Risk of subacromial shoulder disorder in airport baggage handlers: combining duration and intensity of musculoskeletal shoulder loads.

PubMed

Møller, Sanne Pagh; Brauer, Charlotte; Mikkelsen, Sigurd; Alkjær, Tine; Koblauch, Henrik; Pedersen, Ellen Bøtker; Simonsen, Erik B; Thygesen, Lau Caspar

2018-04-01

Musculoskeletal shoulder load among baggage handlers measured by combining duration and intensity based on biomechanical and epidemiological information may be a stronger predictor of subacromial shoulder disorders than baggage handler seniority. In 2012, a cohort of baggage handlers employed at Copenhagen Airport in 1990-2012, and a cohort of unskilled otherwise employed men answered a survey. Self-reported information on work tasks during employment in the airport in combination with work task specific biomechanically modelled forces in the shoulder joint was used to estimate shoulder load. Exposure measures were accumulated shoulder abduction moment, accumulated shoulder compression force, accumulated supraspinatus force and baggage handler seniority. The outcome was subacromial shoulder disorder registered in the Danish National Patient Register. When analyses were adjusted by all confounders except age, exposure variables showed close to significant associations with subacromial shoulder disorder. Results could not confirm our hypothesis that combined information on work task duration and shoulder load intensity was stronger associated with subacromial shoulder disorder than seniority. Practitioner Summary: In this study we sought to identify if the exposure to work-related musculoskeletal shoulder loading including duration and intensity among baggage handlers was associated with subacromial shoulder disorder. We found that there was an association but this was not stronger than that between baggage handler seniority and subacromial shoulder disorder.

Muscular imbalance and shoulder pain in volleyball attackers.

PubMed Central

Kugler, A; Krüger-Franke, M; Reininger, S; Trouillier, H H; Rosemeyer, B

1996-01-01

OBJECTIVE: In overhead sports such as volleyball, baseball, or tennis shoulder problems are very common. The aim of this study was to identify features which may correlate with shoulder problems in volleyball attackers. METHODS: 30 competitive volleyball attackers (mean age 25 years) were included in the study; 15 were suffering from shoulder pain and 15 had no history of shoulder pain. The results were compared with those of a control group of 15 recreational athletes without any overhead sports activities. RESULTS: Volleyball attackers have a different muscular and capsular pattern at the playing shoulder compared to the opposite shoulder. Their playing shoulder is depressed, the scapula lateralised, and the dorsal muscles and the posterior and inferior part of the shoulder capsule shortened. These differences were of more significance in volleyball attackers with shoulder pain than in volleyball players without shoulder pain. In contrast to recreational athletes without any overhead sports activity, there were no significant difference in the comparison of the two shoulders. The histories, clinical and sonographic findings did not reveal further typical features for volleyball attackers with shoulder pain. CONCLUSIONS: Muscular balance of the shoulder girdle is very important in this sport. It is therefore imperative to include adequate stretching and muscular training programme for the prevention, as well as for therapy, of shoulder pain in volleyball attackers. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 PMID:8889124

Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study

PubMed Central

Hatchett, Patricia; Eberly, Valerie J.; Lighthall Haubert, Lisa; Conners, Sandy; Requejo, Philip S.

2015-01-01

Background Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI). Objective The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia. Methods/Design A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks. Results Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility. Limitations Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall. Conclusions Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset. PMID:25721123

Rotator cuff exercises

MedlinePlus

... activities, including your shoulder joint and your shoulder blade Observe your spine and posture as you stand ... band Isometric shoulder exercises Wall push-ups Shoulder blade (scapular) retraction - no tubing Shoulder blade (scapular) retraction - ...

Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: A pilot study.

PubMed

Finley, Margaret A; Rodgers, Mary M

2004-05-01

Although many wheelchair users report shoulder pain, the prevalence of specific pathologies remains controversial. Rotator cuff impingement, glenohumeral instability, and biceps tendonitis have been stated as the most commonly found pathology. This study investigated the prevalence and identity of shoulder pathology in athletic and nonathletic manual wheelchair users (MWCUs). Fifty-two MWCUs (26 athletes, 26 nonathletes) completed a survey regarding the nature of their injury, sports involvement, history, and presence of current and/or past shoulder pathology. Subjects currently experiencing shoulder pain underwent a clinical examination of both shoulders. Analysis of variance (p

Frozen shoulder and the Big Five personality traits.

PubMed

Debeer, Philippe; Franssens, Fien; Roosen, Isabelle; Dankaerts, Wim; Claes, Laurence

2014-02-01

In the past, several studies have suggested the existence of a "periarthritic personality" in patients with frozen shoulder. We conducted a study to determine differences in personality traits in patients with primary and secondary frozen shoulders. We prospectively evaluated 118 patients (84 women and 34 men; mean age, 53.8 years; SD 7.56) with a frozen shoulder. Of these patients, 48 had an idiopathic frozen shoulder and 70 had a secondary frozen shoulder. Personality traits were determined by the NEO Five-Factor Inventory (NEO-FFI) scale. This questionnaire measures the 5 major personality traits and is based on the norms determined in a neutral test situation for 2415 controls. Compared with healthy controls, no differences in personality traits were found in patients with primary and secondary frozen shoulder, except for Conscientiousness and Extraversion, for which patients with secondary frozen shoulder scored significantly higher than healthy controls. Patients with primary frozen shoulder scored significantly higher on Openness to Experience than did patients with secondary frozen shoulder; on the other 4 Big Five personality traits, no significant differences were found between patients with primary and secondary frozen shoulder. More specifically, patients with idiopathic frozen shoulder did not score higher on the trait Neuroticism as would be expected from previous publications. Our study results do not indicate that patients with an idiopathic frozen shoulder have a specific personality compared with healthy controls. Only a few differences were found in personality traits when the entire frozen shoulder group was compared with healthy controls and between patients with primary and secondary frozen shoulders. The results of this study suggest that these differences are not sufficient to speak about a specific "frozen shoulder personality." Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Multimodal assessment of sensorimotor shoulder function in patients with untreated anterior shoulder instability and asymptomatic handball players.

PubMed

Mornieux, Guillaume; Hirschmüller, Anja; Gollhofer, Albert; Südkamp, Norbert P; Maier, Dirk

2018-04-01

Functional evaluation of sensorimotor function of the shoulder joint is important for guidance of sports-specific training, prevention and rehabilitation of shoulder instability. Such assessment should be multimodal and comprise all qualities of sensorimotor shoulder function. This study evaluates feasibility of such multimodal assessment of glenohumeral sensorimotor function in patients with shoulder instability and handball players. Nine patients with untreated anterior instability of their dominant shoulder and 15 asymptomatic recreational handball players performed proprioceptive joint position sense and dynamic stabilization evaluations on an isokinetic device, as well as a functional throwing performance task. Outcome measures were analysed individually and equally weighted in a Shoulder-Specific Sensorimotor Index (S-SMI). Finally, isokinetic strength evaluations were conducted. We observed comparable sensorimotor functions of unstable dominant shoulders compared to healthy, contralateral shoulders (e.g. P=0.59 for S-SMI). Handball players demonstrated superior sensorimotor function of their dominant shoulders exhibiting a significantly higher throwing performance and S-SMI (P<0.001 and P=0.002, respectively), but comparable internal rotator peak torques for both shoulders (P>0.22). The present study proves feasibility of multimodal assessment of shoulder sensorimotor function in overhead athletes and patients with symptomatic anterior shoulder instability. Untreated shoulder instability led to a loss of dominance-related sensorimotor superiority indicating functional internal rotation deficiency. Dominant shoulders of handball players showed a superior overall sensorimotor function but weakness of dominant internal rotation constituting a risk factor for occurrence of posterior superior impingement syndrome. The S-SMI could serve as a diagnostic tool for guidance of sports-specific training, prevention and rehabilitation of shoulder instability.

Use of scoring systems for assessing and reporting the outcome results from shoulder surgery and arthroplasty

PubMed Central

Booker, Simon; Alfahad, Nawaf; Scott, Martin; Gooding, Ben; Wallace, W Angus

2015-01-01

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement. All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers. A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit. A total of 174 research articles that were published in the four journals used some form of shoulder scoring system. The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes. CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent. The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score. PMID:25793164

Musculoskeletal morbidity: the growing burden of shoulder pain and disability and poor quality of life in diabetic outpatients.

PubMed

Laslett, L L; Burnet, S P; Jones, J A; Redmond, C L; McNeil, J D

2007-01-01

To investigate shoulder pain and disability and quality of life (QoL) over 12 months in patients with diabetes and in a non-diabetic control group. Cross-sectional study with 12-month follow-up in diabetic (n=189) and medical (n=99) outpatients employing the Shoulder Pain and Disability Index (SPADI) and SF-36 version 2. The results were analysed using restricted maximum likelihood (REML). The prevalence of current shoulder symptoms was 35% in diabetics and 17% in controls. Shoulder pain and disability as calculated by the SPADI were independently associated with diabetes (vs controls) and current shoulder symptoms, and worsened over 12 months. Disability scores worsened with age in diabetics, and pain scores were higher in diabetics than controls among patients reporting current shoulder symptoms. Poor physical QoL worsened over time in patients with diabetes and was worse in patients with current shoulder symptoms, whether they had diabetes or not. Mental QoL was worse only in patients with current shoulder symptoms. Shoulder symptoms are common, affecting 1 in every 3 diabetic patients and 1 in every 6 control patients. In this study shoulder pain, disability and physical QoL were poorer among diabetics and patients reporting current shoulder symptoms, and worsened over time. Mental QoL was worse in patients reporting current shoulder symptoms and was independent of diabetes. Therefore, shoulder symptoms are common, are associated with poor physical and mental QoL in addition to shoulder pain and disability, and are worse in patients with diabetes, even in a population with relatively moderate shoulder pain and disability.

Recurrent shoulder dystocia: is it predictable?

PubMed

Kleitman, Vered; Feldman, Roi; Walfisch, Asnat; Toledano, Ronen; Sheiner, Eyal

2016-11-01

To examine the course and outcome of deliveries occurring in women who previously experienced shoulder dystocia. In addition, recurrent shoulder dystocia risk factors were assessed. A retrospective cohort analysis comparing all singleton deliveries with and without shoulder dystocia in their preceding delivery was conducted. Independent predictors of recurrent shoulder dystocia were investigated using a multiple logistic regression model. Of the 201,422 deliveries included in the analysis, 307 occurred in women with a previous shoulder dystocia (0.015 %). Women with a history of shoulder dystocia were more likely to be older, experienced higher rates of gestational diabetes mellitus, polyhydramnios, prolonged second stage, operative delivery and macrosomia (>4000 g) in the following delivery. Previous shoulder dystocia was found to be an independent risk factor for recurrent shoulder dystocia (OR = 6.1, 95 % CI 3.2-11.8, p value <0.001) in the multivariable regression analysis. Shoulder dystocia is an independent risk factor for recurrent shoulder dystocia. Deliveries in women with a history of shoulder dystocia are characterized by higher rates of operative delivery, prolonged second stage of labor and macrosomia.

Shoulder CT scan

MedlinePlus

CAT scan - shoulder; Computed axial tomography scan - shoulder; Computed tomography scan - shoulder; CT scan - shoulder ... Risks of CT scans include: Being exposed to radiation Allergic reaction to contrast dye Birth defect if done during pregnancy CT scans ...

Clinical Evaluation of the TITAN™ Total Shoulder System

ClinicalTrials.gov

2018-02-14

Arthritis; Arthritis, Degenerative; Rheumatoid Arthritis; Post-traumatic Arthrosis of Other Joints, Shoulder Region; Rotator Cuff Syndrome of Shoulder and Allied Disorders; Fracture; Avascular Necrosis; Joint Instability; Joint Trauma; Dislocation, Shoulder; Pain, Shoulder

Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes.

PubMed

Sorensen, Christopher J; Hastings, Mary K; Lang, Catherine E; McGill, Janet B; Clark, B Ruth; Bohnert, Kathryn L; Mueller, Michael J

2017-06-01

People with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability. Eighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability. Compared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6±1.7 vs 2.7±0.6AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r=0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level. Persons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes

PubMed Central

Sorensen, Christopher J.; Hastings, Mary K.; Lang, Catherine E.; McGill, Janet B.; Clark, B. Ruth; Bohnert, Kathryn L.; Mueller, Michael J.

2017-01-01

Aim People with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability. METHODS Eighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability. RESULTS Compared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6 ± 1.7 vs 2.7 ± 0.6 AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r = 0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level. CONCLUSIONS Persons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability. PMID:28392042

Maintaining Shoulder Health After Spinal Cord Injury: A Guide to Understanding Treatments for Shoulder Pain

PubMed Central

Van Straaten, Meegan G.; Cloud, Beth A.; Zhao, Kristin D.; Fortune, Emma; Morrow, Melissa M. B.

2017-01-01

Shoulder pain from overuse of the arm is common after spinal cord injury (SCI). This pain can be difficult to eliminate. There are many other complications after SCI; therefore, shoulder pain is sometimes not the first priority. However, if neglected for too long, shoulder pain could mean that more serious problems are happening inside the shoulder joint. Here we present the options available when treatment for shoulder pain is needed. PMID:28185640

Risk of surgery for subacromial impingement syndrome in relation to neck-shoulder complaints and occupational biomechanical exposures: a longitudinal study.

PubMed

Svendsen, Susanne Wulff; Dalbøge, Annett; Andersen, Johan Hviid; Thomsen, Jane Frølund; Frost, Poul

2013-11-01

The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. The study was based on the Musculoskeletal Research Database at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from a job exposure matrix based on expert judgment. We applied multivariable Cox regression. During 280 125 person-years of follow-up among 37 402 persons, 557 first-time operations for SIS occurred. Crude surgery rates increased from 1.1 to 2.5 per 1000 person-years with increasing shoulder load. Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR(adj)) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load showed an HR(adj) of 4.52 (95% CI 2.87-7.13). Subanalyses based on 18 856 persons showed an HR(adj) of 5.40 (95% CI 2.88-10.11) for complaints located specifically in the shoulder in combination with high shoulder load. Based on these findings, persons with neck-shoulder and especially shoulder complaints in combination with high shoulder load seem an obvious target group for interventions aimed at reducing exposures to prevent surgery for SIS.

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

The effect of surgeon and hospital volume on shoulder arthroplasty perioperative quality metrics.

PubMed

Singh, Anshu; Yian, Edward H; Dillon, Mark T; Takayanagi, Miwa; Burke, Mary F; Navarro, Ronald A

2014-08-01

There has been a significant increase in both the incidence of shoulder arthroplasty and the number of surgeons performing these procedures. Literature regarding the relationship between surgeon or hospital volume and the performance of modern shoulder arthroplasty is limited. This study examines the effect of surgeon or hospital shoulder arthroplasty volume on perioperative metrics related to shoulder hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty. Blood loss, length of stay, and operative time were the main endpoints analyzed. Prospective data were analyzed from a multicenter shoulder arthroplasty registry; 1176 primary shoulder arthroplasty cases were analyzed. Correlation and analysis of covariance were used to examine the association between surgeon and hospital volume and perioperative metrics adjusting for age, sex, and body mass index. Surgeon volume is inversely correlated with length of stay for hemiarthroplasty and total shoulder arthroplasty and with blood loss and operative time for all 3 procedures. Hospital volume is inversely correlated with length of stay for hemiarthroplasty, with blood loss for total and reverse shoulder arthroplasty, and with operative time for all 3 procedures. High-volume surgeons performed shoulder arthroplasty 30 to 50 minutes faster than low-volume surgeons did. Higher surgeon and hospital case volumes led to improved perioperative metrics with all shoulder arthroplasty procedures, including reverse total shoulder arthroplasty, which has not been previously described in the literature. Surgeon volume had a larger effect on metrics than hospital volume did. This study supports the concept that complex shoulder procedures are, on average, performed more efficiently by higher volume surgeons in higher volume centers. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Effects of Messages Delivered by Mobile Phone on Increasing Compliance With Shoulder Exercises Among Patients With a Frozen Shoulder.

PubMed

Chen, Hui-Chun; Chuang, Tai-Yuan; Lin, Pi-Chu; Lin, Yen-Kuang; Chuang, Yeu-Hui

2017-07-01

The aim of this study was to examine the effects of reminders, encouragement, and educational messages delivered by mobile phone on shoulder exercise compliance and improvements in shoulder function among patients with a frozen shoulder. A randomized controlled trial design was used. A convenience sample of patients with a frozen shoulder in an orthopedic outpatient clinic was recruited. All participants were instructed on how to do shoulder exercises and were provided with a printed pamphlet about shoulder exercises. Then, the intervention group received reminders, encouragement, and educational messages by mobile phone daily for the next 2 weeks, while the comparison group did not. The intervention group had higher compliance with shoulder exercises than did the comparison group (t = 2.263, p = .03) and had significant improvements in shoulder forward flexion (F = 12.067, p = .001), external rotation (F = 13.61, p = .001), and internal rotation (F = 5.903, p = .018) compared to those in the comparison group after the 2-week intervention. The text messages significantly increased patient compliance with shoulder exercises and thus improved patients' shoulder range of motion. Hospital or clinics can send appropriate messages to patients via text message platforms in order to remind and encourage them to do shoulder exercises. © 2017 Sigma Theta Tau International.

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.

A comparison of peak power in the shoulder press and shoulder throw.

PubMed

Dalziel, W M; Neal, R J; Watts, M C

2002-09-01

The ability to generate peak power is central for performance in many sports. Currently two distinct resistance training methods are used to develop peak power, the heavy weight/slow velocity and light weight/fast velocity regimes. When using the light weight/fast velocity power training method it was proposed that peak power would be greater in a shoulder throw exercise compared with a normal shoulder press. Nine males performed three lifts in the shoulder press and shoulder throw at 30% and 40% of their one repetition maximum (1RM). These lifts were performed identically, except for the release of the bar in the throw condition. A potentiometer attached to the bar measured displacement and duration of the lifts. The time of bar release in the shoulder throw was determined with a pressure switch. ANOVA was used to examine statistically significant differences where the level of acceptance was set at p < 0.05. Peak power was found to be significantly greater in the shoulder throw at 30% of 1 RM condition [F, (1, 23) = 2.325 p < 0.051 and at 40% of 1 RM [F, (1, 23) = 2.905 p < 0.05] compared to values recorded for the respective shoulder presses. Peak power was also greater in the 30% of 1 RM shoulder throw (510 +/- 103W) than in the 40% of 1 RM shoulder press (471 +/- 96W). Peak power was produced significantly later in the shoulder throw versus the shoulder press. This differing power reflected a greater bar velocity of the shoulder throw at both assigned weights compared with the shoulder press.

Shoulder injuries in elite rugby union football matches: Epidemiology and mechanisms.

PubMed

Usman, Juliana; McIntosh, Andrew S; Quarrie, Kenneth; Targett, Stephen

2015-09-01

Shoulder injuries in rugby union football have been the focus of few in-depth studies, despite their frequency and severity. The study's objective was to describe the incidence, patterns and mechanisms of shoulder injuries in rugby. Prospective cohort study of shoulder injury incidence and retrospective case-series study of shoulder injury mechanisms. Data were collected from Super Rugby matches from 2005 to 2010 involving elite level adult male rugby players. 7920 player participation hours and 100 shoulder injuries were recorded during 397 Super Rugby matches. The shoulder injury incidence rate was 13 per 1000 player hours (95% confidence interval 10-16). The mean number of days unavailable for selection due to these injuries was 37 (95% confidence interval 25-54). Tacklers sustained shoulder injuries at a higher rate than ball carriers (Rate Ratio=1.7 (95% confidence interval 0.5-5.3)). The most frequently reported injuries were those to the acromio-clavicular joint; dislocations resulted in the greatest amount of missed play. Using video analysis, 47 of the 100 shoulder injury events were successfully identified and analyzed. The main mechanisms of shoulder injury were contact with the ground with the shoulder/arm in horizontal adduction, flexion, and internal rotation; and impact to the lateral aspect of the shoulder with the elbow flexed and arm at the side. Direct impact to the shoulder, either through player-to-player contact or contact with the ground, is the main cause of shoulder injury. Methods to reduce injury risk, such as shoulder pads and tackle skills, require consideration. Copyright © 2014 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Point-of-care ultrasound facilitates diagnosing a posterior shoulder dislocation.

