtaining axillary radiographs of the shoulder in acute trauma is not always feasible. The authors present a new modification of this radiographic view, in order to assess the anatomic relationship between the humeral head and the glenoid cavity. The incidence is performed with the patient sitting on X-ray table, with the affected limb supported thereon. The authors describe the case of a 28-year-old male who suffered an anterior glenohumeral dislocation that was clearly evidenced by this modified radiograph. The concentric relationship between the humeral head and the glenoid cavity was also easily confirmed by obtaining such radiograph after the reduction maneuver.

  7. Long Term Outcomes of Arthroscopic Shoulder Instability Surgery

    PubMed Central

    Karataglis, D.; Agathangelidis, F.

    2017-01-01

    Background: Anterior shoulder instability has been successfully managed arthroscopically over the past two decades with refined “anatomic” reconstruction procedures involving the use of anchors for the repositioning and re-tensioning of the antero-inferior capsuloligamentous complex, in an effort to recreate its “bumper effect”. Methods: Research and online content related to arthroscopic treatment of shoulder instability was reviewed and their results compared. Results: The short- and mid-term results of this technique have been very satisfactory. The greatest number of recent reports suggests that long-term results (>5 years follow-up) remain rather satisfactory, especially in the absence of significant glenoid bone loss (>20-25%). In these studies recurrent instability, in the form of either dislocation or subluxation, ranges from 5.1 to over 20%, clinical scores, more than 5 years after the index procedure, remain good or excellent in >80% of patient population as do patient satisfaction and return to previous level of activities. As regards arthroscopic non-anatomic bony procedures (Latarjet or Bristow procedures) performed in revision cases or in the presence of >20-25% bone loss of the anteroinferior aspect of the glenoid, recent reports suggest that their long-term results are very satisfactory both in terms of re-dislocation rates and patient satisfaction. Conclusion: It appears that even “lege artis” performance of arthroscopic reconstruction decelerates but does not obliterate the degenerative procedure of dislocation arthropathy. The presence and grade of arthritic changes correlate with the number of dislocations sustained prior to the arthroscopic intervention, the number of anchors used and the age at initial dislocation and surgery. However, the clinical significance of radiologically evident dislocation arthropathy is debatable.

  8. Biomechanics of open Bankart and coracoid abutment procedures in a human cadaveric shoulder model.

    PubMed

    Clavert, Philippe; Kempf, Jean-François; Kahn, Jean-Luc

    2009-01-01

    The specific aims of this experiment were (1) to develop a clinically relevant model of anteroinferior shoulder dislocation in the apprehension position to compare the biomechanics of the intact anterior capsuloligamentous structures, and (2) to evaluate the initial strength of an open Bankart and of a coracoid abutment procedure. Fifteen shoulders from deceased donors were used. For the intact shoulders, mean peak load was 486 N, and stiffness was 26,7 N/mm. For the Bankart repair, the mean peak load was 264 N, and mean stiffness was 14.1 N/mm. Transosseous repairs failed by suture pullout through soft tissues. For the coracoid abutment repair, the mean peak load was 607 N and stiffness was 25.57 N/mm. This study reveals that the biomechanical performance of the Bankart and coracoid abutment repairs fails to reproduce the properties of the natural intact state.

  9. The painful shoulder.

    PubMed

    Flicker, P L

    1980-06-01

    Acute peritendinitis calcarea, adhesive capsulitis, and anterior acromion impingement syndrome are common problems of the shoulder. Needle and drug therapy are indicated to relieve pain in the treatment of acute cases, with a regular home program of exercise essential for successful results in all cases. Surgery is recommended only if the nonoperative approach is unsuccessful.

  10. 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

  11. Frozen shoulder

    MedlinePlus

    ... cut) by bringing the shoulder through a full range of motion. Arthroscopic surgery can also be used to cut ... if you develop shoulder pain that limits your range of motion for an extended period. People who have diabetes ...

  12. 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 ( ...

  13. Shoulder Fractures

    MedlinePlus

    ... Journal of Hand Surgery (JHS) Home Anatomy Shoulder Fractures Email to a friend * required fields From * To * ... create difficulty with its function. Types of Shoulder Fractures The type of fracture varies by age. Most ...

  14. 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.

  15. Shoulder pain

    MedlinePlus

    Pain - shoulder ... changes around the rotator cuff can cause shoulder pain. You may have pain when lifting the arm above your head or ... The most common cause of shoulder pain occurs when rotator cuff tendons ... The tendons become inflamed or damaged. This condition ...

  16. 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. PMID:27275242

  17. Superolateral dislocation of the condyle: report of a rare case.

    PubMed

    Papadopoulos, H; Edwards, R S

    2010-05-01

    Anterior dislocation of the mandibular condyle is commonly seen in patients with chronic dislocation of their temporomandibular joints. Posterior, superior and lateral dislocation is rare. Superolateral dislocation of an intact condyle, let alone intact mandible is uncommon, usually occurring after a traumatic insult to the mandible. The authors report on such a case, and its management.

  18. Ganglion cysts of the shoulder: technique of arthroscopic decompression and fixation of associated type II superior labral anterior to posterior lesions.

    PubMed

    Westerheide, Kenneth J; Karzel, Ronald P

    2003-10-01

    Ganglion cysts of the shoulder and concomitant suprascapular nerve compression should be considered in the differential diagnosis of shoulder pain. They are associated commonly with labral tears, most commonly SLAP lesions. MRI has become commonplace in evaluating shoulder pain and has led to the increased awareness of shoulder cysts. MRI accurately demonstrates the size and location of ganglions, which is critical when planning surgical intervention. It also has shown the frequent association of intra-articular pathology with these cysts. Despite that MRI can detect atrophy, the diagnosis of suprascapular nerve compression can be confirmed only by EMG/NCS, because the presence of a cyst does not necessarily mean the nerve is compressed. Likewise, a positive EMG does not confirm that the compression is caused by a ganglion cyst. EMG/NCVs are necessary for confirming the diagnosis and evaluating nerve and muscle function. A trial of nonoperative management is warranted; however, this is associated with a high failure rate. Aspiration techniques are successful for decompression of the cysts and initial pain relief; however, the intra-articular pathology is not addressed and there is a higher rate of recurrence. Open resection of the ganglion cyst is successful; however, the intra-articular labral tears are not addressed, which can lead to recurrence and the morbidity of the cyst excision is not warranted. Shoulder arthroscopy has led to the identification of associated intra-articular pathology such as SLAP lesions. These were not appreciated previously with open surgery and therefore were not addressed. Arthroscopic techniques have evolved to allow decompression of the ganglion cysts and repair of the labral lesions. This should decrease the possibility of recurrence of the cyst by eliminating the cyst and the pathologic lesion that created it. Arthroscopic excision also avoids much of the morbidity of the open approach and allows intra-articular pathology to be

  19. An Evaluation of the Clinical and Anatomic Predictors of Outcomes at a Minimum of 2 yrs Following the Latarjet Procedure for Recurrent Anterior Shoulder Instability with Glenoid Bone Loss

    PubMed Central

    Mook, William R.; Petri, Maximilian; Greenspoon, Joshua A.; Horan, Marilee P.; Millett, Peter J.

    2015-01-01

    Objectives: Although the Latarjet procedure for the treatment of recurrent shoulder instability is highly successful, reasons for failure are often unclear. The purpose of our study was to evaluate clinical and anatomic characteristics that were predictive of continued instability or poor outcomes following the Latarjet procedure. Methods: In this IRB approved study, patients who underwent open coracoid Latarjet procedures for anteroinferior instability with glenoid bone loss (>20%) prior to October of 2012 were included. Anatomic measurements of coracoid size (anteroposterior surface area, maximal coracoid width), conjoint and subscapularis tendon widths, estimated glenoid defect surface area, Hill-Sach's Interval, and projected postoperative glenoid track engagement were obtained from preoperative cross-sectional imaging. When the projected glenoid track was smaller than the Hill-Sach's interval, the lesion was determined to be outside-&-engaged compared to inside-&-non-engaged. Patient reported subjective data that was prospectively collected and retrospectively reviewed included patient satisfaction, instability events, SANE score, ASES score, DASH score, and SF-12 PCS. Patients that progressed to another shoulder surgery not related to instability were considered complications and patients that continued to experience dislocations or who underwent revision instability surgeries were considered failures. Results: Thirty-nine shoulders in 39 patients (34 men, 5 women) with a mean age of 26 (range 16-43) were included at a mean follow-up was 3.3 years (2- 7.9 years). There were 25 out of 39 that had prior stabilization surgery and 6 workman's compensation claims. One patient was revised due to broken hardware at 2 months and one because of coracoid nonunion at 18 months. One patient experienced postsurgical adhesive capsulitis treated surgically at a year. All subjective outcome scores significantly improved (p<.05) and a 9 out of 10 median satisfaction score was

  20. Shoulder Arthroscopy

    MedlinePlus

    ... affect how your shoulder heals, lying flat may pull on your shoulder and cause discomfort. Some patients are more comfortable sleeping in a reclining chair or propped up in bed during the first days a er ...

  1. Frozen shoulder.

    PubMed Central

    Anton, H. A.

    1993-01-01

    The frozen shoulder is a common cause of shoulder pain and disability. Most patients slowly improve over 12 to 24 months. Some have prolonged loss of movement, pain, and associated disability. Treatments include physiotherapy, corticosteroid injections, and manipulation. Clinical trials of these treatments have produced conflicting results. PMID:8374364

  2. 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…

  3. Shoulder MRI

    MedlinePlus

    ... of the shoulder uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of ... scans, MRI does not utilize ionizing radiation. Instead, radio waves redirect alignment of hydrogen atoms that naturally exist ...

  4. 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

  5. Shoulder electromyography in multidirectional instability.

    PubMed

    Morris, Alfred D; Kemp, Graham J; Frostick, Simon P

    2004-01-01

    We studied shoulder muscle activity in multidirectional instability (MDI) and multidirectional laxity (MDL) of the shoulder, our hypothesis being that altered muscle activity plays a role in their pathogenesis. Six muscles (supraspinatus, infraspinatus, subscapularis, anterior deltoid, middle deltoid, and posterior deltoid) were investigated by use of intramuscular dual fine-wire electrodes in 7 normal shoulders, 5 MDL shoulders, and 6 MDI shoulders. Each subject performed 5 types of exercise (rotation in neutral, 45 degrees of abduction, 90 degrees of abduction, flexion/extension, and abduction/adduction) on an isokinetic muscle dynamometer at two rates, 90 degrees /s and 180 degrees /s. After filtering, rectification, and smoothing, the electromyography signal was normalized by using the peak voltage of the movement cycle. In subjects with MDI, compared with normal subjects, activity patterns of the anterior deltoid were different during rotation in neutral and 90 degrees of abduction, whereas those of the middle and posterior deltoid were different during rotation in 90 degrees of abduction. In subjects with MDL, the posterior deltoid showed increased activity compared with normal subjects during adduction. Activity patterns of the supraspinatus, infraspinatus, and subscapularis appeared similar in both groups. Dual fine-wire electromyography offers insight into the complex role of shoulder girdle muscle function in normal movement and in instability. Altered patterns of shoulder girdle muscle activity and imbalances in muscle forces support the theory that impaired coordination of shoulder girdle muscle activity and inefficiency of the dynamic stabilizers of the glenohumeral joint are involved in the etiology of MDI. Interestingly, the abnormalities are in the deltoid rather than the muscles of the rotator cuff.

  6. 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

  7. Postoperative pectoral swelling after shoulder arthroscopy.

    PubMed

    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.

  8. 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

  9. 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

  10. A biomechanical model correlating shoulder kinetics to pain in young baseball pitchers.

    PubMed

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

    2012-10-01

    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.

  11. What Are Shoulder Problems?

    MedlinePlus

    ... nerves around the shoulder, surgery may be needed. Separation A shoulder separation occurs when the ligaments between the collarbone and ... on an outstretched hand. Treatment for a shoulder separation includes: Rest A sling to keep the shoulder ...

  12. Shoulder biomechanics.

    PubMed

    Lugo, Roberto; Kung, Peter; Ma, C Benjamin

    2008-10-01

    The biomechanics of the glenohumeral joint depend on the interaction of both static and dynamic-stabilizing structures. Static stabilizers include the bony anatomy, negative intra-articular pressure, the glenoid labrum, and the glenohumeral ligaments along with the joint capsule. The dynamic-stabilizing structures include the rotator cuff muscles and the other muscular structures surrounding the shoulder joint. The combined effect of these stabilizers is to support the multiple degrees of motion within the glenohumeral joint. The goal of this article is to review how these structures interact to provide optimal stability and how failure of some of these mechanisms can lead to shoulder joint pathology.

  13. The Contribution of Reverse Shoulder Arthroplasty to Utilization of Primary Shoulder Arthroplasty

    PubMed Central

    Jain, Nitin B.; Yamaguchi, Ken

    2014-01-01

    Background We assessed the contribution of reverse shoulder arthroplasty to overall utilization of primary shoulder arthroplasty, and present age and sex stratified national rates of shoulder arthroplasty. We also assessed contemporary complication rates, mortality, and indications for shoulder arthroplasty, as well as estimates and indications for revision arthroplasty. Methods We used the Nationwide Inpatient Samples for 2009–2011 to calculate estimates of shoulder arthroplasty and assessed trends using joinpoint regression. Results The cumulative estimated utilization of primary shoulder arthroplasty (total anatomical, hemi, and reverse) increased significantly from 52,397 procedures (95% CI=47,093–57,701) in 2009 to 67,184 cases (95% CI=60,638–73,731) in 2011. Reverse shoulder arthroplasty accounted for 42% of all primary shoulder arthroplasty procedures in 2011. The diagnosis of concomitant diagnosis of osteoarthritis and rotator cuff impairment was found in only 29.8% of reverse shoulder arthroplasty cases. The highest rate of reverse shoulder arthroplasty was in the 75–84 year female sub-group (77; 95% CI=67–87). Revision cases were 8.8% and 8.2% of all shoulder arthroplasties in 2009 and 2011, respectively, and 35% of revision cases were secondary to mechanical complications/loosening while 18% were due to dislocation. Conclusions The utilization of primary shoulder arthroplasty significantly increased in just a three year time span, with a major contribution from reverse shoulder arthroplasty in 2011. Indications appear to have expanded as a large percentage of patients did not have rotator cuff pathology. The burden from revision arthroplasties was also substantial and efforts to optimize outcomes and longevity of primary shoulder arthroplasty are needed. Level of evidence Epidemiology Study, Database Analysis PMID:25304043

  14. Frozen Shoulder

    MedlinePlus

    ... you are put to sleep. Your doctor will force your shoulder to move which causes the capsule and scar tissue to stretch or tear. This releases the tightening and increases range of motion. These photos taken through an arthroscope show a ...

  15. 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

  16. Problems With Large Joints: Shoulder Conditions.

    PubMed

    Campbell, Michael

    2016-07-01

    The shoulder is the most mobile joint in the body. It requires an extensive support system to create mobility while providing stability. Although there are many etiologies of shoulder pain, weakness, and instability, most injuries in the shoulder are due to overuse. Rotator cuff tears, labral tears, calcific tendinopathy, and impingement often result from chronic overuse injuries. Acute injuries include dislocations that can cause labral tears or other complications. Frozen shoulder refers to a typically benign condition of restricted range of motion that may spontaneously resolve but can cause prolonged pain and discomfort. The history combined with specific shoulder examination techniques can help family physicians successfully diagnose shoulder conditions. X-ray imaging typically is sufficient to rule out more serious etiologies when evaluating patients with shoulder conditions. However, imaging with magnetic resonance imaging (MRI) study or ultrasonography for rotator cuff tears, and MRI study with intra-articular contrast for labral tears, is needed to confirm these diagnoses. Corticosteroid injections and physical therapy are first-line treatments for most shoulder conditions. Surgical options typically are reserved for patients for whom conservative treatments are ineffective, and typically are performed arthroscopically.

  17. Simple Elbow Dislocation.

    PubMed

    Armstrong, April

    2015-11-01

    Simple elbow dislocation refers to those elbow dislocations that do not involve an osseous injury. A complex elbow dislocation refers to an elbow that has dislocated with an osseous injury. Most simple elbow dislocations are treated nonoperatively. Understanding the importance of the soft tissue injury following a simple elbow dislocation is a key to being successful with treatment.

  18. Shoulder Osteoarthritis

    PubMed Central

    2013-01-01

    Osteoarthritis (OA) is the most frequent cause of disability in the USA, affecting up to 32.8% of patients over the age of sixty. Treatment of shoulder OA is often controversial and includes both nonoperative and surgical modalities. Nonoperative modalities should be utilized before operative treatment is considered, particularly for patients with mild-to-moderate OA or when pain and functional limitations are modest despite more advanced radiographic changes. If conservative options fail, surgical treatment should be considered. Although different surgical procedures are available, as in other joints affected by severe OA, the most effective treatment is joint arthroplasty. The aim of this work is to give an overview of the currently available treatments of shoulder OA. PMID:23365745

  19. 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

  20. [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.

  1. Functional outcomes after fixation of "terrible triad" elbow fracture dislocations.

    PubMed

    Fitzgibbons, Peter G; Louie, Dexter; Dyer, George Sinclair Mitchell; Blazar, Philip; Earp, Brandon

    2014-04-01

    Historically, the published literature on "terrible triad" injuries has shown a high rate of unacceptable results. The use of systematic treatment protocols may improve functional outcome. The authors performed a retrospective study of all patients aged 18 years or older who underwent surgical treatment for "terrible triad" elbow fracture dislocation at their institution over a period 7 years. Surgical treatment involved fixation or replacement of the radial head, repair of the anterior capsule or coronoid fracture in most cases, and repair of the lateral collateral ligament. Outcomes included grip strength, range of motion, Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire score, and a visual analog score for pain as well as radiographic assessment of arthritis, maintenance of reduction, and development of heterotopic ossification. Eighteen patients were identified and 11 enrolled. Seven patients had suture fixation of the coronoid fragment and anterior capsule, 2 had screw fixation, and 2 had no repair of the coronoid. The radial head was replaced in 9 patients and repaired in 1, and a fracture fragment was excised in another. The average follow-up was 38 months. The average arc of motion of the injured elbow was 112° and that of the contralateral elbow was 142°. The average DASH score was 19.7 (scale, 0-100). The average visual analog score for pain was 2.2 (scale, 0-10). No patients had recurrent elbow instability. Three patients underwent further surgical procedures, all for loss of motion. The authors concluded that a systematic approach to the fixation of "terrible triad" elbow fracture dislocations can provide predictable elbow stability and functional range of motion in the medium term.

  2. Unusual Medial-End Clavicle Fracture Combined with Double Disruption of the Superior Shoulder Suspensory Complex (SSSC) : A Case Report in Triathlon Athlete

    PubMed Central

    Poggetti, A; Novi, M; Rosati, M; Battistini, P; Parchi, P; Lisanti, M

    2016-01-01

    Introduction: Most published floating clavicle report a dislocation or fracture of one or both ends of the clavicle. Case Presentation: We reported a new framework of this injury in a young triathlon athlete; medial-end displaced fracture with co-existent double disruption of the superior shoulder suspensory complex (SSSC) with the anterior shoulder arch wholly disconnected from the nearby structure. Conclusion: The management of these complex fractures remains an open debate. The infrequent publications and the rarity of this type of injuries don’t support the surgeon about the choice of the best possible treatment. However, if they are involved Patients with high functional demands, the Authors suggest the surgical management of medial-end clavicle fractures followed by restoration of SSSC complex if damaged on more than two locations. PMID:28116259

  3. 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

  4. "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.

  5. Shoulder separation - aftercare

    MedlinePlus

    Separated shoulder - aftercare; Acromioclavicular joint separation - aftercare; A/C separation - aftercare ... Most shoulder separation injuries are caused by falling onto the shoulder. This causes a tear in the tissue that connects the ...

  6. Shoulder replacement - discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000178.htm Shoulder replacement - discharge To use the sharing features on this page, please enable JavaScript. You had shoulder replacement surgery to replace the bones of your shoulder ...

  7. 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.

  8. 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

  9. Shoulder biomechanics and muscle plasticity: implications in spinal cord injury.

    PubMed

    Lee, Thay Q; McMahon, Patrick J

    2002-10-01

    After spinal cord injury, excessive burden falls on the upper extremity, especially the shoulder. Overall, 51% of persons with spinal cord injury have shoulder problems. Common shoulder problems in persons with spinal cord injury begin with muscle imbalance that can lead to glenohumeral instability, impingement disease, rotator cuff tears, and subsequent degenerative joint disease. These problems can be attributed to the functional demands placed on the shoulder that are specific to patients with spinal cord injury, including overhead activities, wheelchair use, and transfers. Despite preventive exercises, shoulder problems in persons with spinal cord injury remain a significant problem, causing pain and functional limitations. The biomechanics of the shoulder for persons with spinal cord injury resulting from changes in muscle plasticity will be elucidated. Specifically, the effects of scapular protraction that can result from muscle imbalance, the age-dependent properties of the anterior band of the inferior glenohumeral ligament, and the influence of the dynamic restraints around the shoulder will be addressed.

  10. Shoulder muscle activity and function in common shoulder rehabilitation exercises.

    PubMed

    Escamilla, Rafael F; Yamashiro, Kyle; Paulos, Lonnie; Andrews, James R

    2009-01-01

    The rotator cuff performs multiple functions during shoulder exercises, including glenohumeral abduction, external rotation (ER) and internal rotation (IR). The rotator cuff also stabilizes the glenohumeral joint and controls humeral head translations. The infraspinatus and subscapularis have significant roles in scapular plane abduction (scaption), generating forces that are two to three times greater than supraspinatus force. However, the supraspinatus still remains a more effective shoulder abductor because of its more effective moment arm. Both the deltoids and rotator cuff provide significant abduction torque, with an estimated contribution up to 35-65% by the middle deltoid, 30% by the subscapularis, 25% by the supraspinatus, 10% by the infraspinatus and 2% by the anterior deltoid. During abduction, middle deltoid force has been estimated to be 434 N, followed by 323 N from the anterior deltoid, 283 N from the subscapularis, 205 N from the infraspinatus, and 117 N from the supraspinatus. These forces are generated not only to abduct the shoulder but also to stabilize the joint and neutralize the antagonistic effects of undesirable actions. Relatively high force from the rotator cuff not only helps abduct the shoulder but also neutralizes the superior directed force generated by the deltoids at lower abduction angles. Even though anterior deltoid force is relatively high, its ability to abduct the shoulder is low due to a very small moment arm, especially at low abduction angles. The deltoids are more effective abductors at higher abduction angles while the rotator cuff muscles are more effective abductors at lower abduction angles. During maximum humeral elevation the scapula normally upwardly rotates 45-55 degrees, posterior tilts 20-40 degrees and externally rotates 15-35 degrees. The scapular muscles are important during humeral elevation because they cause these motions, especially the serratus anterior, which contributes to scapular upward rotation

  11. Bony instability of the shoulder.

    PubMed

    Bushnell, Brandon D; Creighton, R Alexander; Herring, Marion M

    2008-09-01

    Instability of the shoulder is a common problem treated by many orthopaedists. Instability can result from baseline intrinsic ligamentous laxity or a traumatic event-often a dislocation that injures the stabilizing structures of the glenohumeral joint. Many cases involve soft-tissue injury only and can be treated successfully with repair of the labrum and ligamentous tissues. Both open and arthroscopic approaches have been well described, with recent studies of arthroscopic soft-tissue techniques reporting results equal to those of the more traditional open techniques. Over the last decade, attention has focused on the concept of instability of the shoulder mediated by bony pathology such as a large bony Bankart lesion or an engaging Hill-Sachs lesion. Recent literature has identified unrecognized large bony lesions as a primary cause of failure of arthroscopic reconstruction for instability, a major cause of recurrent instability, and a difficult diagnosis to make. Thus, although such bony lesions may be relatively rare compared with soft-tissue pathology, they constitute a critically important entity in the management of shoulder instability. Smaller bony lesions may be amenable to arthroscopic treatment, but larger lesions often require open surgery to prevent recurrent instability. This article reviews recent developments in the diagnosis and treatment of bony instability.

  12. The Influence of Arthroscopic Remplissage for Engaging Hill-Sachs Lesions Combined with Bankart Repair on Redislocation and Shoulder Function Compared with Bankart Repair Alone

    PubMed Central

    Ko, Sang-Hun; Cha, Jae-Ryong; Hwang, Il-Yeong; Choe, Chang-Gyu; Kim, Min-Seok

    2016-01-01

    Background Recurrence of glenohumeral dislocation after arthroscopic Bankart repair can be associated with a large osseous defect in the posterosuperior part of the humeral head. Our hypothesis is that remplissage is more effective to prevent recurrence of glenohumeral instability without a severe motion deficit. Methods Engaging Hill-Sachs lesions were observed in 48 of 737 patients (6.5%). Twenty-four patients underwent arthroscopic Bankart repair combined with remplissage (group I) and the other 24 patients underwent arthroscopic Bankart repair alone (group II). Clinical outcomes were prospectively evaluated by assessing the range of motion. Complications, recurrence rates, and functional results were assessed utilizing the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, and the Korean Shoulder Score for Instability (KSSI) score. Capsulotenodesis healing after remplissage was evaluated with magnetic resonance imaging. Results The average ASES, Rowe, and KSSI scores were statistically significantly higher in group I than group II. The frequency of recurrence was statistically significantly higher in group II. The average loss in external rotation measured with the arm positioned at the side of the trunk was greater in group II and that in abduction was also higher in group II. Conclusions Compared to single arthroscopic Bankart repair, the remplissage procedure combined with arthroscopic Bankart repair was more effective to prevent the recurrence of anterior shoulder instability without significant impact on shoulder mobility in patients who had huge Hill-Sachs lesions. PMID:27904726

  13. Pain mapping for common shoulder disorders.

    PubMed

    Bayam, Levent; Ahmad, Mudussar A; Naqui, Syed Z; Chouhan, Aroonkumar; Funk, Lennard

    2011-07-01

    We conducted a study to ascertain specific patterns of pain in patients with common shoulder disorders and to describe a comprehensive shoulder pain map. We prospectively studied 94 cases involving an upper limb pain map and correlated the maps with the final diagnoses made by 2 clinicians who were blinded to the pain map findings. Pattern, severity, and type of pain were specific to each common shoulder disorder. In subacromial impingement, pain was predominantly sharp, occurred around the anterior aspect of the shoulder, radiated down the arm, and was associated with dull, aching pain radiating to the hand. A similar pain pattern was found in rotator cuff tears. In acromioclavicular joint pathology, pain was sharp, stabbing, and well localized to the anterosuperior shoulder area. Glenohumeral joint arthritis was marked by the most severe pain, which occurred in a mixed pattern and affected the entire arm. Whereas the pain of instability was a mixture of sharp and dull pain, the pain of calcific tendonitis was severe and sharp. Both pains were limited to the upper arm and shoulder. Pain mapping revealed definitive patterns for shoulder pathologies. We advocate using pain maps as useful diagnostic guides and research tools.

  14. 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

  15. Complicated Congenital Dislocation of the Knee: A Case Report

    PubMed Central

    Madadi, Firooz; Tahririan, Mohammad A.; Karami, Mohsen; Madadi, Firoozeh

    2016-01-01

    Congenital dislocation of the knee (CDK) is a rare disorder. We report the case of a 7-year-old girl with bilateral knee stiffness, marked anterior bowing of both legs, and inability to walk without aid. Radiologic investigation revealed bilateral knee joint dislocation accompanied by severe anterior bowing of both tibia proximally and posterior bowing of both femur distally, demonstrating a complicated congenital knee dislocation. Two-staged open reduction with proximal tibial osteotomy was performed to align the reduced knee joints. The patient was completely independent in her daily activities after surgical correction. PMID:27847857

  16. Chronic bilateral dislocation of temporomandibular joint.

    PubMed

    Shakya, S; Ongole, R; Sumanth, K N; Denny, C E

    2010-01-01

    Dislocation of the condyle of the mandible is a common condition that may occur in an acute or chronic form. It is characterised by inability to close the mouth with or without pain. Dislocation has to be differentiated from subluxation which is a self reducible condition. Dislocation can occur in any direction with anterior dislocation being the commonest one. Various predisposing factors have been associated with dislocation like muscle fatigue and spasm, the defect in the bony surface like shallow articular eminence, and laxity of the capsular ligament. People with defect in collagen synthesis like Ehler Danlos syndrome, Marfan syndrome are said to be genetically predisposed to this condition. Various treatment modalities have been used ranging from conservative techniques to surgical methods. Acute dislocations can be reduced manually or with conservative approach and recurrent and chronic cases can be reduced by surgical intervention. Though the dislocation in our case was 4 months a simple manual reduction proved to be successful. We believe that manual reduction can be attempted as first line of treatment prior to surgical intervention.

  17. Brachial artery injury following opened elbow dislocation associated with accessory brachial artery: two rare entities in a 17-year -old girl: case report.

    PubMed

    Hajji, Rita; Zrihni, Youssef; Naouli, Hamza; Bouarhroum, Abdellatif

    2015-01-01

    Elbow dislocations are the most frequently encountered after shoulder dislocations. In their vast majority, these injuries carry a good prognosis. Although, concomitant arterial injury is rare and make them more serious. In this paper, we report a case of a 17 year old woman with opened elbow dislocation with arterial injury associated to an artery variation: "accessory brachial artery".

  18. Brachial artery injury following opened elbow dislocation associated with accessory brachial artery: two rare entities in a 17-year –old girl: case report

    PubMed Central

    Hajji, Rita; Zrihni, Youssef; Naouli, Hamza; Bouarhroum, Abdellatif

    2015-01-01

    Elbow dislocations are the most frequently encountered after shoulder dislocations. In their vast majority, these injuries carry a good prognosis. Although, concomitant arterial injury is rare and make them more serious. In this paper, we report a case of a 17 year old woman with opened elbow dislocation with arterial injury associated to an artery variation: "accessory brachial artery" PMID:26161188

  19. Shoulder Impingement Treatment

    MedlinePlus

    ... imbalance in the rotator cuff or scapular muscles, postural abnormalities, shoulder joint instability, or improper training or ... with elastic tubing. Figure 2. Shoulder protraction exercise (balance with one arm on wobble board or deflated ...

  20. 9. Painful shoulder complaints.

    PubMed

    Huygen, Frank; Patijn, Jacob; Rohof, Olav; Lataster, Arno; Mekhail, Nagy; van Kleef, Maarten; Van Zundert, Jan

    2010-01-01

    Painful shoulder complaints have a high incidence and prevalence. The etiology is not always clear. Clinical history and the active and passive motion examination of the shoulder are the cornerstones of the diagnostic process. Three shoulder tests are important for the examination of shoulder complaints: shoulder abduction, shoulder external rotation, and horizontal shoulder adduction. These tests can guide the examiner to the correct diagnosis. Based on this diagnosis, in most cases, primarily a conservative treatment with nonsteroidal anti-inflammatory drugs possibly in combination with manual and/or exercise therapy can be started. When conservative treatment fails, injection with local anesthetics and corticosteroids can be considered. In the case of frozen shoulder, a continuous cervical epidural infusion of local anesthetic and small doses of opioids or a pulsed radiofrequency treatment of the nervus suprascapularis can be considered.

  1. Shoulder Joint Replacement

    MedlinePlus

    ... examination. This will assess shoulder motion, stability, and strength. joint. (Right) Osteoarthritis of the shoulder. Note the ... you can start moving sooner and get your strength back more quickly. Talk with your surgeon if ...

  2. Shoulder surgery - discharge

    MedlinePlus

    ... this page: //medlineplus.gov/ency/patientinstructions/000179.htm Shoulder surgery - discharge To use the sharing features on this page, please enable JavaScript. You had shoulder surgery to repair the tissues inside or around ...

  3. Hump behind the shoulders

    MedlinePlus

    ... gov/ency/article/003112.htm Hump behind the shoulders (Dorsocervical fat pad) To use the sharing features ... page, please enable JavaScript. A hump behind the shoulders is an area of fat accumulation on the ...

  4. 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 ...

  5. 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.