PubMed

Mackenzie, David C; Liebmann, Otto

2013-05-01

Posterior shoulder dislocation is an uncommon disruption of the glenohumeral joint. Risk factors include seizure, electric shock, and underlying instabilities of the shoulder joint. A 27-year-old man with a history of recurrent posterior shoulder dislocation presented to the Emergency Department with sudden shoulder pain and reduced range of motion about the shoulder after abducting and internally rotating his arm. Radiographs did not show fracture or dislocation. The treating physician suspected an occult posterior shoulder dislocation, but wanted to avoid performing a computed tomography scan of the shoulder, as the patient had undergone numerous scans during the evaluation of similar complaints. Instead, a point-of-care ultrasound was performed, demonstrating posterior displacement of the humeral head relative to the glenoid rim, confirming the presence of a posterior shoulder dislocation. The patient received procedural sedation, and the shoulder was reduced with real-time ultrasound visualization. The patient tolerated the procedure well, and had decreased pain and improved range of motion. He was discharged with a sling, swathe, and orthopedic follow-up. Point-of-care ultrasound of the shoulder may be used to demonstrate posterior shoulder dislocation. This may have particular utility in the setting of non-diagnostic radiographs. Copyright © 2013. Published by Elsevier Inc.

Computational reverse shoulder prosthesis model: Experimental data and verification.

PubMed

Martins, A; Quental, C; Folgado, J; Ambrósio, J; Monteiro, J; Sarmento, M

2015-09-18

The reverse shoulder prosthesis aims to restore the stability and function of pathological shoulders, but the biomechanical aspects of the geometrical changes induced by the implant are yet to be fully understood. Considering a large-scale musculoskeletal model of the upper limb, the aim of this study is to evaluate how the Delta reverse shoulder prosthesis influences the biomechanical behavior of the shoulder joint. In this study, the kinematic data of an unloaded abduction in the frontal plane and an unloaded forward flexion in the sagittal plane were experimentally acquired through video-imaging for a control group, composed of 10 healthy shoulders, and a reverse shoulder group, composed of 3 reverse shoulders. Synchronously, the EMG data of 7 superficial muscles were also collected. The muscle force sharing problem was solved through the minimization of the metabolic energy consumption. The evaluation of the shoulder kinematics shows an increase in the lateral rotation of the scapula in the reverse shoulder group, and an increase in the contribution of the scapulothoracic joint to the shoulder joint. Regarding the muscle force sharing problem, the musculoskeletal model estimates an increased activity of the deltoid, teres minor, clavicular fibers of the pectoralis major, and coracobrachialis muscles in the reverse shoulder group. The comparison between the muscle forces predicted and the EMG data acquired revealed a good correlation, which provides further confidence in the model. Overall, the shoulder joint reaction force was lower in the reverse shoulder group than in the control group. Copyright © 2015 Elsevier Ltd. All rights reserved.

Biomechanics of Reverse Shoulder Arthroplasty: 
Current Concepts.

PubMed

Lorenzetti, Adam J; Stone, Geoffrey P; Simon, Peter; Frankle, Mark A

2016-01-01

The evolution of reverse shoulder arthroplasty has provided surgeons with new solutions for many complex shoulder problems. A primary goal of orthopaedics is the restoration or re-creation of functional anatomy to reduce pain and improve function, which can be accomplished by either repairing injured structures or replacing them as anatomically as possible. If reconstructible tissue is lacking or not available, which is seen in patients who have complex shoulder conditions such as an irreparable rotator cuff-deficient shoulder, cuff tear arthropathy, or severe glenoid bone loss, substantial problems may arise. Historically, hemiarthroplasty or glenoid grafting with total shoulder arthroplasty yielded inconsistent and unsatisfactory results. Underlying pathologies in patients who have an irreparable rotator cuff-deficient shoulder, cuff tear arthropathy, or severe glenoid bone loss can considerably alter the mechanical function of the shoulder and create treatment dilemmas that are difficult to overcome. A better biomechanical understanding of these pathologic adaptations has improved treatment options. In the past three decades, reverse total shoulder arthroplasty was developed to treat these complex shoulder conditions not by specifically re-creating the anatomy but by using the remaining functional tissue to improve shoulder balance. Reverse total shoulder arthroplasty has achieved reliable improvements in both pain and function. Initial implant designs lacked scientific evidence to support the design rationale, and many implants failed because surgeons did not completely understand the forces involved or the pathology being treated. Implant function and clinical results will continue to improve as surgeons' biomechanical understanding of shoulder disease and reverse shoulder arthroplasty implants increases.

How reverse shoulder arthroplasty works.

PubMed

Walker, Matthew; Brooks, Jordan; Willis, Matthew; Frankle, Mark

2011-09-01

The reverse total shoulder arthroplasty was introduced to treat the rotator cuff-deficient shoulder. Since its introduction, an improved understanding of the biomechanics of rotator cuff deficiency and reverse shoulder arthroplasty has facilitated the development of modern reverse arthroplasty designs. We review (1) the basic biomechanical challenges associated with the rotator cuff-deficient shoulder; (2) the biomechanical rationale for newer reverse shoulder arthroplasty designs; (3) the current scientific evidence related to the function and performance of reverse shoulder arthroplasty; and (4) specific technical aspects of reverse shoulder arthroplasty. A PubMed search of the English language literature was conducted using the key words reverse shoulder arthroplasty, rotator cuff arthropathy, and biomechanics of reverse shoulder arthroplasty. Articles were excluded if the content fell outside of the biomechanics of these topics, leaving the 66 articles included in this review. Various implant design factors as well as various surgical implantation techniques affect stability of reverse shoulder arthroplasty and patient function. To understand the implications of individual design factors, one must understand the function of the normal and the cuff-deficient shoulder and coalesce this understanding with the pathology presented by each patient to choose the proper surgical technique for reconstruction. Several basic science and clinical studies improve our understanding of various design factors in reverse shoulder arthroplasty. However, much work remains to further elucidate the performance of newer designs and to evaluate patient outcomes using validated instruments such as the American Society for Elbow Surgery, simple shoulder test, and the Constant-Murley scores.

Shoulder pain -- a common problem in world-class badminton players.

PubMed

Fahlström, Martin; Yeap, Joo Seng; Alfredson, Håkan; Söderman, Kerstin

2006-06-01

Badminton is a sport that requires a lot of over-shoulder motion, with the shoulder in abduction/external rotation. This questionnaire study on 188 international top-level badminton players during the World Mixed Team Championships showed that previous or present shoulder pain on the dominant side was reported by 52% of the players. Previous shoulder pain was reported by 37% of the players and on-going shoulder pain by 20% of the players. There were no significant differences in the prevalence of shoulder pain between men and women. The majority of the shoulder pain had started gradually. The pain was usually associated with shoulder activity, and stiffness was a common, associated symptom. Furthermore, the shoulder pain was associated with consequences such as sleeping disturbances, changes in training and competition habits, and it also affected activities of daily living. The majority of the players had sought medical advice and had been given different kinds of treatment. The study showed that shoulder pain is a common and significant problem in world-class badminton players, and the consequences are most likely of importance for their training and playing capacity.

Incidence of Shoulder Injury in Elite Wheelchair Athletes Differ Between Sports: A Critically Appraised Topic.

PubMed

Fairbairn, Jessica R; Huxel Bliven, Kellie C

2018-02-06

Clinical Scenario: Until recently, injury epidemiology data on elite Paralympic athletes was limited. Current data suggests high rates of shoulder injury in wheelchair athletes. Differences in shoulder injury rates between sports have not been reported in this population. Is the incidence of shoulder injury in elite wheelchair athletes different between sports? Summary of Key Findings: Shoulder injury rates are high in elite wheelchair athletes, particularly in sports such as field events and fencing that require a stable base (eg, trunk, core control) from which to perform. Wheelchair racing requires repetitive motions that contribute to shoulder injuries, but rates are lower than field sports and fencing. Wheelchair curling and sledge hockey have low shoulder injury risk. Clinical Bottom Line: Shoulder injury rates vary based on sport in elite wheelchair athletes. In addition to incorporating shoulder complex specific rehabilitation for overuse shoulder injuries, clinicians should focus on core and trunk stabilization in elite wheelchair athletes competing in sports such as field events and fencing. Strength of Recommendation: Grade C evidence exists that reports shoulder injury rates among elite wheelchair athletes differ base upon sport participation.

A history of reverse total shoulder arthroplasty.

PubMed

Flatow, Evan L; Harrison, Alicia K

2011-09-01

Management of the cuff-deficient arthritic shoulder has long been challenging. Early unconstrained shoulder arthroplasty systems were associated with high complication and implant failure rates. The evolution toward the modern reverse shoulder arthroplasty includes many variables of constrained shoulder arthroplasty designs. This review explores the development of reverse shoulder arthroplasty, specifically describing (1) the evolution of reverse shoulder arthroplasty designs, (2) the biomechanical variations in the evolution of this arthroplasty, and (3) the current issues relevant to reverse shoulder arthroplasty today. Using a PubMed search, the literature was explored for articles addressing reverse shoulder arthroplasty, focusing on those papers with historical context. Results of the early designs were apparently poor, although they were not subjected to rigorous clinical research and usually reported only in secondary literature. We identified a trend of glenoid component failure in the early reverse designs. This trend was recognized and reported by authors as the reverse shoulder evolved. Authors reported greater pain relief and better function in reverse shoulder arthroplasty with the fundamental change of Grammont's design (moving the center of rotation medially and distally). However, current reports suggest lingering concerns and challenges with today's designs. The history of reverse shoulder arthroplasty involves the designs of many forward-thinking surgeons. Many of these highly constrained systems failed, although more recent designs have demonstrated improved longevity and implant performance. Reverse shoulder arthroplasty requires ongoing study, with challenges and controversies remaining around present-day designs.

Effect of a worktable position on head and shoulder posture and shoulder muscles in manual material handling.

PubMed

Kim, Min-Hee; Yoo, Won-Gyu

2015-06-05

According to a recent research, manual working with high levels of static contraction, repetitive loads, or extreme working postures involving the neck and shoulder muscles causes an increased risk of neck and shoulder musculoskeletal disorders. We investigated the effects of the forwardly worktable position on head and shoulder angles and shoulder muscle activity in manual material handling tasks. The forward head and shoulder angles and the activity of upper trapezius, levator scapulae, and middle deltoid muscle activities of 15 workers were measured during performing of manual material handling in two tasks that required different forward head and shoulder angles. The second manual material task required a significantly increased forward head and shoulder angle. The upper trapezius and levator scapulae muscle activity in second manual material task was increased significantly compared with first manual material task. The middle deltoid muscle activity in second manual material task was not significantly different compared with first manual material task. Based on this result, the forward head and shoulder angles while performing manual work need to be considered in selection of the forward distance of a worktable form the body. The high level contractions of the neck and shoulder muscles correlated with neck and shoulder pain. Therefore, the forward distance of a worktable can be an important factor in preventing neck and shoulder pain in manual material handling workers.

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.

Soft tissue balancing in total shoulder replacement.

PubMed

Mueller, Maike; Hoy, Gregory

2014-03-01

Total shoulder arthroplasty is now capable of recreating near anatomic reproduction of native bony shoulder anatomy, but the function and longevity of anatomic shoulder replacement is dependent on a competent soft tissue envelope and adequate motoring of all musculo-tendinous units about the shoulder. Balancing the soft tissues requires understanding of the anatomy and pathology, as well as technical skills. The advent of reverse shoulder biomechanics has brought with it special requirements of understanding of the soft tissue elements still left in the shoulder despite major rotator cuff deficiency.

Shoulder internal rotation elbow flexion test for diagnosing cubital tunnel syndrome.

PubMed

Ochi, Kensuke; Horiuchi, Yukio; Tanabe, Aya; Waseda, Makoto; Kaneko, Yasuhito; Koyanagi, Takahiro

2012-06-01

Shoulder internal rotation enhances symptom provocation attributed to cubital tunnel syndrome. We present a modified elbow flexion test--the shoulder internal rotation elbow flexion test--for diagnosing cubital tunnel syndrome. Fifty-five ulnar nerves in cubital tunnel syndrome patients and 123 ulnar nerves in controls were examined with 5 seconds each of elbow flexion, shoulder internal rotation, and shoulder internal rotation elbow flexion tests before and after treatment (surgery in 18; conservative in others). For the shoulder internal rotation elbow flexion test position, 90° abduction, maximum internal rotation, and 10° flexion of the shoulder were combined with the elbow flexion test position. The test was considered positive if any symptom for cubital tunnel syndrome developed <5 seconds. Influence of the shoulder internal rotation elbow flexion test was evaluated by nerve conduction studies in 10 cubital tunnel syndrome nerves and 7 control nerves. The sensitivities/specificities of the 5-second elbow flexion, shoulder internal rotation, and shoulder internal rotation elbow flexion tests were 25%/100%, 58%/100%, and 87%/98%, respectively. Sensitivity differences between the shoulder internal rotation elbow flexion test and the other two tests were significant. Shoulder internal rotation elbow flexion test results and cubital tunnel syndrome symptoms were significantly correlated. Influence of the shoulder internal rotation elbow flexion test on the ulnar nerve was seen in 8 of 10 cubital tunnel syndrome nerves but not in controls. The 5-second shoulder internal rotation elbow flexion test is specific, easy and quick provocative test for diagnosing cubital tunnel syndrome. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Specific Shoulder Pathoanatomy in Semiprofessional Water Polo Players

PubMed Central

Klein, Maria; Tarantino, Ignazio; Warschkow, René; Berger, Claus Joachim; Zdravkovic, Vilijam; Jost, Bernhard; Badulescu, Michael

2014-01-01

Background: Shoulders of throwing and swimming athletes are highly stressed joints that often show structural abnormalities on magnetic resonance imaging (MRI). However, while water polo players exhibit a combination of throwing and swimming movements, a specific pattern of pathological findings has not been described. Purpose: To assess specific MRI abnormalities in shoulders of elite water polo players and to compare these findings with a healthy control group. Study Design: Cross-sectional study; Level of evidence, 3. Methods: After performing a power analysis, volunteers were recruited for this study. Both shoulders of 28 semiprofessional water polo players and 15 healthy volunteers were assessed clinically (based on the Constant score) and had bilateral shoulder MRIs. The shoulders were clustered into 3 groups: 28 throwing and 28 nonthrowing shoulders of water polo athletes and 30 shoulders of healthy control subjects. Results: Twenty-eight male water polo players with an average age of 24 years and 15 healthy subjects (30 shoulders) with an average age of 31 years were examined. Compared with controls, significantly more MRI abnormalities in the water polo players' throwing shoulders could be found in the subscapularis, infraspinatus, and posterior labrum (P = .001, P = .024, and P = .041, respectively). Other structures showed no statistical differences between the 3 groups, including the supraspinatus tendon, which had abnormalities in 36% of throwing versus 32% of nonthrowing shoulders and 33% of control shoulders. All throwing shoulders showed abnormal findings in the MRI, but only 8 (29%) were symptomatic. Conclusion: The shoulders of semiprofessional water polo players demonstrated abnormalities in subscapularis and infraspinatus tendons that were not typical abnormalities for swimmers or throwing athletes. Clinical Relevance: The throwing shoulders of water polo players have specific MRI changes. Clinical symptoms do not correlate with the MRI findings. PMID:26535326

Using the Microsoft Kinect™ to assess 3-D shoulder kinematics during computer use.

PubMed

Xu, Xu; Robertson, Michelle; Chen, Karen B; Lin, Jia-Hua; McGorry, Raymond W

2017-11-01

Shoulder joint kinematics has been used as a representative indicator to investigate musculoskeletal symptoms among computer users for office ergonomics studies. The traditional measurement of shoulder kinematics normally requires a laboratory-based motion tracking system which limits the field studies. In the current study, a portable, low cost, and marker-less Microsoft Kinect™ sensor was examined for its feasibility on shoulder kinematics measurement during computer tasks. Eleven healthy participants performed a standardized computer task, and their shoulder kinematics data were measured by a Kinect sensor and a motion tracking system concurrently. The results indicated that placing the Kinect sensor in front of the participants would yielded a more accurate shoulder kinematics measurements then placing the Kinect sensor 15° or 30° to one side. The results also showed that the Kinect sensor had a better estimate on shoulder flexion/extension, compared with shoulder adduction/abduction and shoulder axial rotation. The RMSE of front-placed Kinect sensor on shoulder flexion/extension was less than 10° for both the right and the left shoulder. The measurement error of the front-placed Kinect sensor on the shoulder adduction/abduction was approximately 10° to 15°, and the magnitude of error is proportional to the magnitude of that joint angle. After the calibration, the RMSE on shoulder adduction/abduction were less than 10° based on an independent dataset of 5 additional participants. For shoulder axial rotation, the RMSE of front-placed Kinect sensor ranged between approximately 15° to 30°. The results of the study suggest that the Kinect sensor can provide some insight on shoulder kinematics for improving office ergonomics. Copyright © 2017 Elsevier Ltd. All rights reserved.

Evaluation of safety effectiveness of composite shoulders, wide unpaved shoulders, and wide paved shoulders in Kansas.

DOT National Transportation Integrated Search

2013-03-01

Incremental increases in paved shoulder widths have been studied and are shown in the Highway Safety Manual. While : each incremental increase in shoulder width is beneficial, there is evidence that suggests the relationship between safety : improvem...

The angle of shoulder slope in normal males as a factor in shoulder-harness design.

DOT National Transportation Integrated Search

1965-03-01

In order to establish criteria for more comfortable shoulder-harness design, this study was conducted to determine the angle of slope of the top of the shoulders where poorly fitting shoulder harness may produce discomfort and, occasionally, function...

Shoulder joint impairment among Finns aged 30 years or over: prevalence, risk factors and co-morbidity.

PubMed

Mäkelä, M; Heliövaara, M; Sainio, P; Knekt, P; Impivaara, O; Aromaa, A

1999-07-01

To describe the prevalence, risk factors and consequences of shoulder joint impairment in the population. A representative sample (n = 7217) of the Finnish population aged > or = 30 yr participated in a health examination survey (the Mini-Finland Health Survey). The design of the survey allowed an independent assessment of disability, reported shoulder pain, shoulder joint impairment and major chronic co-morbidity. Shoulder impairment was observed in 8.8%, while pain was reported by 30%. The prevalence of shoulder pain decreased among the elderly, whereas impairments increased up to 20% of those aged 75-80 yr. In addition to age, sex, previous injury to the shoulder joint and a history of physically heavy work, diabetes was associated with shoulder impairment (OR 1.6, 95% CI 1.2-2.1). Shoulder impairment was associated with disability (adjusted OR 2.0, CI 1.6-2.5). Shoulder impairment is an important component of ill health among the elderly, and cannot be reduced to reported pain alone.

Shoulder pain after caesarean section: comparison between general and spinal anaesthesia.

PubMed

Zirak, N; Soltani, G; Hafizi, L; Mashayekhi, Z; Kashani, I

2012-05-01

This study investigated shoulder pain as a maternal complication after caesarean section (CS), evaluation of its prevalence and comparison between spinal anaesthesia (SA) and general anaesthesia (GA) groups. A total of 200 women as CS candidates were allocated into two equal groups; SA and GA. The total prevalence of shoulder pain was 39.45%. The two groups were matched according to demographic data. However, the incidence of shoulder pain in the GA group was more than that in the SA group (p =0.004). Shoulder pain in the right shoulder in the GA group was more prevalent than the left shoulder (p <0.001). Moderate severity of shoulder pain was significantly more in the GA group (p =0.000), while in the SA group, the mild severity was significant (p <0.001). Our study revealed that the incidence of shoulder pain after CS is significant. Moreover, shoulder pain was significantly more common in the GA group than the SA group.

Investigation of a relationship between external force to shoulder and chest injury of WorldSID and THUMS in 32 km/h oblique pole side impact.