  6. 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.

  7. Development of the shoulder girdle musculature.

    PubMed

    Pu, Qin; Huang, Ruijin; Brand-Saberi, Beate

    2016-03-01

    The muscles of the shoulder region are important for movements of the upper limbs and for stabilizing the girdle elements by connecting them to the trunk. They have a triple embryonic origin. First, the branchiomeric shoulder girdle muscles (sternocleidomastoideus and trapezius muscles) develop from the occipital lateral plate mesoderm using Tbx1 over the course of this development. The second population of cells constitutes the superficial shoulder girdle muscles (pectoral and latissimus dorsi muscles), which are derived from the wing premuscle mass. This muscle group undergoes a two-step development, referred to as the "in-out" mechanism. Myogenic precursor cells first migrate anterogradely into the wing bud. Subsequently, they migrate in a retrograde manner from the wing premuscle mass to the trunk. SDF-1/CXCR4 signaling is involved in this outward migration. A third group of shoulder muscles are the rhomboidei and serratus anterior muscles, which are referred to as deep shoulder girdle muscles; they are thought to be derived from the myotomes. It is, however, not clear how myotome cells make contact to the scapula to form these two muscles. In this review, we discuss the development of the shoulder girdle muscle in relation to the different muscle groups.

  8. Shoulder injuries in archery.

    PubMed

    Mann, D L; Littke, N

    1989-06-01

    Twenty-one elite-calibre archers (M = 12, F = 9) were investigated concerning all past and present archery-related shoulder injuries, using a questionnaire and physical examination. The questionnaire revealed that 11 of 21 archers had complained of significant shoulder injuries either currently or during their careers. While 9/12 men never had shoulder problems during an average of 13.5 years, only 4/9 women escaped injury during a mean 10.9 year competitive career. Deficits in training programs were noted, including lack of training and non-specific exercises. Clinical examination demonstrated shoulder asymmetry and decreased flexibility in the drawing arm (DA) shoulder. Functional testing revealed a positive impingement sign in 6/21 DA shoulders. Supraspinatus testing showed abnormalities in 4/21 DA shoulders. Pain was referred posteriorly with the impingement maneuver in 5/21 DA shoulders and abnormal external rotation testing was observed in 8/21 DA shoulders. Generally, the females had proportionally more signs and symptoms of shoulder injury than the men, especially involving the DA shoulder. Testing implicated supraspinatus impingement/tendonitis and infraspinatus/teres minor traction tendonitis. These clinical findings correlated with cadaver prosection observations.

  9. Partial humeral head resurfacing and Latarjet coracoid transfer for treatment of recurrent anterior glenohumeral instability.

    PubMed

    Moros, Chris; Ahmad, Christopher S

    2009-08-01

    Bone deficiencies of either the humeral head or glenoid fossa may cause recurrent shoulder instability following soft tissue stabilization procedures. The engaging Hill-Sachs lesion, a major risk factor for instability, has been identified in a majority of patients with recurrent anterior instability. Guidance for surgical management of large humeral head deficiency presents few available options, with even fewer clinical data to support any one technique. Anteroinferior glenoid deficiency has also been a well-documented source of recurrent instability. The Latarjet coracoid transfer procedure corrects the glenoid defect by restoring the architecture of the inferior rim. Although coracoid transfer addresses containment on the glenoid, a concomitant large humeral head defect is at risk for engagement on the corrected glenoid. This article describes a case of a 50-year-old man presenting with recurrent right shoulder dislocations status post-open stabilization procedure 10 years prior. Radiologic evaluation demonstrated a large Hill-Sachs lesion with adjacent chondral derangement and a nonunion bony Bankart lesion. The Arthrosurface HemiCap humeral head resurfacing prosthesis (Arthrosurface Inc, Franklin, Massachusetts) was used to address the Hill-Sachs lesion with a Latarjet coracoid transfer procedure. We were unable to identify examples in the literature of the HemiCap used in the correction of a Hill-Sachs lesion for recurrent anterior instability. The HemiCap prosthesis has the benefit of correcting the Hill-Sachs lesion and adjacent chondral defect while preserving uninvolved articular surface. The combination of surgical interventions produced a successful result.

  10. Biomechanical analysis of the mechanism of elbow fracture-dislocations by compression force.

    PubMed

    Wake, Hirofumi; Hashizume, Hiroyuki; Nishida, Keiichiro; Inoue, Hajime; Nagayama, Noriyuki

    2004-01-01

    Fracture-dislocations of the coronoid and olecranon were produced experimentally, and their onset mechanisms were analyzed to clarify the effects of compression force on the coronoid and olecranon. The study used two-dimensional finite element method (2D-FEM) simulations and static loading experiments. The latter applied axial force distally to 40 cadaveric elbows. Posterior fracture-dislocations occurred between 15 degrees of extension and 30 degrees of flexion, anterior or posterior fracture-dislocations at 60 degrees, and only anterior fracture-dislocations at 90 degrees. Injuries were mainly to anterior or posterior support structures. The 2D-FEM simulations showed that the stress concentration areas moved from the coronoid process to the olecranon as position changed from extension to flexion. The very high frequency of concurrent fracture-dislocations of radial head or neck in the current study indicated that the radial head may also function as a stabilizer in the anterior support system.

  11. Shoulder imaging in athletes.

    PubMed

    Tirman, Phillip F; Smith, Eric D; Stoller, David W; Fritz, Russell C

    2004-03-01

    Shoulder pain and injuries are common in athletes. Overhead athletes, in particular, place great demands on the shoulder and supporting structures. Magnetic resonance (MR) imaging is well suited to evaluation of the osseous structures and soft tissues of the shoulder and plays an important role in evaluation of shoulder pain in athletes. Primary extrinsic impingement is well evaluated on MR imaging as are the less common posterior superior glenoid impingement and subcoracoid impingement. Rotator cuff tendinosis as well as partial- and full-thickness tears are frequently encountered in the athletic shoulder. The biceps tendon and rotator interval capsular structures are important sources of shoulder pain. Glenohumeral instability that results from a traumatic event or atraumatic multidirectional recurrent instability is assessed. The biceps labral complex is a source of considerable anatomic variability and pathology.

  12. 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

  13. Ligamentous and capsular restraints to experimental posterior elbow joint dislocation.

    PubMed

    Deutch, Søren R; Olsen, Bo S; Jensen, Steen L; Tyrdal, Stein; Sneppen, Otto

    2003-10-01

    Pathological external forearm rotation (PEFR) relates to posterolateral elbow joint instability, and is considered a possible requisite step in a simple posterior elbow joint dislocation. The aim of this study was to evaluate the capsuloligamentous restraint to PEFR. In all, 18 elbow joint specimens were examined in a joint analysis system developed for experimental elbow dislocation. Sequential cutting of capsule and ligaments followed by stability testing provided specific data relating to each capsuloligamentous structure. The primary stabilizers against PEFR in the extended elbow were the anterior capsule and the lateral collateral ligament complex (LCLC), whereas in the flexed elbow the anterior capsule did not have a stabilizing effect. In flexed joint positions, the LCLC seems to be the only immediate stabilizer against PEFR, and thereby against posterolateral instability and possibly against posterior dislocation. The medial collateral ligament did not have any immediate stabilizing effect, but it prevented the final step of the posterior dislocation.

  14. Rehabilitation of the pitching shoulder.

    PubMed

    Pappas, A M; Zawacki, R M; McCarthy, C F

    1985-01-01

    Shoulder pain is a common complaint among baseball pitchers. Frequently, the nature of shoulder pathology can be traced to lack of flexibility and muscular imbalance. This paper describes: the normal biomechanics of a properly functioning shoulder during a baseball pitch, pathomechanics of shoulder problems, flexibility requirements of the throwing shoulder, and the muscular balance necessary for an effective throwing shoulder. Appropriate examination procedures are described along with remedial exercises which ensure normal glenohumeral motion and integrated muscle action.

  15. 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

  16. Irreducible posterolateral elbow dislocation.

    PubMed

    Atkinson, Cameron T; Pappas, Nick D; Lee, Donald H

    2014-02-01

    Elbow dislocations are a high-energy traumatic event resulting in loss of congruence of a stable joint. The majority of elbow dislocations can be reduced by closed means and treated conservatively. We present a case of an irreducible elbow dislocation with reduction blocked by the radial head buttonholed through the lateral ligamentous complex. We performed open reduction with release followed by repair of the lateral ligamentous complex. Clinicians need to understand this unique variant of an elbow dislocation to appropriately treat this operative injury.

  17. Discrete dislocations in graphene

    NASA Astrophysics Data System (ADS)

    Ariza, M. P.; Ortiz, M.

    2010-05-01

    In this work, we present an application of the theory of discrete dislocations of Ariza and Ortiz (2005) to the analysis of dislocations in graphene. Specifically, we discuss the specialization of the theory to graphene and its further specialization to the force-constant model of Aizawa et al. (1990). The ability of the discrete-dislocation theory to predict dislocation core structures and energies is critically assessed for periodic arrangements of dislocation dipoles and quadrupoles. We show that, with the aid of the discrete Fourier transform, those problems are amenable to exact solution within the discrete-dislocation theory, which confers the theory a distinct advantage over conventional atomistic models. The discrete dislocations exhibit 5-7 ring core structures that are consistent with observation and result in dislocation energies that fall within the range of prediction of other models. The asymptotic behavior of dilute distributions of dislocations is characterized analytically in terms of a discrete prelogarithmic energy tensor. Explicit expressions for this discrete prelogarithmic energy tensor are provided up to quadratures.

  18. Milwaukee shoulder syndrome.

    PubMed

    Nadarajah, Channa Vasanth; Weichert, Immo

    2014-01-01

    Milwaukee shoulder syndrome (MSS) is a rare destructive, calcium phosphate crystalline arthropathy. It encompasses an effusion that is noninflammatory with numerous aggregates of calcium hydroxyapatite crystals in the synovial fluid, associated with rotator cuff defects. We describe a patient that presented with recurrent shoulder pain and swelling with characteristic radiographic changes and MSS was confirmed on aspiration of the synovial fluid.

  19. Periprosthetic Shoulder Infection

    PubMed Central

    Franceschini, Vincenzo; Chillemi, Claudio

    2013-01-01

    Shoulder arthroplasty is considered the most effective surgical procedure for endstage shoulder pain from different causes including osteoarthritis, cuff-tear arthropathy, trauma, and tumors. Although uncommon and less frequent than knee or hip periprosthetic infection, periprosthetic shoulder infection represents a devastating complication and, despite treatment, is associated with unsatisfactory results. The most commonly identified microorganisms in periprosthetic shoulder infections are Staphylococcus aureus, coagulase-negative Staphylococci and Propionibacterium acnes. Diagnosis is not always easy and mainly derives from the integration of clinical symptoms, laboratory exams, radiological studies and microbiological swabs. Different options are available for treatment, including antibiotic therapy, lavage and debridement with retention of the prosthesis, one-stage reimplantation, two-stage reimplantation with antibiotic-impregnated cement spacer and resection arthroplasty. The aim of this review is to describe the current knowledge regarding risk factors, etiology, diagnosis and treatment of periprosthetic shoulder infection. PMID:23919098

  20. Spontaneous Late Intraocular Lens and Capsule Tension Ring Dislocation

    PubMed Central

    Koçak Altıntaş, Ayşe Gül; Omay, Aslıhan Esra; Çelik, Selda

    2017-01-01

    In this report, three cases with pseudoexfoliation (PEX) and advanced age with spontaneous intraocular lens (IOL) and capsule tension ring (CTR) dislocation were presented. All of our cases experienced progressive vision loss without an episode of strenuous physical activity, trauma, or any other ocular disease. Spontaneous dislocation was observed 2.5 to 8 years after uneventful phacosurgery. Each patient underwent complete IOL and CTR removal combined with anterior chamber IOL implantation. No complications were noticed during follow-up. As a result, capsule tension ring does not prevent late IOL dislocation after uncomplicated phacosurgery in the presence of PEX. Therefore, close follow-up is essential for patients with PEX.

  1. 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.

  2. Parallel Dislocation Simulator

    SciTech Connect

    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.

  3. Traumatic proximal tibiofibular dislocation.

    PubMed

    Burgos, J; Alvarez-Montero, R; Gonzalez-Herranz, P; Rapariz, J M

    1997-01-01

    Proximal tibiofibular dislocation is an exceptional lesion. Rarer still is its presentation in childhood. We describe the clinical case of a 6-year-old boy, the victim of a road accident. He had a tibiofibular dislocation associated with a metaphyseal fracture of the tibia.

  4. Posterior sternoclavicular dislocations--a diagnosis easily missed.

    PubMed Central

    Thomas, D. P.; Davies, A.; Hoddinott, H. C.

    1999-01-01

    Posterior dislocation of the sternoclavicular joint is a relatively rare injury and can be difficult to diagnose acutely. We report 3 cases of posterior dislocation of the sternoclavicular joint who presented to the Accident & Emergency Department within a 3 month period. All 3 patients had sustained a significant injury to the shoulder region and complained of pain around the medial clavicle. Two patients had also complained of dysphagia following the injury. Plain X-rays of the shoulder and chest were reported as normal by junior and senior medical staff. The diagnosis was delayed until CT scans were performed, and once this was established, open reduction and stabilisation was performed. Images Figure 1 Figure 2 Figure 3 p204-a PMID:10364956

  5. 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.

  6. 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 ...

  7. 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

  8. 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.

  9. 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

  10. PREFERED SURGICAL TECHNIQUE USED BY ORTHOPEDISTS IN ACUTE ACROMIOCLAVICULAR DISLOCATION

    PubMed Central

    NISHIMI, ALEXANDRE YUKIO; ARBEX, DEMETRIO SIMÃO; MARTINS, DIOGO LUCAS CAMPOS; GUSMÃO, CARLOS VINICIUS BUARQUE DE; BONGIOVANNI, ROBERTO RANGEL; PASCARELLI, LUCIANO

    2016-01-01

    ABSTRACT Objective: To determine whether training on shoulder and elbow surgery influences the orthopedist surgeons' preferred technique to address acute acromioclavicular joint dislocation (ACD). Methods: A survey was conducted with shoulder and elbow specialists and general orthopedists on their preferred technique to address acute ACD. Results: Thirty specialists and forty-five general orthopedists joined the study. Most specialists preferred the endobutton technique, while most general orthopedists preferred the modified Phemister procedure for coracoclavicular ligament repair using anchors. We found no difference between specialists and general orthopedists in the number of tunnels used to repair the coracoclavicular ligament; preferred method for wire insertion through the clavicular tunnels; buried versus unburied Kirschner wire insertion for acromioclavicular temporary fixation; and time for its removal; and regarding the suture thread used for deltotrapezoidal fascia closure. Conclusion: Training on shoulder and elbow surgery influences the surgeons' preferred technique to address acute ACD. Level of Evidence V, Expert Opinion. PMID:28149190

  11. Bilateral traumatic hip dislocation associated with sacro-iliac dislocation.

    PubMed

    Galois, L; Meuley, E; Pfeffer, F; Mainard, D; Delagoutte, J P

    We report a rare injury in an 18-year-old woman who sustained posterior bilateral hip dislocation with sacro-iliac dislocation after a high energy motor vehicle accident. She was treated by closed reduction and skeletal traction. Bilateral traumatic hip dislocation is an uncommon occurrence. Rarer still is bilateral traumatic hip dislocation associated with sacro-iliac dislocation because it combines two different mechanisms of trauma. (Hip International 2002; 1: 47-9).

  12. 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

  13. 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.

  14. Electromyographic analysis and its role in the athletic shoulder.

    PubMed

    Glousman, R

    1993-03-01

    In 1944, Inman made some conclusions regarding shoulder function that have become the foundation of a classic model. Clinical observations of the athletic shoulder and its associated common injuries have demonstrated selective weakness of specific rotator cuff muscles rather than generalized muscle impairment. Shoulder mechanics during athletic activities have been evaluated dynamically with electromyography (EMG), which has helped to formulate a base for optimal rehabilitation. Dynamic EMG and high-speed film analysis have been used to evaluate the shoulder during throwing, swimming, tennis, and golf. Evaluation of shoulder function in these various sports revealed that although rotator cuff function is important in all, the emphasis and role of individual muscles varied. The importance of serratus anterior muscle activity to stabilization and protraction of the scapula has been consistently reported. The muscles about the shoulder act according to their mechanical qualities and are function- or sport-specific. A thorough understanding of the mechanics of the normal and pathologic shoulder constitutes the foundation for training and rehabilitation strategies.

  15. 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.

  16. 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

  17. 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

  18. 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.

  19. Shoulder muscle recruitment patterns during a kayak stroke performed on a paddling ergometer.

    PubMed

    Trevithick, Beverley A; Ginn, Karen A; Halaki, Mark; Balnave, Ronald

    2007-02-01

    Precise muscle co-ordination is required to maintain normal shoulder function and alterations in synchrony between shoulder muscles can result in loss of full range of movement and pain. Although shoulder pain in kayakers is high with 53% of elite international paddlers reporting shoulder injuries, little information is available regarding the pattern of shoulder muscle recruitment during paddling. The aim of this study was to investigate the normal recruitment pattern of shoulder muscles during the kayak stroke. Nine recreational paddlers without shoulder pain were examined. EMG data from eight shoulder muscles of the dominant arm were collected simultaneously with video data during simulated paddling on an ergometer. EMG data was normalized to time and peak amplitude. Intersubject consistency was evaluated using Pearson correlation analysis. The results of this study indicated a fair to high correlation in at least one phase of the kayak stroke in five of the muscles examined: upper trapezius, supraspinatus, latissimus dorsi, serratus anterior and rhomboid major. This normative data will enable comparisons with the shoulder muscle recruitment patterns in kayakers with shoulder pain in order to determine the role of altered motor control in the painful kayaking shoulder.

  20. 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

  1. Anterior knee pain.

    PubMed

    LLopis, Eva; Padrón, Mario

    2007-04-01

    Anterior knee pain is a common complain in all ages athletes. It may be caused by a large variety of injuries. There is a continuum of diagnoses and most of the disorders are closely related. Repeated minor trauma and overuse play an important role for the development of lesions in Hoffa's pad, extensor mechanism, lateral and medial restrain structures or cartilage surface, however usually an increase or change of activity is referred. Although the direct relation of cartilage lesions, especially chondral, and pain is a subject of debate these lesions may be responsible of early osteoarthrosis and can determine athlete's prognosis. The anatomy and biomechanics of patellofemoral joint is complex and symptoms are often unspecific. Transient patellar dislocation has MR distinct features that provide evidence of prior dislocation and rules our complication. However, anterior knee pain more often is related to overuse and repeated minor trauma. Patella and quadriceps tendon have been also implicated in anterior knee pain, as well as lateral or medial restraint structures and Hoffa's pad. US and MR are excellent tools for the diagnosis of superficial tendons, the advantage of MR is that permits to rule out other sources of intraarticular derangements. Due to the complex anatomy and biomechanic of patellofemoral joint maltracking is not fully understood; plain films and CT allow the study of malalignment, new CT and MR kinematic studies have promising results but further studies are needed. Our purpose here is to describe how imaging techniques can be helpful in precisely defining the origin of the patient's complaint and thus improve understanding and management of these injuries.

  2. Reverse shoulder arthroplasty.

    PubMed

    Smithers, Christopher J; Young, Allan A; Walch, Gilles

    2011-12-01

    The reverse shoulder arthroplasty emerged as a potential solution for those patients who could not be managed effectively with a conventional total shoulder arthroplasty. Grammont revolutionized the design by medializing and distalizing the center of rotation and utilizing a large convex glenoid surface and concave humeral component with a neck-shaft angle of 155°. This design has been highly successful in cuff deficient shoulders, and indications continue to broaden. Many mid-term studies have improved upon the early encouraging results. Long-term studies are starting to emerge, demonstrating good survivorship, but progressive functional and radiographic deterioration continue to be concerning. Careful patient selection and attention to appropriate technique are required to reduce the current high rate of complications. New prosthesis designs are continuing to develop to address some of these limitations.

  3. 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 of metal and a ...

  4. Shoulder impingement syndrome in relation to shoulder intensive work

    PubMed Central

    Frost, P.; Andersen, J. H.

    1999-01-01

    OBJECTIVES: To analyse the risk of shoulder impingement syndrome relative to shoulder intensive work. METHODS: A cross sectional study of a historical cohort of 1591 workers employed between 1986 and 1993 at a slaughterhouse or a chemical factory. Workers not doing tasks in slaughtering or meat processing constituted the reference group. Intensity of shoulder work in meat processing tasks was assessed by video based observations. Information on shoulder disorders was collected by questionnaire and by physical examinations. Impingement syndrome was diagnosed when shoulder symptoms had been present for at least 3 months during the past year and there were signs of subacromial impingement in the corresponding shoulder at physical examination. Shoulder function was assessed at the same occasion with the Constant scoring technique. Prevalence of shoulder impingement syndrome was analysed according to job title and cumulative exposure. RESULTS: Prevalence ratio for shoulder impingement syndrome was 5.27 (95% confidence interval (95% CI), 2.09 to 12.26) among currently working and 7.90 (95% CI, 2.94 to 21.18) among former slaughterhouse workers. Transformed model based prevalence ratios according to years in slaughterhouse work showed an overall association between cumulative exposure and risk for shoulder impingement syndrome. CONCLUSIONS: This study supports the hypothesis that shoulder intensive work is a risk factor for impingement syndrome of the shoulder. Despite the historical cohort design healthy worker selection may have influenced the exposure- response relation found.   PMID:10472322

  5. 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

  6. 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

  7. Using your shoulder after surgery

    MedlinePlus

    ... medlineplus.gov/ency/patientinstructions/000175.htm Using your shoulder after surgery To use the sharing features on ... please enable JavaScript. You had surgery on your shoulder to repair a muscle, tendon, or cartilage tear. ...

  8. 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.

  9. Delayed treatment of a neonatal type-I Monteggia fracture-dislocation: a case report.

    PubMed

    Smith, William R; Kozin, Scott H; Zlotolow, Dan A

    2017-03-01

    Delayed diagnosis of a Monteggia fracture-dislocation changes a straightforward, treatable injury into a complex problem. Acute neonatal injuries may be missed because of the inability to visualize the unossified skeleton on radiography, interpreted later as 'congenital' dislocations. We report the case of a 14-month-old with a neonatal Monteggia type-I fracture-dislocation secondary to birth trauma, with anterior radial head dislocation and plastic deformation of the ulna. Uniplanar external fixation was used to restore ulnar length and correct angulation, with subsequent radiocapitellar joint closed reduction. Joint congruity was maintained at the 2-year follow-up, with articular remodeling shown on serial arthrogram.

  10. Sleep position and shoulder pain.

    PubMed

    Zenian, John

    2010-04-01

    The overuse theory for musculoskeletal joint pain cannot explain adequately the occurrence of shoulder pain in those who do not engage in activities that involve repeated and stressful use of the shoulder since the percentage of the painful right shoulders usually does not match the percentage of dominant right arms in such individuals. An alternative hypothesis is presented to propose that shoulder pain is caused by postural immobility in the decubitus or side position during sleep. Prolonged pressure on the shoulder caused by the weight of the thorax can produce enough damage to cause subsequent shoulder pain. In order to test this hypothesis, a preliminary study was carried out to compare the laterality of shoulder pain with the laterality of sleep position. The calculated laterality ratios for sleep position and shoulder pain were found to be strikingly similar, suggesting a causal relationship between the two phenomena. However, the prevalence of shoulder pain in the general population was found to be smaller than the percentage of the time people would spend sleeping in the decubitus position. This discrepancy could be explained by the idea that in order for shoulder pain to develop subjects may have to spend longer times in the same decubitus position before changing to another position than the average person would. Additional evidence from published clinical studies also supports the postural theory of shoulder pain. More studies can be done to test this hypothesis by focusing on the sleep habits of patients with shoulder pain. According to the present hypothesis shoulder pain should for the most part occur on the side that the patient preferred to sleep on before the onset of shoulder pain. The postural theory of shoulder pain provides the possibility for a new and noninvasive method to treat shoulder pain by the modification of posture during sleep.

  11. Physical examination of the shoulder.

    PubMed

    King, Joseph J; Wright, Thomas W

    2014-10-01

    This article summarizes the overall assessment of the shoulder joint and seeks to help direct clinicians to diagnose shoulder pathology using standard and specific physical examinations. The history and standard examination can prompt the examiner to focus on specific tests to further evaluate the shoulder and limit the differential diagnoses. An appropriate and directed shoulder physical examination allows the clinician to focus on further diagnostic strategies and treatment options for the patient.

  12. Winging of scapula due to serratus anterior tear.

    PubMed

    Singh, Varun Kumar; Vargaonkar, Gauresh Shantaram

    2014-01-01

    Winging of scapula occurs most commonly due to injury to long thoracic nerve supplying serratus anterior muscle. Traumatic injury to serratus anterior muscle itself is very rare. We reported a case of traumatic winging of scapula due to tear of serratus anterior muscle in a 19-year-old male. Winging was present in neutral position and in extension of right shoulder joint but not on "push on wall" test. Patient was managed conservatively and achieved satisfactory result.

  13. Dislocation climb models from atomistic scheme to dislocation dynamics

    NASA Astrophysics Data System (ADS)

    Niu, Xiaohua; Luo, Tao; Lu, Jianfeng; Xiang, Yang

    2017-02-01

    We develop a mesoscopic dislocation dynamics model for vacancy-assisted dislocation climb by upscalings from a stochastic model on the atomistic scale. Our models incorporate microscopic mechanisms of (i) bulk diffusion of vacancies, (ii) vacancy exchange dynamics between bulk and dislocation core, (iii) vacancy pipe diffusion along the dislocation core, and (iv) vacancy attachment-detachment kinetics at jogs leading to the motion of jogs. Our mesoscopic model consists of the vacancy bulk diffusion equation and a dislocation climb velocity formula. The effects of these microscopic mechanisms are incorporated by a Robin boundary condition near the dislocations for the bulk diffusion equation and a new contribution in the dislocation climb velocity due to vacancy pipe diffusion driven by the stress variation along the dislocation. Our climb formulation is able to quantitatively describe the translation of prismatic loops at low temperatures when the bulk diffusion is negligible. Using this new formulation, we derive analytical formulas for the climb velocity of a straight edge dislocation and a prismatic circular loop. Our dislocation climb formulation can be implemented in dislocation dynamics simulations to incorporate all the above four microscopic mechanisms of dislocation climb.

  14. Supersonic Dislocation Bursts in Silicon

    DOE PAGES

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

    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

  15. Supersonic Dislocation Bursts in Silicon

    SciTech Connect

    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 evolution 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.

  16. Injuries about the shoulder in skiing and snowboarding.

    PubMed

    McCall, D; Safran, M R

    2009-12-01

    There has been a decrease in the overall injury rate, particularly the rate of lower-extremity injuries, for alpine skiing, with a resultant increase in the ratio of upper-extremity to lower-extremity injuries. The upper extremity is injured nearly twice as often during snowboarding than alpine skiing, with approximately half of all snowboarding injuries involving the upper extremity. Shoulder injuries are likely under-reported, as many patients seek evaluation for minor shoulder injuries with their local physicians, and not at the ski medical clinic, where most epidemiology studies obtain their data. Shoulder injuries account for 4 to 11% of all alpine skiing injuries and 22 to 41% of upper-extremity injuries. During snowboarding, shoulder injuries account for 8 to 16% of all injuries and 20 to 34% of upper-extremity injuries. Falls are the most common mechanism of shoulder injury, in addition to pole planting during skiing and aerial manoeuvres during snowboarding. Common shoulder injuries during skiing and snowboarding are rotator cuff strains, glenohumeral dislocations, acromioclavicular separations and clavicle fractures. It is still unclear, when comparing snowboarding and skiing injury data, which sport has the higher incidence of shoulder injuries. Stratifying shoulder injuries by type allows better delineation as to which sport has an increased incidence of certain injury patterns. The differing mechanisms of injury combined with distinct equipment for each sport plays a role in the type and frequency of shoulder injuries seen in these two subgroups. With the increased ratio of upper- to lower-extremity injuries during alpine skiing and the boom in popularity of snowboarding, shoulder injuries are seen with increasing frequency by those who care for alpine sport injuries. According to recent epidemiological data, only clavicle and humerus fractures have shown increased rates of incidence among alpine skiers. Over the past 30 years, there has been a general

  17. The effect of shoulder manipulation on rotator cuff integrity.

    PubMed

    Atoun, Ehud; Funk, Lennard; Copland, Stephen A; Even, Tirtza; Levy, Ofer; Rath, Ehud

    2013-06-01

    The use of shoulder manipulation in the treatment of frozen shoulder remains controversial. Humeral fractures and neurological damage are the risks associated with the procedure. A concern of causing a rotator cuff tear exists but the incidence of iatrogenic rotator cuff tears is not reported. The purpose of this study was to assess the effect of shoulder manipulation for frozen shoulder on the integrity of the rotator cuff. In a prospective study, 32 consecutive patients (33 shoulders) with the diagnosis of frozen shoulder underwent manipulation of the shoulder under anaesthesia (MUA), 18 female and 15 males with mean age at manipulation of 503 years (range: 42-63). The average duration of symptoms before treatment was 6.2 months (range: 2-18 months). The patients were examined prior to the manipulation and at follow-up for combined shoulder range of motion, external and internal rotation and strength. All patients had an ultrasound assessment of the rotator cuff before and at 3 weeks after manipulation of the shoulder. Mean time between manipulation and last follow-up was 133 weeks. None of the patients had ultrasound findings of a rotator cuff tear, prior to the manipulation. In all patients the rotator cuff remained undamaged on ultrasound examination at 3 weeks after the procedure. The mean improvement in motion was 81.2 degrees (from 933 degrees pre-op to 174.5 degrees at last follow-up) for forward flexion; 102.6 degrees (from 68.8 degrees pre-op to 171.4 degrees at last follow-up) for abduction, 49.4 degrees (from 8.8 degrees pre-op to 58.2 degrees at last follow-up) for external rotation and 3.5 levels of internal rotation (range: 2 to 5 levels). These gains in motion were all highly significant (p < 0.0001). No fractures, dislocations or nerve palsies were observed. In this study, manipulation of the shoulder has not been associated with rotator cuff tears. If done properly the procedure appeared to be safe and to result in a marked improvement of range

  18. Elbow Dislocations in Contact Sports.

    PubMed

    Morris, Mark S; Ozer, Kagan

    2017-02-01

    Elbow dislocations are more common in athletes than in the general population. Simple elbow dislocations should be managed with early range of motion and early return to sport, even with high-level contact athletes. Patients with instability on examination or with complex elbow dislocations may require surgical intervention. Overall, the outcomes after simple elbow dislocations are excellent and athletes should be able to return to play without significant limitations.

  19. 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…

  20. Elbow fractures and dislocations.

    PubMed

    Little, Kevin J

    2014-07-01

    Elbow fractures are common in pediatric patients. Most injuries to the pediatric elbow are stable and require simple immobilization; however, more severe fractures can occur, often requiring operative stabilization and/or close monitoring. This article highlights the common fractures and dislocations about the pediatric elbow and discusses the history, evaluation, and treatment options for specific injuries.

  1. 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.

  2. Is conservative treatment still defensible in grade III acromioclavicular dislocation? Are there predictive factors of poor outcome?

    PubMed

    Rasmont, Quentin; Delloye, Christian; Bigare, Elisa; Van Isacker, Tom

    2015-03-01

    The optimal treatment of grade III acromioclavicular (AC) dislocation is still controversial. Recent studies recommend surgery at that stage whereas meta-analysis favours conservative management. The objective of the present investigation was to analyse a clinical series of non-operated grade III AC dislocations and to determine their functional status. Thirty-five patients treated conservatively with a grade III acromioclavicular dislocation were retrospectively reviewed. Simple shoulder test, Oxford shoulder and bilateral Constant shoulder score were used for assessment. Various predictive criteria of poor outcome, particularly scapular dyskinesis were taken into account for analysis. Overall mean and median Constant Score of the injured side were 92.9 and 94, whilst the contralateral shoulder values were respectively 94.9 and 95 (mean and median scores). Ten patients had scapular dyskinesis. Laterality, shoulder activity and scapular dyskinesis were not statistically related to worse outcome. Twenty-eight (80%) patients resumed normal activity within six months. All but two patients were subjectively very satisfied or satisfied. Conservative treatment provided satisfactory results whatever the shoulder activity. No risk factors were predictive of a poorer outcome. Conservative management should remain the first option to manage these injuries.

  3. 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.

  4. 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.

  5. Treatment of Humeral Fracture after Shoulder Arthroplasty using Functional Brace: A Case Report

    PubMed Central

    Terabayashi, Nobuo; Matsumoto, Kazu; Takigami, Iori; Ito, Yoshiki

    2016-01-01

    Introduction: A periprosthetic humeral fracture is rare after shoulder arthroplasty, and such cases have considerable problems. Patients with this kind of fracture are often complicated by osteopenia, other types of severe disease, or are elderly. Surgical treatment of this fracture type carries some risk, and surgeons may be unsure about the most appropriate approach to adopt. Case report: The present case occurred in a 78-year-old woman with an osteoporotic humeral bone, and chronic dislocation of shoulder after shoulder arthroplasty. There were many risk factors for revision surgery or ostheosynthesis. Therefore, we decided to treat the patient by functional bracing. Fortunately, complete radiographic union was confirmed at 17 weeks. She returned to daily life with good functional activity. Conclusion: In our opinion, it is acceptable to select functional bracing for periprosthetic humeral fractures after shoulder arthroplasty without stem loosening in elderly patients with an osteoporotic humeral bone. PMID:28111621

  6. 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

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

    PubMed

    Kim, Min-Hee; Yoo, Won-Gyu

    2016-05-01

    [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.

  8. Shoulder tendon transfer options for adult patients with brachial plexus injury.

    PubMed

    Elhassan, Bassem; Bishop, Alan; Shin, Alexander; Spinner, Robert

    2010-07-01

    Enhancement of upper-extremity function, specifically shoulder function, after brachial plexus injury requires a good understanding of nerve repair and transfer, with their expected outcome, as well as shoulder anatomy and biomechanics enabling the treating surgeon to use available functioning muscles around the shoulder for transfer, to improve shoulder function. Surgical treatment should address painful shoulder subluxation in addition to improvement of function. The literature focuses on improving shoulder abduction, but improving shoulder external rotation should take priority because this function, even if isolated, will allow patients to position their hand in front of their body. With a functional elbow and hand, patients will be able to do most activities of daily living. The lower trapezius has been shown to be a good transfer to restore external rotation of the shoulder. Other parts of the trapezius, levator scapulae, rhomboids, and, when available, the latissimus dorsi, pectoralis major, teres major, biceps, triceps, and serratus anterior muscles can all be used to replace the rotator cuff and deltoid muscle function. To optimize the results, a close working relationship is required between surgeons reconstructing brachial plexus injury and shoulder specialists.

  9. Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus.

    PubMed

    Zafra, M; Uceda, P; Flores, M; Carpintero, P

    2014-09-01

    Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high.

  10. Arthroscopy for shoulder instability and a technique for arthroscopic repair.

    PubMed

    Wiley, A M

    1988-01-01

    At this time the principal role of the arthroscope in the management of dislocating shoulder seems to be the identification of the intra-articular pathology. The findings should enable a surgeon to carry out an appropriate open repair, and the results of such surgery are excellent. Is there a place for arthroscopic repair? Some patients sometimes request it; others have had a failed open repair, or wish to avoid a scar. The author has devised a removable "Rivet," which fixes a loose labrum and the inferior glenohumeral ligament back on to a roughened glenoid margin. Use of this technique avoids some of the hazards that occur with implanting a staple or similar device in the joint. The "Rivet" is removed after 4-6 weeks. Ten patients have been so treated, with a follow-up of 6 months to 2 years. There was one failure, with a return of dislocation.

  11. Recent advances in shoulder research.

    PubMed

    Killian, Megan L; Cavinatto, Leonardo; Galatz, Leesa M; Thomopoulos, Stavros

    2012-06-15

    Shoulder pathology is a growing concern for the aging population, athletes, and laborers. Shoulder osteoarthritis and rotator cuff disease represent the two most common disorders of the shoulder leading to pain, disability, and degeneration. While research in cartilage regeneration has not yet been translated clinically, the field of shoulder arthroplasty has advanced to the point that joint replacement is an excellent and viable option for a number of pathologic conditions in the shoulder. Rotator cuff disease has been a significant focus of research activity in recent years, as clinicians face the challenge of poor tendon healing and irreversible changes associated with rotator cuff arthropathy. Future treatment modalities involving biologics and tissue engineering hold further promise to improve outcomes for patients suffering from shoulder pathologies.

  12. Neglected isolated scaphoid dislocation

    PubMed Central

    Baek, Jong-Ryoon; Cho, Seung Hyun; Lee, Yong Seuk; Roh, Young Hak

    2016-01-01

    The authors present a case of isolated scaphoid dislocation in a 40-year-old male that was undiagnosed for 2 months. The patient was treated by open reduction, Kirschner wire fixation, interosseous ligament repair using a suture anchor and Blatt's dorsal capsulodesis. At 6 years followup, his radiographs of wrist showed a normal carpal alignment with a scapholunate gap of 3 mm and no evidence of avascular necrosis (AVN) of the scaphoid. PMID:27904228

  13. 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

  14. 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.

  15. 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.

  16. 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

  17. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... 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...

  18. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint glenoid (hemi-shoulder) metallic... 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)...

  19. Expanding the differential of shoulder pain: Parsonage-Turner syndrome.

    PubMed

    Schreiber, Adam L; Abramov, Ronnen; Fried, Guy W; Herbison, Gerald J

    2009-08-01

    A 44-year-old man was in his car when it was rear-ended in a minor motor vehicle collision, during which his right forearm contacted the steering wheel. Shortly thereafter, pain in his right shoulder developed, but initial work-up was unremarkable. His pain progressed to shoulder girdle weakness over several months and did not improve after 2.5 years. At the time of consultation, he complained of right-sided neck pain radiating to the right deltoid muscle and axilla as well as right shoulder blade pain with shoulder girdle weakness. Repeated electrodiagnostic studies revealed denervation limited to the serratus anterior and right deltoid muscles without evidence of cervical radiculopathy. He was diagnosed with Parsonage-Turner syndrome, which is a neurologic condition characterized by acute onset of shoulder and arm pain followed by weakness and sensory disturbance. The authors review patient presentation, physical examination, and work-up needed for diagnosis of this syndrome to help physicians avoid administering unnecessary tests and treatment.

  20. Open glenohumeral dislocation: skeletonization of the proximal humerus without associated fracture.

    PubMed

    Maroney, Samuel S; Devinney, D Scott

    2011-11-09

    Shoulder dislocations are common injuries. In the realm of high-energy trauma, enough force can be dissipated to violate the entire soft tissue envelope surrounding the shoulder girdle, generating an open injury. This article presents a case of a young man involved in a motorcycle accident in which he sustained an open glenohumeral dislocation with complete skeletonization of the proximal humerus. There were no associated fractures with his injury. Our patient underwent staged irrigation and debridement of his shoulder with delayed tendoligamentous reconstruction of the skeletonized proximal humerus. After reconstruction, he was immobilized for 3 weeks and then began a progressive shoulder rehabilitation protocol. He healed with no evidence of infection, residual instability, or avascular necrosis at his 4-month follow-up examination. At that point, he had regained functional use of his shoulder for activities of daily living and had no pain. His range of active motion was limited to 90° of flexion and abduction, 0° of external rotation, and internal rotation to the L4. He had complete resolution of a sensory and motor axillary neuropraxia that resulted from his initial injury. It was felt that the patient had potential for continued gains in range of motion and strength.Our patient is only the second description of an open glenohumeral dislocation with no associated fractures of the proximal humerus. This skeletonization of the proximal humerus represents a complex soft tissue injury that severely compromises the functional capacity of the shoulder. Understanding the nature of the injury and the involved structures and maintaining a sound treatment algorithm allow orthopedic surgeons to maximize the patient's functional outcome.

  1. Multidirectional instability of the shoulder: biomechanics, clinical presentation, and treatment strategies.

    PubMed

    Merolla, Giovanni; Cerciello, Simone; Chillemi, Claudio; Paladini, Paolo; De Santis, Elisa; Porcellini, Giuseppe

    2015-08-01

    Multidirectional instability (MDI) of the shoulder is a condition where the dislocation occurs in more than one direction with minimal or no causative trauma. Its pathoanatomy is complex and characterized by a redundant capsule, resulting in increased glenohumeral joint volume. The fact that several further factors may contribute to symptom onset complicates the diagnosis and hampers the identification of a therapeutic approach suitable for all cases. There is general agreement that the initial treatment should be conservative and that surgery should be reserved for patients who have not responded to an ad hoc rehabilitation program. We review the biomechanics, clinical presentation, and treatment strategies of shoulder MDI.

  2. [Congenital knee dislocation: case report].

    PubMed

    Arvinius, C; Luque, R; Díaz-Ceacero, C; Marco, F

    2016-01-01

    Congenital knee dislocation is an infrequent condition with unknown etiology. In some cases it occurs as an isolated condition, while in others it coexists with associated conditions or syndromes. The treatment of congenital knee dislocation is driven by the severity and flexibility of the deformity. The literature includes from serial casting or the Pavlik harness to quadriceps tendon plasty or femoral osteotomies. We report herein the case of a congenital dislocation treated with serial casting with a good outcome.

  3. Dislocation Diffusion in Metallic Materials

    DTIC Science & Technology

    2011-09-08

    DATES COVERED (From - To) April 1,2007-March 31, 2010 4. TITLE AND SUBTITLE Dislocation Diffusion in Metallic Materials 5a. CONTRACT NUMBER...SUPPLEMENTARY NOTES 14. ABSTRACT The goals of this project were: (1) perform a fundamental study of atomic diffusion along dislocation cores in metals and...alloys, (2) develop new methods for the calculation of dislocation diffusion coefficients as functions of temperature and chemical composition and (3

  4. Ultrasound of the shoulder.

    PubMed

    Petranova, Tzvetanka; Vlad, Violeta; Porta, Francesco; Radunovic, Goran; Micu, Mihaela C; Nestorova, Rodina; Iagnocco, Annamaria

    2012-06-01

    Ultrasonography (US) is a helpful imaging tool in the evaluation of the musculoskeletal system. It has some advantages over the other imaging techniques, such as plain radiography, computed tomography and magnetic resonance imaging, represented by the non-invasiveness and multiplanar imaging capability, repeatability, lack of radiation burden, good patient acceptance, and relatively limited costs. US offers an excellent resolution and a possibility for real-time dynamic examination of the joints and surrounding soft tissues, as well as enables monitoring of therapeutic response. The most common clinical indications for US examination of the shoulder are rotator cuff and biceps tendon pathology (tenosynovitis, tendinosis, complete and partial tears, and impingement) and disorders of other soft-tissue structures (joint recesses, bursae, muscles, suprascapular and axillary nerves) as well as bony cortex abnormalities. US is very useful for US-guided procedures (biopsy, joint and bursae aspirations and injections, aspiration and dissolution of calcific tendinosis). The aim of this article is to analyze the current literature about US of the shoulder and to describe both normal and pathological findings.

  5. 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

  6. Shoulder osteoarthritis: diagnosis and management.

    PubMed

    Millett, Peter J; Gobezie, Reuben; Boykin, Robert E

    2008-09-01

    Osteoarthritis of the shoulder is a gradual wearing of the articular cartilage that leads to pain and stiffness. As the joint surface degenerates, the subchondral bone remodels, losing its sphericity and congruity. The joint capsule also becomes thickened, leading to further loss of shoulder rotation. This painful condition is a growing problem in the aging population. In most cases, diagnosis of degenerative joint disease of the shoulder can be made with careful history, physical examination, and radiography. The symptoms and degree of shoulder arthritis visible on radiography determine the best treatment option. Mild degenerative joint disease can be treated with physical therapy and over-the-counter anti-inflammatory medications such as acetaminophen or nonsteroidal anti-inflammatory drugs. More advanced cases of osteoarthritis that are refractory to nonoperative management can be managed with corticosteroid injections. In severe cases, surgery is indicated. Surgical options include arthroscopic debridement, arthroscopic capsular release, and, in the most severe instances, hemiarthroplasty or total shoulder arthroplasty.

  7. Bilateral hip dislocation in a 79 years patient.

    PubMed

    Alexa, O; Cozma, T; Puha, B; Alexa, I D

    2012-01-01

    Bilateral simultaneous dislocation of the hip is an unusual occurrence, especially if there is no previous history of hip abnormality or ligamentous laxity. Most of the reports published until now most frequently describe this type of injury in adults. The majority of case reports present patients with ages ranging between 20 and 30 years old, because at this age the bone is strong enough not to suffer a fracture but a dislocation. The oldest patient with bilateral simultaneous dislocation of the hip described in literature (to our knowledge) is 65 years old. We present the case of a 79 year old man that was involved in an agricultural accident in which a heavy load fell on both his feet while he was laying on the ground. Anteroposterior pelvic radiograph reveal bilateral posterior hip dislocation with an associated left-side acetabular fracture and also a minimum displaced anterior left pelvic ring fracture. Both hips were reduced within three hours of presentation by closed manipulation under spinal anaesthesia. Literature search revealed no case presentation that reported a bilateral simultaneous dislocation of the hip in elderly--to our knowledge, this is the first.

  8. A Rare Combination of Complex Elbow Dislocation and Distal Radial Fracture in Adults

    PubMed Central

    Vaishya, Raju; Krishnan, Midhun; Agarwal, Amit Kumar

    2016-01-01

    Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. The case was treated operatively. We describe two possible mechanisms of injury for these rare injury types. The case underlines the importance of assessing the wrist in the case of an elbow fracture and vice versa. PMID:28003939

  9. A Rare Combination of Complex Elbow Dislocation and Distal Radial Fracture in Adults.

    PubMed

    Vaishya, Raju; Krishnan, Midhun; Vijay, Vipul; Agarwal, Amit Kumar

    2016-11-08

    Although it is common for separate elbow joint dislocation and fracture of forearm bones to occur, it is a rare sighting for both elbow dislocation and ipsilateral fracture of the distal radius. We report a case of an anterior dislocation of the elbow with ipsilateral fracture of the distal radius. The case was treated operatively. We describe two possible mechanisms of injury for these rare injury types. The case underlines the importance of assessing the wrist in the case of an elbow fracture and vice versa.

  10. Shoulder sensorimotor control assessment by force platform: feasibility and reliability.

    PubMed

    Edouard, Pascal; Gasq, David; Calmels, Paul; Ducrot, Sarah; Degache, Francis

    2012-09-01

    Given the important role of the shoulder sensorimotor system in shoulder stability, its assessment appears of interest. Force platform monitoring of centre of pressure (CoP) in upper-limb weight-bearing positions is of interest as it allows integration of all aspects of shoulder sensorimotor control. This study aimed to determine the feasibility and reliability of shoulder sensorimotor control assessment by force platform. Forty-five healthy subjects performed two sessions of CoP measurement using Win-Posturo(®) Medicapteurs force platform in an upper-limb weight-bearing position with the lower limbs resting on a table to either the anterior superior iliac spines (P1) or upper patellar poles (P2). Four different conditions were tested in each position in random order: eyes open or eyes closed with trunk supported by both hands and eyes open with trunk supported on the dominant or non-dominant side. P1 reliability values were globally moderate to high for CoP length, CoP velocity and CoP standard deviation (SD), standard error of measurement ranged from 6·0% to 26·5%, except for CoP area. P2 reliability values were globally low and not clinically acceptable. Our results suggest that shoulder sensorimotor control assessment by force platform is feasible and has good reliability in upper-limb weight-bearing positions when the lower limbs are resting on a table to the anterior superior iliac spines. CoP length, CoP velocity and CoP SD velocity appear to be the most reliable variables.

  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. Effects of augmented trunk stabilization with external compression support on shoulder and scapular muscle activity and maximum strength during isometric shoulder abduction.

    PubMed

    Jang, Hyun-jeong; Kim, Suhn-yeop; Oh, Duck-won

    2015-04-01

    The aim of the present study was to investigate the effects of augmented trunk stabilization with external compression support (ECS) on the electromyography (EMG) activity of shoulder and scapular muscles and shoulder abductor strength during isometric shoulder abduction. Twenty-six women volunteered for the study. Surface EMG was used to monitor the activity of the upper trapezius (UT), lower trapezius (LT), serratus anterior (SA), and middle deltoid (MD), and shoulder abductor strength was measured using a dynamometer during three experimental conditions: (1) no external support (condition-1), (2) pelvic support (condition-2), and (3) pelvic and thoracic supports (condition-3) in an active therapeutic movement device. EMG activities were significantly lower for UT and higher for MD during condition 3 than during condition 1 (p < 0.05). The MD/UT ratio was significantly higher during condition 3 than during conditions 1 and 2, and higher during condition 2 than during condition 1 (p < 0.05). Shoulder abductor strength was significantly higher during condition 3 than during condition 1 (p < 0.05). These findings suggest that augmented trunk stabilization with the ECS may be advantageous with regard to reducing the compensatory muscle effort of the UT during isometric shoulder abduction and increasing shoulder abductor strength.

  13. 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

  14. Misfit dislocations in epitaxy

    NASA Astrophysics Data System (ADS)

    van der Merwe, Jan H.

    2002-08-01

    This article on epitaxy highlights the following: the definition and some historical milestones; the introduction by Frenkel and Kontorowa (FK) of a truncated Fourier series to model the periodic interaction at crystalline interfaces; the invention by Frank and van der Merwe (FvdM)—using the FK model—of (interfacial) misfit dislocations as an important mechanism in accommodating misfit at epilayer-substrate interfaces; the generalization of the FvdM theory to multilayers; the application of the parabolic model by Jesser and van der Merwe to describe, for growing multilayers and superlattices, the impact of Fourier coefficients in the realization of epitaxial orientations and the stability of modes of misfit accommodation; the involvement of intralayer interaction in the latter—all features that impact on the attainment of perfection in crystallinity of thin films, a property that is so vital in the fabrication of useful uniformly thick epilayers (uniformity being another technological requirement), which also depends on misfit accommodation through the interfacial energy that function strongly in the criterion for growth modes, proposed by Bauer; and the ingenious application of the Volterra model by Matthews and others to describe misfit accommodation by dislocations in growing epilayers.

  15. Dislocation-Based Si-Nanodevices

    NASA Astrophysics Data System (ADS)

    Reiche, Manfred; Kittler, Martin; Buca, Dan; Hähnel, Angelika; Zhao, Qing-Tai; Mantl, Siegfried; Gösele, Ulrich

    2010-04-01

    The realization of defined dislocation networks by hydrophobic wafer bonding allows the electrical characterization of individual dislocations. The present paper investigates the properties of such dislocations in samples containing high dislocations densities down to only six dislocations. The current induced by a single dislocation is determined by extrapolation of the current measured for various dislocation densities. Based on our present and previously reported analyses the electronic properties of individual dislocations can be inferred. The investigations show that dislocations in the channel of metal-oxide-semiconductor field-effect transistors (MOSFETs) result in increasing drain currents even at low drain and gate voltages. Because a maximum increase of the current is obtained if a single dislocation is present in the channel, arrays of MOSFETs each containing only one dislocation could be realized on the nanometer scale. The distance of the dislocations can be well controlled by wafer bonding techniques.

  16. Serratus anterior disruption: a complication of rheumatoid arthritis.

    PubMed

    Meythaler, J M; Reddy, N M; Mitz, M

    1986-10-01

    Pathology influencing the serratus anterior muscle contributes to classical medial winging of the scapula. Serratus anterior weakness or injury interferes with regular shoulder movement as this muscle stabilizes the medial border of the scapula against the thorax and rotates the scapula upward and laterally with arm elevation. Traumatic injury to the serratus anterior muscle without electrodiagnostic evidence of neurogenic involvement has only been reported once previously. We report an unusual case of disruption of the serratus anterior as a complication of rheumatoid arthritis. Involvement of the long thoracic nerve was ruled out by electromyography and nerve conduction studies. The injury occurred during routine activities of daily living and was complicated by a recurring subscapular hematoma. Contributing factors of shoulder joint contractures and coagulation abnormalities were associated with the course and treatment of rheumatoid arthritis. Initial treatment was by joint immobilization and reversal of coagulation abnormalities. Later treatment was directed toward joint protection and gradually increasing range of motion exercises.

  17. Shoulder injuries from alpine skiing and snowboarding. Aetiology, treatment and prevention.

    PubMed

    Kocher, M S; Dupré, M M; Feagin, J A

    1998-03-01

    There has been a decrease in the overall injury rate and the rate of lower extremity injuries for alpine skiing, with a resultant increase in the ratio of upper extremity to lower extremity injuries. Upper extremity injuries account for 20 to 35% of all injuries during alpine skiing and nearly 50% of all injuries during snowboarding. The most common upper extremity injuries during skiing are sprain of the thumb metacarpal-phalangeal joint ulnar collateral ligament, and the most common in snowboarding is wrist fracture. Shoulder injuries from skiing and snowboarding have been less well characterised. With the increased ratio of upper to lower extremity injuries during alpine skiing and the boom in popularity of snowboarding, shoulder injuries will be seen with increasing frequency by those who care for alpine sport injuries. Shoulder injuries account for 4 to 11% of all alpine skiing injuries and 22 to 41% of upper extremity injuries. The rate of shoulder injuries during alpine skiing is 0.2 to 0.5 injuries per thousand skier-days. During snowboarding, shoulder injuries account for 8 to 16% of all injuries and 20 to 34% of upper extremity injuries. Falls are the most common mechanism of shoulder injury, in addition to pole planting during skiing and aerial manoeuvres during snowboarding. Common shoulder injuries during skiing and snowboarding are glenohumeral instability, rotator cuff strains, acromioclavicular separations and clavicle fractures. Less common shoulder injuries include greater tuberosity fractures, trapezius strains, proximal humerus fractures, biceps strains, glenoid fractures, scapula fractures, humeral head fractures, sterno-clavicular separations, acromion fractures and biceps tendon dislocation. Prevention of shoulder injuries during skiing and snowboarding may be possible through interventions in education and technique, conditioning and equipment and environment.

  18. Shoulder injuries in soccer players

    PubMed Central

    Longo, Umile Giuseppe; Loppini, Mattia; Berton, Alessandra; Martinelli, Nicolò; Maffulli, Nicola; Denaro, Vincenzo

    2012-01-01

    Summary Even though soccer is the most popular sport of the world, no review is available at present to resume the available data on shoulder injuries in soccer. The aim of this review is to report the available epidemiological data on shoulder specific injuries in soccer players and to describe the common mechanisms of shoulder injuries in soccer. Studies published through September 15, 2011, were identified by using MEDLINE, EMBASE, CINAHL and Pre-CINAHL, Pub-Med, Web of Science, and the full Cochrane Library. Reference lists of included studies were searched by hand. Studies were included if they reported on shoulder injuries in soccer players. Limits were not placed on year of publication, status of publication, or language. The journal, authors, and author affiliations of included studies were masked from 2 reviewers. We planned to perform a study on the epidemiology, mechanisms and management of shoulder injuries in elite soccer players. We also planned to use Review Manager (RevMan. Version 5 for Windows) to calculate the magnitude of treatment effect. No studies on clinical outcome of shoulder injuries in elite soccer athletes were found. No studies on the mechanism of shoulder injury in elite soccer players were found. The results of the available studies on epidemiology are reported. Despite soccer is the world’s game, few studies focused on shoulder injuries in soccer players, and therefore no definitive conclusions can be drawn. Further research is warranted to clarify the epidemiology, mechanisms and management of shoulder injuries in elite soccer players. PMID:23289025

  19. Imaging of postoperative shoulder instability.

    PubMed

    De Filippo, M; Pesce, A; Barile, A; Borgia, D; Zappia, M; Romano, A; Pogliacomi, F; Verdano, M; Pellegrini, A; Johnson, K

    2017-03-01

    Postoperative imaging in shoulder instability is still a challenge for radiologists due to various postsurgical anatomical findings that could be considered pathologic in treated shoulder. For this reason is very important a deep knowledge about surgical procedures, anatomical changes after surgery and the appropriate diagnostic imaging modalities to work up the symptomatic postoperative shoulder. Postoperative imaging options include use conventional radiography, magnetic resonance imaging (MRI), MRI arthrography, computed tomography (CT) and CT arthrography. The purpose of our review is to explain the different surgical procedures and to describe postoperative changes detected with radiological imaging.

  20. Vaccination-related shoulder dysfunction.

    PubMed

    Bodor, Marko; Montalvo, Enoch

    2007-01-08

    We present two cases of shoulder pain and weakness following influenza and pneumococcal vaccine injections provided high into the deltoid muscle. Based on ultrasound measurements, we hypothesize that vaccine injected into the subdeltoid bursa caused a periarticular inflammatory response, subacromial bursitis, bicipital tendonitis and adhesive capsulitis. Resolution of symptoms followed corticosteroid injections to the subacromial space, bicipital tendon sheath and glenohumeral joint, followed by physical therapy. We conclude that the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination.

  1. [Postoperative imaging of the shoulder].

    PubMed

    Wörtler, K; Rummeny, E J

    2004-06-01

    Correct interpretation of imaging findings in the postoperative shoulder is impaired by surgical distortion of normal anatomy and possible artifacts. Advanced postoperative imaging of the shoulder in addition to the selection of the best suited modality necessitates familiarity with the surgical procedure that has been performed and its consecutive morphological changes. This article reviews the most common arthroscopic and open techniques used for treatment of shoulder instability, lesions of the superior labral-bicipital complex, primary impingement, and rotator cuff tears, their typical postoperative imaging findings, as well as the diagnostic performance of cross sectional imaging techniques in the detection of recurrent lesions and complications.

  2. 49 CFR 572.184 - Shoulder assembly.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Shoulder assembly. 572.184 Section 572.184... Dummy, 50th Percentile Adult Male § 572.184 Shoulder assembly. (a) The shoulder (175-3000) is part of...) of this section, the shoulder assembly shall meet performance requirements of paragraph (c) of...

  3. Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers?

    PubMed

    McKenna, Leanda; Straker, Leon; Smith, Anne

    2012-12-01

    The aims of this study were to determine whether scapular and humeral head position can predict the development of shoulder pain in swimmers, whether those predictors were applicable to non-swimmers and the annual rate of shoulder pain in adolescent swimmers and non-swimmers. Forty-six adolescent swimmers and 43 adolescent non-swimmers were examined prospectively with a questionnaire and anthropometric measures. The questionnaire examined demographic and training variables. Anthropometric measures examined the distances between the T7 spinous process and the inferior scapula (Inferior Kibler) and T3 spinous process and the medial spine of the scapula (Superior Kibler), humeral head position in relation to the acromion using palpation, BMI and chest width. Shoulder pain was re-assessed 12 months later by questionnaire. Shoulder pain in swimmers was best predicted by a larger BMI (OR = 1.48, P = 0.049), a smaller Inferior Kibler distance in abduction (e.g. OR = 0.90, P = 0.009) and a smaller horizontal distance between the anterior humeral head and the anterior acromion (OR = 0.76, P = 0.035). These variables were not significantly predictive of shoulder pain in non-swimmers. Annual prevalence of shoulder pain was 23.9% in swimmers and 30.8% in non-swimmers (χ(2) = 0.50, P = 0.478).

  4. Reverse arthroplasty of the shoulder for treating rotator cuff arthropathy☆☆☆

    PubMed Central

    Amaral, Marcus Vinicius Galvão; de Faria, José Leonardo Rocha; Siqueira, Gláucio; Cohen, Marcio; Brandão, Bruno; Moraes, Rickson; Monteiro, Martim; Motta, Geraldo

    2014-01-01

    Objective to present a retrospective analysis on the clinical-functional results and complications among patients with rotator cuff arthropathy (RCA) who underwent reverse arthroplasty of the shoulder. Methods patients with a diagnosis of RCA associated with pseudoparalysis of anterior elevation who underwent reverse arthroplasty of the shoulder with a minimum follow-up of one year were selected. Results preoperative information was gathered from our shoulder and elbow arthroplasty register, comprising age, sex, laterality, history of previous procedures, Constant's functional scores and the preoperative range of motion as described in the protocol of the American Academy of Shoulder and Elbow Surgery (ASES). After a mean follow-up of 44 months, 17 patients (94%) were satisfied with the result from the procedure. Conclusion reverse arthroplasty for treating RCA in patients with pseudoparalysis of the shoulder was shown to be effective in achieving a statistically significant improvement in range of motion regarding anterior flexion and abduction. However, in this series, there was no improvement in range of motion regarding external and internal rotation. Reverse arthroplasty is a procedure that reestablishes shoulder joint function in patients who previously did not present any therapeutic possibilities. PMID:26229813

  5. The normal and the painful shoulders during the breaststroke. Electromyographic and cinematographic analysis of twelve muscles.

    PubMed

    Ruwe, P A; Pink, M; Jobe, F W; Perry, J; Scovazzo, M L

    1994-01-01

    The purpose of this study was to describe and compare electrical activity patterns in 12 shoulder muscles during the breaststroke in 25 competitive swimmers who had normal shoulders and in 14 who had painful shoulders while they performed this stroke in a pool. The electromyographic analysis was synchronized with high-speed cinematography to discern phases of the breaststroke. Means, standard deviations, and t-tests were done for each phase. The differences in muscle activity between the two groups of swimmers demonstrated an increase in the internal rotators in the group with painful shoulders. They also demonstrated a decrease in the teres minor, supraspinatus, and the upper trapezius muscles. These factors increase the risk of impingement. Both the serratus anterior and teres minor muscles in the swimmers with normal shoulders consistently fired at or above 15% manual muscle test throughout the breaststroke cycle and were thus subject to fatigue. Based on these results, exercises for the breaststroke swimmer should be directed toward endurance training of the serratus anterior and teres minor muscles while balancing the internal and external rotators of the shoulder as well as the deltoid and supraspinatus muscles.

  6. Elite swimmers with and without unilateral shoulder pain: mechanical hyperalgesia and active/latent muscle trigger points in neck-shoulder muscles.

    PubMed

    Hidalgo-Lozano, A; Fernández-de-las-Peñas, C; Calderón-Soto, C; Domingo-Camara, A; Madeleine, P; Arroyo-Morales, M

    2013-02-01

    Our aim was to investigate the presence of mechanical hypersensitivity and active trigger points (TrPs) in the neck-shoulder muscles in elite swimmers with/without unilateral shoulder pain. Seventeen elite swimmers with shoulder pain; 18 swimmers without shoulder pain; and 15 elite athletes matched controls were recruited. Pressure pain thresholds (PPT) were assessed over the levator scapulae, sternocleidomastoid, upper trapezius, infraspinatus, scalene, subscapularis and tibialis anterior muscles. TrPs in the levator scapulae, upper trapezius, infraspinatus, scalene, sternocleidomastoid and subscapularis muscles were also explored. Swimmers with shoulder pain showed significant lower PPT in all muscles compared with controls (P<0.01). No differences in PPT were found between swimmers with and without shoulder pain, underlining widespread mechanical hypersensitivity. The mean number of TrPs for elite swimmer with and without shoulder pain was, respectively, 4.7 ± 1 (2.1 ± 1.5 active; 2.6 ± 1.4 latent) and 4.7 ± 1.3 (1.3 ± 1.3 active; 3.4 ± 1.5 latent), whereas healthy athletes only showed latent TrPs (2.4 ± 1.2). Elite swimmers with shoulder pain showed higher number of active TrPs than swimmers without pain, whereas it was the opposite for the number of latent muscle TrP (P<0.05). The reported mechanical hypersensitivity suggests that active TrPs play a role in the development of shoulder pain in elite swimmers.