PubMed

Tanaka, Shinobu; Hayashi, Shigeki; Fukushima, Satoshi; Yasuki, Tsuyoshi

2013-01-01

This article describes the chest injury risk reduction effect of shoulder restraints using finite element (FE) models of the worldwide harmonized side impact dummy (WorldSID) and Total Human Model for Safety (THUMS) in an FE model 32 km/h oblique pole side impact. This research used an FE model of a mid-sized vehicle equipped with various combinations of curtain shield air bags, torso air bags, and shoulder restraint air bags. As occupant models, AM50 WorldSID and THUMS AM50 Version 4 were used for comparison. The research investigated the effect of shoulder restraint air bag on chest injury by comparing cases with and without a shoulder side air bag. The maximum external force to the chest was reduced by shoulder restraint air bag in both WorldSID and THUMS, reducing chest injury risk as measured by the amount of rib deflection, number of the rib fractures, and rib deflection ratio. However, it was also determined that the external force to shoulder should be limited to the chest injury threshold because the external shoulder force transmits to the chest via the arm in the case of WorldSID and via the scapula in the case of THUMS. Because these results show the shoulder restraint air bag effect on chest injury risk, the vent hole size of the shoulder restraint air bag was changed for varying reaction forces to investigate the relationship between the external force to the shoulder and the risk of chest injury. In the case of THUMS, an external shoulder force of 1.8 kN and more force from the shoulder restraint air bag was necessary to help prevent rib fracture. Increasing external force applied to shoulder up to 6.2 kN (the maximum force used in this study) did not induce any rib or clavicle fractures in the THUMS. When the shoulder restraint air bag generated external force to the shoulder from 1.8 to 6.2 kN in THUMS, which were applied to the WorldSID, the shoulder deflection ranged from 35 to 68 mm, and the shoulder force ranged from 1.8 to 2.3 kN. In the test configuration used, a shoulder restraint using the air bag helps reduce chest injury risk by lowering the maximum magnitude of external force to the shoulder and chest. To help reduce rib fracture risk in the THUMS, the shoulder restraint air bag was expected to generate a force of 3.7 kN with a minimum rib deflection ratio. This corresponds to a shoulder rib deflection of 60 mm and a shoulder load of 2.2 kN in WorldSID. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

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

Calcifying tendinitis of the shoulder: midterm results after arthroscopic treatment.

PubMed

Balke, Maurice; Bielefeld, Rebecca; Schmidt, Carolin; Dedy, Nicolas; Liem, Dennis

2012-03-01

Calcifying tendinitis is a common and painful disorder of the shoulder characterized by the presence of calcific deposits in the tendons of the rotator cuff. When nonoperative treatment over a prolonged period of time fails, surgical treatment should be considered. Midterm success rates are inconsistent, and the role of subacromial decompression is still unclear. Our hypotheses were that the rate of supraspinatus tears after arthroscopic treatment of calcifying tendinitis is comparable with that in the contralateral uninvolved shoulder and that subacromial decompression does not have beneficial effects compared with calcium removal alone. Case series; Level of evidence, 4. In 70 shoulders of 62 patients with a mean age of 54 years, arthroscopic removal of calcium deposits of the supraspinatus tendon was performed. In 44 shoulders, additional subacromial decompression was performed. After a mean follow-up of 6 years (range, 2-13 years), patients were clinically investigated, and function was statistically evaluated using Constant and American Shoulder and Elbow Surgeons (ASES) scores. Affected and contralateral shoulders were examined by ultrasound in 48 shoulders, and rotator cuff tears were documented. The mean Constant scores of the operated shoulders were significantly lower than those of the healthy shoulders (P < .001). The ASES scores significantly (P < .001) increased after surgery but were still lower than the ASES scores of the healthy shoulders (P < .001). Concerning the additional subacromial decompression, there were no significant differences in the overall ASES and Constant scores; the subitem "pain" was significantly better in the subacromial decompression group (P = .048). Ultrasound examination at last follow-up (48 shoulders) showed a partial supraspinatus tendon tear in 11 operated and 3 contralateral shoulders. Although the good clinical results after arthroscopic treatment of calcifying tendinitis of the shoulder persist midterm, the affected shoulders present significantly lower clinical scores than healthy shoulders. The rate of partial supraspinatus tendon tears seems to be higher after calcium removal. Additional subacromial decompression seems to reduce postoperative pain.

Evaluation of safety effectiveness of composite shoulders, wide unpaved shoulders, and wide paved shoulders in Kansas : [technical summary].

DOT National Transportation Integrated Search

2013-03-01

Incremental increases in paved shoulder widths have been studied and are shown in the Highway Safety Manual (HSM). While each incremental increase in shoulder width is beneficial, there is evidence that suggests the relationship between safety improv...

49 CFR 572.194 - Shoulder.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Shoulder. 572.194 Section 572.194 Transportation..., Small Adult Female § 572.194 Shoulder. (a) The shoulder structure is part of the upper torso assembly shown in drawing 180-3000. For the shoulder impact test, the dummy is tested as a complete assembly...

49 CFR 572.184 - Shoulder assembly.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 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 this...

49 CFR 572.184 - Shoulder assembly.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 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 this...

21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained cemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shoulder joint metal/polymer non-constrained... Shoulder joint metal/polymer non-constrained cemented prosthesis. (a) Identification. A shoulder joint... shoulder joint. The device limits minimally (less than normal anatomic constraints) translation in one or...

49 CFR 572.194 - Shoulder.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 49 Transportation 7 2012-10-01 2012-10-01 false Shoulder. 572.194 Section 572.194 Transportation..., Small Adult Female § 572.194 Shoulder. (a) The shoulder structure is part of the upper torso assembly shown in drawing 180-3000. For the shoulder impact test, the dummy is tested as a complete assembly...

49 CFR 572.184 - Shoulder assembly.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Shoulder assembly. 572.184 Section 572.184... Test Dummy, 50th Percentile Adult Male § 572.184 Shoulder assembly. (a) The shoulder (175-3000) is part... (b) of this section, the shoulder assembly shall meet performance requirements of paragraph (c) of...

49 CFR 572.194 - Shoulder.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 49 Transportation 7 2014-10-01 2014-10-01 false Shoulder. 572.194 Section 572.194 Transportation..., Small Adult Female § 572.194 Shoulder. (a) The shoulder structure is part of the upper torso assembly shown in drawing 180-3000. For the shoulder impact test, the dummy is tested as a complete assembly...

49 CFR 572.184 - Shoulder assembly.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 7 2013-10-01 2013-10-01 false Shoulder assembly. 572.184 Section 572.184... Test Dummy, 50th Percentile Adult Male § 572.184 Shoulder assembly. (a) The shoulder (175-3000) is part... (b) of this section, the shoulder assembly shall meet performance requirements of paragraph (c) of...

21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shoulder joint metal/polymer non-constrained... Shoulder joint metal/polymer non-constrained cemented prosthesis. (a) Identification. A shoulder joint... shoulder joint. The device limits minimally (less than normal anatomic constraints) translation in one or...

49 CFR 572.194 - Shoulder.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 49 Transportation 7 2011-10-01 2011-10-01 false Shoulder. 572.194 Section 572.194 Transportation..., Small Adult Female § 572.194 Shoulder. (a) The shoulder structure is part of the upper torso assembly shown in drawing 180-3000. For the shoulder impact test, the dummy is tested as a complete assembly...

21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shoulder joint metal/polymer non-constrained... Shoulder joint metal/polymer non-constrained cemented prosthesis. (a) Identification. A shoulder joint... shoulder joint. The device limits minimally (less than normal anatomic constraints) translation in one or...

[The painful hemiplegic shoulder: effects of exercises program according to Bobath].

PubMed

Gialanella, B; Benvenuti, P; Santoro, R

2004-01-01

To verify whether a shoulder exercises program according to Bobath reduced the shoulder pain in hemiplegic patients. We studied a total of 20 patients with pain shoulder. Ten patients are assigned to group R (submitted to rehabilitation) and ten to group R+E (submitted to rehabilitation and shoulder exercises program according to Bobath). Shoulder exercises program was self-performed by the patients after training in occupational rehabilitation unit. The assessment of patients was performed at admission to hospital, at discharge and three months after discharge. Shoulder pain (VAS), shoulder range of motion, disability (FIM), motor function (Fugl-Meyer scale) and spasticity (Ashworth scale) of paretic arm were evaluated in all patients. VAS was similar in both groups at admission and decreased in group R+E at discharge without reaching significant differences (p=0.253). On the contrary, VAS and Shoulder range of motion improved statistically in group R+E (p=0.0001, p<0.04 respectively) after three months. The others variables measured did not change. This study showed that a shoulder exercises program according to Bobath reduces shoulder pain of patients with hemiplegia if it is performed daily and for a long period of time.

Risk factors for shoulder and elbow pain in youth baseball players.

PubMed

Matsuura, Tetsuya; Iwame, Toshiyuki; Suzue, Naoto; Arisawa, Kokichi; Sairyo, Koichi

2017-05-01

This study sought to quantify the 1-year cumulative incidence of shoulder and elbow pain among youth baseball players and identify risk factors associated with the occurrence of shoulder and elbow pain. In total, 900 youth baseball players (aged 7-11 years) were enrolled in a 1-year prospective follow-up study. One year later, the players were asked whether they had experienced episodes of shoulder or elbow pain and the following risk factors for such pain were investigated: age, position, length of baseball experience, training hours per week, and history of shoulder or elbow pain. Data for the groups with and without shoulder or elbow pain were analyzed using multivariate logistic regression models. Episodes of shoulder pain were reported by 18.3% of players and episodes of elbow pain were reported by 35.2% of players. Multivariate analysis showed that shoulder pain was associated with pitcher position, catcher position, longer training hours per week, and history of shoulder and elbow pain, and that elbow pain was associated with age, pitcher position, catcher position, longer training hours per week, and history of elbow pain. Length of baseball experience was not associated with shoulder or elbow pain. History of elbow pain, pitcher position, catcher position, and longer training hours per week were associated with both types of pain. History of shoulder pain was associated with shoulder pain but not elbow pain. Age was associated with elbow pain but not shoulder pain.

Dominant vs. non-dominant shoulder morphology in volleyball players and associations with shoulder pain and spike speed.

PubMed

Challoumas, Dimitrios; Artemiou, Andreas; Dimitrakakis, Georgios

2017-01-01

The aims of our study were to compare the dominant (DOM) and non-dominant (NDOM) shoulders of high-level volleyball athletes and identify possible associations of shoulder adaptations with spike speed (SS) and shoulder pathology. A total of 22 male volleyball players from two teams participating in the first division of the Cypriot championship underwent clinical shoulder tests and simple measurements around their shoulder girdle joints bilaterally. SS was measured with the use of a sports speed radar. Compared with the NDOM side, the DOM scapula was more lateralised, the DOM dorsal capsule demonstrated greater laxity, the DOM dorsal muscles stretching ability was compromised, and the DOM pectoralis muscle was more lengthened. Players with present or past DOM shoulder pain demonstrated greater laxity in their DOM dorsal capsule, tightening of their DOM inferior capsule, and lower SS compared with those without shoulder pain. Dorsal capsule measurements bilaterally were significant predictors of SS. None of the shoulder measurements was associated with team roles or infraspinatus atrophy, while scapular lateralisation was more pronounced with increasing years of experience, and scapular antetilting was greater with increasing age. Adaptations of the DOM shoulder may be linked to pathology and performance. We describe simple shoulder measurements that may have the potential to predict chronic shoulder injury and become part of injury prevention programmes. Detailed biomechanical and large prospective studies are warranted to assess the validity of our findings and reach more definitive conclusions.

Effects of two stretching methods on shoulder range of motion and muscle stiffness in baseball players with posterior shoulder tightness: a randomized controlled trial.

PubMed

Yamauchi, Taishi; Hasegawa, Satoshi; Nakamura, Masatoshi; Nishishita, Satoru; Yanase, Ko; Fujita, Kosuke; Umehara, Jun; Ji, Xiang; Ibuki, Satoko; Ichihashi, Noriaki

2016-09-01

The cross-body stretch and sleeper stretch are widely used for improving flexibility of the posterior shoulder. These stretching methods were modified by Wilk. However, few quantitative data are available on the new, modified stretching methods. A recent study reported the immediate effects of stretching and soft tissue mobilization on the shoulder range of motion (ROM) and muscle stiffness in subjects with posterior shoulder tightness. However, the long-term effect of stretching for muscle stiffness is unknown. The objective of this study was to examine the effects of 2 stretching methods, the modified cross-body stretch (MCS) and the modified sleeper stretch (MSS), on shoulder ROM and muscle stiffness in baseball players with posterior shoulder tightness. Twenty-four college baseball players with ROM limitations in shoulder internal rotation were randomly assigned to the MCS or MSS group. We measured shoulder internal rotation and horizontal adduction ROM and assessed posterior shoulder muscle stiffness with ultrasonic shear wave elastography before and after a 4-week intervention. Subjects were asked to perform 3 repetitions of the stretching exercises every day, for 30 seconds, with their dominant shoulder. In both groups, shoulder internal rotation and horizontal adduction ROM were significantly increased after the 4-week intervention. Muscle stiffness of the teres minor decreased in the MCS group, and that of the infraspinatus decreased in the MSS group. The MCS and MSS are effective for increasing shoulder internal rotation and horizontal adduction ROM and decreasing muscle stiffness of the infraspinatus or teres minor. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Kinematic analysis of dynamic shoulder motion in patients with reverse total shoulder arthroplasty.

PubMed

Kwon, Young W; Pinto, Vivek J; Yoon, Jangwhon; Frankle, Mark A; Dunning, Page E; Sheikhzadeh, Ali

2012-09-01

Reverse total shoulder arthroplasty (rTSA) has been used to treat patients with irreparable rotator cuff dysfunction. Despite the proven clinical efficacy, there is minimal information regarding the underlying changes to the shoulder kinematics associated with this construct. Therefore, we sought to examine the kinematics of dynamic shoulder motion in patients with well-functioning rTSA. We tested 12 healthy subjects and 17 patients with rTSA. All rTSA patients were able to elevate their arms to at least 90° and received the implant as the primary arthroplasty at least 6 months before testing. On average, the rTSA patients elevated their arms to 112° ± 12° (mean ± SD) and reported an American Shoulder and Elbow Surgeons outcome score of 90.6 ± 6.3. A 3-dimensional electromagnetic motion capture device was used to detect the dynamic motion of the trunk, scapula, and humerus during bilateral active shoulder elevation along the sagittal, scapular, and coronal planes. In both healthy and rTSA shoulders, the majority of the humeral-thoracic motion was provided by the glenohumeral motion. Therefore, the ratio of glenohumeral to scapulothoracic (ST) motion was always greater than 1.62 during elevation along the scapular plane. In comparison to healthy subjects, however, the contribution of ST motion to overall shoulder motion was significantly increased in the rTSA shoulders. This increased contribution was noted in all planes of shoulder elevation and was maintained when weights were attached to the arm. Kinematics of the rTSA shoulders are significantly altered, and more ST motion is used to achieve shoulder elevation. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Outcomes of an anatomic total shoulder arthroplasty with a contralateral reverse total shoulder arthroplasty.

PubMed

Cox, Ryan M; Padegimas, Eric M; Abboud, Joseph A; Getz, Charles L; Lazarus, Mark D; Ramsey, Matthew L; Williams, Gerald R; Horneff, John G

2018-06-01

It is common for patients to require staged bilateral shoulder arthroplasties. There is a unique cohort of patients who require an anatomic total shoulder arthroplasty (TSA) and a contralateral reverse shoulder arthroplasty (RSA). This study compared the outcomes of patients with a TSA in 1 shoulder and an RSA in the contralateral shoulder. Our institutional database was queried to identify all patients with a TSA and a contralateral RSA. Data collection included patient demographics, preoperative and latest follow-up shoulder range of motion, radiographic analysis, and postoperative complications. Identified patients were assessed at follow-up visits or contacted by phone for functional outcome scores. Nineteen patients met our inclusion/exclusion criteria. There was statistically significant greater internal rotation in the TSA shoulder (P= .044) but no significant difference in forward elevation (P = .573) or external rotation (P= .368). There was no radiographic evidence of humeral or glenoid component loosening of any arthroplasty implants. There were no significant differences between TSA and RSA shoulders for the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (P= .381), Simple Shoulder Test (P = .352), Single Assessment Numerical Evaluation (P = .709), and visual analog scale satisfaction (P= .448) or pain scores (P= .305). Thirteen patients (68.4%) preferred the RSA side, 1 patient (5.3%; z = 4.04, P < .001) patient preferred the TSA side, and 5 patients expressed no preference. Despite known limitations and differences between TSA and RSA designs, patients who have received both implants are highly satisfied with both. The only parameter in which the TSA had superior outcomes was internal rotation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A pragmatic regional interdependence approach to primary frozen shoulder: a retrospective case series.

PubMed

Wong, Christopher Kevin; Strang, Bryanna L; Schram, Galen A; Mercer, Elizabeth A; Kesting, Rebecca S; Deo, Kabi S

2018-05-01

Although the shoulder is known to move together with the scapula and other upper quarter joints, the current frozen shoulder clinical practice guidelines describe only physical therapy study treatments directed to the shoulder. None received a strong recommendation, highlighting the need for alternate interventions. This retrospective case series describes a pragmatic regional interdependence approach to frozen shoulder with impairment and functional outcomes, noting whether final ROM approached normal. Five consecutive patients referred with frozen shoulder diagnoses attended 11-21 sessions over 5-10 weeks with one physical therapist. Treatment addressed inter-related regions (shoulder, shoulder girdle, scapulothoracic/humerothoracic, and spine) following a pragmatic approach using impairment-based interventions (joint/soft tissue mobilization, muscle stretching/strengthening) as well as patient education, modalities and warm up that addressed individual presentations. All patients improved on all outcomes. Mean shoulder ROM at discharge, the impairment outcome, demonstrated large effect size increases: flexion (117 ± 10-179 ± 12, d  = 5.9), abduction (74 ± 8-175 ± 9, d  = 9.3), external rotation (23 ± 7-89 ± 2, d  = 12.0). The Disability of Arm Shoulder Hand functional outcome score upon follow up demonstrated a large effect size improvement ( d  = 1.5) from 40.0 ± 19.4-6.2 ± 3.7. Final ROM approached normal. This case series utilized a regional interdependence approach to frozen shoulder that included manual therapy interventions directed to consistent upper quarter body segments. Shoulder ROM was returned to near normal with functional improvements evident months after discharge. A pragmatic regional interdependence approach addressing multiple joints related to shoulder function may benefit other people with frozen shoulder. 4.

Incidence of and risk factors for traumatic anterior shoulder dislocation: an epidemiologic study in high-school rugby players.

PubMed

Kawasaki, Takayuki; Ota, Chihiro; Urayama, Shingo; Maki, Nobukazu; Nagayama, Masataka; Kaketa, Takefumi; Takazawa, Yuji; Kaneko, Kazuo

2014-11-01

The incidence of reinjuries due to glenohumeral instability and the major risk factors for primary anterior shoulder dislocation in youth rugby players have been unclear. The purpose of this study was to investigate the incidence, mechanisms, and intrinsic risk factors of shoulder dislocation in elite high-school rugby union teams during the 2012 season. A total of 378 male rugby players from 7 high-school teams were investigated by use of self-administered preseason and postseason questionnaires. The prevalence of a history of shoulder dislocation was 14.8%, and there were 21 events of primary shoulder dislocation of the 74 overall shoulder injuries that were sustained during the season (3.2 events per 1000 player-hours of match exposure). During the season, 54.3% of the shoulders with at least one episode of shoulder dislocation had reinjury. This study also indicated that the persistence of glenohumeral instability might affect the player's self-assessed condition, regardless of the incidence during the current season. By a multivariate logistic regression method, a history of shoulder dislocation on the opposite side before the season was found to be a risk factor for contralateral primary shoulder dislocation (odds ratio, 3.56; 95% confidence interval, 1.27-9.97; P = .02). High-school rugby players with a history of shoulder dislocation are not playing at full capacity and also have a significant rate of reinjury as well as a high risk of dislocating the other shoulder. These findings may be helpful in deciding on the proper treatment of primary anterior shoulder dislocation in young rugby players. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings.

PubMed

Gil-Agudo, Ángel; Solís-Mozos, Marta; Crespo-Ruiz, Beatriz; Del-Ama Eng, Antonio J; Pérez-Rizo, Enrique; Segura-Fragoso, Antonio; Jiménez-Díaz, Fernando

2014-01-01

Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.

Echographic and Kinetic Changes in the Shoulder Joint after Manual Wheelchair Propulsion Under Two Different Workload Settings

PubMed Central

Gil-Agudo, Ángel; Solís-Mozos, Marta; Crespo-Ruiz, Beatriz; del-Ama Eng, Antonio J.; Pérez-Rizo, Enrique; Segura-Fragoso, Antonio; Jiménez-Díaz, Fernando

2014-01-01

Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics. PMID:25566539

Physiotherapy treatment of the diabetic shoulder: a longitudinal study following patients with diabetes and shoulder pain using a pre-post treatment design.