  7. Neurohistological examination of the inferior glenohumeral ligament of the shoulder.

    PubMed

    Steinbeck, Jörn; Brüntrup, Jens; Greshake, Oliver; Pötzl, Wolfgang; Filler, Timm; Liljenqvist, Ulf

    2003-03-01

    The neural histology of the anterior band of the inferior glenohumeral ligament (IGHL) was studied in 11 fresh shoulder specimen using a special silver impregnation technique. Between the collagen fibers small myelinated and unmyelinated dendrites could be detected. The appearance of neurovascular structures in the adjacent synovial layer clearly exceeded the typical supply to soft tissues. Analysing about 11,000 sections Ruffini mechanoreceptors that are known to be slow adapting were found on the humeral insertion of the band. The sections containing these neural end organs were identified by means of transillumination and reflection-contrast microscopy and reconstructed using three-dimensional image processing. The presence of neural structures including Ruffini corpuscles in these most important passive stabilizers of the shoulder joint shows that these ligaments function also as an active safety device. There slow adaption is a prerequisite for muscular reflexes counteracting the tensile stresses to which the passive stabilizing structures of the shoulder are exposed. A disruption of the continuity of these structures by mechanical forces or surgery can reduce the biofeedback and proprioceptive quality and thus lead to a decrease of shoulder function and/or stability. These observations should be taken into account when planning surgical interventions involving the IGHL. Procedures like capsule shifts or plications may affect mechanoreceptor orientation and concentrations, thereby affecting the interaction between these structures and the synergistic muscles. When possible, these intervention should avoid receptor-dense regions while attempting to restore normal anatomical orientation and tissue tension.

  8. [Winter sports and shoulder arthroplasty].

    PubMed

    Kirchhoff, C; Imhoff, A B; Hinterwimmer, S

    2008-09-01

    Nowadays, a general negative evaluation of sportive activity regarding different kinds of sport following arthroplasty is at present no more scientifically supported. However, at present no valid guidelines regarding sportive activity of patients after implantation of shoulder joint arthroplasty exist. The question regarding the ability of performing winter sports activities of patients treated with shoulder joint endoprothesis has not been answered so far. Therefore the aim of the presented work was to identify winter sports-specific risks for patients treated with shoulder joint endoprothesis as well as to critically discuss the actual literature in refer to winter sport activities. Criteria for the education of patients with shoulder joint endoprothesis as well as consultation regarding winter sport activities will be provided for the orthopaedic surgeon.

  9. 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.

  10. 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.

  11. Buckling of dislocation in graphene

    NASA Astrophysics Data System (ADS)

    Yao, Yin; Wang, Shaofeng; Bai, Jianhui; Wang, Rui

    2016-10-01

    The buckling of dislocation in graphene is discussed through the lattice theory of dislocation and elastic theory. The approximate solution of the buckling is obtained based on the inner stress distribution caused by different structure of dislocations and is proved to be suitable by the simulation. The position of the highest buckling is predicted to be at the vertex of the pentagon far away from the heptagon. The buckling is strongly influenced by the internal stress and the distance between the extrusive area and stretching area, as well as the critical stress σc. The SW defect is proved to be unbuckled due to its strong interaction between extrusion and stretching.

  12. Quenched dislocation enhanced supersolid ordering.

    PubMed

    Toner, John

    2008-01-25

    I show using Landau theory that quenched dislocations can facilitate the supersolid to normal solid transition, making it possible for the transition to occur even if it does not in a dislocation-free crystal. I make detailed predictions for the dependence of the supersolid to normal solid transition temperature T_{c}(L), superfluid density rho_{S}(T,L), and specific heat C(T,L) on temperature T and dislocation spacing L, all of which can be tested against experiments. The results should also be applicable to an enormous variety of other systems, including, e.g., ferromagnets.

  13. An Unusual Traumatic Presentation: Luxatio Erecta Humeri and Concomitant Hip Dislocation

    PubMed Central

    Anarat, Berkan; Ersin, Mehmet; Erşen, Ali; Şen, Cengiz

    2016-01-01

    Introduction. Inferior dislocation of the glenohumeral joint, known as luxatio erecta humeri, and posterior hip dislocation are both rare presentations in the emergency department. The most common aetiology is falling for luxatio erecta humeri. The aim of this manuscript was to present a unique case in terms of luxatio erecta humeri, which has a different aetiology, treatment method, and concomitant injury. Presentation of Case. We report a construction worker who was rescued from a collapsed building who presented with both luxatio erecta humeri and complex posterior hip dislocation. An orthopaedic surgeon reducted luxatio erecta humeri with a one-step reduction technique under procedural anaesthesia as soon as the patient's vital signs were stable. Discussion. Different concomitant injuries and various injury mechanisms have been described in regard to inferior shoulder dislocation in the literature. However, posterior dislocation of the hip as a concomitant distant region injury and trapping as an injury mechanism for luxatio erecta humeri are being described for the first time in this case report. Two reduction manoeuvers, one-step and two-step, have been used for this dislocation. Some authors suggested that a two-step manoeuver can be more easy to apply. In our specific case, luxatio erecta was easily reducted by a single operator in a single attempt. Conclusion. Luxatio erecta humeri may occur from trapping and complex injuries can accompany luxatio erecta humeri in patients with multiple trauma. A one-step closed reduction can be easily applied by a single operator under procedural anaesthesia. PMID:28078152

  14. A new surgical technique for extensive exposure of the proximal humerus and shoulder.

    PubMed

    Puthezhath, Kishore; Puthur, Dominic K

    2013-11-01

    Different techniques have been described for surgical exposure of the shoulder and proximal humerus. However, the neurovascular and muscular anatomy in the proximity of the humerus precludes the use of a "safe" extensive approach. We here present a new technique for extensive exposure of the proximal humerus and shoulder for wide resection of tumors. By reflecting the deltoid with its origin as an osteomyocutaneous flap downwards and backwards, the entire shoulder, including the rotator cuff and proximal humerus, are exposed with minimal damage to the blood supply and function of the deltoid muscle. This approach, which is a logical combination of anterior, transacromial and deltoid splitting approaches, was used in 17 patients, 11 achieving satisfactory functional results. Our new surgical approach reduces intraoperative damage to the blood supply of the deltoid and results in better function of the shoulder postoperatively because both the powerful intermediate muscle fibers of the deltoid and its acromial origin remain intact.

  15. Effects of height and load weight on shoulder muscle work during overhead lifting task.

    PubMed

    Blache, Y; Desmoulins, L; Allard, P; Plamondon, A; Begon, M

    2015-01-01

    Few musculoskeletal models are available to assess shoulder deeper muscle demand during overhead lifting tasks. Our objective was to implement a musculoskeletal model to assess the effect of lifting height and load on shoulder muscle work. A musculoskeletal model scaled from 15 male subjects was used to calculate shoulder muscle work during six lifting tasks. Boxes containing three different loads (6, 12 and 18 kg) were lifted by the subjects from the waist to shoulder or eye level. After optimisation of the maximal isometric force of the model's muscles, the bio-fidelity of the model was improved by 19%. The latter was able to reproduce the subjects' lifting movements. Mechanical work of the rotator cuff muscles, upper trapezius and anterior deltoid was increased with lifting load and height augmentation. In conclusion, the use of a musculoskeletal model validated by electromyography enabled to evaluate the muscle demand of deep muscles during lifting tasks.

  16. New concepts in restoring shoulder elevation in a stiff and painful shoulder patient.

    PubMed

    Donatelli, Robert; Ruivo, R M; Thurner, Michael; Ibrahim, Mahmoud Ibrahim

    2014-02-01

    The treatment and evaluation of a stiff and painful shoulder, characteristic of adhesive capsulitis and "frozen" shoulders, is a dilemma for orthopedic rehabilitation specialists. A stiff and painful shoulder is all-inclusive of Adhesive capsulitis and Frozen Shoulder diagnoses. Adhesive capsulitis and frozen shoulder will be referred to as a stiff and painful shoulder, throughout this paper. Shoulder motion occurs in multiple planes of movement. Loss of shoulder mobility can result in significant functional impairment. The traditional treatment approach to restore shoulder mobility emphasizes mobilization of the shoulder overhead. Forced elevation in a stiff and painful shoulder can be painful and potentially destructive to the glenohumeral joint. This manuscript will introduce a new biomechanical approach to evaluate and treat patients with stiff and painful shoulders.

  17. Perforation of the sigmoid colon due to intradiscal spacer dislocation.

    PubMed

    Ruf, Michael; Voigt, Andreas; Kupczyk-Joeris, Dieter; Merk, Harry R

    2011-07-01

    A case of late dislocation of a disc spacer L5/S1 with perforation of the sigmoid colon and transanal passage 4 years after implantation is reported. The objective is to describe an uncommon complication of anterior endoscopic spondylodesis L5/S1. To our knowledge, this is the first report on this rare complication. A 39-year-old patient suffering from a spondylolisthesis L5/S1 (Meyerding grade 2) with bilateral lysis L5 was operated with posterior instrumentation L5/S1 and anterior endoscopic insertion of two disc spacers. 4 years after surgery the patient noticed one of the spacers in the toilet. Radiographic examination of the colon with contrast dye revealed a perforation at the distal sigmoid colon. At the lumbosacral junction there was a bony defect at the site of the absent spacer and an anterior dislocation of the second spacer. A partial resection of the colon at the perforation site with end-to-end anastomosis was performed. The second spacer was removed, and the defect was packed with autologous cancellous bone and local antibiotics. The further course was uneventful. 2 weeks postoperatively the patient was discharged without signs of infection. The radiographic examination after 6 months showed healing of the bone graft with bony fusion L5/S1. In case of incomplete or absent bony fusion the dislocation of intradiscal spacers may arise even years after the primary surgery. In consequence periodical radiographic examinations of spinal instrumentations are recommended until complete bony fusion occurred. Unclear abdominal symptoms following anterior spine surgery require immediate examination.

  18. 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

  19. 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

  20. Elbow fracture-dislocation combined with Galeazzi fracture in adult: A case report and literature review

    PubMed Central

    Asadollahi, Saeed; Shepherd, David; Hau, Raphael C.

    2013-01-01

    INTRODUCTION Galeazzi fracture associated with ipsilateral posterior elbow dislocation and radial head fracture is a rare pattern of injury. Few reports exist that describes this injury pattern and its treatment. We describe a case report of simultaneous occurrence of Galeazzi fracture and ipsilateral dislocation of elbow. PRESENTATION OF CASE A 58 year-old female presented with Galeazzi fracture and posterior elbow dislocation associated with radial head fracture of left upper extremity. This was managed with closed reduction of the elbow, open reduction and internal fixation of the radial shaft fracture and K-wire stabilisation of the unstable distal radioulnar joint. Prophylactic fasciotomy was performed. At 10 months follow-up, the outcome was favourable with the American shoulder and elbow surgeon score of 92 and the disabilities of the arm, shoulder and hand score of 18. DISCUSSION The presumed mechanism of the injury was a forceful axial loading of a hyperpronated forearm and extended elbow. Our literature review shows that this pattern of injury occurs as a result of high energy trauma in young individuals, and successful outcome can be achieved by addressing each component of this complex injury individually. CONCLUSION Simultaneous occurrence of elbow dislocation and Galeazzi fracture seems to be the result of extreme axial force and unique position of upper extremity at the time of impact. Individualised approach to each component of this injury can result in favourable outcome. PMID:23726112

  1. ARTHROSCOPIC TREATMENT OF ACROMIOCLAVICULAR JOINT DISLOCATION BY TIGHT ROPE TECHNIQUE (ARTHREX®)

    PubMed Central

    GÓmez Vieira, Luis Alfredo; Visco, Adalberto; Daneu Fernandes, Luis Filipe; GÓmez Cordero, Nicolas Gerardo

    2015-01-01

    Presenting the arthroscopic treatment by Tight Rope - Arthrex® system for acute acromioclavicular dislocation and to evaluate results obtained with this procedure. Methods: Between August 2006 and May 2007, 10 shoulders of 10 patients with acute acromioclavicular dislocation were submitted to arthroscopic repair using the Tight Rope - Arthrex® system. Minimum follow-up was 12 months, with a mean of 15 months. Age ranged from 26 to 42, mean 34 years. All patients were male. Radiology evaluation was made by trauma series x-ray. The patients were assisted in the first month weekly and after three months after the procedure. Clinical evaluation was based on the University of California at Los Angeles (UCLA) criteria. Results: All patients were satisfied after the arthroscopic procedure and the mean UCLA score was 32,5. Conclusion: The arthroscopic treatment by Tight Rope – Arthrex® system for acute acromioclavicular dislocation showed to be an efficient technique. PMID:26998453

  2. Editorial Commentary: Shoulder Arthroscopy, Shoulder Hemiarthroplasty, and Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis.

    PubMed

    Lubowitz, James H

    2015-06-01

    Shoulder arthroscopy offers a safe, effective, and less invasive alternative to arthroplasty in patients under 60 years of age with glenohumeral arthritis. However, indications include joint space of greater than 2 mm. For patients who do not meet arthroscopic indications, total shoulder arthroplasty is more effective than hemiarthroplasty. Performance and publication bias may effect generalizability of these findings. Biologic treatment options seem on the horizon.

  3. 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

  4. Pediatric complex divergent elbow dislocation.

    PubMed

    van Wagenberg, Jan-Maarten F; van Huijstee, Pieter J; Verhofstad, Michiel H J

    2011-01-01

    A divergent dislocation of the elbow is a very rare injury, and only a few cases have been described in the literature. It is characterized as a dorsal dislocation of the ulnohumeral joint combined with a lateral dislocation of the proximal radius. All three articulations of the elbow joint are involved. Like in our case, it can be accompanied by an avulsion fracture of the coronoid and a distal radius fracture. For correct understanding of the injury, proper radiographic studies are imperative. In contrast to some earlier reports that advise a conservative approach, we performed a very aggressive operative treatment. To ensure anatomic reconstruction of the elbow, surgical exposure of the various injuries was performed first. After gross reduction of the joint dislocation, definitive osteosynthesis of the distal radius fracture was performed. Subsequently, the coronoid process and lateral collateral ligament could be repaired anatomically, improving the stability of the elbow. An uneventful recovery with excellent elbow motion and stability was achieved.

  5. Successful closed manipulation of a pure lateral traumatic dislocation of the elbow joint using a modified Stimson's technique: a case report

    PubMed Central

    Khan, Sameer K; Chopra, Rajat; Chakravarty, Debasis

    2008-01-01

    Introduction Pure lateral elbow dislocation is rare, and a successful closed reduction is even rarer. Reduction can be hindered by swelling, soft tissue interposition or associated fractures. Case presentation We present a pure lateral traumatic dislocation of the elbow joint in a 40-year-old man. This was successfully manipulated and reduced in casualty using a modification of the gravity-aided 'hanging arm' technique originally described for shoulder dislocations by Stimson. Conclusion We strongly recommend the use of this simple technique in these rare yet difficult injuries, in order to avoid potential complications with general anaesthesia and surgery. PMID:18498622

  6. 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.

  7. 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

  8. On the hierarchy of interfacial dislocation structure

    NASA Astrophysics Data System (ADS)

    Balluffi, R. W.; Olson, G. B.

    1985-04-01

    Many different types of dislocations have been defined in dislocation models for grain boundaries and interphase boundaries. It is emphasized that there is no unique dislocation model for a boundary, and that the formal dislocation content depends upon the choice of the lattice correspondence relating the adjoining lattices. However, it is concluded that no problems of real physical significance arise from this lack of uniqueness. “Best≓, or most useful, descriptions often exist, and these are discussed. A hierarchy consisting of four different types of interfacial dislocations may be distinguished, which is useful in describing the dislocation content of interfaces. These entities are termed: (1) primary interfacial dislocations; (2) secondary interfacial dislocations; (3) coherency interfacial dislocations; and (4) translational interfacial dislocations. While there may be a lack of agreement on terminology in the literature, it is believed that these dislocation types are distinguishable and play unique roles in useful dislocation models for interfaces. Detailed descriptions of these dislocation types are given, and actual examples in real interfaces are presented. It is concluded that dislocation descriptions of interface structures become of purely formal significance in the limit of fully incoherent interfaces since the cores are then delocalized. The utility of various dislocation descriptions therefore depends on the degree to which various types of local coherency exist.

  9. Physical therapy management of isolated serratus anterior muscle paralysis.

    PubMed

    Watson, C J; Schenkman, M

    1995-03-01

    This case report presents a patient who developed right shoulder pain following strenuous upper-extremity exercise. Approximately 6 weeks later his pain resolved, he noticed persistent right upper-extremity weakness. He was referred to physical therapy for evaluation and treatment. Physical therapy evaluation revealed isolated serratus anterior muscle paralysis. A long thoracic neuropathy was subsequently confirmed by electromyographic testing. The etiology, pathophysiology, and pathokinesiology of serratus anterior muscle paralysis are reviewed. A case is presented, illustrating how the clinical decision making is based on the pathokinesiology and pathophysiology. The patient was followed over the course of 17 months and has recovered full right shoulder active range of motion. His serratus anterior muscle strength has increased to Good minus, and he reports significantly improved functional use of the upper extremity.

  10. Quantifying shoulder rotation weakness in patients with shoulder impingement.

    PubMed

    Tyler, Timothy F; Nahow, Rachael C; Nicholas, Stephen J; McHugh, Malachy P

    2005-01-01

    The purpose of this study was to determine whether strength deficits could be detected in individuals with and without shoulder impingement, all of whom had normal shoulder strength bilaterally according to grading of manual muscle testing. Strength of the internal rotators and external rotators was tested isokinetically at 60 degrees /s and 180 degrees /s, as well as manually with a handheld dynamometer (HHD) in 17 patients and 22 control subjects. Testing was performed with the shoulder positioned in the scapular plane and in 90 degrees of shoulder abduction with 90 degrees of elbow flexion (90-90). The peak torque was determined for each movement. The strength deficit between the involved and uninvolved arms (patients) and the dominant and nondominant arms (control subjects) was calculated for each subject. Comparisons were made for the scapular-plane and 90-90 positions between isokinetic and HHD testing. Despite a normal muscle grade, patients had marked weakness (28% deficit, P < .01) in external rotators at the 90-90 position tested with the HHD. In contrast, external rotator weakness was not evident with isokinetic testing at the 90-90 position (60 degrees /s and 180 degrees /s, 0% deficit, P = .99). In control subjects, greater internal rotator strength in the dominant compared with the nondominant arm was evident with the HHD at the 90-90 position (11%, P < .01) and in the scapular plane (7%, P < .05). Using an HHD while performing manual muscle testing can quantify shoulder strength deficits that may not be apparent with isokinetic testing. By using an HHD during shoulder testing, clinicians can identify weakness that may have been presumed normal.

  11. Palmar-divergent dislocation of the scaphoid and the lunate.

    PubMed

    Komura, Shingo; Yokoi, Tatsuo; Suzuki, Yasushi

    2011-03-01

    We describe a patient with palmar-divergent dislocation of the scaphoid and lunate. After successful closed reduction, the scapholunate and lunotriquetral ligaments were sutured through the dorsal approach, and the anterior capsule was sutured through the palmar approach. The scapholunate and lunotriquetral joints were fixed with Kirschner wires for 7 weeks. At the 1-year follow-up, magnetic resonance imaging showed no evidence of avascular necrosis of the scaphoid or lunate, and radiographs showed no evidence of the dorsal and volar intercalated segment instability patterns associated with carpal instability. However, flexion of the scaphoid and a break in Gilula's line remained. To our knowledge, this is the first report showing treatment of palmar-divergent dislocation of the scaphoid and lunate by suturing the carpal interosseous ligaments.

  12. Temporomandibular joint sounds and disc dislocations incidence after orotracheal intubation.

    PubMed

    Rodrigues, Estela T; Suazo, Iván C; Guimarães, Antonio S

    2009-01-01

    The aim of this study was to analyze the temporomandibular joint (TMJ) disc displacement and articular sounds incidence after orotracheal intubation. A prospective cohort study was conducted in the Hospital Universitário do Oeste do Paraná (HUOP), in Cascavel, Brazil. 100 patients (aged 14-74 years, mean 44 years), 34 male and 66 female, in need of surgical procedure with orotracheal intubation were evaluated. The anterior disc displacement with reduction incidence and the nonclassifiable sounds incidence by the Research Diagnostic Criteria Axis I was evaluated in all patients after orotracheal intubation. The patients was evaluated one day before and until two days after the procedure. Eight percent present with anterior disc displacement with reduction and 10% presented nonclassifiable sounds after the orotracheal intubation. There was no correlation of any kind regarding gender related influence in the incidence of disc dislocations (P = 0.2591) and TMJ sounds (P = 0.487). Although anterior disc dislocations and TMJ sounds after anesthetic with orotracheal intubation presented a low incidence (8%-10%), it is recommended that the evaluation of TMJ signs and symptoms be done before the anesthetic procedure to take care with susceptible patients manipulation.

  13. MRI of anterior knee pain.

    PubMed

    Samim, Mohammad; Smitaman, Edward; Lawrence, David; Moukaddam, Hicham

    2014-07-01

    Anterior knee pain is the most common knee complaint. It may be due to a variety of soft tissue or osseous abnormalities. Knowledge of the radiologic appearance of the abnormalities allows more accurate diagnosis of the cause of the pain including chondral abnormalities, patellar instability and dislocation, femoral trochlear dysplasia, abnormal patellar location, bipartite patella, various tendinopathies, bursal inflammation, traction apophysitis in pediatric and adolescent patients, and miscellaneous diseases including mediopatellar plica syndrome and Hoffa's disease. Radiographs are often obtained to exclude acute osseous abnormalities, such as fractures. Magnetic resonance (MR) imaging offers superior soft tissue contrast resolution and allows for more accurate evaluation of the underlying etiology and therefore may improve treatment and possible surgical planning.

  14. In vivo pediatric shoulder muscle volumes and their relationship to 3D strength.

    PubMed

    Im, Hyun Soo; Alter, Katharine E; Brochard, Sylvain; Pons, Christelle; Sheehan, Frances T

    2014-08-22

    In the pediatric shoulder, injury and pathology can disrupt the muscle force balance, resulting in severe functional losses. As little data exists pertaining to in vivo pediatric shoulder muscle function, musculoskeletal data are crucially needed to advance the treatment of pediatric shoulder pathology/injury. Therefore, the purpose of this study was to develop a pediatric database of in vivo volumes for the major shoulder muscles and correlate these volumes with maximum isometric flexion/extension, internal/external rotation, and abduction/adduction joint moments. A methodology was developed to derive 3D shoulder muscle volumes and to divide the deltoid into sub-units with unique torque producing capabilities, based on segmentation of three-dimensional magnetic resonance images. Eleven typically developing children/adolescents (4F/7M, 12.0 ± 3.2 years, 150.8 ± 16.7 cm, 49.2 ± 16.4 kg) participated. Correlation and regression analyses were used to evaluate the relationship between volume and maximum, voluntary, isometric joint torques. The deltoid demonstrated the largest (30.4 ± 1.2%) and the supraspinatus the smallest (4.8 ± 0.5%) percent of the total summed volume of all six muscles evaluated. The anterior and posterior deltoid sections were 43.4 ± 3.9% and 56.6 ± 3.9% of the total deltoid volume. The percent volumes were highly consistent across subjects. Individual muscle volumes demonstrated moderate-high correlations with torque values (0.70-0.94, p<0.001). This study presents a comprehensive database documenting normative pediatric shoulder muscle volume. Using these data a clear relationship between shoulder volume and the torques they produce was established in all three rotational degrees-of-freedom. This study furthers the understanding of shoulder muscle function and serves as a foundation for evaluating shoulder injury/pathology in the pediatric/adolescent population.

  15. Localized Pigmented Villonodular Synovitis of the shoulder: a rare presentation of an uncommon pathology.

    PubMed

    Madruga Dias, João; Costa, Maria Manuela; Duarte, Artur; Pereira da Silva, José A

    2013-01-01

    Pigmented Vilonodular Synovitis is a rare clinical entity characterized as a synovial membrane benign tumour, despite possible aggressive presentation with articular destruction. The localized variant is four times less frequent and the shoulder involvement is uncommon. We present the case of a Caucasian 59 year-old patient, who presented with left shoulder pain, of uncharacteristic quality, with local swelling and marked functional limitation of 1 month duration. Shoulder ultrasonography showed subacromial bursitis. An ultrasound-guided aspiration was performed: synovial fluid was citrine-colored and translucid. One month later, the patient maintained swelling, pain and functional impairment of the left shoulder. New shoulder ultrasound revealed exuberant subacromial bursitis, which was again aspirated using ultrasound guidance. The synovial fluid was haematic, without changes in the cell count or biochemical analysis and cultural exams. We performed an injection with 60 mg of hexacetonide triamcinolone. Two months later there was a relapse, with shoulder ultrasonography once more showing subacromial bursitis with extensive synovial membrane proliferation. Shoulder MRI revealed subacromial bursitis involving the anterior, posterior and medial recesses, with deltoid distension, but without tendinous or intra-articular involvement. In the interior of the bursa hypointense images in T2 were observed, suggesting the diagnosis of Pigmented Vilonodular Synovitis. The patient had surgical bursectomy with success and without complications. The histological exam of the operatory piece confirmed the imaging diagnosis. Pigmented Vilonodular Synovitis is uncommon, rarely affecting the shoulder in a localized variant. It is a diagnosis to be considered in shoulder pain, especially if associated with recurrent subacromial bursitis.

  16. Adhesive capsulitis of the shoulder.

    PubMed

    Neviaser, Andrew S; Neviaser, Robert J

    2011-09-01

    Adhesive capsulitis is characterized by painful, gradual loss of active and passive shoulder motion resulting from fibrosis and contracture of the joint capsule. Other shoulder pathology can produce a similar clinical picture, however, and must be considered. Management is based on the underlying cause of pain and stiffness, and determination of the etiology is essential. Subtle clues in the history and physical examination can help differentiate adhesive capsulitis from other conditions that cause a stiff, painful shoulder. The natural history of adhesive capsulitis is a matter of controversy. Management of true capsular restriction of motion (ie, true adhesive capsulitis) begins with gentle, progressive stretching exercises. Most patients improve with nonsurgical treatment. Indications for surgery should be individualized. Failure to obtain symptomatic improvement and continued functional disability following ≥6 months of physical therapy is a general guideline for surgical intervention. Diligent postoperative therapy to maintain motion is required to minimize recurrence of adhesive capsulitis.

  17. 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.

  18. 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.

  19. Dislocation multi-junctions and strain hardening.

    PubMed

    Bulatov, Vasily V; Hsiung, Luke L; Tang, Meijie; Arsenlis, Athanasios; Bartelt, Maria C; Cai, Wei; Florando, Jeff N; Hiratani, Masato; Rhee, Moon; Hommes, Gregg; Pierce, Tim G; de la Rubia, Tomas Diaz

    2006-04-27

    At the microscopic scale, the strength of a crystal derives from the motion, multiplication and interaction of distinctive line defects called dislocations. First proposed theoretically in 1934 (refs 1-3) to explain low magnitudes of crystal strength observed experimentally, the existence of dislocations was confirmed 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 that tie the dislocations together. Here we report that interactions among three dislocations result in the formation of unusual elements of dislocation network topology, termed 'multi-junctions'. We first predict the existence of multi-junctions using dislocation dynamics and atomistic simulations and then confirm their existence by transmission electron microscopy 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 body-centred cubic crystals.

  20. 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

  1. 14 CFR 91.521 - Shoulder harness.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... combined safety belt and shoulder harnesses that were approved and installed before March 6, 1980, may... belt and shoulder harnesses that were approved and installed before March 6, 1980, may continue to...

  2. 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)

  3. 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.

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

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 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)...

  6. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 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...

  7. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 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...

  8. 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...

  9. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 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)...

  10. Shoulder Injuries Among United States High School Athletes During the 2005–2006 and 2006–2007 School Years

    PubMed Central

    Bonza, John E; Fields, Sarah K; Yard, Ellen E; Dawn Comstock, R

    2009-01-01

    Context: The shoulder is one of the most commonly injured body sites among athletes. Little previous research describes shoulder injury patterns in high school athletes. Objective: To describe and compare shoulder injury rates and patterns among high school athletes in 9 sports (football, soccer, basketball, baseball, and wrestling for boys and soccer, volleyball, basketball, and softball for girls). Design: Prospective injury surveillance study. Setting: Injury data were collected from 100 nationally representative US high schools via High School Reporting Information Online. Patients or Other Participants: Athletes from participating high schools injured while involved in a school-sanctioned practice or competition in 1 of the above sports during the 2005–2006 and 2006–2007 school years. Main Outcome Measure(s): Shoulder injury rates, diagnoses, severity, and mechanisms. Results: During the 2005–2006 and 2006–2007 school years, athletes in this study sustained 805 shoulder injuries during 3 550 141 athlete-exposures (AEs), for an injury rate of 2.27 shoulder injuries per 10 000 AEs. This corresponds to an estimated 232 258 shoulder injuries occurring nationwide during this time. Shoulder injuries were more likely to occur during competition than practice (rate ratio  =  3.01, 95% confidence interval  =  2.62, 3.46). Shoulder injury rates per 10 000 AEs were highest in football (5.09), wrestling (4.34), and baseball (1.90). Common shoulder injury diagnoses included sprains/strains (39.6%), dislocations/separations (23.7%), contusions (11.5%), and fractures (6.6%). Although 44.8% of athletes sustaining a shoulder injury returned to play in less than 1 week, 22.9% were out of play for more than 3 weeks, and 6.2% of shoulder injuries required surgery. Common mechanisms of shoulder injury included player-to-player contact (57.6%) and contact with the playing surface (22.8%). Conclusions: High school shoulder injury rates and patterns varied

  11. Reverse Shoulder Arthroplasty – A Literature Review

    PubMed Central

    Mahmood, Aatif; Malal, Joby Jacob George; Waseem, Mohammed

    2013-01-01

    Professor Grammont revolutionised shoulder surgery with his reverse shoulder arthroplasty design. Patients who had poor results from a conventional shoulder replacement because of cuff deficiency can now be treated effectively. Although designed for cuff tear arthropathy, indications continue to evolve and broaden. The initial results look very promising and the implant has gained much popularity over the years. The article provides an extensive literature review of the indications, results and complications for reverse shoulder arthroplasty. PMID:24082977

  12. Reverse shoulder arthroplasty - a literature review.

    PubMed

    Mahmood, Aatif; Malal, Joby Jacob George; Waseem, Mohammed

    2013-01-01

    Professor Grammont revolutionised shoulder surgery with his reverse shoulder arthroplasty design. Patients who had poor results from a conventional shoulder replacement because of cuff deficiency can now be treated effectively. Although designed for cuff tear arthropathy, indications continue to evolve and broaden. The initial results look very promising and the implant has gained much popularity over the years. The article provides an extensive literature review of the indications, results and complications for reverse shoulder arthroplasty.

  13. Shoulder Injuries in the Overhead Throwing Athlete.

    PubMed

    Mlynarek, Ryan A; Lee, Simon; Bedi, Asheesh

    2017-02-01

    The overhead pitching motion is a coordinated sequence of movements that subjects the shoulder to extreme forces. The ultimate goal of this complex, dynamic activity is to generate high ball velocity and accuracy. In doing so, repetitive throwing can cause adaptive and pathologic changes in the thrower's shoulder. This article reviews the relevant shoulder anatomy, the kinetic chain, and throwing mechanics, as well as common shoulder injuries and surgical options for the treating orthopedic surgeon.

  14. 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

  15. 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.

  16. Thermal effects in dislocation theory

    NASA Astrophysics Data System (ADS)

    Langer, J. S.

    2016-12-01

    The mechanical behaviors of polycrystalline solids are determined by the interplay between phenomena governed by two different thermodynamic temperatures: the configurational effective temperature that controls the density of dislocations, and the ordinary kinetic-vibrational temperature that controls activated depinning mechanisms and thus deformation rates. This paper contains a review of the effective-temperature theory and its relation to conventional dislocation theories. It includes a simple illustration of how these two thermal effects can combine to produce a predictive theory of spatial heterogeneities such as shear-banding instabilities. Its main message is a plea that conventional dislocation theories be reformulated in a thermodynamically consistent way so that the vast array of observed behaviors can be understood systematically.

  17. 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.

  18. [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.

  19. 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…

  20. On the Shoulders of Giants...

    DTIC Science & Technology

    2013-01-01

    REFERENCES 1. Newton I. Turnbull HW, ed. Correspondence of Isaac Newton . Vol I: 1661Y1675. Cambridge, United Kingdom: Cambridge University Press; 1959:416...calendar), Sir Isaac Newtonopined to Robert Hooke, ‘‘If I have seen further [than you and Descartes], it is by standing on the shoulders of giants.’’1 That

  1. Biomechanics of complex shoulder instability.

    PubMed

    Degen, Ryan M; Giles, Joshua W; Thompson, Stephen R; Litchfield, Robert B; Athwal, George S

    2013-10-01

    Identification and treatment of the osseous lesions associated with complex shoulder instability remains challenging. Further biomechanical testing is required to delineate critical defect values and determine which treatments provide improved glenohumeral joint stability for the various defect sizes, while minimizing the associated complications.

  2. Effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability.

    PubMed

    Ng, Choong; Bialocerkowski, Andrea; Hinman, Rana

    2007-06-01

    Background  Anterior instability is a frequent complication following a traumatic glenohumeral dislocation. Frequently the underlying pathology associated with recurrent instability is a Bankart lesion. Surgical correction of Bankart lesions and other associated pathology is the key to successful treatment. Open surgical glenohumeral stabilisation has been advocated as the gold standard because of consistently low postoperative recurrent instability rates. However, arthroscopic glenohumeral stabilisation could challenge open surgical repair as the gold standard treatment for traumatic anterior glenohumeral instability. Objectives  Primary evidence that compared the effectiveness of arthroscopic versus open surgical glenohumeral stabilisation was systematically collated regarding best-practice management for adults with traumatic anterior glenohumeral instability. Search strategy  A systematic search was performed using 14 databases: MEDLINE, Cumulative Index of Nursing and Allied Health (CINAHL), Allied and Complementary Medicine Database (AMED), ISI Web of Science, Expanded Academic ASAP, Proquest Medical Library, Evidence Based Medicine Reviews, Physiotherapy Evidence Database, TRIP Database, PubMed, ISI Current Contents Connect, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Studies published between January 1984 and December 2004 were included in this review. No language restrictions were applied. Selection criteria  Eligible studies were those that compared the effectiveness of arthroscopic versus open surgical stabilisation for the management of traumatic anterior glenohumeral instability, which had more than 2 years of follow up and used recurrent instability and a functional shoulder questionnaire as primary outcomes. Studies that used non-anatomical open repair techniques, patient groups that were specifically 40 years or older, or had multidirectional instability or other concomitant

  3. Uncommon indications for reverse total shoulder arthroplasty.

    PubMed

    Hyun, Yoon Suk; Huri, Gazi; Garbis, Nickolas G; McFarland, Edward G

    2013-12-01

    Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty.

  4. Uncommon Indications for Reverse Total Shoulder Arthroplasty

    PubMed Central

    Hyun, Yoon Suk; Huri, Gazi; Garbis, Nickolas G.

    2013-01-01

    Total shoulder arthroplasty and shoulder hemiarthroplasty have been the traditional method for treating a variety of shoulder conditions, including arthritis, cuff tear arthropathy, and some fracture types. However, these procedures did not provide consistently good results for patients with torn rotator cuffs. The development of the reverse prosthesis by Grammont in the late 20th century revolutionized the treatment of the rotator-cuff-deficient shoulder with arthritis. The main indication for the reverse prosthesis remains the patient with cuff tear arthropathy who has pain and loss of motion. Because the reverse total shoulder arthroplasty produced such good results in these patients, the indications for the reverse prosthesis have expanded to include other shoulder conditions that have previously been difficult to treat successfully and predictably. This review discusses and critically reviews these newer indications for the reverse total shoulder arthroplasty. PMID:24340143

  5. 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.

  6. Traumatic posterior atlantooccipital dislocation with Jefferson fracture and fracture-dislocation of C6-C7: a case report with survival.

    PubMed

    Park, J B; Ha, K Y; Chang, H

    2001-12-01

    Atlantooccipital dislocation (AOD) is a rare and usually fatal injury. In the current study, the authors reported an extremely rare case of posterior AOD with Jefferson fracture and fracture-dislocation of C6-C7. The patient survived the injury and had only incomplete quadriplegia below the C7 segment with anterior cord syndrome. He was successfully managed with in situ occipitocervical fusion using the Cotrel-Dubousset rod system, corpectomy of C6, and anterior interbody fusion of C5-C7 with plating. To our knowledge, this is the first report of posterior AOD with two other non-contiguous cervical spine injuries. A high index of suspicion and careful examination of the upper cervical spine should be considered as the key to the diagnosis of AOD in cases that involve multiple or lower cervical spine injuries.

  7. A survey of temporomandibular joint dislocation: aetiology, demographics, risk factors and management in 96 Nigerian cases.

    PubMed

    Ugboko, V I; Oginni, F O; Ajike, S O; Olasoji, H O; Adebayo, E T

    2005-07-01

    A retrospective study of 96 cases of temporomandibular joint dislocation was undertaken. Patients' ages ranged from 9 to 85 years (mean+/-SD, 35.3+/-17.4 years) and peak incidence was at 20-29 years. Mean duration was 7.9 weeks (range, 1h to 3 years). Acute, chronic and recurrent dislocations were seen in 46 (47.9%), 29 (30.2%) and 21 (21.9%) patients, respectively. Males dominated in all three categories but this was not statistically significant (P = 0.8). Excessive mouth opening while yawning (44 cases) was the commonest cause of dislocation, followed by road traffic accidents (13 cases). Ten patients (10.4%) had an underlying systemic disease, the commonest being epilepsy (four cases); those with acute dislocation recorded the highest incidence of underlying illness. Bilateral anterior (86 cases) dislocations were the most frequent. Of the 96 patients, 89 (92.7%) were available for treatment. Manual reduction with or without anaesthesia proved effective for 38/45 acute, 5/24 chronic and 14/20 recurrent cases. Chronic dislocations were treated mainly by surgical osteotomy (13/24). Vertical subsigmoid and oblique ramus osteotomies were the commonest surgical techniques recorded. Treatment was satisfactory for all patients surgically handled except for one case of anterior open bite postoperatively. This study has shown that excessive mouth opening while yawning is the commonest cause of temporomandibular joint dislocation in Nigerians, and conservative approaches to management remain quite effective irrespective of the duration and clinical subtype. The best choice of surgical technique should be determined by proper clinical evaluation and the need to avoid or minimize postoperative morbidity.

  8. Pathological fracture dislocation of the acetabulum in a patient with neurofibromatosis-1

    PubMed Central

    Saibaba, Balaji; Sen, Ramesh Kumar; Sharma, Manish; Nahar, Uma

    2016-01-01

    Skeletal neurofibromatosis (NF) commonly manifests as scoliosis and tibial dysplasias. NF affecting the pelvic girdle is extremely rare. Pathological fracture of the acetabulum leading to anterior hip dislocation in a patient with NF-1 has never been reported in the literature. The paper presents the clinical symptomatology, the course of management and the successful outcome of such a rare case of NF-1. Histopathological and immunohistochemistry studies showing abundant spindle cells, which are S-100 positive and of neural origin are the classical hallmarks of neurofibromatous lesions. Tumor resection and iliofemoral arthrodesis can be considered as a valid option in young patients with pathological fracture dislocation of the acetabulum. PMID:26955185

  9. Treatment of Chopart Fracture-Dislocations.

    PubMed

    Klaue, Kaj

    2010-06-01

    The Chopart articular space was used by François Chopart (1743-1795) as a practical space for amputation in cases of distal foot tumor. It corresponds to the center of the foot and allows for essential articulation by means of the talo-calcaneo-navicular joint (coxa pedis). Chopart fracture-dislocations may therefore include fractures of the navicular, the cuboid, the talus, and calcaneus. The treatment priorities should therefore include addressing all of the injured soft tissues by immediate joint reduction or restoring bony alignment, including the avoidance of threatening compartment syndromes. Subsequent anatomical bone and joint reconstruction, if possible, should first address the talar head and the navicular. The anterior process of the calcaneus and the cuboid should be aligned to preserve foot alignment in the sagittal and horizontal planes. In severe joint destructions, isolated fusion of the calcaneo-cuboidal joint may help preserve functional mobility of the foot. Isolated or associated talo-navicular fusion considerably limits functional mobility of the foot.

  10. [Case report and literature review: elbow fracture dislocation in children].

    PubMed

    Guzmdn, R; Rincón, D; Camacho, J

    2015-01-01

    Elbow dislocation in children is a very infrequent traumatic event which was first described by Stimson in 1900 and then by Tachdjian in 1990. Its estimated incidence ranges from 3% to 6% of all elbow injuries, peaking at 13-14 years. Elbow trauma is classified considering the direction in which the proximal radioulnar joint shifts with respect to the humerus, into posterior and anterior dislocation. The former is the most frequent and accounts for 95% of cases. Elbow fracture dislocation is an even rarer event. The incidence rate of avulsion fracture of the medial epicondyle is 25-36%, of the lateral condyle 4%, of the olecranon 1.7%, of the radial head 8%, of the coronoid process 3.5%, and others, 3.5%. At present there is no consensus in the literature on how to treat this type of lesions, particularly because some authors advocate nonsurgical management, while others propose surgical management as the definitive treatment. What is clear, however, is that a late diagnosis or untimely treatment may affect the child's growth and lead to serious complications. The purpose of this study is to share our experience and good results with the surgical management of these infrequent cases.

  11. Atlanto-axial dislocation complicating a type II odontoid fracture. Reduction and final fixation.

    PubMed

    Riouallon, G; Pascal-Moussellard, H

    2014-05-01

    A case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture is reported. This is a rare case of traumatic posterolateral C1-C2 dislocation associated with odontoid fracture. Its management is discussed. A traumatic dislocation of atlanto-axial joint associated with an odontoid fracture remains a rare injury. No case of posterior dislocation has been reported so far in the literature with this type of management. The case is of a 25 year-old-man with a primary atlanto-axial posterolateral dislocation associated with a type II displaced odontoid fracture without any neurological complication. The patient underwent gentle traction during 24 hours with a halo frame. An incomplete reduction was achieved. Two days later, a complete reduction was obtained thanks to a preoperative manual traction maintained by a Mayfield (R) modified skull clamp. Anterior C1-C2 fixation was performed according to Vaccaro's technique. The patient wore a cervical collar and underwent physiotherapy during three months. To our best knowledge, this case represents the first traumatic atlanto-axial dislocation associated with an odontoid fracture which was treated through retropaharyngeal approach. This had been rendered possible thanks to the final reduction maneuver in extension.

  12. Pathomechanics of the throwing shoulder.

    PubMed

    Kibler, W Ben; Thomas, Stephen J

    2012-03-01

    Many anatomic, physiological, and biomechanical alterations have been observed in overhead athletes who present with painful shoulders. This is probably due to the complex kinetic chain mechanics required in the overhead throwing or serving motion. Any alteration along the kinetic chain can result in deficits in force production or increase in joint loads in other parts of the chain. The "disabled throwing shoulder" (DTS) is a general term that describes the limitations in function that exist in symptomatic overhead athletes. DTS typically results from a "cascade to injury" with alterations in the kinetic chain. Evaluation of athletes with the DTS should include examination of the local and distant anatomic injuries and screening for physiological (muscle inflexibilities, weakness, or imbalances) or biomechanical (motions, positions) alterations.

  13. Anesthesiological Considerations in Shoulder Surgery

    PubMed Central

    Lanna, M.; Pastore, A.; Policastro, C.; Iacovazzo, C.

    2012-01-01

    In 1970, Winnie proposed the brachial plexus block as an alternative and effective anaesthesia technique for shoulder surgery. From that date, several techniques have been developed to approach the brachial plexus: the use of a nerve stimulator and, more recently, the ultrasound guided nerve blockade have made the procedure easier and more effective; the availability of the new drugs demonstrates some major advantages due to the application of peripheral blocks. Nowadays the attention has been focused on postoperative pain control: although many techniques have been proposed, the application of a continuous infusion of local anaesthetics through an interscalene catheter seems the best available technique to achieve pain relief after shoulder surgery. Advantages ad disadvantages of regional anaesthesia and adverse events associated with interscalene brachial plexus blockade are reviewed. PMID:23905051

  14. [Instrumental diagnosis in shoulder instability].

    PubMed

    Lalla, E; Rosa, D; Grillo, G; Belfiore, G

    1989-01-01

    The authors call attention to the pathology caused by glenohumeral instability and, in particular, to painful shoulders in athletes which so often cause problems in diagnosis. An instrumental protocol for diagnosis is suggested, based on several specific radiographic views, Ct scan and arthro-Ct scan, with double contrast medium, the latter having the task of determining lesion which would not otherwise be able to be studied.

  15. Shoulder pathoanatomy in marathon kayakers

    PubMed Central

    Hagemann, G; Rijke, A; Mars, M

    2004-01-01

    Objectives: To determine the prevalence of soft and hard tissue abnormalities and their interrelations in the shoulders of marathon kayakers and to examine the pathoanatomical factors that predispose these athletes to injury. Methods: Fifty two long distance kayakers completed a questionnaire. Their shoulders were examined for range of motion, pain, and stability using a standard set of 10 clinical tests. The shoulder was subsequently scanned by magnetic resonance imaging (MRI) in three planes and evaluated for evidence of injury or other abnormality. The relation of clinical symptoms and MRI findings was investigated with respect to kayaker's age, number of years kayaking, and number of marathon races completed. Results: Thirty subjects were asymptomatic at the time of scanning, and twenty two showed symptoms of pain and/or instability. MRI showed acromioclavicular hypertrophy, acromial or clavicular spur, supraspinatus tendinitis, and partial tear of the supraspinatus as the most common abnormalities. Kayaker's age, number of years kayaking, and number of races completed did not relate significantly to symptoms or to the presence of an abnormality on MRI scan. Of all the pathoanatomical findings that are reported to predispose to rotator cuff injury, only acromial and clavicular spurs were found to correlate highly with supraspinatus muscle pathology. Conclusions: Rotator cuff injuries make up a large portion of the injuries seen in marathon kayakers, about twice the number reported for sprint kayakers. These injuries are the result of secondary impingement factors associated with overuse, possibly specific to kayakers, and not the result of bony restrictions around the shoulder joint. Acromioclavicular hypertrophy is a common finding in marathon kayakers, but is possibly the result of portaging or a previous injury. PMID:15273173

  16. 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

  17. Evolution of geometrically necessary dislocation density from computational dislocation dynamics

    NASA Astrophysics Data System (ADS)

    Guruprasad, P. J.; Benzerga, A. A.

    2009-07-01

    This paper presents a method for calculating GND densities in dislocation dynamics simulations. Evolution of suitably defined averages of GND density as well as maps showing the spatial nonuniform distribution of GNDs are analyzed under uniaxial loading. Focus is laid on the resolution dependence of the very notion of GND density, its dependence upon physical dimensions of plastically deformed specimens and its sensitivity to initial conditions. Acknowledgments Support from the National Science Foundation (CMMI-0748187) is gratefully acknowledged.

  18. 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.

  19. 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.

  20. 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.

  1. Effects of diagonal shoulder training in a closed kinematic chain for secondary impingement syndrome: a case study

    PubMed Central

    Kim, Soo-Han; Park, Du-Jin

    2015-01-01

    [Purpose] This study examined the effects of diagonal shoulder training on an individual with secondary impingement due to scapular dyskinesis. [Subject] A 54 year-old female with secondary impingement participated in this study. [Methods] The patient performed diagonal shoulder training in 4-point kneeling, 3 times per day for 20 minutes over a period of 6 weeks. Evaluations of shoulder pain, range of motion, upper trapezius/lower serratus anterior ratio, and impingement were performed before training and at 2, 4, and 6 weeks. [Results] The patient’s parameters improved gradually. All parameters returned to normal ranges at 4 weeks. [Conclusion] Diagonal shoulder training is effective for improving dysfunction in individuals with secondary impingement. In addition, this training should be applied for more than 4 weeks. PMID:26180371

  2. The effects of isometric contraction of shoulder muscles on cervical multifidus muscle dimensions in healthy office workers.

    PubMed

    Rahnama, Leila; Rezasoltani, Asghar; Khalkhali Zavieh, Minoo; Noori Kochi, Farhang; Akbarzadeh Baghban, Alireza

    2014-07-01

    It is argued that cervical multifidus muscles (CMM) are responsible for providing neck stability. However, whether they are actually activated during the tasks performed by the upper extremities to the neck is still unknown. Therefore, the aim of this study was to examine the effects of isometric contraction of shoulder muscles on the dimensions of CMM. Twenty three healthy males voluntarily participated in this study. Ultrasonography imaging of CMM was conducted at rest and at 25%, 50%, 75%, and 100% of maximal voluntary contraction of shoulder muscles in 6 directions of shoulder movements. Anterior-posterior dimension (APD), lateral dimension (LD), shape ratio and multiplied linear dimension (MLD) of cervical multifidus were measured. The APD of CMM was increased while LD and shape ratio were decreased by shoulder muscles contraction (P < 0.01).

  3. Infected shoulder joint with loose Suture Anchor in the joint after Bankart’s Repair- A Case Report

    PubMed Central

    Kumar, Mukesh; Thilak, Jai

    2016-01-01

    Introduction: The glenoid labrum is frequently torn in traumatic glenohumeral dislocation; arthroscopic repair is the standard method of treatment. The complications associated with this repair are pulling out of metal suture anchors, chondrolysis and joint infection. The infection of joint after arthroscopy is less than 1%. Staphylococcus is most common organism and rarely followed by Pseudomonas aeruginosa. We report a case of infected shoulder with chondrolysis of the joint and pulled out metal suture anchor lying inside the joint after Bankart’s repair. Case Report: A 22-year-old gentleman came to us with complaints of shoulder joint pain & gross restriction of movements for one year, with history of intermittent fever and treatment in nearby hospital. He also gives past history of recurrent dislocation of shoulder with last episode 18 months back, which was diagnosed as Bankart’s lesion and arthroscopic Bankart’s repair was done 15 months back. He was evaluated at our institute and suspected to have infection of shoulder joint with pulled out metal suture anchor inside the joint. Arthroscopic removal of suture anchor and debridement of shoulder joint was done, Culture was obtained and culture specific antibiotics were given for six weeks, and significant improvement was observed with this line of treatment. At lyear follow up, the patient was able to perform his daily activities with terminal restriction of range of motion. Conclusions: Shoulder joint infection is rare after Bankart’s repair and required a high degree of suspicion. Any foreign materials inside the joint should be taken out & followed with aggressive treatment by debridement, irrigation and culture specific antibiotics. Suppression of joint infection with antibiotics should be avoided specially when there is foreign body inside the joint. PMID:27703928

  4. From the unstable painful shoulder to multidirectional instability in the young athlete.

    PubMed

    Ren, Haifeng; Bicknell, Ryan T

    2013-10-01

    In conclusion, instability as a cause of shoulder pain in the young athlete is a difficult and often missed diagnosis. These young patients often seek treatment of shoulder pain but do not recall any episodes of shoulder instability. As a result, these uncommon, poorly described forms of instability are often misdiagnosed. A heightened clinical suspicion and an accurate, prompt diagnosis of instability is of paramount importance in this athletic group. It dictates appropriate treatment of the condition, avoids treatment delays and failure, provides better outcomes, and ensures timely return to play. UPS and MDI are two forms of this diagnosis. In UPS, patients at risk are young hyperlax athletes with a history of direct trauma or forceful overextension of the shoulder. They have shoulder pain that is described as deep anterior, reproduced with an anterior apprehension test and relieved with a relocation test. Soft tissue and/or bony lesions consistent with instability (observed on imaging or at arthroscopy) are necessary to confirm the diagnosis of UPS. Once the diagnosis is made, standard arthroscopic techniques with labrum reinsertion and/or anteroinferior capsule plication can lead to predictable good results and return to sport. In MDI, patients at risk are also young hyperlax athletes. However, these patients often do not have a history of trauma. They have shoulder pain that is often somewhat vague in location and is reproduced with a sulcus and/or hyper abduction test. Soft tissue and/or bony lesions consistent with instability are uncommon, with the exception of capsular laxity. The mainstay of treatment is physiotherapy rehabilitation. When surgery is necessary, open capsular shift and arthroscopic capsular plication are effective.

  5. High recurrence of instability in adolescents playing contact sports after arthroscopic shoulder stabilization.

    PubMed

    Nixon, Matthew F; Keenan, Oisin; Funk, Lennard

    2015-05-01

    Sixty-one shoulders in 57 adolescents underwent primary arthroscopic shoulder stabilization for labral tears sustained during contact sports (all Stanmore type 1). Mean follow-up was 22 months, mean age 16.8 (13-18) years. Postoperatively, the median subjective improvement was 90%, median VAS pain was 0 and mean Oxford Instability Score was 26.8. Sixty-one per cent returned to preinjury sporting level. A higher than expected proportion reported recurrent dislocation, with 15% followed up for 1 year and 31% for 4 years. Of these 11 requiring further surgery, 90% of redislocations occurred while playing rugby. Sex, type of sport, hyperlaxity and tear morphology were not significantly related to recurrence. Adolescents are at high risk for recurrence following arthroscopic stabilization. Patients should be counselled for the higher recurrence rate and consideration should be made for other aetiological factors such as returning to contact sports and joint hyperlaxity.

  6. Three-dimensional shoulder kinematics in individuals with C5-C6 spinal cord injury.

    PubMed

    Acosta, A M; Kirsch, R F; van der Helm, F C

    2001-01-01

    The shoulder kinematics of five able-bodied subjects and those of five arms in three subjects with spinal cord injuries at C5 or C6 levels were measured as the subjects elevated their arms in three different planes: coronal, scapular and sagittal. The range of humeral elevation was significantly reduced in all spinal cord injury (SCI) subjects relative to able-bodied subjects. Over this restricted range of humeral motion, the scapula of SCI subjects tended to be medially rotated, relative to able-bodied subjects, and the protraction and spinal tilt angles of the scapula of the SCI subjects indicated scapular winging. These results are consistent with paralysis or at least with significant weakness of the serratus anterior muscle. If further study confirms this hypothesis, functional neuromuscular stimulation of the serratus anterior muscle via a nerve cuff electrode may be an effective intervention for improving shoulder function in C5-C6 SCI.

  7. Management of the hemiplegic shoulder complex.

    PubMed

    Griffin, Christine

    2014-01-01

    Hemiplegia in the upper limb and shoulder complex is a common secondary impairment resulting from a cerebrovascular event; evidence-based intervention is required for effective treatment. Prior to addressing shoulder movement, biomechanical alignment of the pelvis and trunk must first be assessed. Extreme care must be taken when completing passive range of motion with the hemiplegic shoulder; motion should not exceed beyond 90° of shoulder flexion and abduction without scapular upward rotation and humeral head external rotation. It is recommended that the use of slings with upper limb hemiplegia be limited. A subluxation of the shoulder can be treated with surface neuromuscular electrical stimulation if the recommended protocol of 6 hours daily, 5 days a week, for 6 weeks is utilized. Taping/strapping for a subluxation has conflicting evidence for reducing the development of hemiplegic shoulder pain, and it does not improve upper limb function or range of motion.

  8. Musculoskeletal dysfunctions associated with swimmers' shoulder.

    PubMed

    Struyf, Filip; Tate, Angela; Kuppens, Kevin; Feijen, Stef; Michener, Lori A

    2017-02-11

    Shoulder pain is the most reported area of orthopaedic injury in swimmers. The so-called 'swimmers' shoulder' has been applied to a variety of complaints involving shoulder pain in swimmers without specific reference to contributing mechanisms or structures. Knowledge of dysfunctions associated with swimmers' shoulder can assist clinicians in developing rehabilitation strategies. This literature review aims at providing clinicians insight into the musculoskeletal mechanisms and impairments associated with swimmers' shoulder that could aid them in developing rehabilitation strategies. The following musculoskeletal dysfunctions will be discussed: muscle activity, strength, endurance, muscle control, range of motion, glenohumeral laxity, glenohumeral instability, shoulder posture and scapular dyskinesis. The findings in this review may have implications for swimmers, their coaches, and rehabilitation specialists working with swimmers.

  9. [Arthrography in congenital hip dislocation].

    PubMed

    Sipukhin, Ia M; Bazlova, E S; Cheberiak, N V

    1992-01-01

    The paper is concerned with the results of contrast arthrography in 73 children with hip joint dysplasia, among which true dislocations prevailed (70 patients). In addition to bone alterations, arthrography revealed various soft tissue changes like hypertrophy and deformity of limbus, soft tissue interposition, separation of the articular sac with the presence of an isthmus, disintegration of articular cartilages. These findings are used to define indications for surgical intervention as well as for planning the area of operation.

  10. 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...

  11. 21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 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...

  12. 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

  13. Evaluation of Shoulder-Stabilizing Braces

    PubMed Central

    Baker, Hayden P.; Tjong, Vehniah K.; Dunne, Kevin F.; Lindley, Tory R.; Terry, Michael A.

    2016-01-01

    Background: Shoulder injuries remain one of the most common injuries among collegiate football athletes. Offensive linemen in particular are prone to posterior labral pathology. Purpose: To evaluate the efficacy of shoulder bracing in collegiate offensive linemen with respect to injury prevention, severity, and lost playing time. Study Design: Cohort study; Level of evidence, 3. Methods: Offensive linemen at a single collegiate institution wore bilateral shoulder-stabilizing braces for every contact practice and game beginning in the spring of 2013. Between spring of 2007 and fall of 2012, offensive linemen did not wear any shoulder braces. Player injury data were collected for all contact practices and games throughout these time periods to highlight differences with brace use. Results: Forty-five offensive linemen (90 shoulders) participated in spring and fall college football seasons between 2007 and 2015. There were 145 complete offensive linemen seasons over the course of the study. Offensive linemen not wearing shoulder braces completed 87 seasons; offensive linemen wearing shoulder braces completed 58 seasons. Posterior labral tear injury rates were calculated for players who wore the shoulder braces (0.71 per 1000 athlete-exposures) compared with shoulders of players who did not wear the braces (1.90 per 1000 athlete-exposures). The risk ratio was 0.46 (95% CI, 0.16-1.30; P = .14). Mean time (contact practices and games) missed due to injury was significant, favoring less time missed by players who used braces (8.7 vs 36.60 contact practices and games missed due to injury; P = .0019). No significant difference in shoulder labral tears requiring surgery was found for brace use compared with no brace use. Conclusion: Shoulder-stabilizing braces were shown not to prevent posterior labral tears among collegiate offensive lineman, although they were associated with less time lost to injury. The results of this study have clinical significance, indicating that

  14. 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.

  15. Propionibacterium acnes infections in shoulder surgery.

    PubMed

    Horneff, John G; Hsu, Jason E; Huffman, G Russell

    2014-10-01

    Perioperative shoulder infections involving Propionibacterium acnes can be difficult to identify in a patient who presents with little more than pain and stiffness in the postoperative period. Although indolent in its growth and presentation, infection of the shoulder with P acnes can have devastating effects, including failure of the surgical intervention. This article reviews the importance of a comprehensive physical, radiologic, and laboratory evaluation, and discusses appropriate preventive and treatment strategies for P acnes infections of the shoulder.

  16. 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.

  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. Passage of an Anterior Odontoid Screw through Gastrointestinal Tract

    PubMed Central

    Leitner, L.; Brückmann, C. I.; Gilg, M. M.; Bratschitsch, G.; Radl, R.

    2017-01-01

    Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening. PMID:28194180

  19. Incidence of shoulder pain in repetitive work

    PubMed Central

    Leclerc, A; Chastang, J; Niedhammer, I; Landre, M; Roquelaure, Y

    2004-01-01

    Aims: To determine the predictiveness of personal and occupational factors for the onset of shoulder pain in occupations requiring repetitive work. Methods: A sample of 598 workers in five activity sectors completed a self administered questionnaire in 1993–94 and again three years later. Both questionnaires included questions about shoulder pain. The associations between various factors at baseline and subsequent shoulder pain were studied among subjects free from shoulder pain at baseline. Results: The incidence of shoulder pain was associated with several independent risk factors: depressive symptoms, low level of job control, and biomechanical constraints. After adjustment for other risk factors, the presence of depressive symptoms predicted occurrence of shoulder pain. A low level of job control was also associated with the onset of shoulder pain in both sexes. For men, repetitive use of a tool was a strong predictor, while the two most important biomechanical risk factors for women were use of vibrating tools and working with arms above shoulder level. Conclusion: This study used a longitudinal approach to examine different sets of risk factors for shoulder pain simultaneously. The results confirm the role of several biomechanical constraints. Psychological symptoms and a low level of job control also play a role. PMID:14691271

  20. 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.

  1. Postsurgical shoulder strength in the older patient.

    PubMed

    Hartsell, H D

    1993-12-01

    Following surgery, a goal of rehabilitation is to return the surgical extremity to its original strength. However, for the older rotator cuff repair patient, we are unsure if this is a realistic goal. The purpose of this study was to determine the quality of shoulder strength in older males who had undergone rotator cuff repair and acromioplasty surgery and to determine if test position and test velocity effects for rotation at the shoulder existed. Nine patients (mean age = 60.8 years) were tested bilaterally on the Cybex II isokinetic dynamometer for two movements (internal/external rotation), two velocities (60 degrees/sec, 120 degrees/sec), and two positions (neutral, 90 degrees abduction) to determine the peak torques for the shoulders. Following a three-way analysis of variance (ANOVA) with repeated measures, results indicated that the surgical shoulder had torque values approximating the nonsurgical shoulder and that test position had no significant effect on the internal or external rotation torques produced. As seen with nonshoulder-impaired younger subjects, peak torque decreased with increased test velocities. It was concluded that the older rotator cuff repair patient may be expected to attain a level of strength in the surgical shoulder similar to or exceeding the nonsurgical shoulder and that either test position recommended by Cybex for testing of the shoulder rotators was acceptable. Clinically, a full functional recovery similar to the nonsurgical shoulder should be expected in the older patient with postsurgical rotator cuff repair and acromioplasty.

  2. [Asymmetric bilateral traumatic dislocation of the hip joint: a case report].

    PubMed

    Azar, Nikola; Yalçinkaya, Merter; Akman, Yunus Emre; Uzümcügil, Onat; Kabukçuoğlu, Yavuz S

    2010-08-01

    Bilateral traumatic dislocation of the hip is a rare condition. Simultaneous asymmetric traumatic dislocation of the hip, one hip anterior and the other posterior, is even more unusual. This article reports a 21-year-old male patient with asymmetric bilateral dislocation of the hip joint, injured due to a landslide during a canal excavation. The patient was treated conservatively and evaluated according to Thompson and Epstein clinical and radiographic criteria after a follow-up period of 10 years and six months. The clinical result was perfect and radiographical result was good. We determined that our case had occurred as a result of a mechanism that has not been previously published in the literature and evaluated it from this point of view.

  3. 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.

  4. Elbow locking in a patient with a congenital radial head dislocation: Case report.

    PubMed

    Kim, H-J; Kim, P-T; Lee, H-J; Deslivia, M F

    2017-01-10

    Snapping elbow is a rare condition, which has various possible causes such as impinged plica, annular ligament, or other extra-articular causes. We report a case of 15-year-old boy who had snapping elbow and sudden-onset flexion contracture of the elbow. Simple radiographs showed bilateral anterior dislocation of hypoplastic radial heads. Magnetic resonance images with the elbow extended as much as possible showed that the annular ligament hemmed the dislocated radial neck. By surgical incision of the annular ligament which checkreined the radial neck, the patients could regain full extension of the elbow. We recommend careful consideration of surgical excision of ligamentous structure which blocks extension in the patients who have history of snapping elbow with congenital radial head dislocation.

  5. Bilateral Patella Dislocation after Total Knee Arthroplasty: A Report of Two Cases and a Review of the Literature

    PubMed Central

    Vaishya, Raju; Panthi, Sagar; Vijay, Vipul; Vaish, Abhishek

    2017-01-01

    Patellar instability is a known but catastrophic complication after total knee arthroplasty (TKA). The occurrence of bilateral dislocation of the patella after TKA is exceedingly rare. It may present as anterior knee pain, and diagnosis can easily be made clinically or by plain radiographs. Early diagnosis with surgical realignment and repair of the extensor mechanism can provide good outcomes after this complication.