PubMed

Kyhlbäck, Maria; Schröder Winter, Helena; Thierfelder, Tomas; Söderlund, Anne

2014-01-01

The aim of this study was to describe and evaluate a physiotherapy program targeted to reduce pain intensity and improve the daily functioning of diabetics with shoulder problems. It was hypothesized that patients receiving specific physiotherapy treatment improved more frequently and rapidly than diabetic patients followed up without specific physiotherapeutic intervention. A pre-post treatment design was completed for a group of 10 subjects. The treatment protocol, also applied during the daily activities of the subjects, was aiming at reducing pain intensity and shoulder stiffness and improving impaired functioning in daily activities by muscle relaxation, light-load exercise and enhancing proper shoulder co-ordination. The group analysis showed significant decrease of pain intensity level as well as improved shoulder functioning and sustained level of subject self-efficacy beliefs throughout the study period. The results suggest that it is possible to relieve shoulder pain intensity and improve daily activities of patients with diabetes-related shoulder problems by employing a physiotherapy program focusing on muscle relaxation, light-load exercise and on the enhancement of proper shoulder co-ordination in daily activities. A physiotherapy program can be effective in reducing pain and improving shoulder function in diabetics with shoulder problems. The treatment should focus on muscle relaxation, light-load exercise and on the enhancement of proper shoulder co-ordination in daily activities.

Short-term Clinical Results of Manipulation Under Ultrasound-Guided Brachial Plexus Block in Patients with Idiopathic Frozen Shoulder and Diabetic Secondary Frozen Shoulder.

PubMed

Ando, Akira; Hamada, Junichiro; Hagiwara, Yoshihiro; Sekiguchi, Takuya; Koide, Masashi; Itoi, Eiji

2018-01-01

This study examined the effectiveness of manipulation under ultrasound-guided brachial plexus block in patients with recalcitrant idiopathic frozen shoulder and diabetic secondary frozen shoulder (diabetic frozen shoulder). Forty-four idiopathic frozen shoulders and 10 diabetic frozen shoulders with failed conservative treatment for at least 3 months were included in this study. The manipulation was performed under ultrasound-guided brachial plexus block and visual analogue scale, range of motion, and Constant scores were measured before manipulation and at the last follow-up examination. No major complications were observed during the procedure. Sufficient improvement was not obtained in two patients during the procedure and to avoid complications, the procedure was discontinued and subsequently arthroscopic capsular release was performed. Visual analogue scale, range of motion towards all directions, and Constant scores were significantly improved after the manipulation in both the idiopathic frozen shoulder and diabetic frozen shoulder groups, however the diabetic group showed inferior results compared with those of the idiopathic group. This manipulation was effective and shortened the duration of symptoms in most of the idiopathic and diabetic frozen shoulders without major complications during the procedure. Diabetic frozen shoulder showed inferior clinical results and difficulty in recovery in range of motion, which indicated that diabetic frozen shoulder should be discussed as a different entity.

21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shoulder joint metal/polymer semi-constrained... Shoulder joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A shoulder joint... shoulder joint. The device limits translation and rotation in one or more planes via the geometry of its...

14 CFR 137.42 - Fastening of safety belts and shoulder harnesses.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Fastening of safety belts and shoulder... AGRICULTURAL AIRCRAFT OPERATIONS Operating Rules § 137.42 Fastening of safety belts and shoulder harnesses. No... belt and shoulder harness properly secured about that person except that the shoulder harness need not...

14 CFR 137.42 - Fastening of safety belts and shoulder harnesses.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Fastening of safety belts and shoulder... AGRICULTURAL AIRCRAFT OPERATIONS Operating Rules § 137.42 Fastening of safety belts and shoulder harnesses. No... belt and shoulder harness properly secured about that person except that the shoulder harness need not...

14 CFR 137.42 - Fastening of safety belts and shoulder harnesses.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Fastening of safety belts and shoulder... AGRICULTURAL AIRCRAFT OPERATIONS Operating Rules § 137.42 Fastening of safety belts and shoulder harnesses. No... belt and shoulder harness properly secured about that person except that the shoulder harness need not...

14 CFR 137.42 - Fastening of safety belts and shoulder harnesses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Fastening of safety belts and shoulder... AGRICULTURAL AIRCRAFT OPERATIONS Operating Rules § 137.42 Fastening of safety belts and shoulder harnesses. No... belt and shoulder harness properly secured about that person except that the shoulder harness need not...

21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shoulder joint metal/polymer semi-constrained... Shoulder joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A shoulder joint... shoulder joint. The device limits translation and rotation in one or more planes via the geometry of its...

14 CFR 137.42 - Fastening of safety belts and shoulder harnesses.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Fastening of safety belts and shoulder... AGRICULTURAL AIRCRAFT OPERATIONS Operating Rules § 137.42 Fastening of safety belts and shoulder harnesses. No... belt and shoulder harness properly secured about that person except that the shoulder harness need not...

21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shoulder joint metal/polymer semi-constrained... Shoulder joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A shoulder joint... shoulder joint. The device limits translation and rotation in one or more planes via the geometry of its...

Separated Shoulder

MedlinePlus

... that hold your collarbone (clavicle) to your shoulder blade. In a mild separated shoulder, the ligaments might ... ligaments that hold your collarbone to your shoulder blade. Risk factors Participating in contact sports, such as ...

Dislocated Shoulder

MedlinePlus

... up of three bones: your collarbone, your shoulder blade, and your upper arm bone. The top of ... fits into a cuplike socket in your shoulder blade. A shoulder dislocation is an injury that happens ...

Stemless shoulder arthroplasty: a literature review

PubMed Central

PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

2015-01-01

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

Strength Asymmetry of the Shoulders in Elite Volleyball Players

PubMed Central

Hadzic, Vedran; Sattler, Tine; Veselko, Matjaž; Markovic, Goran; Dervisevic, Edvin

2014-01-01

Context: Volleyball players are reported to have shoulder strength imbalances. Previous authors have primarily investigated small samples of male players at a single skill level, without considering playing position, and with inconsistent findings. Objective: To evaluate shoulder strength asymmetry and a history of shoulder injury in a large sample of professional volleyball players of both sexes across different playing positions and skill levels. Design: Descriptive laboratory study. Patients or Other Participants: A sample of 183 volleyball players (99 men, 84 women). Main Outcome Measure(s): We assessed shoulder internal-rotator and external-rotator concentric strength at 60°/s using an isokinetic dynamometer and dominant-nondominant differences in shoulder strength and strength ratios using repeated-measures analyses of variance. Peak torque was normalized for body mass and external-rotation/internal-rotation concentric strength. Results: Internal-rotation strength was asymmetric in favor of the dominant side in both sexes, regardless of previous shoulder injury status. Male volleyball players had a lower shoulder strength ratio on the dominant side, regardless of previous shoulder injury status. However, this finding was valid only when hand dominance was taken into account. Female volleyball players playing at a higher level (ie, first versus second division) were 3.43 times more likely to have an abnormal strength ratio. Playing position was not associated with an abnormal shoulder strength ratio or strength asymmetry. Conclusions: In male volleyball players, the external-rotation/internal-rotation strength ratio of the dominant shoulder was lower, regardless of playing position, skill level, or a previous shoulder injury. In female players, the ratio was less only in those at a higher skill level. Although speculative, these findings generally suggest that female volleyball players could have a lower risk of developing shoulder-related problems than male volleyball players. Isokinetic shoulder testing may reveal important information about the possible risk factors for shoulder injuries, so we recommend including it in the functional screening of volleyball players. PMID:24673238

Strength asymmetry of the shoulders in elite volleyball players.

PubMed

Hadzic, Vedran; Sattler, Tine; Veselko, Matjaž; Markovic, Goran; Dervisevic, Edvin

2014-01-01

Volleyball players are reported to have shoulder strength imbalances. Previous authors have primarily investigated small samples of male players at a single skill level, without considering playing position, and with inconsistent findings. To evaluate shoulder strength asymmetry and a history of shoulder injury in a large sample of professional volleyball players of both sexes across different playing positions and skill levels. Descriptive laboratory study. A sample of 183 volleyball players (99 men, 84 women). We assessed shoulder internal-rotator and external-rotator concentric strength at 60°/s using an isokinetic dynamometer and dominant-nondominant differences in shoulder strength and strength ratios using repeated-measures analyses of variance. Peak torque was normalized for body mass and external-rotation/internal-rotation concentric strength. Internal-rotation strength was asymmetric in favor of the dominant side in both sexes, regardless of previous shoulder injury status. Male volleyball players had a lower shoulder strength ratio on the dominant side, regardless of previous shoulder injury status. However, this finding was valid only when hand dominance was taken into account. Female volleyball players playing at a higher level (ie, first versus second division) were 3.43 times more likely to have an abnormal strength ratio. Playing position was not associated with an abnormal shoulder strength ratio or strength asymmetry. In male volleyball players, the external-rotation/internal-rotation strength ratio of the dominant shoulder was lower, regardless of playing position, skill level, or a previous shoulder injury. In female players, the ratio was less only in those at a higher skill level. Although speculative, these findings generally suggest that female volleyball players could have a lower risk of developing shoulder-related problems than male volleyball players. Isokinetic shoulder testing may reveal important information about the possible risk factors for shoulder injuries, so we recommend including it in the functional screening of volleyball players.

The Influence of Surgical Stabilization on Glenohumeral Abduction Using 3-Dimensional Computed Tomography in Patients With Shoulder Instability.

PubMed

Bakshi, Neil K; Jameel, Omar F; Merrill, Zachary F; Debski, Richard E; Sekiya, Jon K

2016-08-01

This study compared the amount of glenohumeral abduction during arm abduction in the affected and unaffected shoulders of 3 groups of patients with shoulder instability: failed surgical stabilization, successful surgical stabilization, and unstable shoulder with no prior surgical intervention. All patients underwent bilateral shoulder computed tomography scans in 3 positions: 0° of abduction and 0° of external rotation (0-0 position), 30° of abduction and 30° of external rotation (30-30 position), and arms maximally abducted (overhead position). Three-dimensional computed tomography reconstruction was performed for both shoulders in all 3 positions. A specialized coordinate system marked specific points and directions on the humerus and glenoid of each model. These coordinates were used to calculate the glenohumeral abduction for the normal and affected sides in the 0-0, 30-30, and overhead positions. Thirty-nine patients with shoulder instability were included, of whom 14 had failed surgical repairs, 10 had successful surgical repairs, and 15 had unstable shoulders with no prior surgical intervention. In the overhead position, patients with failed surgical intervention had significantly less glenohumeral abduction in the failed shoulder (95.6° ± 12.7°) compared with the normal shoulder (101.5° ± 12.4°, P = .02). Patients with successfully stabilized shoulders had significantly less glenohumeral abduction in the successfully stabilized shoulder (93.6° ± 10.8°) compared with the normal shoulder (102.1° ± 12.5°, P = .03). Unstable shoulders with no prior surgical intervention (102.1° ± 10.3°) did not differ when compared with the normal shoulders (101.9° ± 10.9°, P = .95). Surgical intervention, regardless of its success, limits the amount of abduction at the glenohumeral joint. Level III, retrospective comparative study. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The Shoulder Objective Practical Assessment Tool: Evaluation of a New Tool Assessing Residents Learning in Diagnostic Shoulder Arthroscopy.

PubMed

Talbot, Christopher L; Holt, Edward M; Gooding, Benjamin W T; Tennent, Thomas D; Foden, Philip

2015-08-01

To design and validate an objective practical assessment tool for diagnostic shoulder arthroscopy that would provide residents with a method to evaluate their progression in this field of surgery and to identify specific learning needs. We designed and evaluated the shoulder Objective Practical Assessment Tool (OPAT). The shoulder OPAT was designed by us, and scoring domains were created using a Delphi process. The shoulder OPAT was trialed by members of the British Elbow & Shoulder Society Education Committee for internal consistency and ease of use before being offered to other trainers and residents. Inter-rater reliability and intrarater reliability were calculated. One hundred forty orthopaedic residents, of varying seniority, within 5 training regions in the United Kingdom, were questioned regarding the tool. A pilot study of 6 residents was undertaken. Internal consistency was 0.77 (standardized Cronbach α). Inter-rater reliability was 0.60, and intrarater reliability was 0.82. The Spearman correlation coefficient (r) between the global summary score for the shoulder OPAT and the current assessment tool used in postgraduate training for orthopaedic residents undertaking diagnostic shoulder arthroscopy equaled 0.74. Of the residents, 82% agreed or strongly agreed when asked if the shoulder OPAT would be a useful tool in monitoring progression and 72% agreed or strongly agreed with the introduction of the shoulder OPAT within the orthopaedic domain. This study shows that the shoulder OPAT fulfills several aspects of reliability and validity when tested. Despite the inter-rater reliability being 0.60, we believe that the shoulder OPAT has the potential to play a role alongside the current assessment tool in the training of orthopaedic residents. The shoulder OPAT can be used to assess residents during shoulder arthroscopy and has the potential for use in medical education, as well as arthroscopic skills training in the operating theater. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Imaging evaluation on adaptability of proximal humeral anatomy after shoulder replacement with individualized shoulder prosthesis].

PubMed

Shi, Youxing; Tang, Kanglai; Yuan, Chengsong; Tao, Xu; Wang, Huaqing; Chen, Bo; Guo, Yupeng

2015-03-24

Modern shoulder prosthesis has evolved through four generations. And the fourth generation technology has a core three-dimensional design of restoring 3D reconstruction of proximal humeral anatomy. Thus a new shoulder prosthesis is developed on the basis of the technology of 3D prosthesis. Assessment of whether shoulder prosthesis can restore individualized reconstruction of proximal humeral anatomy is based on the adaptability of proximal humeral anatomy. To evaluate the adaptability of proximal humeral anatomy through measuring the parameters of proximal humeral anatomy after shoulder replacement with individualized shoulder prosthesis and compare with normal data. The parameters of proximal humeral anatomy were analyzed and evaluated for a total of 12 cases undergoing shoulder replacement with individualized shoulder prosthesis. The relevant anatomical parameters included neck-shaft angle (NSA), retroversion angle (RA), humeral head height (HH) and humeral head diameter (HD). And the anatomical parameters were compared with the data from normal side. All underwent shoulder replacement with individualized shoulder prosthesis. The postoperative parameters of proximal humeral anatomy were compared with those of normal side. And the difference of NSA was < 3°, RA < 3°, HH < 3 mm and HD < 2 mm. And paired-sample t test was used to study the parameters of proximal humeral anatomy between postoperative and normal side. The normal and postoperative NSA was (140.2 ± 6.8)° and (139.5 ± 6.6)° respectively, RA (34.4 ± 3.3)° and (33.8-3.1)°, HH (15.3 ± 2.1) mm and (14.6+0.9) mm, HW (42.2 ± 2.82) mm and (41.8 ± 2.33) mm respectively. No significant difference existed between two groups (P > 0.05). Individualized shoulder prosthesis has excellent adaptability to shoulder. All core parameters are freely adjustable and specification models may be optimized. With matching tools, individualized shoulder prosthesis improves the accuracy and reliability in shoulder replacement.

Preventing pressure ulcers

MedlinePlus

... Hips Spine Tailbone area Elbows Shoulders and shoulder blades Back of the head Ears Call your health ... your tailbone area Under your shoulders and shoulder blades Under your elbows Other tips are: DO NOT ...

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

PubMed Central

Sheehan, Scott E.; Orwin, John F.; Lee, Kenneth S.

2016-01-01

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 PMID:27726738

Shoulder arthroplasty for sequelae of poliomyelitis.

PubMed

Werthel, Jean-David; Schoch, Bradley; Sperling, John W; Cofield, Robert; Elhassan, Bassem T

2016-05-01

Polio infection can often lead to orthopedic complications such as arthritis, osteoporosis, muscle weakness, skeletal deformation, and chronic instability of the joints. The purpose of this study was to assess the outcomes and associated complications of arthroplasty in shoulders with sequelae of poliomyelitis. Seven patients (average age, 70 years) were treated between 1976 and 2013 with shoulder arthroplasty for the sequelae of polio. One patient underwent reverse shoulder arthroplasty, 2 had a hemiarthroplasty, and 4 had total shoulder arthroplasty. Average follow-up was 87 months. Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Overall pain scores improved from 5 to 1.6 points (on a 5-point scale) after shoulder arthroplasty. Six shoulders had no or mild pain at latest follow-up, and 6 shoulders rated the result as much better or better. Mean shoulder elevation improved from 72° to 129°, and external rotation improved from 11° to 56°. Average strength in elevation decreased from 3.9 to 3.4 postoperatively, and external rotation strength decreased from 3.9 to 3.3. This, however, did not reach significance. Evidence of muscle imbalance with radiographic instability was found in 4 shoulders that demonstrated superior subluxation, anterior subluxation, or both. This remained asymptomatic. No shoulder required revision or reoperation. Shoulder arthroplasty provides significant pain relief and improved motion in patients with sequelae of poliomyelitis. Muscle weakness may be responsible for postoperative instability, and careful selection of the patient with good upper extremity muscles must be made. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Isometric shoulder strength in young swimmers.

PubMed

McLaine, Sally J; Ginn, Karen A; Fell, James W; Bird, Marie-Louise

2018-01-01

The prevalence of shoulder pain in young swimmers is high. Shoulder rotation strength and the ratio of internal to external rotation strength have been reported as potential modifiable risk factors associated with shoulder pain. However, relative strength measures in elevated positions, which include flexion and extension, have not been established for the young swimmer. The aim of this study was to establish clinically useful, normative shoulder strength measures and ratios for swimmers (14-20 years) without shoulder pain. Cross-sectional, observational study. Swimmers (N=85) without a recent history of shoulder pain underwent strength testing of shoulder flexion and extension (in 140° abduction); and internal and external rotation (in 90° abduction). Strength tests were performed in supine using a hand-held dynamometer and values normalised to body weight. Descriptive statistics were calculated for strength and strength ratios (flexion:extension and internal:external rotation). Differences between groups (based on gender, history of pain, test and arm dominance) were explored using independent and paired t tests. Normative shoulder strength values and ratios were established for young swimmers. There was a significant difference (p<0.002) in relative strength between males and females for all tests with no differences in strength ratios. Relative strength of the dominant and non-dominant shoulders (except for extension); and for swimmers with and without a history of shoulder pain was not significantly different. A normal shoulder strength profile for the young swimmer has been established which provides a valuable reference for the clinician assessing shoulder strength in this population. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Cutoff value of Japanese Orthopaedic Association shoulder score in patients with rotator cuff repair: Based on the University of California at Los Angeles shoulder score.

PubMed

Imai, Takaki; Gotoh, Masafumi; Tokunaga, Tsuyoshi; Kawakami, Jyunichi; Mitsui, Yasuhiro; Fukuda, Keiji; Ogino, Misa; Okawa, Takahiro; Shiba, Naoto

2017-05-01

The Japanese Orthopaedic Association shoulder score cutoff values were calculated in patients with rotator cuff repair using the University of California at Los Angeles shoulder score. Overall, 175 patients with rotator cuff repair were subjects in this study. The University of California at Los Angeles and Japanese Orthopaedic Association shoulder scores were evaluated before surgery and at 3, 6, 9, and 12 months after surgery. The cutoff value of the Japanese Orthopaedic Association shoulder score was determined using the 4-stage criteria of the University of California at Los Angeles shoulder score and a University of California at Los Angeles shoulder score of 28 points, which is the boundary between an excellent/good group and a fair/poor group. Both the JOA shoulder and UCLA shoulder scores showed significant improvement at 6, 9, and 12 months from the preoperative scores (p < 0.0001). There was a strong correlation between the total values of the two scores (r = 0.85, p < 0.0001). The cutoff value of the Japanese Orthopaedic Association shoulder score based on the highest accuracy from receiver operating characteristic curve analysis was 83 points. A Japanese Orthopaedic Association shoulder score cutoff value of 83 was equivalent to a University of California at Los Angeles shoulder score cutoff value of 28 for distinguishing between excellent/good and fair/poor outcomes after rotator cuff repair. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Indications and outcomes of shoulder arthroscopy after shoulder arthroplasty.

PubMed

Horner, Nolan S; de Sa, Darren; Heaven, Sebastian; Simunovic, Nicole; Bedi, Asheesh; Athwal, George S; Ayeni, Olufemi R

2016-03-01

Arthroscopy is a widely used intervention in the treatment of a variety of shoulder conditions. Arthroscopy has also been selectively used in symptomatic patients after shoulder arthroplasty. The purpose of this systematic review was to determine indications for shoulder arthroscopy in patients after shoulder arthroplasty and to report patient outcomes after these procedures. The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate for studies involving shoulder arthroscopy in shoulder arthroplasty patients. A full-text review of eligible studies was conducted in duplicate, and references were searched using predetermined inclusion and exclusion criteria. The review included 11 studies containing 84 patients. All were Level IV evidence. The most common indications for shoulder arthroscopy in the setting of shoulder arthroplasty were pain or loss of range of motion without a clear diagnosis, suspected periprosthetic infection, and rotator cuff assessment. Although 92% of patients were satisfied with the procedure and standardized shoulder scores increased in all studies that reported them, 44% of patients still went on to additional revision surgery after arthroscopy. Shoulder arthroscopy in patients after arthroplasty is most frequently used as a diagnostic tool; however, it has utility in treating a number of predetermined pathologies. Despite the low sample size and quality of evidence in our review, patient satisfaction after arthroscopy is high because standardized outcome scores improve, and the risk of complications is low. However, a high percentage of patients who receive arthroscopy later require further surgery. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Analysis of factors that affect shoulder balance after correction surgery in scoliosis: a global analysis of all the curvature types.

PubMed

Hong, Jae-Young; Suh, Seung-Woo; Modi, Hitesh N; Yang, Jae-Hyuk; Park, Si-Young

2013-06-01

To identify factors that can affect postoperative shoulder balance in AIS. 89 adolescent idiopathic scoliosis patients with six types of curvatures who underwent surgery were included in this study. Whole spine antero-posterior and lateral radiographs were obtained pre- and postoperatively. In radiograms, shape and changes in curvatures were analyzed. In addition, four shoulder parameters and coronal balance were analyzed in an effort to identify factors significantly related to postoperative shoulder balance. In general, all the four shoulder parameters (CHD, CA, CRID, RSH) were slightly increased at final follow up (t test, P < 0.05), although there was a decrease in Lenke type II and IV curvatures. However, pre- and postoperative shoulder parameters were not significantly different between each curvature types (ANOVA, P > 0.05). Moreover, no significant differences of pre- and postoperative shoulder level between different level of proximal fusion groups (ANOVA, P > 0.05) existed. In the analysis of coronal curvature changes, no difference was observed in every individual coronal curvatures between improved shoulder balance and aggravated groups (P > 0.05). However, the middle to distal curve change ratio was significantly lower in patients with aggravated shoulder balance (P < 0.05). In addition, patients with smaller preoperative shoulder imbalance showed the higher chance of aggravation after surgery with similar postoperative changes (P < 0.05). Significant relations were found between correction rate of middle, and distal curvature, and postoperative shoulder balance. In addition, preoperative shoulder level difference can be a determinant of postoperative shoulder balance.

Shoulder arthroplasty in osteoarthritis: current concepts in biomechanics and surgical technique

PubMed Central

Merolla, G; Nastrucci, G; Porcellini, G

Shoulder arthroplasty is a technically demanding procedure to restore shoulder function in patients with severe osteoarthritis of the glenohumeral joint. The modern prosthetic system exploit the benefits of modularity and the availibility of additional sizes of the prosthetic components. In this paper we describe the biomechanics of shoulder arthroplasty and the technique for shoulder replacement including total shoulder arthroplasty (TSA) with all-polyethylene and metal-backed glenoid component, humeral head resurfacing and stemless humeral replacement. PMID:24251240

Shoulder joint loading and posture during medicine cart pushing task.

PubMed

Xu, Xu; Lin, Jia-Hua; Boyer, Jon

2013-01-01

Excessive physical loads and awkward shoulder postures during pushing and pulling are risk factors for shoulder pain. Pushing a medicine cart is a major component of a work shift for nurses and medical assistants in hospitals and other health care facilities. A laboratory experiment was conducted to examine the effects of common factors (e.g., lane congestion, cart load stability, floor surface friction) on shoulder joint moment and shoulder elevation angle of participants during cart pushing. Participants pushed a medicine cart on straight tracks and turning around right-angle corners. Peak shoulder joint moments reached 25.1 Nm, 20.3 Nm, and 26.8 Nm for initial, transition, and turning phases of the pushing tasks, indicating that shoulder joint loading while pushing a medical cart is comparable to levels previously reported from heavy manual activities encountered in industry (e.g., garbage collection). Also, except for user experience, all other main study factors, including congestion level, cart load stability, location of transition strip, shoulder tendency, surface friction, and handedness, significantly influenced shoulder joint moment and shoulder elevation angle. The findings provide a better understanding of shoulder exposures associated with medicine cart operations and may be helpful in designing and optimizing the physical environment where medicine carts are used.

Influence of Playing a Prolonged Tennis Match on Shoulder Internal Range of Motion.

PubMed

Martin, Caroline; Kulpa, Richard; Ezanno, Felix; Delamarche, Paul; Bideau, Benoit

2016-08-01

Shoulder range of motion (ROM) deficits have been identified as an injury risk factor among tennis players. It is well known that shoulder internal rotation deficit increases with age and years of play, but there is a lack of knowledge regarding the influence of a prolonged tennis match on shoulder ROM. To examine changes in shoulder ROM during a prolonged tennis match. Descriptive laboratory study. Shoulder passive internal and external rotation ROM were measured on 8 male tennis players before, every 30 minutes during, and just after a 3-hour tennis match. Total ROM was calculated as the combination of shoulder internal and external rotations. Ball velocity on the serve was measured with a radar gun before, at midmatch, and just after the match. Decreases in shoulder internal rotation (-20.8°; P = .005), total ROM (-24.6°; P = .001), and serve velocity (-1.8 m/s; P = .002) were observed at the end of the match. No statistically significant difference was observed for shoulder external rotation after the match (P = .460). Passive shoulder internal rotation and total ROM are significantly decreased during a 3-hour tennis match. The results show that a prolonged tennis match play can modify values of shoulder ROM. © 2016 The Author(s).

Shoulder range of motion and strength in young competitive tennis players with and without history of shoulder problems.

PubMed

Gillet, Benoît; Begon, Mickaël; Diger, Marine; Berger-Vachon, Christian; Rogowski, Isabelle

2018-05-01

To assess the effect of a history of shoulder problems on the shoulder flexibility and strength in young competitive tennis players. Cross-sectional study. Ninety-one competitive and asymptomatic tennis players aged between 8 and 15 years old were divided into two groups according to the presence or absence of a history of shoulder problems. Glenohumeral joint ranges of motion and the strength of eight shoulder muscles were bilaterally assessed. Five agonist/antagonist muscle strength ratios were also reported. Ranges of motion, strengths and strength ratios were bilaterally compared between the two groups. Players with a history of shoulder problems presented a higher total arc of rotation for both glenohumeral joints (p = 0.02) and a lower external/internal glenohumeral rotator muscle strength ratio (p = 0.02) for both sides. They also presented stronger upper trapezius (p = 0.03) and dominant serratus anterior (p = 0.008) muscles than players without a history of shoulder problems. Having a history of shoulder problems may alter the balance between mobility and stability within the shoulder complex suggesting that particular attention should be given to dominant and non-dominant shoulder functions by coaches and clinicians. Copyright © 2018 Elsevier Ltd. All rights reserved.

Frozen shoulder

MedlinePlus

... Changes in your hormones, such as during menopause Shoulder injury Shoulder surgery Open heart surgery Cervical disk disease ... and the A.D.A.M. Editorial team. Shoulder Injuries and Disorders Read more NIH MedlinePlus Magazine Read ...

Shoulder Blade Squeeze (Posture Exercise)

MedlinePlus

... Weight Exercise at Home Shoulder Blade Squeeze Shoulder Blade Squeeze Make an Appointment Ask a Question Find ... it: Stand straight and tall. Pull your shoulder blades back and slightly downward to bring your elbows ...

Shoulder surgery - discharge

MedlinePlus

... do not have to. Activity If you had rotator cuff or other ligament or labral surgery, you need ... 2015:chap 45. Read More Frozen shoulder Osteoarthritis Rotator cuff problems Rotator cuff repair Shoulder arthroscopy Shoulder CT ...

Shoulder Arthroplasty Imaging: What’s New

PubMed Central

Gregory, T.M

2017-01-01

Background: Shoulder arthroplasty, in its different forms (hemiarthroplasty, total shoulder arthroplasty and reverse total shoulder arthroplasty) has transformed the clinical outcomes of shoulder disorders. Improvement of general clinical outcome is the result of stronger adequacy of the treatment to the diagnosis, enhanced surgical techniques, specific implanted materials, and more accurate follow up. Imaging is an important tool in each step of these processes. Method: This article is a review article declining recent imaging processes for shoulder arthroplasty. Results: Shoulder imaging is important for shoulder arthroplasty pre-operative planning but also for post-operative monitoring of the prosthesis and this article has a focus on the validity of plain radiographs for detecting radiolucent line and on new Computed Tomography scan method established to eliminate the prosthesis metallic artefacts that obscure the component fixation visualisation. Conclusion: Number of shoulder arthroplasties implanted have grown up rapidly for the past decade, leading to an increase in the number of complications. In parallel, new imaging system have been established to monitor these complications, especially component loosening PMID:29152007

Dislocated Shoulder: Symptoms and Causes

MedlinePlus

... arm bone pops out of the cup-shaped socket that's part of your shoulder blade. The shoulder ... your upper arm bone out of your shoulder socket. Partial dislocation — in which your upper arm bone ...

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

Nine-year outcome after anatomic stemless shoulder prosthesis: clinical and radiologic results.

PubMed

Hawi, Nael; Magosch, Petra; Tauber, Mark; Lichtenberg, Sven; Habermeyer, Peter

2017-09-01

Several stemless shoulder implants are available on the market, but only a few studies have presented results with sufficient mid- to long-term follow-up. The present study evaluated clinical and radiologic outcomes 9 years after anatomic stemless shoulder replacement. This is a prospective cohort study evaluating the stemless shoulder prosthesis since 2005. Anatomic stemless shoulder replacement using a single prosthesis was performed in 49 shoulders; 17 underwent total shoulder replacement, and 32 underwent hemiarthroplasty. Forty-three patients were clinically and radiologically monitored after a mean of 9 years (range, 90-127 months; follow-up rate, 88%). The indications for shoulder replacement were primary osteoarthritis in 7 shoulders, post-traumatic in 24, instability in 7, cuff tear arthropathy in 2, postinfectious arthritis in 1, and revision arthroplasty in 2. The Constant-Murley Score improved significantly from 52% to 79% (P < .0001). The active range of motion also increased significantly for flexion from 101° to 118° (P = .022), for abduction from 79° to 105° (P = .02), and for external rotation from 21° to 43° (P < .0001). Radiologic evaluation revealed incomplete radiolucency in 1 patient without clinical significance or further intervention. No revision caused by loosening or countersinking of the humeral implant was observed. The 9-year outcome after stemless shoulder replacement is comparable to that of third- and fourth-generation standard shoulder arthroplasty. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evaluation of regression-based 3-D shoulder rhythms.

PubMed

Xu, Xu; Dickerson, Clark R; Lin, Jia-Hua; McGorry, Raymond W

2016-08-01

The movements of the humerus, the clavicle, and the scapula are not completely independent. The coupled pattern of movement of these bones is called the shoulder rhythm. To date, multiple studies have focused on providing regression-based 3-D shoulder rhythms, in which the orientations of the clavicle and the scapula are estimated by the orientation of the humerus. In this study, six existing regression-based shoulder rhythms were evaluated by an independent dataset in terms of their predictability. The datasets include the measured orientations of the humerus, the clavicle, and the scapula of 14 participants over 118 different upper arm postures. The predicted orientations of the clavicle and the scapula were derived from applying those regression-based shoulder rhythms to the humerus orientation. The results indicated that none of those regression-based shoulder rhythms provides consistently more accurate results than the others. For all the joint angles and all the shoulder rhythms, the RMSE are all greater than 5°. Among those shoulder rhythms, the scapula lateral/medial rotation has the strongest correlation between the predicted and the measured angles, while the other thoracoclavicular and thoracoscapular bone orientation angles only showed a weak to moderate correlation. Since the regression-based shoulder rhythm has been adopted for shoulder biomechanical models to estimate shoulder muscle activities and structure loads, there needs to be further investigation on how the predicted error from the shoulder rhythm affects the output of the biomechanical model. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Work-related shoulder-neck complaints in industry: a pilot study.

PubMed

Bjelle, A; Hagberg, M; Michaelson, G

1987-10-01

Twenty-six industrial workers, selected from employment records, were examined with a questionnaire, anthropometric measures, muscle strength measurements and filming during work cycles to study the influence of ergonomic factors on shoulder-neck complaints. No differences were observed when comparing age or anthropometric measurements between the nine workers with and the 17 without shoulder-neck complaints. Significantly weaker shoulder muscles were found in workers with shoulder-neck complaints than in those without. A higher median strain on the shoulders in the working situation of workers with shoulder-neck complaints than in the group with no complaints was suggested from the results of a biomechanical analysis of the different work tasks.

Navigating the Alphabet Soup of Labroligamentous Pathology of the Shoulder.

PubMed

Fitzpatrick, Darren; Grubin, Jeremy

2016-02-01

Because of the widespread use of eponyms and acronyms to describe labroligamentous findings in the shoulder, interpreting shoulder magnetic resonance imaging reports can be challenging. A summary of the appearance of these lesions on shoulder magnetic resonance images can help the orthopedic surgeon to understand these entities as imaging findings and to determine the appropriate treatment for patients with shoulder injuries.

The volleyball athlete's shoulder: biomechanical adaptations and injury associations.

PubMed

Challoumas, Dimitrios; Stavrou, Antonio; Dimitrakakis, Georgios

2017-06-01

In volleyball, the dominant shoulder of the athlete undergoes biomechanical and morphological adaptations; however, definitive conclusions about their exact nature, aetiology, purpose and associations with shoulder injury have not been reached. We present a systematic review of the existing literature describing biomechanical adaptations in the dominant shoulders of volleyball players and factors that may predispose to shoulder pain/injury. A thorough literature search via Medline, EMBASE and SCOPUS was conducted for original studies of volleyball players and 15 eligible articles were identified. Assessment of study quality was performed using the STROBE statement. The reviewed literature supports the existence of a glenohumeral internal rotation deficit (GIRD) and a possible (and less pronounced) external rotation gain in the dominant vs. the non-dominant shoulder of volleyball athletes. Unlike other overhead sports, the GIRD in volleyball athletes appears to be anatomical as a response to the repetitive overhead movements and not to be associated with shoulder pain/injury. Additionally, the dominant shoulder exhibits muscular imbalance, which appears to be a significant risk factor for shoulder pain. Strengthening of the external rotators should be used alongside shoulder stretching and joint mobilisations, core strengthening and optimisation of spike technique as part of injury management and prevention programmes.

The effects of shoulder stabilization exercises and pectoralis minor stretching on balance and maximal shoulder muscle strength of healthy young adults with round shoulder posture.

PubMed

Kim, Mi-Kyoung; Lee, Jung Chul; Yoo, Kyung-Tae

2018-03-01

[Purpose] The purpose of this study was to analyze the effects of pectoralis minor stretching and shoulder strengthening with an elastic band on balance and maximal shoulder muscle strength in young adults with rounded shoulder posture. [Subjects and Methods] Nineteen subjects with rounded shoulder posture were randomly divided into 2 groups: a shoulder stabilization exercise group and a stretching exercise group. The groups performed each exercise for 40 minutes, 3 times a week, for 4 weeks. Static balance (eyes open and closed), dynamic balance (the limits of stability in 4 directions) and shoulder muscle strength in 5 directions were measure before and after the exercises. [Results] The stretching exercise demonstrated a significant difference between the pre- and post-exercise in the static balance with eyes closed and extension and horizontal abduction strength while the stabilization exercise demonstrated significant difference in the left and right directions between the pre- and post-exercise of the dynamic balance and flexion strength. The stabilization exercise demonstrated significant differences shown in the flexion between the pre- and post-test. [Conclusion] The shoulder stabilization and stretching exercises improved the static balance, dynamic balance, and muscle strength.

Italian cross-cultural adaptation and validation of three different scales for the evaluation of shoulder pain and dysfunction after neck dissection: University of California - Los Angeles (UCLA) Shoulder Scale, Shoulder Pain and Disability Index (SPADI) and Simple Shoulder Test (SST).

PubMed

Marchese, C; Cristalli, G; Pichi, B; Manciocco, V; Mercante, G; Pellini, R; Marchesi, P; Sperduti, I; Ruscito, P; Spriano, G

2012-02-01

Shoulder syndrome after neck dissection is a well known entity, but its incidence and prognostic factors influencing recovery have not been clearly assessed due to the heterogeneity of possible evaluations. The University of California - Los Angeles (UCLA) Shoulder Scale, the Shoulder Pain and Disability Index (SPADI) and the Simple Shoulder Test (SST) are three English-language questionnaires commonly used to test shoulder impairment. An Italian version of these scales is not available. The aim of the present study was to translate, culturally adapt and validate an Italian version of UCLA Shoulder Scale, SPADI and SST. Translation and cross-cultural adaptation of the SPADI, the UCLA shoulder scale and the SST was performed according to the international guidelines. Sixty-six patients treated with neck dissection for head and neck cancer were called to draw up these scales. Forty patients completed the same questionnaires a second time one week after the first to test the reproducibility of the Italian versions. All the English-speaking Italian patients (n = 11) were asked to complete both the English and the Italian versions of the three questionnaires to validate the scales. No major problems regarding the content or the language were found during the translation of the 3 questionnaires. For all three scales, Cronbach's α was > 0.89. The Pearson correlation coefficient was r > 0.91. With respect to validity, there was a significant correlation between the Italian and the English versions of all three scales. This study shows that the Italian versions of UCLA Shoulder Scale, SPADI and SST are valid instruments for the evaluation of shoulder dysfunction after neck dissection in Italian patients.

Investigation of central pain processing in shoulder pain: converging results from two musculoskeletal pain models

PubMed Central

Valencia, Carolina; Kindler, Lindsay L.; Fillingim, Roger B.; George, Steven Z.

2011-01-01

Recent reports suggest deficits in conditioned pain modulation (CPM) and enhanced suprathreshold heat pain response (SHPR) potentially play a role in the development of chronic pain. The purpose of this study was to investigate whether central pain processing was altered in 2 musculoskeletal shoulder pain models. The goals of this study were to determine whether central pain processing: 1) differs between healthy subjects and patients with clinical shoulder pain, 2) changes with induction of exercise induced muscle pain (EIMP), and 3) changes 3 months after shoulder surgery. Fifty eight patients with clinical shoulder pain and 56 age and sex matched healthy subjects were included in these analyses. The healthy cohort was examined before inducing EIMP, and 48 and 96 hours later. The clinical cohort was examined before shoulder surgery and 3 months later. CPM did not differ between the cohorts, however; SHPR was elevated for patients with shoulder pain compared to healthy controls. Induction of acute shoulder pain with EIMP resulted in increased shoulder pain intensity but did not change CPM or SHPR. Three months following shoulder surgery clinical pain intensity decreased but CPM was unchanged from pre-operative assessment. In contrast SHPR was decreased and showed values comparable with healthy controls at 3 months. Therefore, the present study suggests that: 1) clinical shoulder pain is associated with measurable changes in central pain processing, 2) exercise-induced shoulder pain did not affect measures of central pain processing, and 3) elevated SHPR was normalized with shoulder surgery. Collectively our findings support neuroplastic changes in pain modulation were associated with decreases in clinical pain intensity only, and could be detected more readily with thermal stimuli. PMID:22208804

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 clinical and functional outcomes to the point that arthroscopic treatment is considered nowadays the standard of care. PMID:28400880

Does arthroscopic rotator cuff repair improve patients' activity levels?

PubMed

Baumgarten, Keith M; Chang, Peter S; Dannenbring, Tasha M; Foley, Elaine K

2018-06-04

Rotator cuff repair decreases pain, improves range of motion, and increases strength. Whether these improvements translate to an improvement in a patient's activity level postoperatively remains unknown. The Shoulder Activity Level is a valid and reliable outcomes survey that can be used to measure a patient's shoulder-specific activity level. Currently, there are no studies that examine the effect of rotator cuff repair on shoulder activity level. Preoperative patient-determined outcomes scores collected prospectively on patients undergoing rotator cuff repair were compared with postoperative scores at a minimum of 2 years. These scores included the Shoulder Activity Level, Western Ontario Rotator Cuff Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Single Assessment Numeric Evaluation, and simple shoulder test. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. Included were 281 shoulders from 273 patients with a mean follow-up of 3.7 years. The postoperative median Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), Single Assessment Numeric Evaluation (30 vs. 95), and simple shoulder test (4 vs. 11) scores were statistically significantly improved compared with preoperative scores (P < .0001). The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11; P < .0001). Patients reported a statistically significant deterioration of their Shoulder Activity Level score after rotator cuff repair compared with their preoperative scores, although disease-specific and joint-specific quality of life scores all had statistically significantly improvement. This study suggests that patients generally have (1) significant improvements in their quality of life and (2) small deteriorations in activity level after arthroscopic rotator cuff repair. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The outcome of manipulation under general anesthesia for the management of frozen shoulder in patients with diabetes mellitus.