  6. Difference in the Electromyographic Onset of the Deep and Superficial Multifidus during Shoulder Movement while Standing

    PubMed Central

    Abiko, Teppei; Shimamura, Ryota; Ogawa, Daisuke; Abiko, Yoko; Hirosawa, Masaki; Momose, Natsumi; Tsuchihashi, Wataru; Suzuki, Takaharu; Takei, Hitoshi

    2015-01-01

    Based on the current literature, it remains unclear whether electromyographic onset of the deep fibers of the multifidus (DM) is dependent on the direction of shoulder movement and the position of the center of foot pressure (CFP). In the present study, we re-examined the electromyographic onset of the DM during shoulder flexion and extension and investigated the influence of the CFP position before arm movement. Intramuscular and surface electrodes recorded the electromyographic onset of the DM, superficial fibers of the multifidus (SM), rectus abdominis, and anterior and posterior deltoid. Eleven healthy participants performed rapid, unilateral shoulder flexion and extension in response to audio stimuli at three CFP positions: quiet standing, extreme forward leaning, and extreme backward leaning. It was found that the electromyographic onset of the DM and SM relative to the deltoid was dependent on the direction of arm movement. Additionally, of all electromyographic onsets recorded, only that of the DM occurred earlier in the extreme forward leaning position than in the extreme backward leaning position during shoulder flexion. These results suggest that the electromyographic onset of DM was influenced by the biomechanical disturbance such as shoulder movement and CFP position. PMID:25850066

  7. Shoulder Muscle Activation of Novice and Resistance Trained Women during Variations of Dumbbell Press Exercises.

    PubMed

    Luczak, Joshua; Bosak, Andy; Riemann, Bryan L

    2013-01-01

    Previous research has compared the effects of trunk inclination angle on muscle activation using barbells and Smith machines in men. Whether similar effects occur with the use of dumbbells or in women remains unknown. The purpose was to compare upper extremity surface electromyographical (EMG) activity between dumbbell bench, incline, and shoulder presses. Dominate arm EMG data were recorded for collegiate-aged female resistance trained individuals (n = 12) and novice female resistance trained exercisers (n = 12) from which average EMG amplitude for each repetition phase (concentric, eccentric) was computed. No significant differences were found between experienced and novice resistance trained individuals. For the upper trapezius and anterior deltoid muscles, shoulder press activation was significantly greater than incline press which in turn was significantly greater than bench press across both phases. The bench and incline presses promoted significantly greater pectoralis major sternal activation compared to the shoulder press (both phases). While pectoralis major clavicular activation during the incline press eccentric phase was significantly greater than both the bench and shoulder presses, activation during the bench press concentric phase promoted significantly greater activation than the incline press which in turn was significantly greater than the shoulder press. These results provide evidence for selecting exercises in resistance and rehabilitation programs.

  8. 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

  9. Neck-shoulder crossover: how often do neck and shoulder pathology masquerade as each other?

    PubMed

    Sembrano, Jonathan N; Yson, Sharon C; Kanu, Okezika C; Braman, Jonathan P; Santos, Edward Rainier G; Harrison, Alicia K; Polly, David W

    2013-09-01

    Cases of consecutive new patients seen at orthopedic spine and shoulder clinics were reviewed. Four percent of spine patients had significant shoulder pathology, and 3.6% of shoulder patients had significant spine pathology. Identification of the correct pain generator is a prerequisite for effective treatment in patients with neck and/or shoulder problems. However, distinguishing between the two can be difficult. Relative frequencies of how often one is mistaken for the other have not been well established. Six hundred ninety-four new patients were seen at the orthopedic shoulder clinic (n = 452) or spine clinic (n = 242) at an academic institution during a 2-year period. One hundred seven patients had previous shoulder surgery, and 39 had previous neck surgery. The 548 patients (shoulder clinic, 345; spine clinic, 203) who had no previous surgery were reviewed with respect to workup performed, final diagnosis, subsequent operative procedures, and incidence of referral from the shoulder clinic to the spine clinic and vice versa. Among the patients seen at the shoulder clinic, 325 (94.2%) had shoulder pathology, 6 (1.7%) had neck but no shoulder pathology, 6 (1.7%) had shoulder and neck pathology, and 8 (2.3%) had an unidentifiable cause of pain. Of the 12 patients with neck pathology, none underwent neck surgery. Among the patients seen at the spine clinic, 182 (89.7%) had neck pathology, 5 (2.5%) had shoulder but no neck pathology, 3 (1.5%) had neck and shoulder pathology, and 13 (6.4%) had an unidentifiable cause of pain. Of the 8 patients with shoulder pathology, 1 (12.5%) underwent shoulder surgery. Our analysis suggests that for patients who present to a shoulder surgeon's clinic for shoulder pain, 3.6% will turn out to have neck pathology. For patients who present to a spine surgeon's clinic for neck pain, 4% may turn out to have shoulder pathology. Thus, approximately 1 in 25 patients seen at a surgeon's clinic for a presumed shoulder or neck problem may

  10. Effect of power-assisted hand-rim wheelchair propulsion on shoulder load in experienced wheelchair users: A pilot study with an instrumented wheelchair.

    PubMed

    Kloosterman, Marieke G M; Buurke, Jaap H; de Vries, Wiebe; Van der Woude, Lucas H V; Rietman, Johan S

    2015-10-01

    This study aims to compare hand-rim and power-assisted hand-rim propulsion on potential risk factors for shoulder overuse injuries: intensity and repetition of shoulder loading and force generation in the extremes of shoulder motion. Eleven experienced hand-rim wheelchair users propelled an instrumented wheelchair on a treadmill while upper-extremity kinematic, kinetic and surface electromyographical data was collected during propulsion with and without power-assist. As a result during power-assisted propulsion the peak resultant force exerted at the hand-rim decreased and was performed with significantly less abduction and internal rotation at the shoulder. At shoulder level the anterior directed force and internal rotation and flexion moments decreased significantly. In addition, posterior and the minimal inferior directed forces and the external rotation moment significantly increased. The stroke angle decreased significantly, as did maximum shoulder flexion, extension, abduction and internal rotation. Stroke-frequency significantly increased. Muscle activation in the anterior deltoid and pectoralis major also decreased significantly. In conclusion, compared to hand-rim propulsion power-assisted propulsion seems effective in reducing potential risk factors of overuse injuries with the highest gain on decreased range of motion of the shoulder joint, lower peak propulsion force on the rim and reduced muscle activity.

  11. [Tendon ruptures of the shoulder].

    PubMed

    Habermeyer, P

    1989-08-01

    Common sports, involving raising the arms above the head, i.e., throwing, racquet games and swimming, often result in rotator cuff tendinitis. During the throwing motion, the humeral head and its overlying biceps tendon and rotator cuff must pass rapidly under the coraco-acromial arch. Damage to these structures can occur by several mechanism. First, an increase in the size of the structures passing underneath the arch may lead to impingement. This can occur either by way of hypertrophy of the musculotendinous cuff or by way of inflammation of the cuff. Second, a decreased space available underneath the arch secondary to osteophyte formation of the acromion and fibrosis of the subacromial space may lead to impingement. Third, weakness or incompetence of the rotator cuff allows the humerus to ride up and impinge on the coracoacromial arch with motion of the shoulder. Tendinitis can be combined with increased laxity of the glenohumeral joint and/or acquired instability due to a labral tear. Prevention of overuse injuries is a cornerstone of our treatment concept. The muscle tendon unit requires passive and neuromuscular facilitated streching after warming-up exercises. Muscular imbalance and weakness are prevented by balanced eccentric strenthening with particular attention to the external rotators and scapular muscles. Knowledge of the mechanics of the pitching motion, tennis serve, swimming stroke, etc. is of paramount importance in the prevention of injuries. As the onset of shoulder problems contributes to a particularly fatiguing situation, extreme fatique performance severity should be avoided. Every effort must be made to apply conservative treatment when overuse problems arise in the athlete's shoulder.(ABSTRACT TRUNCATED AT 250 WORDS)

  12. 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.

  13. Factors predisposing to dislocation of the Thompson hemiarthroplasty: 22 dislocations in 338 patients.

    PubMed

    Pajarinen, Jarkko; Savolainen, Vesa; Tulikoura, Ilkka; Lindahl, Jan; Hirvensalo, Eero

    2003-02-01

    In a series of 338 patients, we have retrospectively analyzed technical and anatomical factors, which may predispose to a dislocation of the Thompson hemiprosthesis. 22 patients (7%) had at least 1 dislocation during the 6-month follow-up. The most significant independent factor predisposing to dislocation was the use of a posterior approach (dislocation rate 16%). We examined the radiographs and data on operations in the 22 patients, using 79 random patients without dislocation as controls. Factors correlating with an increase in the incidence of dislocation were the length of the residual femoral neck > 0.5 cm in short patients (< 165 cm), and considerable change in the postoperative offset of the hip. Acetabular measurements showed no correlation to the dislocation. Our findings suggest that the main factors predicting dislocation are technical and not related to anatomical measurements.

  14. Massively-Parallel Dislocation Dynamics Simulations

    SciTech Connect

    Cai, W; Bulatov, V V; Pierce, T G; Hiratani, M; Rhee, M; Bartelt, M; Tang, M

    2003-06-18

    Prediction of the plastic strength of single crystals based on the collective dynamics of dislocations has been a challenge for computational materials science for a number of years. The difficulty lies in the inability of the existing dislocation dynamics (DD) codes to handle a sufficiently large number of dislocation lines, in order to be statistically representative and to reproduce experimentally observed microstructures. A new massively-parallel DD code is developed that is capable of modeling million-dislocation systems by employing thousands of processors. We discuss the general aspects of this code that make such large scale simulations possible, as well as a few initial simulation results.

  15. Enabling Strain Hardening Simulations with Dislocation Dynamics

    SciTech Connect

    Arsenlis, A; Cai, W

    2006-12-20

    Numerical algorithms for discrete dislocation dynamics simulations are investigated for the purpose of enabling strain hardening simulations of single crystals on massively parallel computers. The algorithms investigated include the /(N) calculation of forces, the equations of motion, time integration, adaptive mesh refinement, the treatment of dislocation core reactions, and the dynamic distribution of work on parallel computers. A simulation integrating all of these algorithmic elements using the Parallel Dislocation Simulator (ParaDiS) code is performed to understand their behavior in concert, and evaluate the overall numerical performance of dislocation dynamics simulations and their ability to accumulate percents of plastic strain.

  16. Elbow dislocation with ipsilateral distal radius fracture

    PubMed Central

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-01-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer. PMID:24082758

  17. Elbow dislocation with ipsilateral distal radius fracture.

    PubMed

    Meena, Sanjay; Trikha, Vivek; Kumar, Rakesh; Saini, Pramod; Sambharia, Abhishek Kumar

    2013-07-01

    Elbow dislocation associated with ipsilateral distal radius fracture is a rare pattern of injury, although it is common for elbow dislocation and forearm fractures to occur separately. We report a rare case of a 20-year-old male who had a posterior elbow dislocation and ipsilateral distal radius fracture. Elbow dislocation was first reduced in extension and distal radius fracture was then reduced in flexion. Both the injuries were conservatively managed. At 6 months follow-up, the patient had no pain in his elbow and minimal pain in his wrist on heavy lifting and had resumed his work as a laborer.

  18. Microdiffraction Analysis of Hierarchical Dislocation Organization

    SciTech Connect

    Barabash, R.I.; Ice, G.E.

    2007-12-19

    This article describes how x-ray microdiffraction is influenced by the number, kind, and organization of dislocations. Particular attention is placed on micro-Laue diffraction, where polychromatic x-rays are diffracted into characteristic Laue patterns that are sensitive to the dislocation content and arrangement. Diffraction is considered for various stages of plastic deformation. For early stages of plastic deformation with random dislocation spacing, the intensity in reciprocal space is redistributed about Laue spots with a length scale proportional to the number of dislocations within the sample volume and with a characteristic shape that depends on the kinds of dislocations and the momentum transfer vector. Unpaired dislocations that contribute to lattice rotations cause the largest redistribution of scattered intensity. In later stages of plastic deformation, strong interactions between individual dislocations cause them to organize into correlated arrangements. Here again, xray diffraction Laue spots are broadened in proportion to the number of excess (unpaired) dislocations inside the wall and to the total number of unpaired walls, but the broadening can be discontinuous. With microdiffraction it is possible to quantitatively test models of dislocation organization.

  19. Congenital dislocation of the patella - clinical case.

    PubMed

    Miguel Sá, Pedro; Raposo, Filipa; Santos Carvalho, Manuel; Alegrete, Nuno; Coutinho, Jorge; Costa, Gilberto

    2016-01-01

    Congenital patellar dislocation is a rare condition in which the patella is permanently dislocated and cannot be reduced manually. The patella develops normally as a sesamoid bone of the femur. This congenital dislocation results from failure of the internal rotation of the myotome that forms the femur, quadriceps muscle and extensor apparatus. It usually manifests immediately after birth, although in some rare cases, the diagnosis may be delayed until adolescence or adulthood. Early diagnosis is important, thereby allowing surgical correction and avoiding late sequelae, including early degenerative changes in the knee. A case of permanent dislocation of the patella is presented here, in a female child aged seven years.

  20. 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...

  1. Return to sports after shoulder arthroplasty.

    PubMed

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-09-18

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication.

  2. Return to sports after shoulder arthroplasty

    PubMed Central

    Johnson, Christine C; Johnson, Daniel J; Liu, Joseph N; Dines, Joshua S; Dines, David M; Gulotta, Lawrence V; Garcia, Grant H

    2016-01-01

    Many patients prioritize the ability to return to sports following shoulder replacement surgeries, including total shoulder arthroplasty (TSA), reverse total shoulder arthroplasty (RTSA), and hemiarthroplasty (HA). While activity levels after hip and knee replacements have been well-established in the literature, studies on this topic in the field of shoulder arthroplasty are relatively limited. A review of the literature regarding athletic activity after shoulder arthroplasty was performed using the PubMed database. All studies relevant to shoulder arthroplasty and return to sport were included. The majority of patients returned to their prior level of activity within six months following TSA, RTSA, and shoulder HA. Noncontact, low demand activities are permitted by most surgeons postoperatively and generally have higher return rates than contact sports or high-demand activities. In some series, patients reported an improvement in their ability to participate in sports following the arthroplasty procedure. The rates of return to sports following TSA (75%-100%) are slightly higher than those reported for HA (67%-76%) and RTSA (75%-85%). Patients undergoing TSA, RTSA, and shoulder HA should be counseled that there is a high probability that they will be able to return to their preoperative activity level within six months postoperatively. TSA has been associated with higher rates of return to sports than RTSA and HA, although this may reflect differences in patient population or surgical indication. PMID:27672564

  3. Musculotendinous infraspinatus rupture and shoulder weakness.

    PubMed

    Lipford, Melissa C; Bond, Jeffrey R; Steinmann, Scott P; Kumar, Neeraj

    2011-12-01

    We report a patient with bilateral simultaneous onset of weakness of shoulder lateral rotation due to musculotendinous infraspinatus rupture that occurred after shoulder steroid injections. Disruption of the musculotendinous junction of the infraspinatus is a rare recently described entity. Electromyography is normal, and magnetic resonance image findings are characteristic.

  4. Irreducible dislocation of the radial head with undisplaced olecranon fracture in a child: a case report.

    PubMed

    Takase, Katsumi; Mizuochi, Jun

    2011-09-01

    Irreducible isolated dislocation of the radial head is a rare injury. In this study, we describe a patient with irreducible dislocation of the radial head associated with an undisplaced fracture of the olecranon. A 6-year-old girl fell down while walking and suffered injury to the posterior aspect of the proximal ulnar shaft with the right elbow in a slightly flexed position. Plain radiographs of the elbow revealed an anterior-medial dislocation of the radial head and an undisplaced fracture of the olecranon. However, the attempted closed reduction was not successful. An open reduction was then performed through a lateral approach. The radial head was found to be protruding through a buttonhole tear of the anterior joint capsule, causing the joint to become interposed between the articular surfaces of the joint, precluding closed reduction. Once the interposed capsule was extricated from the joint, the radial head could be easily reduced. At this point, no tear of the annular ligament was observed. Six months after the surgery, the patient was able to use her elbow fully and without pain. The range of motion was 0-140° for both extension and flexion and 90° for pronation and supination. Plain radiographs revealed a united bone of the olecranon and good reduction of the radial head. The radial head pushed through the tear of the anterior joint capsule. This buttonhole effect on the radial head prevented closed reduction of the radial head.

  5. 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.

  6. The results of adductor magnus tenodesis in adolescents with recurrent patellar dislocation.

    PubMed

    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.

  7. Treatment of the Open Glenohumeral Joint with the Anterior Deltoid Muscle Flap

    PubMed Central

    Xipoleas, George D.; Woods, Daniel; Batac, Joseph; Addona, Tommaso

    2016-01-01

    Summary: Upper extremity reconstruction is most often encountered in trauma patients. Although the rate of complications from elective orthopedic procedures remains relatively low, these complications are oftentimes in the form of open joints or joint infections that can be devastating. Classically, wounds of the shoulder girdle have been treated with large muscles such as the pectoralis major, pectoralis minor, and latissimus dorsi. Flaps more local to the area including the deltoid muscle flap have been overlooked due to their small size. Despite its size, the anterior deltoid can be used for shoulder girdle reconstruction with minimal functional deficit and allows for reconstruction of the glenohumeral joint without sacrifice of the larger muscles of the upper trunk. This study reports a case of a chronic shoulder girdle wound and successful management with the use of an anterior deltoid muscle flap. PMID:27826470

  8. 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

  9. Failure of polymerized lactic acid tacks in shoulder surgery.

    PubMed

    Wilkerson, John P; Zvijac, John E; Uribe, John W; Schürhoff, Matthias R; Green, Jeremy B

    2003-01-01

    The purpose of this study was to evaluate 4 cases in which bioabsorbable polymerized lactic acid tacks failed after arthroscopic shoulder surgery. Four male elite athletes with recurrent shoulder pain were seen a mean of 7.5 months (range, 3-10 months) after initial arthroscopy. Three of the cases involved superior labrum anterior-to-posterior (SLAP) lesion stabilization, and the fourth case was a rotator cuff (RTC) repair. In the three labral repairs, the implant had broken and the unabsorbed fragments were visible with magnetic resonance imaging. The device used in the RTC repair showed no signs of absorption. All 4 patients underwent arthroscopic removal of the polymer tack fragments to alleviate their symptoms, 2 of whom had foreign-body reactions that required synovectomy. On the basis of clinical examination and magnetic resonance imaging, 2 of the SLAP lesions and the RTC tear had healed. The third patient with a SLAP lesion required arthroscopic debridement of a portion of the labrum. The intact RTC implant had backed out of its insertion point. In all 3 labral repairs, the polymerized lactic acid implant experienced a mechanical failure near the head-shaft junction. We theorize that the labral implants failed because of the variable rate of degradation along the shaft of the devices from the intraarticular to intraosseous regions.

  10. 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

  11. Dislocated interests and climate change

    NASA Astrophysics Data System (ADS)

    Davis, Steven J.; Diffenbaugh, Noah

    2016-06-01

    The predicted effects of climate change on surface temperatures are now emergent and quantifiable. The recent letter by Hansen and Sato (2016 Environ. Res. Lett. 11 034009) adds to a growing number of studies showing that warming over the past four decades has shifted the distribution of temperatures higher almost everywhere, with the largest relative effects on summer temperatures in developing regions such as Africa, South America, southeast Asia, and the Middle East (e.g., Diffenbaugh and Scherer 2011 Clim. Change 107 615-24 Anderson 2011 Clim. Change 108 581; Mahlstein et al 2012 Geophys. Res. Lett. 39 L21711). Hansen and Sato emphasize that although these regions are warming disproportionately, their role in causing climate change—measured by cumulative historical CO2 emissions produced—is small compared to the US and Europe, where the relative change in temperatures has been less. This spatial and temporal mismatch of climate change impacts and the burning of fossil fuels is a critical dislocation of interests that, as the authors note, has ‘substantial implications for global energy and climate policies.’ Here, we place Hansen and Sato’s ‘national responsibilities’ into a broader conceptual framework of problematically dislocated interests, and briefly discuss the related challenges for global climate mitigation efforts.

  12. Palmar dislocation of scaphoid and lunate.

    PubMed

    Idrissi, Khalid Koulali; Galiua, Farid

    2011-09-28

    A palmar dislocation of scaphoid and lunate is uncommon. We have found only 19 reported cases in the literature. We reported a simultaneous, divergent dislocation. The closed reduction followed by percutaneous pinning has given a good result without avascular necrosis of any carpal bone.

  13. Statistics of dislocation pinning at localized obstacles

    SciTech Connect

    Dutta, A.; Bhattacharya, M. Barat, P.

    2014-10-14

    Pinning of dislocations at nanosized obstacles like precipitates, voids, and bubbles is a crucial mechanism in the context of phenomena like hardening and creep. The interaction between such an obstacle and a dislocation is often studied at fundamental level by means of analytical tools, atomistic simulations, and finite element methods. Nevertheless, the information extracted from such studies cannot be utilized to its maximum extent on account of insufficient information about the underlying statistics of this process comprising a large number of dislocations and obstacles in a system. Here, we propose a new statistical approach, where the statistics of pinning of dislocations by idealized spherical obstacles is explored by taking into account the generalized size-distribution of the obstacles along with the dislocation density within a three-dimensional framework. Starting with a minimal set of material parameters, the framework employs the method of geometrical statistics with a few simple assumptions compatible with the real physical scenario. The application of this approach, in combination with the knowledge of fundamental dislocation-obstacle interactions, has successfully been demonstrated for dislocation pinning at nanovoids in neutron irradiated type 316-stainless steel in regard to the non-conservative motion of dislocations. An interesting phenomenon of transition from rare pinning to multiple pinning regimes with increasing irradiation temperature is revealed.

  14. Fast Fourier transform discrete dislocation dynamics

    NASA Astrophysics Data System (ADS)

    Graham, J. T.; Rollett, A. D.; LeSar, R.

    2016-12-01

    Discrete dislocation dynamics simulations have been generally limited to modeling systems described by isotropic elasticity. Effects of anisotropy on dislocation interactions, which can be quite large, have generally been ignored because of the computational expense involved when including anisotropic elasticity. We present a different formalism of dislocation dynamics in which the dislocations are represented by the deformation tensor, which is a direct measure of the slip in the lattice caused by the dislocations and can be considered as an eigenstrain. The stresses arising from the dislocations are calculated with a fast Fourier transform (FFT) method, from which the forces are determined and the equations of motion are solved. Use of the FFTs means that the stress field is only available at the grid points, which requires some adjustments/regularizations to be made to the representation of the dislocations and the calculation of the force on individual segments, as is discussed hereinafter. A notable advantage of this approach is that there is no computational penalty for including anisotropic elasticity. We review the method and apply it in a simple dislocation dynamics calculation.

  15. Dislocation generation during early stage sintering.

    NASA Technical Reports Server (NTRS)

    Sheehan, J. E.; Lenel, F. V.; Ansell, G. S.

    1973-01-01

    Discussion of the effects of capillarity-induced stresses on dislocations during early stage sintering. A special version of Hirth's (1963) theoretical calculation procedures modified to describe dislocation nucleation on planes meeting the sintering body's neck surface obliquely is shown to predict plastic flow at stress levels know to exist between micron size metal particles in the early stages of sintering.

  16. 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.

  17. Characterization of Geometrically Necessary Dislocation Content with EBSD-Based Continuum Dislocation Microscopy

    NASA Astrophysics Data System (ADS)

    Ruggles, Timothy J.

    Modeling of plasticity is often hampered by the difficulty in accurately characterizing dislocation density on the microscale for real samples. It is particularly difficult to resolve measured dislocation content onto individual dislocation systems at the length scales most commonly of interest in plasticity studies. Traditionally, dislocation content is analyzed at the continuum level using the Nye tensor and the fundamental relation of continuum dislocation theory to interpret information measured by diffraction techniques, typically EBSD or High Resolution EBSD. In this work the established Nye-Kroner method for resolving measured geometrically necessary dislocation content onto individual slip systems is assessed and extended. Two new methods are also presented to relieve the ambiguity of the Nye-Kroner method. One of these methods uses modified classical dislocation equations to bypass the Nye-Kroner relation, and the other estimates the bulk dislocation density via the entry-wise one-norm of the Nye tensor. These methods are validated via a novel simulation of distortion fields around continuum fields of dislocation density based on classical lattice mechanics and then applied to actual HR-EBSD scans of a micro-indented single crystals of nickel and tantalum. Finally, a detailed analysis of the effect of the spacing between points in an EBSD scan (which is related to the step size of the numerical derivatives used in EBSD dislocation microscopy) on geometrically necessary dislocation measurements is conducted.

  18. Glide dislocation nucleation from dislocation nodes at semi-coherent {111} Cu–Ni interfaces

    SciTech Connect

    Shao, Shuai; Wang, Jian; Beyerlein, Irene J.; Misra, Amit

    2015-07-23

    Using atomistic simulations and dislocation theory on a model system of semi-coherent {1 1 1} interfaces, we show that misfit dislocation nodes adopt multiple atomic arrangements corresponding to the creation and redistribution of excess volume at the nodes. We identified four distinctive node structures: volume-smeared nodes with (i) spiral or (ii) straight dislocation patterns, and volume-condensed nodes with (iii) triangular or (iv) hexagonal dislocation patterns. Volume-smeared nodes contain interfacial dislocations lying in the Cu–Ni interface but volume-condensed nodes contain two sets of interfacial dislocations in the two adjacent interfaces and jogs across the atomic layer between the two adjacent interfaces. Finally, under biaxial tension/compression applied parallel to the interface, we show that the nucleation of lattice dislocations is preferred at the nodes and is correlated with the reduction of excess volume at the nodes.

  19. Glide dislocation nucleation from dislocation nodes at semi-coherent {111} Cu–Ni interfaces

    DOE PAGES

    Shao, Shuai; Wang, Jian; Beyerlein, Irene J.; ...

    2015-07-23

    Using atomistic simulations and dislocation theory on a model system of semi-coherent {1 1 1} interfaces, we show that misfit dislocation nodes adopt multiple atomic arrangements corresponding to the creation and redistribution of excess volume at the nodes. We identified four distinctive node structures: volume-smeared nodes with (i) spiral or (ii) straight dislocation patterns, and volume-condensed nodes with (iii) triangular or (iv) hexagonal dislocation patterns. Volume-smeared nodes contain interfacial dislocations lying in the Cu–Ni interface but volume-condensed nodes contain two sets of interfacial dislocations in the two adjacent interfaces and jogs across the atomic layer between the two adjacent interfaces.more » Finally, under biaxial tension/compression applied parallel to the interface, we show that the nucleation of lattice dislocations is preferred at the nodes and is correlated with the reduction of excess volume at the nodes.« less

  20. Dislocation core radii near elastic stability limits

    NASA Astrophysics Data System (ADS)

    Sawyer, C. A.; Morris, J. W., Jr.; Chrzan, D. C.

    2013-04-01

    Recent studies of transition metal alloys with compositions that place them near their limits of elastic stability [e.g., near the body-centered-cubic (BCC) to hexagonal-close-packed (HCP) transition] suggest interesting behavior for the dislocation cores. Specifically, the dislocation core size is predicted to diverge as the stability limit is approached. Here a simple analysis rooted in elasticity theory and the computation of ideal strength is used to analyze this divergence. This analysis indicates that dislocation core radii should diverge as the elastic limits of stability are approached in the BCC, HCP, and face-centered-cubic (FCC) structures. Moreover, external stresses and dislocation-induced stresses also increase the core radii. Density functional theory based total-energy calculations are combined with anisotropic elasticity theory to compute numerical estimates of dislocation core radii.

  1. Acute traumatic posterior elbow dislocation in children.

    PubMed

    Lieber, Justus; Zundel, Sabine M; Luithle, Tobias; Fuchs, Jörg; Kirschner, Hans-Joachim

    2012-09-01

    Traumatic posterior dislocation of the elbow is often associated with significant morbidity and incomplete recovery. The aim of this study was to retrospectively analyse the outcome of 33 children (median age 10.8 years). Patients underwent reduction and assessment of stability under general anaesthesia. Pure dislocations (n=10) were immobilized, whereas unstable fractures (n=23) were stabilized. Refixation of ligaments was performed if stability was not achieved by fracture stabilization alone. Immobilization was continued for 26 (pure dislocations) or 35 days (associated injuries), respectively. Results were excellent (n=9) or good (n=1) after pure dislocation. Results were excellent (n=15), good (n=7) or poor (n=1) in children with associated injuries. Accurate diagnosis, concentric stable reduction of the elbow as well as stable osteosynthesis of displaced fractures are associated with good results in children with acute posterior elbow dislocations.

  2. Bipolar dislocation of the forearm (floating forearm).

    PubMed

    Aşkar, Hüseyin; Ertürk, Cemil; Altay, Mehmet Akif; Akif Altay, Mehmet; Bilge, Ali

    2014-01-01

    Bipolar dislocation of the forearm (floating forearm) is an unusual injury and is therefore often overlooked. We report a 28-year-old male patient who presented at another center with a history of a fall while climbing a tree. The patient's left elbow was treated with closed reduction and immobilization with a long-arm cast brace due to elbow dislocation. However, the patient was admitted with pain and swelling of the wrist to our emergency department the following day. Physical and radiological examination revealed dorsal trans-scaphoid perilunate dislocation. A dorsal incision was performed for open reduction and internal fixation to provide wide surgical exposure. Concomitant occurrence of elbow dislocation and fracture-dislocation of the perilunate is infrequent. Therefore, physicians should be aware of possible additional injuries and current recommended treatment methods.

  3. Internal stresses, dislocation mobility and ductility

    NASA Astrophysics Data System (ADS)

    Saada, G.

    1991-06-01

    The description of plastic deformation must take into account individual mechanisms and heterogeneity of plastic strain. Influence of dislocation interaction with forest dislocations and of cross slip are connected with the organization of dipole walls. The latter are described and their development is explained as a consequence of edge effects. Applications are discussed. La description de la déformation plastique doit prendre en compte les interactions individuelles des dislocations et l'hétérogénéité à grande échelle de la déformation plastique. Les interactions des dislocations mobiles avec la forêt de dislocations, le glissement dévié, ont pour effet la création de parois dipolaires. Celles-ci sont décrites et leur développement est appliqué à partir des effets de bord.

  4. Propionibacterium acnes infection after shoulder surgery

    PubMed Central

    Kadler, Benjamin K.; Mehta, Saurabh S.; Funk, Lennard

    2015-01-01

    Propionibacterium acnes has been implicated as a cause of infection following shoulder surgery, may occur up to 2 years after the index operation and has been shown to be responsible for up to 56% of shoulder infections after orthopedic implant. Male patients within the population undergoing shoulder surgery are particularly at risk, especially if their shoulder surgery involved prosthesis or was posttraumatic. P. acnes infection can be difficult to diagnose clinically and laboratory techniques require prolonged and specialized cultures. Usual inflammatory markers are not raised in infection with this low virulence organism. Delayed diagnosis with P. acnes infection can result in significant morbidity prior to prosthesis failure. Early diagnosis of P. acnes infection and appropriate treatment can improve clinical outcomes. It is important to be aware of P. acnes infection in shoulder surgery, to evaluate risk factors, to recognize the signs of P. acnes infection, and to promptly initiate treatment. The signs and symptoms of P. acnes infection are described and discussed. Data were collected from PubMed™, Web of Science, and the NICE Evidence Healthcare Databases - AMED (Ovid), BNI (Ovid), CINAHL (EBSCO), Embase (Ovid), HMIC: DH-Data and Kings Fund (Ovid), Medline (Ovid), and PsycINFO (Ovid). The search terms used were “P. acnes,” “infection,” “shoulder,” and “surgery.” In this review, we summarize the current understanding of the prevention and management of P. acnes infection following shoulder surgery. PMID:26622132

  5. Evolution of the reverse total shoulder prosthesis.

    PubMed

    Jazayeri, Reza; Kwon, Young W

    2011-01-01

    Over the last decade, reverse total shoulder arthroplasty has gained significant popularity due to its ability to address difficult reconstructive shoulder problems that could not be adequately treated in the past. The concept of the reverse shoulder prosthesis was introduced in the 1970s, but the initial attempts were associated with high complication and implant failure rates. The pioneering work of Paul Grammont (shifting the center of rotation medially and distally) and the development of the DELTA prosthesis have been fundamental to all subsequent reverse shoulder arthroplasty systems. These semiconstrained prostheses utilize the deltoid to improve function and stability of the shoulder joint by coupling a convex glenoid with a concave humeral component. Modern generations of reverse shoulder prosthesis continue to evolve on the fundamentals of Grammont. Though results of these new prosthesis demonstrate promising outcomes, many controversies and challenges continue to be refined. An historical review of the evolution of reverse shoulder arthroplasty is presented, as well as the currently expanding indications for its application.