PubMed

Jenkins, Emily F; Thomas, William J C; Corcoran, John P; Kirubanandan, Ravisankar; Beynon, Celia R; Sayers, Adrian E; Woods, David A

2012-11-01

Frozen shoulder has a greater incidence, more severe course, and resistance to treatment in patients with diabetes mellitus compared with the general population. We hypothesized that diabetic patients with frozen shoulder undergoing treatment with manipulation under general anaesthesia (MUA) would have the same outcome as patients without diabetes. We retrospectively analyzed data collected during a 10-year period of referrals for frozen shoulder. In all cases, a standardized MUA protocol was followed once the diagnosis of frozen shoulder in the frozen phase was made; this included an early repeat MUA in individuals with recurrence. We compared outcomes for patients documented as having diabetes with a nondiabetic control group and assessed the effect of insulin dependence and frozen shoulder etiology within the diabetic group. Of a consecutive series of 315 frozen shoulders, 36 patients (39 shoulders) were included in the diabetic group, with 256 patients (274 shoulders) as controls. There was a significant improvement in range of movement and Oxford Shoulder Score (P all <.001), with no difference between diabetic and control groups at early or late follow-up (mean, 41 months). A repeat procedure was required in 36% of diabetic patients compared with 15% of control patients. Recurrence in the diabetic group was influenced by etiology (47% of primary vs 0% of secondary frozen shoulders) and insulin requirement (39% insulin-dependent vs. 31% non-insulin-dependent). We provide a strategy for the management of diabetic frozen shoulders using MUA and estimates of success and recurrence rates that may be useful when informing consent. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Structural Analysis and Design of PCC Shoulders

DOT National Transportation Integrated Search

1982-04-01

A structural evaluation of PCC highway shoulders has been conducted and a comprehensive design procedure for plain jointed concrete shoulders developed. The procedure can be used to provide PCC shoulders either for rehabilitation of existing pavement...

Recurrent Shoulder Dystocia: Risk Factors and Counseling.

PubMed

Gurewitsch Allen, Edith D

2016-12-01

A prior history of delivery complicated by shoulder dystocia confers a 6-fold to nearly 30-fold increased risk of shoulder dystocia recurrence in a subsequent vaginal delivery, with most reported rates between 12% and 17%. Whereas prevention of shoulder dystocia in the general population is neither feasible nor cost-effective, directing intervention efforts at the particular subgroup of women with a prior history of shoulder dystocia has merit. Potentially modifiable risk factors and individualized management strategies that may reduce shoulder dystocia recurrence and its associated significant morbidities are reviewed.

Predictors of shoulder dystocia at the time of operative vaginal delivery.

PubMed

Palatnik, Anna; Grobman, William A; Hellendag, Madeline G; Janetos, Timothy M; Gossett, Dana R; Miller, Emily S

2016-11-01

It remains uncertain whether clinical factors known prior to delivery can predict which women are more likely to experience shoulder dystocia in the setting of operative vaginal delivery. We sought to identify whether shoulder dystocia can be accurately predicted among women undergoing an operative vaginal delivery. This was a case-control study of women undergoing a low or outlet operative vaginal delivery from 2005 through 2014 in a single tertiary care center. Cases were defined as women who experienced a shoulder dystocia at the time of operative vaginal delivery. Controls consisted of women without a shoulder dystocia at the time of operative vaginal delivery. Variables previously identified to be associated with shoulder dystocia that could be known prior to delivery were abstracted from the medical records. Bivariable analyses and multivariable logistic regression were used to identify factors independently associated with shoulder dystocia. A receiver operating characteristic curve was created to evaluate the predictive value of the model for shoulder dystocia. Of the 4080 women who met inclusion criteria, shoulder dystocia occurred in 162 (4.0%) women. In bivariable analysis, maternal age, parity, body mass index, diabetes, chorioamnionitis, arrest disorder as an indication for an operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg were significantly associated with shoulder dystocia. In multivariable analysis, parity, diabetes, chorioamnionitis, arrest disorder as an indication for operative vaginal delivery, vacuum use, and estimated fetal weight >4 kg remained independently associated with shoulder dystocia. The area under the curve for the generated receiver operating characteristic curve was 0.73 (95% confidence interval, 0.69-0.77), demonstrating only a modest ability to predict shoulder dystocia before performing an operative vaginal delivery. While risk factors for shoulder dystocia at the time of operative vaginal delivery can be identified, reliable prediction of shoulder dystocia in this setting cannot be attained. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of Shoulder-Stabilizing Braces: Can We Prevent Shoulder Labrum Injury in Collegiate Offensive Linemen?

PubMed

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

2016-12-01

Shoulder injuries remain one of the most common injuries among collegiate football athletes. Offensive linemen in particular are prone to posterior labral pathology. To evaluate the efficacy of shoulder bracing in collegiate offensive linemen with respect to injury prevention, severity, and lost playing time. Cohort study; Level of evidence, 3. 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. 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. 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 wearing a shoulder brace provides a protective factor for offensive linemen.

Reliability of shoulder internal rotation passive range of motion measurements in the supine versus sidelying position.

PubMed

Lunden, Jason B; Muffenbier, Mike; Giveans, M Russell; Cieminski, Cort J

2010-09-01

Clinical measurement, reliability. To compare intrarater and interrater reliability of shoulder internal rotation (IR) passive range of motion measurements utilizing a standard supine position and a sidelying position. Glenohumeral IR range of motion deficits are often noted in patients with shoulder pathology. Excellent intrarater reliability has been found when measuring this motion. However, interrater reliability has been reported as poor to fair. Some clinicians currently use a sidelying position for IR stretching with patients who have shoulder pathology. However, no objective data exist for IR passive range of motion measured in this sidelying position, either in terms of reliability or normative values. Seventy subjects (mean age, 36.8 years), with (n = 19) and without (n = 51) shoulder pathology, were included in this study. Shoulder IR passive range of motion of the dominant shoulder or involved shoulder was measured by 2 investigators in 2 positions: (1) a standard supine position, with the shoulder at 90 degrees of abduction, and (2) in sidelying on the tested side, with the shoulder flexed to 90 degrees . Intrarater reliability for supine measurements was good to excellent (ICC3,1 = 0.70-0.93) and for sidelying measurements was excellent (ICC3,1 = 0.94-0.98). Interrater reliability was fair to good for the supine measurement (ICC2,2 = 0.74-0.81) and good to excellent for the sidelying measurement (ICC2,2 = 0.88-0.96). The mean (range) value of the dominant shoulder sidelying IR passive range of motion was 40 degrees (11 degrees to 69 degrees ) for healthy subjects and 25 degrees (-16 degrees to 49 degrees) for subjects with shoulder pathology. For subjects with shoulder pathology, measurements of shoulder IR made in the sidelying position had superior intrarater and interrater reliability compared to those in the standard supine position.

Shoulder Instability

MedlinePlus

... as bad as the pain of a sudden injury. Your shoulder might be sore when you move it. It ... Treatment How is shoulder instability treated? Treatment for shoulder instability depends on how bad your injury is and how important it is for you ...

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 ...

Decreased shoulder function and pain common in recreational badminton players.

PubMed

Fahlström, M; Söderman, K

2007-06-01

The aim of this study was to describe the prevalence and consequences of painful conditions in the shoulder region in recreational badminton players. A questionnaire study was performed on 99 players, of whom 57 were also assessed with Constant score. Previous or present pain in the dominant shoulder was reported by 52% of the players. Sixteen percent of the players had on-going shoulder pain associated with badminton play. A majority of these players reported that their training habits were affected by the pain. Total Constant score was lower in the painful shoulders. Furthermore, range of active pain-free shoulder abduction was decreased. However, isometric shoulder strength test showed no differences when compared with pain-free shoulders. Even though the pain caused functional problems, the players were still playing with on-going symptoms. The diagnoses were mostly unknown, although history and clinical tests indicate problems resembling subacromial impingement.

Role of Tool Shoulder End Features on Friction Stir Weld Characteristics of 6082 Aluminum Alloy

NASA Astrophysics Data System (ADS)

Mugada, Krishna Kishore; Adepu, Kumar

2018-03-01

Understanding the temperature generation around the tool shoulder contact is one of the important aspects of the friction stir welding process. In the present study, the effects of various tool shoulder end feature on the temperature and mechanical properties of the 6082 aluminum alloy were investigated. The experimental results show that the axial force during the welding is considerably reduced by using tools with shoulder end features. The detailed observation revealed that around the tool shoulder contact, the amount of heat generation is higher between trialing edge (TE) to retreating side-leading edge corner (RS-LE) counter clockwise direction and lower between RS-LE to TE clockwise direction. Out of the four shoulder end featured tools, the welds produced with ridges shoulder tool resulted in superior properties with significantly lower axial force (approximately 32%) compared to plane shoulder tool.

Deficits in Glenohumeral Passive Range of Motion Increase Risk of Shoulder Injury in Professional Baseball Pitchers: A Prospective Study.

PubMed

Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Aune, Kyle T; Porterfield, Ron A; Harker, Paul; Evans, Timothy J; Andrews, James R

2015-10-01

Shoulder injuries from repetitive baseball pitching continue to be a serious, common problem. To determine whether passive range of motion of the glenohumeral joint was predictive of shoulder injury or shoulder surgery in professional baseball pitchers. Cohort study; Level of evidence, 2. Passive range of motion of the glenohumeral joint was assessed with a bubble goniometer during spring training for all major and minor league pitchers of a single professional baseball organization over a period of 8 successive seasons (2005-2012). Investigators performed a total of 505 examinations on 296 professional pitchers. Glenohumeral external and internal rotation was assessed with the pitcher supine and the arm abducted to 90° in the scapular plane with the scapula stabilized anteriorly at the coracoid process. Total rotation was defined as the sum of internal and external glenohumeral rotation. Passive shoulder flexion was measured with the pitcher supine and the lateral border of the scapula manually stabilized. After examination, shoulder injuries and injury durations were recorded by each pitcher's respective baseball organization and reported to the league as an injury transaction as each player was placed on the disabled list. Highly significant side-to-side differences were noted within subjects for each range of motion measurement. There were 75 shoulder injuries and 20 surgeries recorded among 51 pitchers, resulting in 5570 total days on the disabled list. Glenohumeral internal rotation deficit, total rotation deficit, and flexion deficit were not significantly related to shoulder injury or surgery. Pitchers with insufficient external rotation (<5° greater external rotation in the throwing shoulder) were 2.2 times more likely to be placed on the disabled list for a shoulder injury (P = .014; 95% CI, 1.2-4.1) and were 4.0 times more likely to require shoulder surgery (P = .009; 95% CI, 1.5-12.6). Insufficient shoulder external rotation on the throwing side increased the likelihood of shoulder injury and shoulder surgery. Sports medicine clinicians should be aware of these findings and develop a preventive plan that addresses this study's findings to reduce pitchers' risk of shoulder injury and surgery. © 2015 The Author(s).

Tendon transfer options about the shoulder in patients with brachial plexus injury.

PubMed

Elhassan, Bassem; Bishop, Allen T; Hartzler, Robert U; Shin, Alexander Y; Spinner, Robert J

2012-08-01

The purpose of this study was to evaluate the early outcome of shoulder tendon transfer in patients with brachial plexus injury and to determine the factors associated with favorable outcomes. Fifty-two patients with traumatic brachial plexus injury and a paralytic shoulder were included in the study. All patients were evaluated at a mean of nineteen months (range, twelve to twenty-eight months) postoperatively. Twelve patients had a C5-6 injury, twenty-two had a C5-7 injury, five had a C5-8 injury, and thirteen had a C5-T1 injury. Transfer of the lower portion of the trapezius muscle was performed either in isolation or as part of multiple tendon transfers to improve shoulder function. Additional muscles transferred included the middle and upper portions of the trapezius, levator scapulae, upper portion of the serratus anterior, teres major, latissimus dorsi, and pectoralis major. All patients had a stable shoulder postoperatively. Shoulder external rotation improved substantially in all patients from no external rotation (hand-on-belly position) to a mean of 20° (p = 0.001). Patients who underwent additional transfers had marginal improvement of shoulder flexion, from a mean of 10° preoperatively to 60° postoperatively, and of shoulder abduction, from a mean of 10° to 50° (p = 0.01 for each). Mean pain on a visual analog scale improved from 6 points preoperatively to 2 points postoperatively. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score improved from 59 to 47 points (p = 0.001). The mean Subjective Shoulder Value improved from 5% to 40% (p = 0.001). Greater age, higher body mass index, and more extensive nerve injury were associated with a poorer DASH score in a multivariate analysis (p = 0.003). Tendon transfers about the shoulder can improve shoulder function in patients with brachial plexus injury resulting in a paralytic shoulder. Significant improvement of shoulder external rotation but only marginal improvements of shoulder abduction and flexion can be achieved. The outcome can be expected to be better in patients with less severe nerve injury.

Clavicle Chest Cage Angle Difference: Is It a Radiographic and Clinical Predictor of Postoperative Shoulder Imbalance in Lenke I Adolescent Idiopathic Scoliosis?

PubMed

Han, Xiao; Liu, Zhen; Qiu, Yong; Sha, Shifu; Yan, Huang; Jin, Mengran; Zhu, Zezhang

2016-09-01

A retrospective study. To evaluate the effect of preoperative clavicle chest cage angle difference (CCAD) on postoperative radiographic shoulder imbalance, cosmetic shoulder balance, patient's satisfaction, and surgeon's fulfillment in Lenke I adolescent idiopathic scoliosis (AIS). CCAD is a novel predictor of postoperative radiographic shoulder imbalance in AIS. However, radiographic shoulder balance does not always correspond to cosmetic shoulder balance. Forty-four Lenke I AIS patients treated with posterior spinal fusion with a minimum 2-year follow-up were analyzed. Shoulder height difference (SHD) and CCAD were measured on anteroposterior standing radiographs. The inner shoulder height (SHi) and the outer shoulder height (SHo) were measured using the patients' photographs. The patients' satisfaction and the surgeons' fulfillment were evaluated using a questionnaire. A receiver operative characteristic curve analysis was performed to explore the threshold values of preoperative CCAD in the prediction of the final follow-up radiographic shoulder imbalance, patients' satisfaction, and surgeons' fulfillment. At the final follow-up, the preoperative CCAD was significantly greater in patients with unbalanced shoulders (SHD ≥1 cm). For cosmetic shoulder balance at the final follow-up, there was no significant difference in preoperative CCAD between Group 1i (SHi ≥1 cm, n = 14) and Group 2i (SHi <1 cm, n = 30), and the preoperative CCAD was also similar between Group 1o (SHo ≥1 cm, n = 17) and Group 2o (SHo <1 cm, n = 27). For patients' satisfaction and surgeons' fulfillment, the preoperative CCAD was significantly greater in patients with unsatisfied outcomes. The threshold value of preoperative CCAD to predict the final follow-up radiographic shoulder imbalance, patients' satisfaction, and surgeons' fulfillment was 5.5°. CCAD is a good radiographic predictor for postoperative radiographic shoulder imbalance in Lenke I AIS patients. Moreover, it is also associated with the patients' satisfaction and surgeons' fulfillment postoperatively. However, CCAD cannot predict postoperative cosmetic shoulder balance. 4.

Arm lymphoedema and upper limb impairments in sentinel node-negative breast cancer patients: A one year follow-up study.

PubMed

De Groef, An; Van Kampen, Marijke; Tieto, Elena; Schönweger, Petra; Christiaens, Marie-Rose; Neven, Patrick; Geraerts, Inge; Gebruers, Nick; Devoogdt, Nele

2016-10-01

The aim of this study is (1) to investigate the prevalence rate of arm lymphedema, pain, impaired shoulder range of motion, strength and shoulder function one year after a sentinel lymph node biopsy (SLNB) for breast cancer and (2) to determine predictive factors for these complications. A longitudinal study was performed. One hundred patients with a sentinel-lymph node negative breast cancer were included. All patients were measured before surgery and one year after. Arm lymphedema was measured with the perimeter, pain with the Visual Analogue Scale, shoulder range of motion with an inclinometer, strength with a handheld dynamometer and shoulder function with the Disability of Arm, Shoulder and Hand questionnaire. Patient-, breast cancer- and treatment-related variables were recorded. One year after surgery 8% of sentinel node-negative breast cancer patients had developed arm lymphedema. Fifty percent of patients had pain, 30% had an impaired shoulder range of motion, 8% had a decreased handgrip strength and 49% had an impaired shoulder function. Pain, shoulder range of motion, strength and shoulder dysfunctions changed significantly over one year (p < 0.001). Higher Body Mass Index is a predictive variable for shoulder dysfunctions one year post-SLNB. Prevalence rate of lymphedema and other upper limb impairments may not be underestimated after SLNB. Pain, shoulder range of motion, handgrip strength and shoulder function change significantly up to one year compared to preoperative values in sentinel node-negative breast cancer patients. Copyright © 2016 Elsevier Ltd. All rights reserved.

Can we predict shoulder dystocia?

PubMed

Revicky, Vladimir; Mukhopadhyay, Sambit; Morris, Edward P; Nieto, Jose J

2012-02-01

To analyse the significance of risk factors and the possibility of prediction of shoulder dystocia. This was a retrospective cohort study. There were 9,767 vaginal deliveries at 37 and more weeks of gestation analysed during 2005-2007. Studied population included 234 deliveries complicated by shoulder dystocia. Shoulder dystocia was defined as a delivery that required additional obstetric manoeuvres to release the shoulders after gentle downward traction has failed. First, a univariate analysis was done to identify the factors that had a significant association with shoulder dystocia. Parity, age, gestation, induction of labour, epidural analgesia, birth weight, duration of second stage of labour and mode of delivery were studied factors. All factors were then combined in a multivariate logistic regression analysis. Adjusted odds ratios (Adj. OR) with 95% confidence intervals (CI) were calculated. The incidence of shoulder dystocia was 2.4% (234/9,767). Only mode of delivery and birth weight were independent risk factors for shoulder dystocia. Parity, age, gestation, induction of labour, epidural analgesia and duration of second stage of labour were not independent risk factors. Ventouse delivery increases the risk of shoulder dystocia almost 3 times, forceps delivery comparing to the ventouse delivery increases risk almost 3.4 times. Risk of shoulder dystocia is minimal with the birth weight of 3,000 g or less. It is difficult to foretell the exact birth weight and the mode of delivery, therefore occurrence of shoulder dystocia is highly unpredictable. Regular drills for shoulder dystocia and awareness of increased incidence with instrumental deliveries are important to reduce fetal and maternal morbidity and mortality.

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

PubMed

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

2016-09-01

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. 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. 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). 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.

Kinematic evaluation of patients with total and reverse shoulder arthroplasty during rehabilitation exercises with different loads.

PubMed

de Toledo, Joelly Mahnic; Loss, Jefferson Fagundes; Janssen, Thomas W; van der Scheer, Jan W; Alta, Tjarco D; Willems, W Jaap; Veeger, DirkJan H E J

2012-10-01

Following shoulder arthroplasty, any well-planned rehabilitation program should include muscle strengthening. However, it is not always clear how different external loads influence shoulder kinematics in patients with shoulder prostheses. The objective of this study was to describe shoulder kinematics and determine the contribution of the scapulothoracic joint to total shoulder motion of patients with total and reverse shoulder arthroplasties and of healthy individuals during rehabilitation exercises (anteflexion and elevation in the scapular plane) using different loading conditions (without external load, 1 kg and elastic resistance). Shoulder motions were measured using an electromagnetic tracking device. A force transducer was used to record force signals during loaded conditions using elastic resistance. Statistical comparisons were made using a three-way repeated-measures analysis of variance with a Bonferroni post hoc testing. The scapula contributed more to movement of the arm in subjects with prostheses compared to healthy subjects. The same applies for loaded conditions (1 kg and elastic resistance) relative to unloaded tasks. For scapular internal rotation, upward rotation and posterior tilt no significant differences among groups were found during both exercises. Glenohumeral elevation angles during anteflexion were significantly higher in the total shoulder arthroplasty group compared to the reverse shoulder arthroplasty group. Differences in contribution of the scapula to total shoulder motion between patients with different types of arthroplasties were not significant. However, compared to healthy subjects, they were. Furthermore, scapular kinematics of patients with shoulder arthroplasty was influenced by implementation of external loads, but not by the type of load. Copyright © 2012 Elsevier Ltd. All rights reserved.

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

Relationship between extrinsic factors and the acromio-humeral distance.

PubMed

Mackenzie, Tanya Anne; Herrington, Lee; Funk, Lenard; Horsley, Ian; Cools, Ann

2016-06-01

Maintenance of the subacromial space is important in impingement syndromes. Research exploring the correlation between biomechanical factors and the subacromial space would be beneficial. To establish if relationship exists between the independent variables of scapular rotation, shoulder internal rotation, shoulder external rotation, total arc of shoulder rotation, pectoralis minor length, thoracic curve, and shoulder activity level with the dependant variables: AHD in neutral, AHD in 60° arm abduction, and percentage reduction in AHD. Controlled laboratory study. Data from 72 male control shoulders (24.28years STD 6.81 years) and 186 elite sportsmen's shoulders (25.19 STD 5.17 years) were included in the analysis. The independent variables were quantified and real time ultrasound was used to measure the dependant variable acromio-humeral distance. Shoulder internal rotation and pectoralis minor length, explained 8% and 6% respectively of variance in acromio-humeral distance in neutral. Pectoralis minor length accounted for 4% of variance in 60° arm abduction. Total arc of rotation, shoulder external rotation range, and shoulder activity levels explained 9%, 15%, and 16%-29% of variance respectively in percentage reduction in acromio-humeral distance during arm abduction to 60°. Pectorals minor length, shoulder rotation ranges, total arc of shoulder rotation, and shoulder activity levels were found to have weak to moderate relationships with acromio-humeral distance. Existence and strength of relationship was population specific and dependent on arm position. Relationships only accounted for small variances in AHD indicating that in addition to these factors there are other factors involved in determining AHD. Copyright © 2016 Elsevier Ltd. All rights reserved.

Finite element models of the human shoulder complex: a review of their clinical implications and modelling techniques.

PubMed

Zheng, Manxu; Zou, Zhenmin; Bartolo, Paulo Jorge Da Silva; Peach, Chris; Ren, Lei

2017-02-01

The human shoulder is a complicated musculoskeletal structure and is a perfect compromise between mobility and stability. The objective of this paper is to provide a thorough review of previous finite element (FE) studies in biomechanics of the human shoulder complex. Those FE studies to investigate shoulder biomechanics have been reviewed according to the physiological and clinical problems addressed: glenohumeral joint stability, rotator cuff tears, joint capsular and labral defects and shoulder arthroplasty. The major findings, limitations, potential clinical applications and modelling techniques of those FE studies are critically discussed. The main challenges faced in order to accurately represent the realistic physiological functions of the shoulder mechanism in FE simulations involve (1) subject-specific representation of the anisotropic nonhomogeneous material properties of the shoulder tissues in both healthy and pathological conditions; (2) definition of boundary and loading conditions based on individualised physiological data; (3) more comprehensive modelling describing the whole shoulder complex including appropriate three-dimensional (3D) representation of all major shoulder hard tissues and soft tissues and their delicate interactions; (4) rigorous in vivo experimental validation of FE simulation results. Fully validated shoulder FE models would greatly enhance our understanding of the aetiology of shoulder disorders, and hence facilitate the development of more efficient clinical diagnoses, non-surgical and surgical treatments, as well as shoulder orthotics and prosthetics. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.

Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants.

PubMed

Holschen, M; Franetzki, B; Witt, K-A; Liem, D; Steinbeck, J

2017-08-01

Is reverse total shoulder arthroplasty a feasible treatment option for failed shoulder arthroplasty? A retrospective study of 44 cases with special regards to stemless and stemmed primary implants. Due to humeral or glenoid bone-loss and rotator cuff insufficiency reverse total shoulder arthroplasty often means the only remaining treatment option in revision shoulder arthroplasty. This study investigates the clinical outcome of patients treated with a reverse total shoulder in revision cases with special regard to stemless and stemmed primary implants. From 2010 to 2012 60 failed shoulder arthroplasties were converted to reverse total shoulder arthroplasty. Forty-four patients were available for follow-up after a mean of 24 months. Patients were assessed with X-rays, Constant- and ASES Score and a questionnaire about their subjective satisfaction. The total number of observed complications was seven (16%). Ninety-eight percent of the patients were satisfied with their clinical result. Patients achieved a mean normalized constant score of 70.2% and a mean ASES Score of 65.3. Patients with stemless primary implants achieved a higher normalized constant score than patients with stemmed primary implants (82 vs. 61.8%; p = 0009). Reverse total shoulder arthroplasty provides satisfactory clinical results and a high patient satisfaction in revision shoulder arthroplasty. The complication rate needs to be considered and discussed with the patient prior to surgery. Presence or absence of a stem of revised shoulder arthroplasties interferes with the outcome. LEVEL OF EVIDENCE IV: (Retrospective study).

Six-week physical rehabilitation protocol for anterior shoulder dislocation in athletes

PubMed Central

Gaballah, Ahmed; Zeyada, Mohamed; Elgeidi, Adham; Bressel, Eadric

2017-01-01

Anterior shoulder dislocations are common in young athletes. The mechanism for the first or primary shoulder dislocation may involve a collision or a fall typically with the arm in an abducted and externally rotated position. The aim of this study was to design a physical rehabilitation program using the elastic band and resistive exercise to improve joint strength and range of motion in individuals diagnosed with a first-time shoulder dislocation. Twelve physically active males with a first-time acute shoulder dislocation were asked to volunteer. Participants began a physical rehabilitation program 2 weeks after the shoulder dislocation, which was confirmed by a referring physician. The rehabilitation program was 6 weeks in duration and required the participants to engage in progressive resistive loads/duration using elastic bands and weights 5 days per week. Pretest and posttest measures included shoulder strength and range of motion. All outcome measures were compared between the injured and uninjured shoulder, which served as the control condition in this study. There were statistically significant differences between the injured and uninjured shoulder for measures of strength and range of motion during pretests (P<0.01) but not post-tests (P<0.53). Finally, there were no differences between shoulders in regards to the volume measure suggesting that any changes in muscle atrophy or swelling were not detected. The physical rehabilitation program proposed in this study was effective at improving strength and range of motion in the injured shoulder as evidenced by the similarity in posttest values between the injured and uninjured shoulder. PMID:28702449

Cadaveric Study of the Articular Branches of the Shoulder Joint.

PubMed

Eckmann, Maxim S; Bickelhaupt, Brittany; Fehl, Jacob; Benfield, Jonathan A; Curley, Jonathan; Rahimi, Ohmid; Nagpal, Ameet S

This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process. Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint.

Downhole tool

DOEpatents

Hall, David R.; Muradov, Andrei; Pixton, David S.; Dahlgren, Scott Steven; Briscoe, Michael A.

2007-03-20

A double shouldered downhole tool connection comprises box and pin connections having mating threads intermediate mating primary and secondary shoulders. The connection further comprises a secondary shoulder component retained in the box connection intermediate a floating component and the primary shoulders. The secondary shoulder component and the pin connection cooperate to transfer a portion of makeup load to the box connection. The downhole tool may be selected from the group consisting of drill pipe, drill collars, production pipe, and reamers. The floating component may be selected from the group consisting of electronics modules, generators, gyroscopes, power sources, and stators. The secondary shoulder component may comprises an interface to the box connection selected from the group consisting of radial grooves, axial grooves, tapered grooves, radial protrusions, axial protrusions, tapered protrusions, shoulders, and threads.

[Isokinetic testing of the shoulder of handball players].

PubMed

Michael, J W-P; König, D P; Bertram, C; Hessling, U; Eysel, P

2005-09-01

Aim of the study was to evaluate an isokinetic profile testing handball players to describe muscular imbalance. 30 athletes (15 male and 15 female) were measured at the Cybex 6000 test-unit for concentric internal and external rotation. Both shoulders, throwing arm (dominant shoulder) and the opposite shoulder were tested by speeds at 60 degrees/s and 180 degrees/s. There were sex specific differences which are also found in other sports. But these contrary data are not useful to define effective training concepts for handball-players with shoulder problems. From our point of view isokinetic testing of the shoulder joint in handball players can not reach any sufficient result. From our point of view there is no reason for using isokinetic testing to evaluate shoulder problems.

Review of paved shoulders.

DOT National Transportation Integrated Search

1990-01-01

The objectives of this study were (1) to review the literature on paved shoulders, (2) to survey state departments of transportation on their use of paved shoulders on two laneroads, (3) to perform a cost analysis on paved shoulders, and (4) to draw ...

Ultrasonographic evaluation of the canine shoulder.

PubMed

Long, C D; Nyland, T G

1999-01-01

The aim of this study was to determine the normal ultrasonographic anatomy of the canine shoulder. Fourteen shoulders from 7 clinically normal mid-sized dogs were radiographed and imaged using high frequency ultrasound. Each shoulder was isolated postmortem, and the ultrasonographic and gross anatomy was studied during dissection. The ultrasonographic appearance of the shoulder specimens was similar to that found in the live dogs. Twenty-four shoulders isolated postmortem from 12 variably sized dogs were also used to characterize the normal ultrasound anatomy over a range of sizes. Important anatomic structures that could be consistently evaluated were the biceps tendon and bursa, the bicipital groove surface, the supraspinatous tendon, the infraspinatous tendon, the teres minor tendon, and the caudal aspect of the humeral head. Results of ultrasonographic examination of 4 dogs with shoulder lameness are described to illustrate some applications of canine shoulder ultrasonography in the evaluation of the canine shoulder. In these dogs, ultrasound was a valuable tool to evaluate effusion and synovial proliferation within the bicipital bursa, supraspinatous and biceps tendinitis, biceps tendon strain, and dystrophic calcification.

[Prediction, prevention and management of shoulder dystocia].

PubMed

Csorba, Roland

2012-05-20

Shoulder dystocia is one of the most tragic, fatal and unexpected obstetrical events, which is mostly unpredictable and unpreventable. This clinical picture is defined as a delivery that requires additional obstetric maneuvers to release the shoulders after gentle downward traction has failed. Shoulder dystocia occurs when the fetal shoulder impacts on the maternal symphysis or sacral promontory. The incidence of shoulder dystocia is 0.2-0.6%. High perinatal mortality and morbidity is associated with the condition, even when it is managed appropriately. Obstetricians should be aware of the existing risk factors, but should always be alert to the possibility of shoulder dystocia in all labors. Maternal morbidity is also increased, particularly postpartum hemorrhage, rupture of the uterus, injury of the bladder, urethra and the bowels and fourth-degree perineal tears. Complications of the newborn include asphyxia, perinatal mortality, fracture of the clavicula and the humerus. Brachial plexus injuries are one of the most important fetal complications of shoulder dystocia, complicating 4-16% of such deliveries. The purpose of this article is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia.

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.

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.…

Magnetic Resonance Imaging and Arthroscopic Correlation in Shoulder Instability.

PubMed

Knapik, Derrick M; Voos, James E

2017-12-01

The shoulder is the most inherently unstable joint in the body, prone to high rates of anterior dislocations with subsequent injuries to soft tissue and bony stabilizing structures, resulting in recurrent shoulder instability. Advanced imaging utilizing magnetic resonance (MR) imaging and MR arthrography allows for thorough evaluation of lesions present in the unstable shoulder and is critical for preoperative planning. Arthroscopic shoulder stabilization in the appropriately selected patient can help restore stability and function. This review highlights correlations between MR imaging and arthroscopy of the most commonly reported soft tissue and bony injuries present in patients with shoulder instability.

Reflex muscle contraction in anterior shoulder instability.

PubMed

Wallace, D A; Beard, D J; Gill, R H; Eng, B; Carr, A J

1997-01-01

Reduced proprioception may contribute to recurrent anterior shoulder instability. Twelve patients with unilateral shoulder instability were investigated for evidence of deficient proprioception with an activated pneumatic cylinder and surface electromyography electrodes; the contralateral normal shoulder was used as a control. The latency between onset of movement and the detection of muscle contraction was used as an index of proprioception. No significant difference in muscle contraction latency was detected between the stable and unstable shoulders, suggesting that there was no significant defect in muscular reflex activity. This study does not support the use proprioception-enhancing physiotherapy in the treatment of posttraumatic anterior shoulder instability.

Presentation of frozen shoulder among diabetic and non-diabetic patients.

PubMed

Uddin, Mohammad Moin; Khan, Aminuddin A; Haig, Andrew J; Uddin, Mohammad Kafil

2014-12-01

The literature is inconsistent regarding the level of pain and disability in frozen shoulder patients with or without diabetes mellitus. The aim of this study is to evaluate some demographic features of frozen shoulder patients and to look into the disparity of information by comparing the level of pain and disability due to frozen shoulder between diabetic and non-diabetic people. This is a prospective comparative study. People with frozen shoulder attending an outpatient department were selected by consecutive sampling. Disability levels were assessed by the Shoulder Pain & Disability Index (SPADI). Means of pain and disability scores were compared using unpaired t-test. Among 140 persons with shoulder pain 99 (71.4%) had frozen shoulder. From the participating 40 frozen shoulder patients, 26 (65%) were males and 14 (35%) were females. Seventeen participants (42.5%) were diabetic, two (5%) had impaired glucose tolerance and 21 (52.5%) patients were non-diabetic. Mean disability scores (SPADI) were 51 ± 15.5 in diabetic and 57 ± 16 in non-diabetic persons. The differences in pain and disability level were not statistically significance (respectively, p = 0.24 and p = 0.13 at 95% confidence interval). No difference was found in level of pain and disability level between frozen shoulder patients with and without diabetes.

Ultrasonographic Findings of the Shoulder in Patients with Rheumatoid Arthritis and Comparison with Physical Examination

PubMed Central

Kim, Su Ho; Seo, Young-Il

2007-01-01

The objectives of this study were: 1) to identify the ultrasonographic (US) abnormalities and 2) to compare the findings of physical examination with US findings in rheumatoid arthritis (RA) patients with shoulder pain. We studied 30 RA patients. Physical examination was performed systemically as follows: 1) area of tenderness; 2) range of passive and active shoulder motion; 3) impingement tests; 4) maneuvers for determining the location of the tendon lesions. US investigations included the biceps, the supraspinatus, infraspinatus, and subscapularis tendons; the subacromial-subdeltoid bursa; and the glenohumeral and acromioclavicular joints. Thirty RA patients with 35 painful and 25 non-painful shoulders were examined. The range of motion affected the most by shoulder pain was abduction. The most frequent US finding of shoulder joint was effusion in the long head of the biceps tendon. Among the rotator cuff tendons, subscapularis was the most frequently involved. Tendon tear was also common among non-painful shoulders. Physical examination used for the diagnosis of shoulder pain had low sensitivity and specificity for detecting abnormalities in the rheumatoid shoulder joint. In conclusion, US abnormalities showed frequent tendon tears in our RA patients. Physical examination had low sensitivity and specificity for detecting rotator cuff tear in the rheumatoid shoulder joint. PMID:17728506

Propionibacterium acnes infection in shoulder arthroscopy patients with postoperative pain.

PubMed

Horneff, John G; Hsu, Jason E; Voleti, Pramod B; O'Donnell, Judith; Huffman, G Russell

2015-06-01

Recent studies have identified Propionibacterium acnes as the causal organism in an increasing number of postoperative shoulder infections. Most reports have found a high rate of P acnes infection after open surgery, particularly shoulder arthroplasty. However, there are limited data regarding P acnes infections after shoulder arthroscopy. We prospectively collected data on all shoulder arthroscopies performed by the senior author from January 1, 2009, until April 1, 2013. Cultures were taken in all revision shoulder arthroscopy cases performed for pain, stiffness, or weakness. In addition, 2 cultures were taken from each of a cohort of 32 primary shoulder arthroscopy cases without concern for infection to determine the false-positive rate. A total of 1,591 shoulder arthroscopies were performed during this period, 68 (4.3%) of which were revision procedures performed for pain, stiffness, or weakness. A total of 20 revision arthroscopies (29.4%) had positive culture findings, and 16 (23.5%) were positive for P acnes. In the control group, 1 patient (3.2%) had P acnes growth. The rate of P acnes infection in patients undergoing revision shoulder arthroscopy is higher than previously published and should be considered in cases characterized by refractory postoperative pain and stiffness. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Experimental research on safety impacts of the inside shoulder based on driving simulation.

PubMed

Zhao, Xiaohua; Ding, Han; Wu, Yiping; Ma, Jianming; Zhong, Liande

2015-03-01

Statistical data shows that single-vehicle crashes account for half of all traffic crashes on expressways in China, and previous research has indicated that main contributing factors were related to whether and how the inside shoulder was paved. The inside shoulder provides space for drivers to make evasive maneuvers and accommodate driver errors. However, lower-cost construction solutions in China have resulted in the design of numerous urban expressway segments that lack inside shoulders. This paper has two objectives. The first is to reveal the safety impacts of inside shoulders on urban expressways by driving simulator experiment. The second objective is to propose optimal range and recommended value of inside shoulder width for designing inside shoulders of urban expressways. The empirical data, including subjects' eye movement data, heart rate (HR) and the lateral position of vehicles, were collected in a driving simulator. The data were analyzed to evaluate the safety impacts of the inside shoulder. The results have revealed that the inside shoulder has an impact on drivers' visual perception, behaviors, and psychology; in particular, it has a significant effect on vehicle operations. In addition, this paper recommends the desired and optimal inside shoulder widths for eight-lane, two-way divided expressways. Copyright © 2014 Elsevier Ltd. All rights reserved.

Exploring the Use of Educational Material About Shoulder Dysfunction: A Quality Improvement Project in People With Amyotrophic Lateral Sclerosis.

PubMed

Burke, Katherine; Ellrodt, Amy Swartz; Levine, Jason; Adams, Taylor; Allis, Rebecca; Macmurdie, Ian; Paganoni, Sabrina

2018-05-01

Shoulder pain is a common secondary complication of amyotrophic lateral sclerosis (ALS) that can contribute to functional decline and decreased participation in daily activities. The purpose of this study was to assess the effectiveness of an educational brochure aimed at improving knowledge regarding shoulder pain and dysfunction in people with ALS. Participants completed a preintervention survey with questions regarding their knowledge of how ALS may affect their shoulders. After completing the presurvey, they were mailed a brochure that described shoulder health and range of motion and stretching exercises. Four weeks after receiving the brochure, participants were then asked to determine the effectiveness of the educational materials in terms of impact on shoulder-related knowledge and self-efficacy with regard to prevention of shoulder pain and dysfunction. More than 50% of participants reported pain, decreased range of motion, or weakness in at least one shoulder since being diagnosed with ALS. All participants were interested in receiving educational materials, and all agreed that the brochure was easy to interpret and understand, with most (87%) reporting that it was helpful. Educational brochures are one strategy to improve awareness about shoulder health and to educate patients with ALS about exercises that may help reduce shoulder pain and dysfunction.

Shoulder pain among high-level volleyball players and preseason features.

PubMed

Forthomme, Benedicte; Wieczorek, Valerie; Frisch, Anne; Crielaard, Jean-Michel; Croisier, Jean-Louis

2013-10-01

The main goal of this prospective study was to identify the most significant intrinsic risk factors for shoulder pain by measuring strength developed by shoulder rotators and by carrying out various morphostatic assessments. Sixty-six players (mean ± SD age = 24 ± 5 yr) were recruited from nine volleyball teams from the first and second divisions (34 men and 32 women) to participate in the study. Before the start of the volleyball season, all the participants completed a preseason questionnaire and underwent both a bilateral isokinetic evaluation of the shoulders and morphostatic measurements. During the subsequent 6 months of the competition period, the players reported through a weekly questionnaire any shoulder pain experienced. During the ongoing season, 23% (15 of 66 players) of the volleyball players experienced dominant shoulder pain. Interestingly, participants who reported a history of dominant shoulder pain were found to have nine times higher risk of suffering further pain in their dominant shoulder. The eccentric maximal strength developed by the internal and external rotators was found to represent a protective factor in the volleyball players (respective odds ratios = 0.946, P = 0.01 and 0.94, P = 0.05). No risk factors were found among the shoulder morphostatic measurements. In our study, the evaluation of shoulder rotator muscle strength through isokinetic assessment, especially eccentric mode, appeared to be the most contributing parameter to identify risk factors for shoulder pain. This evaluation should allow to better identify players at risk.

Epidemiology of shoulder and elbow pain in youth baseball players.