  6. Rheumatoid shoulder assessed by ultrasonography: prevalence of abnormalities and associated factors

    PubMed Central

    Elbinoune, Imane; Amine, Bouchra; Wabi, Moudjibou; Rkain, Hanan; Aktaou, Souad; Hajjaj-Hassouni, Najia

    2016-01-01

    Introduction The shoulder involvement in rheumatoid arthritis (RA) is common. It can be subclinical and compromise the function of the upper limb. Musculoskeletal ultrasonography can detect subclinical abnormalities in rheumatoid shoulder. Our aim was to assess the prevalence of ultrasound abnormalities in rheumatoid shoulder, and investigate their association with different parameters. Methods Cross-sectional study including 37 patients with RA, meeting the ACR/EULAR 2010 classification criteria, who were enrolled during a month. A questionnaire with sociodemographic, clinical and laboratory data was filled in for all patients. Ultrasound evaluation was performed by a single experienced operator. For each patient, both of shoulders were evaluated. Results Mean age was 50 years with female predominance. Median disease duration of RA was 7.5 years. All patients had a seropositive form of RA. Mean clinical DAS28 was 5.1. Mean HAQ was 1.2. Thirty-one (83.8%) patients had involvement of the shoulder: unilateral in 9(24.3%) cases and bilateral in 22(59.5%) cases. Synovitis was found in 16(43.2%) patients with Doppler in 4 (10.8%) cases. Sub-acromial bursitis was noted in 14 (37.8%) cases and the effusion in 20 (54.1%). Synovitis was noted especially in elderly individuals (p: 0.01). The Doppler was visualized in elderly patients (p: 0.01), with a shorter disease duration (p: 0.02) and with a high SDAI (p: 0.006). US inflammatory findings in anterior recess of glenohumeral joint were linked to a higher synovial index (p: 0.03) and a higher level of rheumatoid factor (p: 0.01). Conclusion 59.5% of our RA patients had bilateral involvement of the shoulder which was related to the disease activity. Ultrasound should be a systematic tool to look for the involvement of this joint in RA patients. PMID:27800090

  7. 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.

  8. [Analysis of clinical symptoms in shoulder arthropathy].

    PubMed

    Fabiś, J; Zwierzchowski, H

    1996-01-01

    Frequency of chosen clinical symptoms has been analyzed in 236 patients aged 10 to 80 years with shoulder pathology. It was found that "impingement syndrome" is characteristic for periarthritis humeroscapularis simplex. Active and passive movement restriction of the shoulder was frequently observed in periarthritis humeroscapularis simplex acuta; passive one greater than 50% was typical for capsulitis adhesiva. Crepitus at the movements, muscle wasting, impingement syndrome pain at the abduction and external rotation against resistance is indicative of periarthritis humeroscapularis destructive. Sonographic assessment of the shoulder is recommended in every case with the biceps long head rupture suspicion.

  9. [Comprehensive arthroscopic management of shoulder osteoarthritis].

    PubMed

    Ríos, D; Martetschlager, F; Millett, P J

    2012-01-01

    Shoulder osteoarthritis has been considered as a cause of severe pain and loss of shoulder function. Many patients with shoulder osteoarthritis are young and have demanding activities, which leads to questioning the choice of arthroplasty. This is why in this paper we describe the comprehensive arthroscopic management (CAM) that combines arthroscopic debridement, capsular release, osteoplasty of the lower humeral head, and auxiliary nerve decompression. In our experience this technique has shown short-term promising results as it decreases pain and allows patients to resume high performance demanding activities.

  10. 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.

  11. Ultrasonography of the canine shoulder joint and its pathological changes.

    PubMed

    Piórek, A; Adamiak, Z

    2010-01-01

    The objective of this study was to present and discuss the available data on canine shoulder joint ultrasonography. The paper presents the method of ultrasonographic examination of the shoulder joint area, describes the normal structure of the shoulder joint in dogs, and discusses the most frequently encountered shoulder joint pathologies.

  12. Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

    PubMed Central

    2009-01-01

    Introduction Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging. Case presentation We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve. Conclusion During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure. PMID:19830192

  13. 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

  14. Shoulder Arthroplasty: Key Steps to Improve Outcomes and Minimize Complications.

    PubMed

    Cheung, Emilie V; Diaz, Roberto; Athwal, George S; Sanchez-Sotelo, Joaquin; Sperling, John W

    2016-01-01

    Advances in shoulder replacement surgery have allowed for the successful treatment of various shoulder conditions. As the elderly population increases and the surgical indications for shoulder replacement surgery continue to expand, the number of shoulder replacements performed annually will continue to increase. Accordingly, the number of complications also will be expected to increase. Successful shoulder replacement outcomes require surgeons to have a thorough understanding of the surgical indications, surgical technique, and potential complications of the procedure. By reviewing the key aspects of shoulder replacement surgery and focusing on the surgical technique and common complications for both anatomic and reverse total shoulder arthroplasty, surgeons can help improve outcomes and minimize complications.

  15. Pectoralis major transfer for serratus anterior paralysis.

    PubMed

    Steinmann, Scott P; Wood, Michael B

    2003-01-01

    Serratus anterior paralysis can result in winging of the scapula and weakness of arm elevation. The etiology of the condition is injury to the long thoracic nerve. There are many proposed causes of long thoracic nerve injury including acute trauma, Parsonage-Turner syndrome, or viral illness. The long length of the long thoracic nerve makes it prone to compression injury along the chest wall. Most patients recover nerve function with conservative treatment. In those in whom nerve function fails to recover, surgical treatment involving pectoralis major transfer may be beneficial. In this study 9 patients underwent pectoralis major transfer with a fascia lata extension graft. The symptoms of most were improved, with correction of the winging and improved movement in the affected shoulder.

  16. 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

  17. Evolution, Interaction, and Intrinsic Properties of Dislocations in Intermetallics: Anisotropic 3D Dislocation Dynamics Approach

    SciTech Connect

    Chen, Qian

    2008-01-01

    The generation, motion, and interaction of dislocations play key roles during the plastic deformation process of crystalline solids. 3D Dislocation Dynamics has been employed as a mesoscale simulation algorithm to investigate the collective and cooperative behavior of dislocations. Most current research on 3D Dislocation Dynamics is based on the solutions available in the framework of classical isotropic elasticity. However, due to some degree of elastic anisotropy in almost all crystalline solids, it is very necessary to extend 3D Dislocation Dynamics into anisotropic elasticity. In this study, first, the details of efficient and accurate incorporation of the fully anisotropic elasticity into 3D discrete Dislocation Dynamics by numerically evaluating the derivatives of Green's functions are described. Then the intrinsic properties of perfect dislocations, including their stability, their core properties and disassociation characteristics, in newly discovered rare earth-based intermetallics and in conventional intermetallics are investigated, within the framework of fully anisotropic elasticity supplemented with the atomistic information obtained from the ab initio calculations. Moreover, the evolution and interaction of dislocations in these intermetallics as well as the role of solute segregation are presented by utilizing fully anisotropic 3D dislocation dynamics. The results from this work clearly indicate the role and the importance of elastic anisotropy on the evolution of dislocation microstructures, the overall ductility and the hardening behavior in these systems.

  18. Functional activities characteristics of shoulder complex movements: Exploration with a 3-D electromagnetic measurement system.

    PubMed

    Lin, Jiu-Jenq; Hanten, William P; Olson, Sharon L; Roddey, Toni S; Soto-Quijano, David A; Lim, Hyun K; Sherwood, Arthur M

    2005-01-01

    The high prevalence of shoulder-related dysfunction has focused increased attention on functional activity assessment. This study (1) tested the reliability of three-dimensional shoulder complex movements during four functional tasks representing different levels of task difficulty, (2) characterized the four functional tasks, and (3) examined the relationships between age and shoulder movements. Twenty-five asymptomatic subjects, all veterans aged 30-82, performed the four functional tasks. Good within-session reliability was found (movement pattern: similarity index = 0.81 to 0.97, peak values: intraclass correlation coefficients = 0.88 to 0.99). The raising arm to overhead height task (hard task) placed the greatest demand on scapular motions and humeral elevation (p < 0.005). During the functional tasks, significant correlations existed between age and scapular tipping, humeral elevation, and scapular upward rotation (r = -0.62 to 0.50, p < 0.05). Correlation results indicated that elderly subjects have a greater potential for serratus anterior muscle weakness and shoulder capsule tightness.

  19. The shoulder in baseball pitching: biomechanics and related injuries-part 1.

    PubMed

    Park, Samuel S; Loebenberg, Mark L; Rokito, Andrew S; Zuckerman, Joseph D

    The extreme range of motion at the shoulder, the high angular velocities and torques, and the repetitious nature of the pitching motion combine to make the shoulder vulnerable to injury during the baseball pitch. An understanding of the biomechanics that contribute to shoulder injuries during each phase of the pitching motion can facilitate the athlete's diagnosis, treatment, and rehabilitation. Common injuries that occur during the late cocking and acceleration phases of the pitch include anterior instability and impingement, bicipital tendinitis, and subacromial impingement. Nonoperative treatment consisting of an initial period of rest and NSAIDS, followed by physical therapy and a gradual return to activity, is usually successful. When this approach fails, surgical intervention, either arthroscopic or open, may be necessary. Physical therapy and rehabilitation are directed toward restoring the integrity and strength of the dynamic and static stabilizers of the shoulder joint, yet preserving the range of motion necessary for performance. Through rehabilitation, the dedicated athlete can often return to the pitching mound at his previous level of performance.

  20. Influence of shoulder pain on muscle function: implications for the assessment and therapy of shoulder disorders.

    PubMed

    Struyf, Filip; Lluch, Enrique; Falla, Deborah; Meeus, Mira; Noten, Suzie; Nijs, Jo

    2015-02-01

    Shoulder pain is often a challenging clinical phenomenon because of the potential mismatch between pathology and the perception of pain. Current evidence clearly emphasizes an incomplete understanding of the nature of shoulder pain. Indeed, the effective diagnosis and treatment of shoulder pain should not only rely upon a detailed knowledge of the peripheral pathologies that may be present in the shoulder, but also on current knowledge of pain neurophysiology. To assess and treat shoulder pain, a comprehensive understanding of the way in which pain is processed is essential. This review reflects modern pain neurophysiology to the shoulder and aims to answer the following questions: why does my shoulder hurt? What is the impact of shoulder pain on muscle function? What are the implications for the clinical examination of the shoulder? And finally, what are the clinical implications for therapy? Despite the increasing amount of research in this area, an in-depth understanding of the bidirectional nociception-motor interaction is still far from being achieved. Many questions remain, especially related to the treatment of nociception-motor interactions.

  1. Total reverse shoulder arthroplasty: European lessons and future trends.

    PubMed

    Seebauer, Ludwig

    2007-12-01

    In the late 1980s, Grammont introduced a new reverse total shoulder arthroplasty (TSA), with a hemisphere directly attached to the glenoid surface and with medial positioning of the center of rotation to overcome former shortcomings. Over the past few years, results from several mid- and long-term clinical studies of this new TSA have demonstrated that unexpectedly good functional outcomes and pain relief (Constant-Score, 60-69) could be achieved, even in patients with progressive superior migration, joint destruction, and rotator cuff deficiency. In all these studies, however, limited range of passive internal rotation and no improvement in active external rotation capacity were reported. In addition, glenoid erosion ("inferior glenoid notching") was reported in all these studies as a frequent phenomenon, occurring in 10% to 42%. The clinical impact of inferior notching is the subject of controversy, and its correlation with glenoid component loosening is not clear. In addition, rates of perioperative and postoperative complications (eg, dislocations, infections, hematomas, fractures) seem to be higher with this new TSA than with the conventional TSA. Improvements in prosthesis design and implantation technique (eg, easier and more reproducible surgical technique) should contribute to better range of motion, lower complication rates, and a lower frequency and lesser amount of inferior glenoid notching.

  2. On Dislocation Glide in Planetary Interiors

    NASA Astrophysics Data System (ADS)

    Cordier, P.; Carrez, P.; Gouriet, K.; Kraych, A.; Ritterbex, S.

    2015-12-01

    The dynamics of hot planets depends strongly on how heat is transported to their surfaces through large scale convection flows. This is ultimately controlled by the rheology of high-pressure phases under extreme conditions. Whenever solid rocks are concerned, plastic flow results from the propagation of crystal defects (point defects, dislocations, grain boundaries). In this presentation we focus on the role of pressure on dislocation glide which is usually the most efficient strain-producing mechanism. Dislocation glide is assessed through multiscale numerical modeling. First, dislocations are modeled at the atomic scale based on first-principles calculations to incorporate the influence of pressure. Then the mobility law of dislocation at finite temperature is modeled by describing thermally-activated mechanisms for dislocation glide based on the kink-pair model. Then the flow stress at the grain scale is deduced either from application of the Orowan equation or by dislocation dynamics modeling. This approach is applied to wadsleyite, ringwoodite, bridgmanite and post-perovskite. Mechanical properties are either calculated at laboratory strain-rates to be compared with experiments when available or at mantle strain-rate to assess their efficiency under natural conditions.

  3. Thermodynamic forces in single crystals with dislocations

    NASA Astrophysics Data System (ADS)

    Van Goethem, Nicolas

    2014-06-01

    A simple model for the evolution of macroscopic dislocation regions in a single crystal is presented. This model relies on maximal dissipation principle within Kröner's geometric description of the dislocated crystal. Mathematical methods and tools from shape optimization theory provide equilibrium relations at the dislocation front, similarly to previous work achieved on damage modelling (J Comput Phys 33(16):5010-5044, 2011). The deformation state variable is the incompatible strain as related to the dislocation density tensor by a relation involving the Ricci curvature of the crystal underlying elastic metric. The time evolution of the model variables follows from a novel interpretation of the Einstein-Hilbert flow in terms of dislocation microstructure energy. This flow is interpreted as the dissipation of non-conservative dislocations, due to the climb mechanism, modelled by an average effect of mesoscopic dislocations moving normal to their glide planes by adding or removing points defects. The model equations are a fourth-order tensor parabolic equation involving the operator "incompatibility," here appearing as a tensorial counterpart of the scalar Laplacian. This work encompasses and generalizes results previously announced (C R Acad Sci Paris Ser I 349:923-927, 2011), with in addition a series of physical interpretations to give a meaning to the newly introduced concepts.

  4. Rotator Cuff and Shoulder Conditioning Program

    MedlinePlus

    ... relieve shoulder pain and prevent further injury. Flexibility: Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury. Gently stretching after strengthening exercises can help reduce muscle soreness ...

  5. 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.

  6. Shoulder biomechanics: today's consensus and tomorrow's perspectives.

    PubMed

    Cutti, Andrea Giovanni; Veeger, H E J DirkJan

    2009-05-01

    Shoulder biomechanics is a fast growing field, which is progressively expanding its focus to include more applied research. The papers included in this Special Issue confirm this trend. After a classification of the papers as dealing with fundamental or applied research through theoretical or experimental methods, in this Editorial we tried to summarize the elements of consensus and the open issues discussed during the last International Shoulder Group meeting, held in Bologna (Italy) in 2008.

  7. Chronic acromioclavicular joint dislocations treated by the GraftRope device

    PubMed Central

    Nordin, Jonas S; Aagaard, Knut E; Lunsjö, Karl

    2015-01-01

    Background and purpose Surgical treatment of chronic acromioclavicular joint dislocations is challenging, and no single procedure can be considered to be the gold standard. In 2010, the GraftRope method (Arthrex Inc., Naples, FL) was introduced in a case series of 10 patients, showing good clinical results and no complications. We wanted to evaluate the GraftRope method in a prospective consecutive series. Patients and methods 8 patients with chronic Rockwood type III–V acromioclavicular joint dislocations were treated surgically using the GraftRope method. The patients were clinically evaluated and a CT scan was performed to assess the integrity of the repair. Results and interpretation In 4 of the 8 patients, loss of reduction was seen within the first 6 weeks postoperatively. A coracoid fracture was the reason in 3 cases and graft failure was the reason in 1 case. In 3 of the 4 patients with intact repairs, the results were excellent with no subjective shoulder disability 12 months postoperatively. It was our intention to include 30 patients in this prospective treatment series, but due to the high rate of complications the study was discontinued prematurely. Based on our results and other recent reports, we cannot recommend the GraftRope method as a treatment option for chronic acromioclavicular joint dislocations. PMID:25323800

  8. Dislocation of the Elbow: A Retrospective Multicentre Study of 86 Patients

    PubMed Central

    de Haan, Jeroen; Schep, Niels W.L; Zengerink, Imme; van Buijtenen, Jesse; Tuinebreijer, Wim E; den Hartog, Dennis

    2010-01-01

    The objective of this retrospective multicentre cohort study was to prospectively assess the long-term functional outcomes of simple and complex elbow dislocations. We analysed the hospital and outpatient records of 86 patients between 01.03.1999 and 25.02.2009 with an elbow dislocation. After a mean follow-up of 3.3 years, all patients were re-examined at the outpatient clinic for measurement of different outcomes. The mean range of motion was ROM 135.5°. The Mayo elbow performance index (MEPI) scored an average of 91.9 (87.5% of the patients were rated excellent or good). The average Quick disabilities of the arm, shoulder and hand (Quick- DASH) score was 9.7, the sports/music score 11.5 and work score 6.1. The Oxford function score was 75.7, Oxford pain score 75.2 and Oxford social-psychological score 73.9. Elbow dislocation is a mild disease and generally, the outcome is excellent. Functional results might improve with early active movements. PMID:20352027

  9. Distribution of distances between dislocations in different types of dislocation substructures in deformed Cu-Al alloys

    SciTech Connect

    Trishkina, L. Zboykova, N.; Koneva, N. Kozlov, E.; Cherkasova, T.

    2016-01-15

    The aim of the investigation was the determination of the statistic description of dislocation distribution in each dislocation substructures component forming after different deformation degrees in the Cu-Al alloys. The dislocation structures were investigated by the transmission diffraction electron microscopy method. In the work the statistic description of distance distribution between the dislocations, dislocation barriers and dislocation tangles in the deformed Cu-Al alloys with different concentration of Al and test temperature at the grain size of 100 µm was carried out. It was established that the above parameters influence the dislocation distribution in different types of the dislocation substructures (DSS): dislocation chaos, dislocation networks without disorientation, nondisoriented and disoriented cells, in the walls and inside the cells. The distributions of the distances between dislocations in the investigated alloys for each DSS type formed at certain deformation degrees and various test temperatures were plotted.

  10. [Posterior dislocation of the sternoclavicular joint].

    PubMed

    Mäkinen, Tatu; Madanat, Rami; Heinänen, Mikko; Brinck, Tuomas; Pajarinen, Jarkko

    2013-01-01

    Posterior dislocation of the sternoclavicular joint is a rare injury. It can be associated with life-threatening complications. Computed tomography is the imaging modality of choice with which possible associated injuries can be detected. Acute injuries are managed with closed reduction under general anaesthesia. A fracture-dislocation is inherently more unstable than an isolated dislocation. Surgical treatment is advocated in cases of delayed diagnosis or failed closed reduction. With early diagnosis and treatment, the long-term outcome of this injury is good.

  11. [Conservative treatment of congenital patellar dislocation].

    PubMed

    Zajonz, D; Schumann, E; Wojan, M; Moche, M; Heyde, C-E

    2017-02-01

    This article presents the rare case of a boy who was born in our hospital with valgus deformity and external rotation of the right lower leg because of congenital patellar dislocation. In the case presented a stable repositioning of the patella could be achieved by redressment with a plaster cast and leg brace. During a 4-year follow-up there were no tendencies towards dislocation during the clinical examination and no dislocation events were documented. In selected cases an attempt at conservative repositioning and retention treatment appears to be worthwhile before surgical treatment is indicated.

  12. Intrauterine Temporomandibular Joint Dislocation: Prenatal Sonographic Evaluation

    PubMed Central

    Çil, Ahmet Said; Bozkurt, Murat; Bozkurt, Duygu Kara

    2014-01-01

    Congenital temporomandibular joint (TMJ) diseases are very rare disorders and are usually diagnosed in childhood. Developmental disorders of the TMJ such as hypoplasia, hyperplasia, and aplasia of the TMJ compartments are characterized by TMJ dysfunction. In childhood, these patients experience recurrent dislocation, pain, and malocclusion. We present the case of a 25-week fetus with unilateral TMJ dislocation with fluid retention in the joint diagnosed by ultrasonography. To the best of our knowledge, this is the first case of TMJ dislocation diagnosed by ultrasonographic evaluation during the prenatal period. PMID:23669613

  13. Surgical Treatment for Subaxial Cervical Facet Dislocations with Incomplete or without Neurological Deficit: A Prospective Study of 52 Cases.

    PubMed

    Jiang, Xingjie; Yao, Yu; Yu, Mingchen; Cao, Yong; Yang, Huilin

    2017-02-09

    BACKGROUND This study aimed to treat patients with subaxial cervical facet dislocations with incomplete or without neurological deficit by a prospectively designed surgical protocol and observe the short-term clinical outcomes. MATERIAL AND METHODS Fifty-two consecutive subaxial cervical dislocation patients with incomplete or without neurological deficit were enrolled. The surgical strategy was determined based on whether or not the initial anterior closed reduction was successful and whether or not the patients were simultaneously combined with traumatic disc herniation (TDH). Postoperative radiographs were used to assess the reduction and fusion, and kyphosis and lordosis of cervical spines were calculated. The neck pain was assessed by visual analog scale. Body function and neurologic status was evaluated according to the Neck Disability Index and classification of American Spinal Injury Association. Clinical and radiologic outcomes were compared before and after the surgery and during the follow-up. The average follow-up period was 23 months. RESULTS Five patients with TDH and 17 with non-TDH were successfully treated by a single anterior approach, 22 non-TDH patients by a posterior-anterior approach, and another eight TDH patients by an anterior-posterior-anterior approach. No neurologic deterioration or other severe adverse events occurred postoperatively. The kyphosis angle of the dislocated levels was well restored after surgery, and the neck pain was significantly relieved as well. The neurologic status was obviously improved, and bony fusion was obtained in all patients within one-year follow-up. CONCLUSIONS Our prospectively designed surgical strategy is effective for the treatment of patients with subaxial cervical dislocation with incomplete or without neurological deficit.

  14. Surgical Treatment for Subaxial Cervical Facet Dislocations with Incomplete or without Neurological Deficit: A Prospective Study of 52 Cases

    PubMed Central

    Jiang, Xingjie; Yao, Yu; Yu, Mingchen; Cao, Yong; Yang, Huilin

    2017-01-01

    Background This study aimed to treat patients with subaxial cervical facet dislocations with incomplete or without neurological deficit by a prospectively designed surgical protocol and observe the short-term clinical outcomes. Material/Methods Fifty-two consecutive subaxial cervical dislocation patients with incomplete or without neurological deficit were enrolled. The surgical strategy was determined based on whether or not the initial anterior closed reduction was successful and whether or not the patients were simultaneously combined with traumatic disc herniation (TDH). Postoperative radiographs were used to assess the reduction and fusion, and kyphosis and lordosis of cervical spines were calculated. The neck pain was assessed by visual analog scale. Body function and neurologic status was evaluated according to the Neck Disability Index and classification of American Spinal Injury Association. Clinical and radiologic outcomes were compared before and after the surgery and during the follow-up. The average follow-up period was 23 months. Results Five patients with TDH and 17 with non-TDH were successfully treated by a single anterior approach, 22 non-TDH patients by a posterior-anterior approach, and another eight TDH patients by an anterior-posterior-anterior approach. No neurologic deterioration or other severe adverse events occurred postoperatively. The kyphosis angle of the dislocated levels was well restored after surgery, and the neck pain was significantly relieved as well. The neurologic status was obviously improved, and bony fusion was obtained in all patients within one-year follow-up. Conclusions Our prospectively designed surgical strategy is effective for the treatment of patients with subaxial cervical dislocation with incomplete or without neurological deficit. PMID:28182597

  15. Anterior Cruciate Ligament (ACL) Injuries

    MedlinePlus

    ... Week of Healthy Breakfasts Shyness Anterior Cruciate Ligament (ACL) Injuries KidsHealth > For Teens > Anterior Cruciate Ligament (ACL) ... and Recovery Coping With an ACL Injury About ACL Injuries A torn anterior cruciate ligament (ACL) is ...

  16. "Conjugate channeling" effect in dislocation core diffusion: carbon transport in dislocated BCC iron.

    PubMed

    Ishii, Akio; Li, Ju; Ogata, Shigenobu

    2013-01-01

    Dislocation pipe diffusion seems to be a well-established phenomenon. Here we demonstrate an unexpected effect, that the migration of interstitials such as carbon in iron may be accelerated not in the dislocation line direction ξ, but in a conjugate diffusion direction. This accelerated random walk arises from a simple crystallographic channeling effect. c is a function of the Burgers vector b, but not ξ, thus a dislocation loop possesses the same everywhere. Using molecular dynamics and accelerated dynamics simulations, we further show that such dislocation-core-coupled carbon diffusion in iron has temperature-dependent activation enthalpy like a fragile glass. The 71° mixed dislocation is the only case in which we see straightforward pipe diffusion that does not depend on dislocation mobility.

  17. Traumatic bilateral knee dislocations, unilateral hip dislocation, and contralateral humeral amputation: a case report.

    PubMed

    Voos, James E; Heyworth, Benton E; Piasecki, Dana P; Henn, R Frank; MacGillivray, John D

    2009-02-01

    Bilateral traumatic knee dislocations are a rarity. We report a case of bilateral traumatic knee dislocations with concomitant right hip dislocation and complete traumatic amputation of the left, nondominant upper extremity at the level of the proximal one-third of the humerus. Angiograms revealed no evidence of popliteal artery injury. Orthopedic treatment consisted of immediate reduction of the dislocations and urgent revision amputation of the upper extremity. Staged, bilateral knee ligamentous reconstructions were performed on hospital days 24 and 29, respectively. Despite this constellation of devastating injuries, the patient had a satisfactory outcome. In patients with high-energy hip or knee dislocations, the bilateral hips and knees should be carefully examined to check for associated fractures and/or dislocations.

  18. “Conjugate Channeling” Effect in Dislocation Core Diffusion: Carbon Transport in Dislocated BCC Iron

    PubMed Central

    Ishii, Akio; Li, Ju; Ogata, Shigenobu

    2013-01-01

    Dislocation pipe diffusion seems to be a well-established phenomenon. Here we demonstrate an unexpected effect, that the migration of interstitials such as carbon in iron may be accelerated not in the dislocation line direction , but in a conjugate diffusion direction. This accelerated random walk arises from a simple crystallographic channeling effect. is a function of the Burgers vector b, but not , thus a dislocation loop possesses the same everywhere. Using molecular dynamics and accelerated dynamics simulations, we further show that such dislocation-core-coupled carbon diffusion in iron has temperature-dependent activation enthalpy like a fragile glass. The 71° mixed dislocation is the only case in which we see straightforward pipe diffusion that does not depend on dislocation mobility. PMID:23593255

  19. Comprehensive Shoulder US Examination: A Standardized Approach with Multimodality Correlation for Common Shoulder Disease.

    PubMed

    Lee, Matthew H; Sheehan, Scott E; Orwin, John F; Lee, Kenneth S

    2016-10-01

    Shoulder pain is one of the most common musculoskeletal conditions encountered in primary care and specialty orthopedic clinic settings. Although magnetic resonance (MR) imaging is typically the modality of choice for evaluating the soft-tissue structures of the shoulder, ultrasonography (US) is becoming an important complementary imaging tool in the evaluation of superficial soft-tissue structures such as the rotator cuff, subacromial-subdeltoid bursa, and biceps tendon. The advantages of US driving its recent increased use include low cost, accessibility, and capability for real-time high-resolution imaging that enables dynamic assessment and needle guidance. As more radiologists are considering incorporating shoulder US into their practices, the development of a standardized approach to performing shoulder US should be a priority to facilitate the delivery of high-quality patient care. Familiarity with and comfort in performing a standardized shoulder US examination, as well as knowledge of the types of anomalies that can be evaluated well with US, will enhance the expertise of those working in musculoskeletal radiology practices and add value in the form of increased patient and health care provider satisfaction. This review describes the utility and benefits of shoulder US as a tool that complements MR imaging in the assessment of shoulder pain. A standardized approach to the shoulder US examination is also described, with a review of the basic technique of this examination, normal anatomy of the shoulder, common indications for shoulder US, and characteristic US findings of common shoulder diseases-with select MR imaging and arthroscopic correlation. Online supplemental material is available for this article. (©)RSNA, 2016.

  20. 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

  1. [Anterior tarsal tunnel syndrome].

    PubMed

    Miliam, Palle B; Basse, Peter N

    2009-03-30

    Anterior tarsal tunnel syndrome is a rare entrapment neuropathy of the deep peroneal nerve beneath the extensor retinaculum of the ankle. It may be rare because it is underrecognized clinically.We present a case regarding a 29-year-old man, drummer, who for one and a half year experienced clinical symptoms of anterior tarsal tunnel syndrome. A surgical decompression of the anterior tarsal tunnel was performed, and at the check three months later the symptoms where gone. One year after, there were still no symptoms.

  2. [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.

  3. Fundamentals in generalized elasticity and dislocation theory of quasicrystals: Green tensor, dislocation key-formulas and dislocation loops

    NASA Astrophysics Data System (ADS)

    Lazar, Markus; Agiasofitou, Eleni

    2014-12-01

    The present work provides fundamental quantities in generalized elasticity and dislocation theory of quasicrystals. In a clear and straightforward manner, the three-dimensional Green tensor of generalized elasticity theory and the extended displacement vector for an arbitrary extended force are derived. Next, in the framework of dislocation theory of quasicrystals, the solutions of the field equations for the extended displacement vector and the extended elastic distortion tensor are given; that is, the generalized Burgers equation for arbitrary sources and the generalized Mura-Willis formula, respectively. Moreover, important quantities of the theory of dislocations as the Eshelby stress tensor, Peach-Koehler force, stress function tensor and the interaction energy are derived for general dislocations. The application to dislocation loops gives rise to the generalized Burgers equation, where the displacement vector can be written as a sum of a line integral plus a purely geometric part. Finally, using the Green tensor, all other dislocation key-formulas for loops, known from the theory of anisotropic elasticity, like the Peach-Koehler stress formula, Mura-Willis equation, Volterra equation, stress function tensor and the interaction energy are derived for quasicrystals.

  4. Anisotropic Dislocation Line Energy and Crack Tip Dislocation Nucleation in (alpha)RDX

    DTIC Science & Technology

    2013-11-01

    November 2013 Anisotropic Dislocation Line Energy and Crack Tip Dislocation Nucleation in αRDX Lynn B. Munday and Jaroslaw Knap Computational ...public release; distribution is unlimited. 13. SUPPLEMENTARY NOTES 14. ABSTRACT This work reports on the algorithms used to determine the...anisotropic and isotropic elastic properties of dislocations and their nucleation from a crack tip. The appendix contains a numerical implementation of these

  5. Use of the fulcrum axis improves the accuracy of true anteroposterior radiographs of the shoulder.

    PubMed

    Braunstein, V; Kirchhoff, C; Ockert, B; Sprecher, C M; Korner, M; Mutschler, W; Wiedemann, E; Biberthaler, P

    2009-08-01

    In 100 patients the fulcrum axis which is the line connecting the anterior tip of the coracoid and the posterolateral angle of the acromion, was used to position true anteroposterior radiographs of the shoulder. This method was then compared with the conventional radiological technique in a further 100 patients. Three orthopaedic surgeons counted the number of images without overlap between the humeral head and glenoid and calculated the amount of the glenoid surface visible in each radiograph. The analysis was repeated for intraobserver reliability. The learning curves of both techniques were studied. The amount of free visible glenoid space was significantly higher using the fulcrum-axis method (64 vs 31) and the comparable glenoid size increased significantly (8.56 vs 6.47). Thus the accuracy of the anteroposterior radiographs of the shoulder is impaired by using this technique. The intra and interobserver reliability showed a high consistency. No learning curve was observed for either technique.

  6. 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

    Gagnon, Dany; Babineau, Annie-Claude; Champagne, Audrey; Desroches, Guillaume; Aissaoui, Rachid

    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.

  7. Automated identification and indexing of dislocations in crystal interfaces

    DOE PAGES

    Stukowski, Alexander; Bulatov, Vasily V.; Arsenlis, Athanasios

    2012-10-31

    Here, we present a computational method for identifying partial and interfacial dislocations in atomistic models of crystals with defects. Our automated algorithm is based on a discrete Burgers circuit integral over the elastic displacement field and is not limited to specific lattices or dislocation types. Dislocations in grain boundaries and other interfaces are identified by mapping atomic bonds from the dislocated interface to an ideal template configuration of the coherent interface to reveal incompatible displacements induced by dislocations and to determine their Burgers vectors. Additionally, the algorithm generates a continuous line representation of each dislocation segment in the crystal andmore » also identifies dislocation junctions.« less

  8. Automated identification and indexing of dislocations in crystal interfaces

    SciTech Connect

    Stukowski, Alexander; Bulatov, Vasily V.; Arsenlis, Athanasios

    2012-10-31

    Here, we present a computational method for identifying partial and interfacial dislocations in atomistic models of crystals with defects. Our automated algorithm is based on a discrete Burgers circuit integral over the elastic displacement field and is not limited to specific lattices or dislocation types. Dislocations in grain boundaries and other interfaces are identified by mapping atomic bonds from the dislocated interface to an ideal template configuration of the coherent interface to reveal incompatible displacements induced by dislocations and to determine their Burgers vectors. Additionally, the algorithm generates a continuous line representation of each dislocation segment in the crystal and also identifies dislocation junctions.

  9. Quenched pinning and collective dislocation dynamics

    PubMed Central

    Ovaska, Markus; Laurson, Lasse; Alava, Mikko J.

    2015-01-01

    Several experiments show that crystalline solids deform in a bursty and intermittent fashion. Power-law distributed strain bursts in compression experiments of micron-sized samples, and acoustic emission energies from larger-scale specimens, are the key signatures of the underlying critical-like collective dislocation dynamics - a phenomenon that has also been seen in discrete dislocation dynamics (DDD) simulations. Here we show, by performing large-scale two-dimensional DDD simulations, that the character of the dislocation avalanche dynamics changes upon addition of sufficiently strong randomly distributed quenched pinning centres, present e.g. in many alloys as immobile solute atoms. For intermediate pinning strength, our results adhere to the scaling picture of depinning transitions, in contrast to pure systems where dislocation jamming dominates the avalanche dynamics. Still stronger disorder quenches the critical behaviour entirely. PMID:26024505

  10. Hydrogenated vacancies lock dislocations in aluminium

    PubMed Central

    Xie, Degang; Li, Suzhi; Li, Meng; Wang, Zhangjie; Gumbsch, Peter; Sun, Jun; Ma, Evan; Li, Ju; Shan, Zhiwei

    2016-01-01

    Due to its high diffusivity, hydrogen is often considered a weak inhibitor or even a promoter of dislocation movements in metals and alloys. By quantitative mechanical tests in an environmental transmission electron microscope, here we demonstrate that after exposing aluminium to hydrogen, mobile dislocations can lose mobility, with activating stress more than doubled. On degassing, the locked dislocations can be reactivated under cyclic loading to move in a stick-slip manner. However, relocking the dislocations thereafter requires a surprisingly long waiting time of ∼103 s, much longer than that expected from hydrogen interstitial diffusion. Both the observed slow relocking and strong locking strength can be attributed to superabundant hydrogenated vacancies, verified by our atomistic calculations. Vacancies therefore could be a key plastic flow localization agent as well as damage agent in hydrogen environment. PMID:27808099

  11. Dislocation Glasses: Aging during Relaxation and Coarsening

    SciTech Connect

    Bako, B.; Groma, I.; Gyoergyi, G.; Zimanyi, G. T.

    2007-02-16

    The dynamics of dislocations is reported to exhibit a range of glassy properties. We study numerically various versions of 2D edge dislocation systems, in the absence of externally applied stress. Two types of glassy behavior are identified (i) dislocations gliding along randomly placed, but fixed, axes exhibit relaxation to their spatially disordered stable state; (ii) if both climb and annihilation are allowed, irregular cellular structures can form on a growing length scale before all dislocations annihilate. In all cases both the correlation function and the diffusion coefficient are found to exhibit aging. Relaxation in case (i) is a slow power law, furthermore, in the transient process (ii) the dynamical exponent z{approx_equal}6, i.e., the cellular structure coarsens relatively slowly.

  12. Hydrogenated vacancies lock dislocations in aluminium

    NASA Astrophysics Data System (ADS)

    Xie, Degang; Li, Suzhi; Li, Meng; Wang, Zhangjie; Gumbsch, Peter; Sun, Jun; Ma, Evan; Li, Ju; Shan, Zhiwei

    2016-11-01

    Due to its high diffusivity, hydrogen is often considered a weak inhibitor or even a promoter of dislocation movements in metals and alloys. By quantitative mechanical tests in an environmental transmission electron microscope, here we demonstrate that after exposing aluminium to hydrogen, mobile dislocations can lose mobility, with activating stress more than doubled. On degassing, the locked dislocations can be reactivated under cyclic loading to move in a stick-slip manner. However, relocking the dislocations thereafter requires a surprisingly long waiting time of ~103 s, much longer than that expected from hydrogen interstitial diffusion. Both the observed slow relocking and strong locking strength can be attributed to superabundant hydrogenated vacancies, verified by our atomistic calculations. Vacancies therefore could be a key plastic flow localization agent as well as damage agent in hydrogen environment.

  13. Developmental Dislocation (Dysplasia) of the Hip (DDH)

    MedlinePlus

    ... developmental dysplasia (dislocation) of the hip (DDH), the hip joint has not formed normally. The ball is loose ... be taken to provide detailed pictures of the hip joint. Treatment When DDH is detected at birth, it ...

  14. Complete dorsal dislocation of the carpal scaphoid with perilunate dorsal dislocation

    PubMed Central

    Kang, Jong Woo; Park, Jong Hoon; Suh, Dong Hun; Park, Jong Woong

    2016-01-01

    Complete dorsal dislocation of the carpal scaphoid combined with dorsal perilunate dislocation is an extremely rare carpal injury. We describe the case of a 23-year-old man who presented with a complete dorsal dislocation of the carpal scaphoid, combined with a perilunate dislocation. Surgical treatment was performed with open reduction and interosseus ligament repair. At 4 years follow up, the patient's wrist pain had completely resolved without limitations of wrist joint motion and without evidence of avascular necrosis of the carpal scaphoid. PMID:27512229

  15. 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…

  16. Why does my shoulder hurt? A review of the neuroanatomical and biochemical basis of shoulder pain.

    PubMed

    Dean, Benjamin John Floyd; Gwilym, Stephen Edward; Carr, Andrew Jonathan

    2013-11-01

    If a patient asks 'why does my shoulder hurt?' the conversation will quickly turn to scientific theory and sometimes unsubstantiated conjecture. Frequently, the clinician becomes aware of the limits of the scientific basis of their explanation, demonstrating the incompleteness of our understanding of the nature of shoulder pain. This review takes a systematic approach to help answer fundamental questions relating to shoulder pain, with a view to providing insights into future research and novel methods for treating shoulder pain. We shall explore the roles of (1) the peripheral receptors, (2) peripheral pain processing or 'nociception', (3) the spinal cord, (4) the brain, (5) the location of receptors in the shoulder and (6) the neural anatomy of the shoulder. We also consider how these factors might contribute to the variability in the clinical presentation, the diagnosis and the treatment of shoulder pain. In this way we aim to provide an overview of the component parts of the peripheral pain detection system and central pain processing mechanisms in shoulder pain that interact to produce clinical pain.

  17. The reverse Segond fracture: not associated with knee dislocation and rarely with posterior cruciate ligament tear.

    PubMed

    Peltola, Erno K; Lindahl, Jan; Koskinen, Seppo K

    2014-06-01

    The aims of this study were to assess the incidence of reverse Segond fracture, to examine the associated ligamentous injuries, and to examine how often reverse Segond fracture coexists with a knee dislocation. At a level 1 trauma center, an 11-year period of emergency department multidetector-row computed tomography (MDCT) examinations for knee trauma was evaluated for reverse Segond and Segond fractures. Surgical findings served as the reference standard for intra-articular injuries. The hospital discharge register was searched for the diagnosis of knee dislocation from August 2000 through the end of August 2011. A total of 1,553 knee MDCT examinations were evaluated. Ten patients with a reverse Segond fracture were found, comprising 0.64 % of emergency room acute knee trauma MDCT examinations. Seven patients who had a reverse Segond fracture were operated: Three had an avulsion fracture of the anterior cruciate ligament, one had an avulsion fracture of posterior cruciate ligament, two had a lateral meniscal tear, and two had a medial collateral ligament tear. The ratio of reverse Segond fractures to Segond fractures was 1:4. None of the 71 knee dislocation patients had a reverse Segond fracture. Reverse Segond fracture is a rare finding even in a level 1 trauma center. Cruciate ligament injuries appear to be associated with avulsion fracture, but every patient does not have PCL injury, as previously reported. Our results do not support the association of knee dislocation with reverse Segond fracture.

  18. Traumatic posterior dislocation of hip in children.

    PubMed

    Kutty, S; Thornes, B; Curtin, W A; Gilmore, M F

    2001-02-01

    Traumatic posterior dislocation of the hip joint in children is an uncommon injury. It constitutes a true orthopedic emergency. It makes up over 80% of pediatric hip dislocations. In children, it can occur as a result of minimal trauma, which is attributed to a soft pliable acetabulum and ligamentous laxity. In skeletally mature adolescents, a greater force is required to dislocate the hip joint. Delay in reduction is associated with long-term complications such as avascular necrosis and degenerative arthritis. Avascular necrosis is related to the duration of dislocation. A poorer prognosis is associated with delay in reduction beyond 6 hours, advanced skeletal maturity, or multiple traumas. Prompt reduction minimizes complications. We report two cases of traumatic posterior dislocation of hip in children aged 3 and 14 years. Both were reduced within 6 hours of dislocation, and review at 6 months revealed normal examination and no evidence of any post-traumatic changes. Post-reduction treatment remains without a consensus. This review highlights the clinical presentation, management, and time-sensitive complications of the injury.

  19. Investigation of the Dynamics of a Screw Dislocation in Copper

    NASA Astrophysics Data System (ADS)

    Kolupaeva, S. N.; Petelina, Yu. P.; Polosukhin, K. A.; Petelin, A. E.

    2015-08-01

    A modification of the mathematical model of forming the crystallographic shear band is proposed in which the strength of elastic interaction between all dislocations of the forming dislocation pileups is taken into account in addition to the Peach-Keller force; lattice, impurity, and dislocation friction; linear tension; viscous braking; and intensity of generation of point defects behind kinks. The model is used to investigate the influence of the dislocation density on the time characteristics of the formation of dislocation loops in copper.

  20. 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

  1. 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

  2. X-ray and neutron diffraction measurements of dislocation density and subgrain size in a friction stir welded aluminum alloy

    SciTech Connect

    Claussen, Bjorn; Woo, Wanchuck; Zhili, Feng; Edward, Kenik; Ungar, Tamas

    2009-01-01

    The dislocation density and subgrain size were determined in the base material and friction-stir welds of 6061-T6 aluminum alloy. High-resolution X-ray diffraction measurement was performed in the base material. The result of the line profile analysis of the X-ray diffraction peak shows that the dislocation density is about 4.5 x 10{sup 14} m{sup 02} and the subgrain size is about 200 nm. Meanwhile, neutron diffraction measurements have been performed to observe the diffraction peaks during friction-stir welding (FSW). The deep penetration capability of the neutron enables us to measure the peaks from the midplane of the Al plate underneath the tool shoulder of the friction-stir welds. The peak broadening analysis result using the Williamson-Hall method shows the dislocation density of about 3.2 x 10{sup 15} m{sup -2} and subgrain size of about 160 nm. The significant increase of the dislocation density is likely due to the severe plastic deformation during FSW. This study provides an insight into understanding the transient behavior of the microstructure under severe thermomechanical deformation.

  3. At-home resistance tubing strength training increases shoulder strength in the trained and untrained limb.

    PubMed

    Magnus, C R A; Boychuk, K; Kim, S Y; Farthing, J P

    2014-06-01

    The purpose was to determine if an at-home resistance tubing strength training program on one shoulder (that is commonly used in rehabilitation settings) would produce increases in strength in the trained and untrained shoulders via cross-education. Twenty-three participants were randomized to TRAIN (strength-trained one shoulder; n = 13) or CONTROL (no intervention; n = 10). Strength training was completed at home using resistance tubing and consisted of maximal shoulder external rotation, internal rotation, scaption, retraction, and flexion 3 days/week for 4 weeks. Strength was measured via handheld dynamometry and muscle size measured via ultrasound. For external rotation strength, the trained (10.9 ± 10.9%) and untrained (12.7 ± 9.6%) arm of TRAIN was significantly different than CONTROL (1.6 ± 13.2%; -2.7 ± 12.3%; pooled across arm; P < 0.05). For internal rotation strength, the trained (14.8 ± 11.3%) and untrained (14.6 ± 10.1%) arm of TRAIN was significantly different than CONTROL (6.4 ± 11.2%; 5.1 ± 8.8%; pooled across arm; P < 0.05). There were no significant differences for scaption strength (P = 0.056). TRAIN significantly increased muscle size in the training arm of the supraspinatus (1.90 ± 0.32 to 1.99 ± 0.31 cm), and the anterior deltoid (1.08 ± 0.37 to 1.21 ± 0.39 cm; P < 0.05). This study suggests that an at-home resistance tubing training program on one limb can produce increases in strength in both limbs, and has implications for rehabilitation after unilateral shoulder injuries.

  4. Aesthetic evolution of anterior maxillary crowns: a literature review.

    PubMed

    Paul, S J; Pietrobon, N

    1998-01-01

    The aesthetics of anterior maxillary restorations and health of the surrounding tissues are primary determinants of the successful outcome of a clinical procedure. Various restorative materials and application techniques have been developed to achieve optimal aesthetics. While early porcelain-fused-to-metal restorations exhibited metal margins, the development of shoulder porcelain margins in the 1980s resulted in a significant aesthetic improvement. Only in the 1990s, however, did all-porcelain restorations finally achieve the strength and complete range of optical characteristics exhibited by the natural dentition.

  5. 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

  6. 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

  7. US anatomy of the shoulder: Pictorial essay.

    PubMed

    Precerutti, M; Garioni, E; Madonia, L; Draghi, F

    2010-12-01

    A thorough knowledge of the anatomy of the shoulder is essential for the assessment of its condition. The purpose of this article is to provide a useful tool for the ultrasound (US) study of this joint. The shoulder girdle and upper arm are made up of a number of muscles and tendons: rotator cuff (supraspinatus, infraspinatus, teres minor and subscapularis), humeral biceps, deltoid and pectoral muscles, which can all be evaluated at US examination. Various and complex capsular ligamentous structures contribute to the stability of the shoulder, but only a few can be adequately evaluated by US and will therefore receive particular attention. Numerous serous bursae are situated among muscles, skin, subcutaneous tissues, joint capsule structures and bones to prevent friction and they can be evaluated by US only in the presence of pathologies. Subacromial-subdeltoid and subcoracoid bursa are most frequently involved and will therefore be described in detail. There are furthermore nerves and vessels providing the various components of the shoulder with innervation and vascularization, and they can also be studied by US. The shoulder girdle (humerus, scapula, clavicle and sternal manubrium) is situated in the deep layers; only the cortex of the bone can be seen at US as a continuous hyperechoic line. For a better understanding of the location and relationship between the structures which can be studied by US, magnetic resonance imaging (MRI) can be carried out as this method provides a wider and more complete view of the structures.

  8. Shoulder arthroplasty: evolving techniques and indications.

    PubMed

    Walch, Gilles; Boileau, Pascal; Noël, Eric

    2010-12-01

    The development of modern shoulder replacement surgery started over half a century ago with the pioneering work done by CS Neer. Several designs for shoulder prostheses are now available, allowing surgeons to select the best design for each situation. When the rotator cuff is intact, unconstrained prostheses produce reliable and reproducible results, with prosthesis survival rates of 97% after 10 years and 84% after 20 years. In patients with three- or four-part fractures of the proximal humerus, the outcome of shoulder arthroplasty depends largely on healing of the greater tuberosity, which is therefore a major treatment objective. Factors crucial to greater tuberosity union include selection of the optimal prosthesis design, flawless fixation of the tuberosities, and appropriate postoperative immobilization. The reverse shoulder prosthesis developed by Grammont has been recognized since 1991 as a valid option for patients with glenohumeral osteoarthritis. Ten-year prosthesis survival rates are 91% overall (including trauma and revisions) and 94% for glenohumeral osteoarthritis with head migration. These good results are generating interest in the reverse shoulder prosthesis as a treatment option in situations where unconstrained prostheses are unsatisfactory (primary glenohumeral osteoarthritis with marked glenoid cavity erosion; comminuted fractures in patients older than 75 years; post-traumatic osteoarthritis with severe tuberosity malunion or nonunion; massive irreparable rotator cuff tears with pseudoparalysis; failed rotator cuff repair; and proximal humerus tumor requiring resection of the rotator cuff insertions).

  9. The Kaiser Permanente Shoulder Arthroplasty Registry

    PubMed Central

    Ake, Christopher F; Burke, Mary F; Singh, Anshuman; Yian, Edward H; Paxton, Elizabeth W; Navarro, Ronald A

    2015-01-01

    Background and purpose Shoulder arthroplasty is being performed in the United States with increasing frequency. We describe the medium-term findings from a large integrated healthcare system shoulder arthroplasty registry. Patients and methods Shoulder arthroplasty cases registered between January 2005 and June 2013 were included for analysis. The registry included patient characteristics, surgical information, implant data, attrition, and patient outcomes such as surgical site infections, venous thromboembolism, and revision procedures. Results During the study period, 6,336 primary cases were registered. Median follow-up time for all primaries was 3.3 years; 461 cases were lost to follow-up by ending of health plan membership. Primary cases were predominantly female (56%) and white (81%), with an average age of 70 years. The most common reason for surgery was osteoarthritis in 60% of cases, followed by acute fracture (17%) and rotator cuff tear arthropathy (15%). In elective shoulder arthroplasty procedures, 200 all-cause revisions (4%) were reported, with glenoid wear being the most common reason. Interpretation Most arthroplasties were elective procedures: over half performed for osteoarthritis. Glenoid wear was the most common reason for revision of primary shoulder arthroplasty in elective cases. PMID:25727949

  10. 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

  11. The evaluation of the failed shoulder arthroplasty.

    PubMed

    Wiater, Brett P; Moravek, James E; Wiater, J Michael

    2014-05-01

    As the incidence of shoulder arthroplasty continues to rise, the orthopedic shoulder surgeon will be increasingly faced with the difficult problem of evaluating a failed shoulder arthroplasty. The patient is usually dissatisfied with the outcome of the previous arthroplasty as a result of pain, but may complain of poor function due to limited range of motion or instability. A thorough and systematic approach is necessary so that the most appropriate treatment pathway can be initiated. A comprehensive history and physical examination are the first steps in the evaluation. Diagnostic studies are numerous and include laboratory values, plain radiography, computed tomography, ultrasound imaging, joint aspiration, nuclear scans, and electromyography. Common causes of early pain after shoulder arthroplasty include technical issues related to the surgery, such as malposition or improper sizing of the prosthesis, periprosthetic infection, neurologic injury, and complex regional pain syndrome. Pain presenting after a symptom-free interval may be related to chronic periprosthetic infection, component wear and loosening, glenoid erosion, rotator cuff degeneration, and fracture. Poor range of motion may result from inadequate postoperative rehabilitation, implant-related factors, and heterotopic ossification. Instability is generally caused by rotator cuff deficiency and implant-related factors. Unfortunately, determining the cause of a failed shoulder arthroplasty can be difficult, and in many situations, the source of pain and disability is multifactorial.

  12. The Mature Athlete’s Shoulder

    PubMed Central

    Tokish, John M.

    2014-01-01

    Context: The mature athlete’s shoulder remains a challenging clinical condition to manage. A normal natural history of the shoulder includes stiffness, rotator cuff tears, and osteoarthritis, all of which can become increasingly more symptomatic as an athlete ages. Evidence Acquisition: PubMed (1978-2013). Study Design: Clinical review. Level of Evidence: Level 3-4. Results: Rotator cuff pathology increases with age and activity level. Partial tears rarely heal, and debridement of significant partial tears results in poorer outcomes than those of repair. Repair of partial-thickness tears can be accomplished with completion and subsequent repair or in situ repair. The most successful result for treatment of osteoarthritis in the shoulder remains total shoulder arthroplasty, with more than 80% survival at 20 years and high rates of return to sport. Caution should be taken in patients younger than 60 years, as they show much worse results with this treatment. Adhesive capsulitis of the shoulder can be successfully treated with nonoperative management in 90% of cases. Conclusion: Mature athletes tend to have rotator cuff pathology, osteoarthritis, and stiffness, which may limit their participation in athletic events. Age is a significant consideration, even within the “mature athlete” population, as patients younger than 50 years should be approached differently than those older than 65 years with regard to treatment regimens and postoperative restriction. PMID:24427439

  13. Post-surgical unilateral temporomandibular joint dislocation treated by open reduction followed by orthodontic treatment.

    PubMed

    Satake, H; Yamada, T; Kitamura, N; Yoshimura, T; Sasabe, E; Yamamoto, T

    2011-03-01

    A case of prolonged unilateral temporomandibular joint (TMJ) dislocation, which was treated by open surgical reduction and post-surgical orthodontic therapy, is presented. A 58-year-old woman presented complaining of facial asymmetry and malocclusion. She had received surgery for a malignant tumour in the right retromolar region 7 years previously. It was considered that contraction of the pterygoid muscle by surgical injury caused anterior meniscal displacement and TMJ dislocation. Since manual manipulation failed, direct open reduction was performed after separation of the lateral pterygoid muscle from the condylar head and removal of the intra-articular scar tissues. Although the condylar head was returned to the glenoid fossa, optimal occlusion was not obtained because of compensatory tooth movement and inclination. Satisfactory occlusion and symmetric facial appearance were brought about by post-surgical orthodontic therapy.

  14. [Iritis with destabilization of the intraocular pressure due to dislocation of a posterior chamber intraocular lens].

    PubMed

    Handzel, D M

    2012-04-01

    This report concerns the case of a 67-year-old male patient who underwent uncomplicated phacoemulsification with implantation of a posterior chamber intraocular lens (IOL). After an interval of 2 months the patient developed iritis together with an uncontrollable increase in intraocular pressure. After a detailed examination a dislocated haptic of the IOL was identified as the cause of the symptoms. The dislocation had led to uveitis-glaucoma-hyphema syndrome although no hemorrhage was observed. In addition to this complication the haptic had arroded the zonular complex which made implantation of an anterior chamber lens necessary. Although improvements in operating techniques, lens materials and designs have been made uveitis-glaucoma-hyphema syndrome has to be kept in mind. Surgical intervention is the only therapeutic option.

  15. Fracture dislocation of the sacro-coccygeal joint in a 12-year-old boy. A case report and literature review.

    PubMed

    Hamoud, K; Abbas, J

    2015-11-01

    A case report and literature review. To present a rare case of facture dislocation of the sacro-coccygeal joint in a 12-year-old boy who was treated conservatively. Fracture dislocations of the sacrum or the sacro-coccygeal joint are infrequent injuries and are rarely reported. The treatment for these disorders is usually conservative. Detailed description of the anterior dislocation (Salter-Harris type I) of the sacro-coccygeal joint in this child and its management are presented, with review of the relevant literature. A conservative treatment was performed, with excellent clinical and radiological result at three years after the injury. MR imaging obtained at two years showed very good healing and alignment. Fracture dislocation of the sacro-coccygeal joint in the pediatric population should be treated conservatively, as the potential of healing and remodeling is great. Closed reduction should not be attempted.

  16. Unrecognized bilateral temporomandibular joint dislocation after general anesthesia with a delay in diagnosis and management: a case report

    PubMed Central

    2013-01-01

    Introduction Anterior bilateral temporomandibular joint dislocation is not an uncommon occurrence and has been reported before. However, its diagnosis can easily be overlooked, especially by clinicians who are unfamiliar with this pathology. Continuous discussion of the pathology is required to prevent delays in diagnosis, which can lead to long-term sequelae for the patient. Case presentation We present the case of a 66-year-old Somali woman who experienced a bilateral anterior temporomandibular joint dislocation after a general anesthetic for an exploratory laparotomy for excision of a pelvic sarcoma. She first presented in the intensive care unit with preauricular pain and an inability to close her mouth, and was initially misdiagnosed and treated for a muscle spasm. The cause of her misdiagnosis was multifactorial - opioid-related sedation, language and cultural barrier, and unfamiliarity with the pathology. Her diagnosis was proven 18 hours after the completion of surgery with a plain X-ray. A manual closed reduction was performed with minimal sedation by oral surgery. Conclusion We provided an in-depth discussion of temporomandibular joint dislocation and suggest a simple test that would prevent delayed diagnosis of temporomandibular joint dislocation in any patient undergoing general anesthesia. A normal mandibular excursion should be tested in every patient after surgery in the postoperative care unit, by asking the patient to open and close their mouth during the immediate postoperative recovery period or passively performing the range of motion test. PMID:24139071

  17. Quantum dynamics of a single dislocation

    NASA Astrophysics Data System (ADS)

    de Gennes, Pierre-Gilles

    We discuss the zero temperature motions of an edge dislocation in a quantum solid (e.g., He4). If the dislocation has one kink (equal in length to its Burgers vector b) the kink has a creation energy U and can move along the line with a certain transfer integral t. When t and U are of comparable magnitude, two opposite kinks can form an extended bound state, with a size l. The overall shape of the dislocation in the ground state is then associated with a random walk of persistence length l (along the line) and hop sizes b. We also discuss the motions of kinks under an applied shear stress σ: the glide velocity is proportional to exp(-σ*/σ), where σ* is a characteristic stress, controlled by tunneling processes. Mouvements quantiques d'une dislocation. On analyse le mouvement à température nulle d'une dislocation coin dans un solide quantique (He4). La dislocation peut avoir un cran (d'énergie U) dans son plan de glissement. Le cran peut avancer ou reculer le long de la dislocation par effet tunnel, avec une certaine intégrale de transfert t. Deux crans de signe opposé peuvent former un état lié. En présence d'une contrainte extérieure σ, la ligne doit avancer avec une vitesse ~exp(-σ*/σ) où σ* est une contrainte seuil, contrôlée par l'effet tunnel.

  18. Electromyographic analysis of shoulder muscles during press-up variations and progressions.

    PubMed

    Herrington, Lee; Waterman, Rosemary; Smith, Laura

    2015-02-01

    Due to the versatility of the press-up it is a popular upper extremity strengthening and rehabilitation exercise. Press-up programmes are often progressed by increasing weight-bearing load and using unstable bases of support. Despite the popularity of the press-up research examining press-up variations is limited. The aim of the study was to examine the influence of common press-up exercises on serratus anterior, infraspinatus, anterior deltoid, pectoralis major and latissimus dorsi muscles overall EMG activity. Twenty-one healthy individuals participated in this study. Surface electrodes were placed on pectoralis major, anterior deltoid, infraspinatus, serratus anterior and latissimus dorsi muscles. Participants were tested under 7 static press-up conditions that theoretically progressively increase weight-bearing load and proprioceptive challenge while surface electromyographic activity was recorded. There was a high correlation between increased weight-bearing load and increased EMG activity for all muscles in stable base conditions. The introduction of the unstable base conditions resulted in an activation decline in all muscles. Within the two-armed press-up the Swiss ball resulted in decreased activation in all muscles except pectoralis major. Serratus anterior demonstrated the greatest activation as a percentage of maximum isometric contraction across all exercises. The findings of this study indicate that by varying the weight-bearing load and base of support whilst in the press-up position results in significantly different demands on shoulder and scapula muscles.

  19. A comparison of ketamine versus etomidate for procedural sedation for the reduction of large joint dislocations

    PubMed Central

    Salen, Philip; Grossman, Michelle; Grossman, Michael; Milazzo, Anthony; Stoltzfus, Jill

    2016-01-01

    Study Objectives: Ketamine and etomidate are used for procedural sedation (PS) to facilitate the performance of painful procedures. We hypothesized that ketamine produces adequate and comparable sedation conditions for dislocated large joint reduction when compared to etomidate and results in fewer adverse events. Methods: This Institutional Review Board approved prospective trial compared a convenience sample of subjects, who were randomized to receive either ketamine or etomidate for PS to facilitate reduction of large joint dislocations. Following informed consent, subjects were assigned via a computer-generated algorithm to receive either etomidate (0.1 mg/kg) or ketamine (0.5 mg/kg) intravenously; if PS was not sufficient, subjects received repeat doses of etomidate or ketamine until adequate PS was achieved. The protocol's primary endpoint was a successful reduction of dislocated, large joints. Secondary endpoints included alteration in blood pressure, vomiting, recovery agitation, hypersalivation, laryngospasm, myoclonus, hypoxia, airway assistance with chin lift or jaw thrust, bag-valve-mask ventilation, endotracheal intubation, utilization of additional doses of ketamine or etomidate, and recovery time from sedation. Results: Total enrollment was eighty subjects, 46 in the ketamine cohort and 34 in the etomidate cohort. The two PS groups were comparable in terms of gender, age, and weight. There was no significant difference in the primary endpoint of large joint dislocation reduction between the ketamine and etomidate cohorts (46/46, 100%; 32/34, 94.1%; P – 0.1). Shoulder, hip, and ankle joints account for the majority of joint reductions in this trial. Titration of PS was necessary for almost half of each cohort as evidenced by the utilization of additional dosages of the sedative agents: ketamine (22/46, 47.8%) and etomidate (14/34, 41.2%; P – 0.56). Among secondary outcome variables, significant differences between ketamine and etomidate cohorts

  20. Physical examination of the overhead athlete's shoulder.

    PubMed

    Sewick, Amy; Kelly, John D; Rubin, Ben

    2012-03-01

    Overhead athletes seek the services of an orthopedic surgeon because of pain and/or dysfunction. It is important to address the cause of the symptoms more so than the source of the patient's pain, so that treatment will eliminate the problem rather than merely ameliorate symptoms temporarily. In order to accomplish a thorough assessment of shoulder function, the examiner must expand his/her view from isolated assessment of the glenohumeral joint range of motion, stability, assessment of rotator cuff strength, palpation and provocative maneuvers, and add assessment of the shoulder in the context of the kinetic chain. The examination of the thrower's shoulder, coupled with a thorough history, will usually provide a solid functional diagnosis and provide a good idea as to the presence of structural damage. As a result, the value of rehabilitation and the benefit of surgical intervention are made more predictable.