PubMed

Matsuura, Tetsuya; Suzue, Naoto; Iwame, Toshiyuki; Arisawa, Kokichi; Fukuta, Shoji; Sairyo, Koichi

2016-01-01

There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. The purpose of this study was to investigate risk factors for shoulder and elbow pain in child and adolescent baseball players. A total of 1563 players aged 7 to 12 years participated in this investigation. Subjects were asked whether they had experienced episodes of shoulder or elbow pain. We investigated the following risk factors for shoulder and elbow pain: age, position, years of baseball experience, and training hours per week. Data from the groups with and without shoulder and elbow pain were analyzed using multivariate logistic regression models. Among the 1563 participants, 15.9% and 29.2% reported episodes of shoulder and elbow pain, respectively. Multivariate analysis showed that shoulder pain was associated with age 10, 11, and 12 years, and that elbow pain was associated with age 10, 11, and 12 years, playing catcher, and >2 years of baseball experience. Training hours per week were not associated with either shoulder or elbow pain. In over 1000 baseball players aged 7 to 12 years, 15.9% reported episodes of shoulder pain, while 29.2% reported elbow pain in the throwing arm. The associated risk factors were different for each type of pain. Shoulder pain was associated with increased age while elbow pain was associated with increased age, increased years of baseball experience, and playing catcher.

Bicycle-Related Shoulder Injuries: Etiology and the Need for Protective Gear.

PubMed

Goldstein, Yariv; Dolkart, Oleg; Kaufman, Ehud; Amar, Eyal; Sharfman, Zachary T; Rath, Ehud; Mozes, Gavriel; Maman, Eran

2016-01-01

The popularity of bicycle riding for recreation, exercise and transportation has grown enormously in recent years, which has led to an increased incidence of bicycle-related injuries. While these injuries involve mainly the musculoskeletal system, data on shoulder-specific injuries incurred while bike riding are lacking. Classifying these shoulder injuries may provide insight and assistance in the creation and implementation of effective protective gear and measures. To investigate the types and mechanisms of shoulder injuries among cyclists. This study retrospectively examined all cyclists who incurred shoulder injuries while riding and were admitted to the emergency department and shoulder clinic between January 2008 and November 2013. The study included 157 subjects with various bicycle-related shoulder injuries treated with either conservative or surgical measures. Eighty-four percent of injuries were caused by a direct blow to the shoulder, 7% by falling on an outstretched hand, 6% were traction injuries, and 3% were due to hyperabduction. Nine different clinical types of injury were observed; the most common injuries were clavicle fractures (32%), followed by acromioclavicular joint dislocations (22%), rotator cuff tears (22%), and humeral fractures (8%). Fifty-one percent of subjects were managed with conservative care and the remaining patients required surgical interventions. Shoulder injuries incurred while riding a bicycle span the entire spectrum of shoulder injuries and often result in debilitating conditions. Although the use of helmets is increasing, there is currently no effective protective gear or measures to prevent riders from suffering shoulder injuries.

Cortical activation pattern during shoulder simple versus vibration exercises: a functional near infrared spectroscopy study.

PubMed

Jang, Sung Ho; Yeo, Sang Seok; Lee, Seung Hyun; Jin, Sang Hyun; Lee, Mi Young

2017-08-01

To date, the cortical effect of exercise has not been fully elucidated. Using the functional near infrared spectroscopy, we attempted to compare the cortical effect between shoulder vibration exercise and shoulder simple exercise. Eight healthy subjects were recruited for this study. Two different exercise tasks (shoulder vibration exercise using the flexible pole and shoulder simple exercise) were performed using a block paradigm. We measured the values of oxygenated hemoglobin in the four regions of interest: the primary sensory-motor cortex (SM1 total, arm somatotopy, and leg and trunk somatotopy), the premotor cortex, the supplementary motor area, and the prefrontal cortex. During shoulder vibration exercise and shoulder simple exercise, cortical activation was observed in SM1 (total, arm somatotopy, and leg and trunk somatotopy), premotor cortex, supplementary motor area, and prefrontal cortex. Higher oxygenated hemoglobin values were also observed in the areas of arm somatotopy of SM1 compared with those of other regions of interest. However, no significant difference in the arm somatotopy of SM1 was observed between the two exercises. By contrast, in the leg and trunk somatotopy of SM1, shoulder vibration exercise led to a significantly higher oxy-hemoglobin value than shoulder simple exercise. These two exercises may result in cortical activation effects for the motor areas relevant to the shoulder exercise, especially in the arm somatotopy of SM1. However, shoulder vibration exercise has an additional cortical activation effect for the leg and trunk somatotopy of SM1.

The presence and influence of posterior capsule tightness on different shoulder problems.

PubMed

Duzgun, Irem; Turgut, Elif; Çinar-Medeni, Özge; Kafa, Nihan; Tuna, Zeynep; Elbasan, Bulent; Oskay, Deran

2017-01-01

In the literature it has been shown that posterior capsule flexibility is a precursor to shoulder problems. However, no study thus far has shown the influence of the flexibility of posterior capsule in different shoulder pathologies. This study set about to compare the role of posterior capsule tightness in different shoulder problems. One-hundred-twenty-five patients diagnosed with shoulder subacromial impingement syndrome (n= 52), partial rotator cuff tear (n= 31) or frozen shoulder (n= 42) and 30 asymptomatic peers participated in the study. Horizontal adduction was assessed in side-lying position for posterior capsule tightness. Pain was measured via the visual analogue scale and shoulder range of motion and active total elevation was assessed with goniometer. Hand behind the back (HBB) test was assessed the active internal rotation by measuring the distance between T5 and the thumb. It was found that the affected side of the posterior capsules of the patients with subacromial impingement syndrome (p< 0.001), partial rotator cuff tear (p< 0.001) and frozen shoulder (p< 0.001) was stiffer than their healthy side. There were significant differences among groups in the level of tightness in the posterior capsule between the affected and the healthy sides (p< 0.001). All range of motion of the shoulder including HBB test and the posterior capsule tightness of the affected side are found to be correlated (p< 0.05). This study emphasized that the posterior capsule's susceptibility to tightness is most evident in frozen shoulder among different shoulder problems.

Is neck tilt and shoulder imbalance the same phenomenon? A prospective analysis of 89 adolescent idiopathic scoliosis patients (Lenke type 1 and 2).

PubMed

Kwan, Mun Keong; Wong, Kai Ann; Lee, Chee Kean; Chan, Chris Yin Wei

2016-02-01

To introduce a new clinical neck tilt grading and to investigate clinically and radiologically whether neck tilt and shoulder imbalance is the same phenomenon in AIS patients. 89 AIS Lenke 1 and 2 cases were assessed prospectively using the new clinical neck tilt grading. Shoulder imbalance and neck tilt were correlated with coracoid height difference (CHD), clavicle\\rib intersection distance (CRID), clavicle angle (CA), radiographic shoulder height (RSH), T1 tilt and cervical axis. Mean age was 17.2 ± 3.8 years old. 66.3 % were Lenke type 1 and 33.7 % were type 2 curves. Strong intraobserver (0.79) and interobserver (0.75) agreement of the clinical neck tilt grading was noted. No significant correlation was observed between clinical neck tilt and shoulder imbalance (0.936). 56.3 % of grade 3 neck tilt, 50.0 % grade 2 neck tilt patients had grade 0 shoulder imbalance. In patients with grade 2 shoulder imbalance, 42.9 % had grade 0, 35.7 % grade 1, 14.3 % grade 2 and only 7.1 % had grade 3 neck tilt. CHD, CRID, CA and RSH correlated with shoulder imbalance. T1 tilt and cervical axis measurements correlated with neck tilt. In conclusion, neck tilt is distinct from shoulder imbalance. Clinical neck tilt has poor correlation with clinical shoulder imbalance. Clinical neck tilt grading correlated with cervical axis and T1 tilt whereas clinical shoulder grading correlated with CHD, RSH CRID and CA.

Functional shoulder ratios with high velocities of shoulder internal rotation are most sensitive to determine shoulder rotation torque imbalance: a cross-sectional study with elite handball players and controls.

PubMed

Castro, Marcelo Peduzzi de; Fonseca, Pedro; Morais, Sara Tribuzi; Borgonovo-Santos, Márcio; Coelho, Eduardo Filipe Cruz; Ribeiro, Daniel Cury; Vilas-Boas, João Paulo

2017-12-04

The aim of the present study was to determine which approach to calculating shoulder ratios is the most sensitive for determining shoulder torque imbalance in handball players. Twenty-six participants (handball athletes, n = 13; healthy controls, n = 13) performed isokinetic concentric and eccentric shoulder internal rotation (IR) and external rotation (ER) assessment at 60, 180 and 300°/s. We used eight approaches to calculating shoulder ratios: four concentric (i.e. concentric ER torque divided by concentric IR torque), and four functional (i.e. eccentric ER torque divided by concentric IR torque) at the velocities of 60, 180 and 300°/s for both IR and ER, and combining 60°/s of ER and 300°/s of IR. A three factorial ANOVA (factors: shoulder ratios, upper limb sides, and groups) along with Tukey's post-hoc analysis, and effect sizes were calculated. The findings suggested the functional shoulder ratio combining 60°/s of ER and 300°/s of IR is the most sensitive to detect differences between upper limbs for handball players, and between players and controls for the dominant side. The functional shoulder ratio combining 60°/s of ER with 300°/s of IR seems to present advantages over the other approaches for identifying upper limb asymmetries and differences in shoulder torque balance related to throwing.

Treatment of myofascial trigger points in common shoulder disorders by physical therapy: a randomized controlled trial [ISRCTN75722066].

PubMed

Bron, Carel; Wensing, Michel; Franssen, Jo Lm; Oostendorp, Rob Ab

2007-11-05

Shoulder disorders are a common health problem in western societies. Several treatment protocols have been developed for the clinical management of persons with shoulder pain. However available evidence does not support any protocol as being superior over others. Systematic reviews provide some evidence that certain physical therapy interventions (i.e. supervised exercises and mobilisation) are effective in particular shoulder disorders (i.e. rotator cuff disorders, mixed shoulder disorders and adhesive capsulitis), but there is an ongoing need for high quality trials of physical therapy interventions. Usually, physical therapy consists of active exercises intended to strengthen the shoulder muscles as stabilizers of the glenohumeral joint or perform mobilisations to improve restricted mobility of the glenohumeral or adjacent joints (shoulder girdle). It is generally accepted that a-traumatic shoulder problems are the result of impingement of the subacromial structures, such as the bursa or rotator cuff tendons. Myofascial trigger points (MTrPs) in shoulder muscles may also lead to a complex of symptoms that are often seen in patients diagnosed with subacromial impingement or rotator cuff tendinopathy. Little is known about the treatment of MTrPs in patients with shoulder disorders.The primary aim of this study is to investigate whether physical therapy modalities to inactivate MTrPs can reduce symptoms and improve shoulder function in daily activities in a population of chronic a-traumatic shoulder patients when compared to a wait-and-see strategy. In addition we investigate the recurrence rate during a one-year-follow-up period. This paper presents the design for a randomized controlled trial to be conducted between September 2007 - September 2008, evaluating the effectiveness of a physical therapy treatment for non-traumatic shoulder complaints. One hundred subjects are included in this study. All subjects have unilateral shoulder pain for at least six months and are referred to a physical therapy practice specialized in musculoskeletal disorders of the neck-, shoulder-, and arm. After the initial assessment patients are randomly assigned to either an intervention group or a control-group (wait and see). The primary outcome measure is the overall score of the Dutch language version of the DASH (Disabilities of Arm, Shoulder and Hand) questionnaire. Since there is only little evidence for the efficacy of physical therapy interventions in certain shoulder disorders, there is a need for further research. We found only a few studies examining the efficacy of MTrP therapy for shoulder disorders. Therefore we will perform a randomised clinical trial of the effect of physical therapy interventions aimed to inactivate MTrPs, on pain and impairment in shoulder function in a population of chronic a-traumatic shoulder patients. We opted for an intervention strategy that best reflects daily practice. Manual high velocity thrust techniques and dry-needling are excluded. Because in most physical therapy interventions, blinding of the patient and the therapist is not possible, we will perform a randomised, controlled and observer-blinded study. This randomized clinical trial is registered at current controlled trials ISRCTN75722066.

Shoulder arthroplasty options in young (<50 years old) patients: review of current concepts.

PubMed

Johnson, Michael H; Paxton, E Scott; Green, Andrew

2015-02-01

Prosthetic shoulder arthroplasty provides excellent pain relief and functional restoration for patients with glenohumeral arthritis, but concerns of survivorship have limited its use in younger patients. Despite general reports of high long-term survivorship, implant failure and functional deterioration after total shoulder arthroplasty are major concerns in the management of younger patients. In addition to having a longer life expectancy, younger patients also tend to be more active and can be expected to place greater demands on their shoulder arthroplasty. Alternative strategies have been developed and used for shoulder arthroplasty in younger patients. This manuscript reviews current concepts of shoulder arthroplasty in young patients. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A COMPARATIVE STUDY OF PASSIVE SHOULDER ROTATION RANGE OF MOTION, ISOMETRIC ROTATION STRENGTH AND SERVE SPEED BETWEEN ELITE TENNIS PLAYERS WITH AND WITHOUT HISTORY OF SHOULDER PAIN

PubMed Central

Moreno-Pérez, V.; Elvira, JLL.; Fernandez-Fernandez, J.; Vera-Garcia, FJ.

2018-01-01

Background Glenohumeral internal rotation deficit and external rotation strength have been associated with the development of shoulder pain in overhead athletes. Objective To examine the bilateral passive shoulder rotational range of motion (ROM), the isometric rotational strength and unilateral serve speed in elite tennis players with and without shoulder pain history (PH and NPH, respectively) and compare between dominant and non-dominant limbs and between groups. Study Design Cohort study. Methods Fifty-eight elite tennis players were distributed into the PH group (n = 20) and the NPH group (n = 38). Serve velocity, dominant and non-dominant passive shoulder external and internal rotation (ER and IR) ROM, total arc of motion (TAM: the sum of IR and ER ROM), ER and IR isometric strength, bilateral deficits and ER/IR strength ratio were measured in both groups. Questionnaires were administered in order to classify characteristics of shoulder pain. Results The dominant shoulder showed significantly reduced IR ROM and TAM, and increased ER ROM compared to the non-dominant shoulder in both groups. Isometric ER strength and ER/IR strength ratio were significantly lower in the dominant shoulder in the PH group when compared with the NPH group. No significant differences between groups were found for serve speed. Conclusion These data show specific adaptations in the IR, TAM and ER ROM in the dominant shoulder in both groups. Isometric ER muscle weakness and ER/IR strength ratio deficit appear to be associated with history of shoulder injuries in elite tennis players. It would be advisable for clinicians to use the present information to design injury prevention programs. Level of evidence 2 PMID:29484240

A COMPARATIVE STUDY OF PASSIVE SHOULDER ROTATION RANGE OF MOTION, ISOMETRIC ROTATION STRENGTH AND SERVE SPEED BETWEEN ELITE TENNIS PLAYERS WITH AND WITHOUT HISTORY OF SHOULDER PAIN.

PubMed

Moreno-Pérez, V; Elvira, Jll; Fernandez-Fernandez, J; Vera-Garcia, F J

2018-02-01

Glenohumeral internal rotation deficit and external rotation strength have been associated with the development of shoulder pain in overhead athletes. To examine the bilateral passive shoulder rotational range of motion (ROM), the isometric rotational strength and unilateral serve speed in elite tennis players with and without shoulder pain history (PH and NPH, respectively) and compare between dominant and non-dominant limbs and between groups. Cohort study. Fifty-eight elite tennis players were distributed into the PH group (n = 20) and the NPH group (n = 38). Serve velocity, dominant and non-dominant passive shoulder external and internal rotation (ER and IR) ROM, total arc of motion (TAM: the sum of IR and ER ROM), ER and IR isometric strength, bilateral deficits and ER/IR strength ratio were measured in both groups. Questionnaires were administered in order to classify characteristics of shoulder pain. The dominant shoulder showed significantly reduced IR ROM and TAM, and increased ER ROM compared to the non-dominant shoulder in both groups. Isometric ER strength and ER/IR strength ratio were significantly lower in the dominant shoulder in the PH group when compared with the NPH group. No significant differences between groups were found for serve speed. These data show specific adaptations in the IR, TAM and ER ROM in the dominant shoulder in both groups. Isometric ER muscle weakness and ER/IR strength ratio deficit appear to be associated with history of shoulder injuries in elite tennis players. It would be advisable for clinicians to use the present information to design injury prevention programs. 2.

Subjective and objective outcome after revision arthroscopic stabilization for recurrent anterior instability versus initial shoulder stabilization.

PubMed

Krueger, David; Kraus, Natascha; Pauly, Stephan; Chen, Jianhai; Scheibel, Markus

2011-01-01

The value of arthroscopic revision shoulder stabilization after failed instability repair is still a matter of debate. Arthroscopic revision shoulder stabilization using suture anchors provides equivalent subjective and objective results compared with initial arthroscopic instability repair. Cohort study; Level of evidence, 3. Twenty consecutive patients who underwent arthroscopic revision shoulder stabilization using suture anchors (group 2) were matched for age, gender, and handedness (dominant or nondominant) with 20 patients who had initial arthroscopic instability repair using the same technique (group 1). At the time of follow-up, a complete physical examination of both shoulders and evaluation with the Rowe score, Walch-Duplay score, Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and the Subjective Shoulder Value were performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of osteoarthritis. After a minimum follow-up of 24 months, no recurrent dislocations were observed in either group. The apprehension sign was positive in 2 cases of revision surgery (0 vs 2; P > .05). No significant differences in the Rowe score (89 vs 81.8 points) were found between groups 1 and 2 (P > .05). However, group 2 revealed significantly lower scores in the Walch-Duplay score (85.3 vs 75.5 points), Melbourne Instability Shoulder Score (90.2 vs 73.7 points), Western Ontario Shoulder Instability Index (89.8% vs 68.9%), and Subjective Shoulder Value (91.8% vs 69.2%) (P < .05). Signs of instability arthropathy were found more often in patients with arthroscopic revision surgery (2 vs 5; P > .05). Arthroscopic revision shoulder stabilization is associated with a lower subjective outcome compared with initial arthroscopic stabilization. The objective results found in this study may overestimate the clinical outcome in this patient population.

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

Effects of 6-week sling-based training of the external-rotator muscles on the shoulder profile in elite female high school handball players.

PubMed

Genevois, Cyril; Berthier, Philippe; Guidou, Vincent; Muller, Franck; Thiebault, Boris; Rogowski, Isabelle

2014-11-01

In women's handball, the large numbers of throws and passes make the shoulder region vulnerable to overuse injuries. Repetitive throwing motions generate imbalance between shoulder internal- and external-rotator muscles. It has not yet been established whether sling-based training can improve shoulder external-rotator muscle strength. This study investigated the effectiveness of a 6-wk strengthening program in improving shoulder functional profile in elite female high school handball players. Crossover study. National elite handball training center. 25 elite female high school handball players. The program, completed twice per week for 6 wk, included sling-based strengthening exercises using a suspension trainer for external rotation with scapular retraction and scapular retraction alone. Maximal shoulder external- and internal-rotation strength, shoulder external- and internal-rotation range of motion (ROM), and maximal throwing velocity were assessed preintervention and postintervention for dominant and nondominant sides. After sling training, external- and internal-rotation strength increased significantly for both sides (P ≤ .001, and P = .004, respectively), with the result that there was no significant change in external- and internal-rotation strength ratios for either the dominant or the nondominant shoulder. No significant differences were observed for external-rotation ROM, while internal-rotation ROM decreased moderately, in particular in the dominant shoulder (P = .005). Maximal throwing velocity remained constant for the dominant arm, whereas a significant increase was found for the nondominant arm (P = .017). This 6-wk strengthening program was effective in improving shoulder external-rotator muscle strength but resulted in a decrease in the ROM in shoulder internal rotation, while throwing velocity remained stable. Adding a stretching program to this type of sling-based training program might help avoid potential detrimental effects on shoulder ROM.

Shoulder arthrodesis for treatment of flail shoulder in children with polio.

PubMed

Miller, Joshua D; Pinero, Joseph R; Goldstein, Rachel; Yen, Yi-Meng; Eves, William; Otsuka, Norman Y

2011-09-01

Poliomyelitis in children can cause paralysis of shoulder girdle muscles leading to a flail shoulder. Shoulder arthrodesis is indicated as a possible treatment for these children in order to stabilize the shoulder. This retrospective study reviewed all shoulder arthrodesis surgeries owing to complications of polio performed at a major medical institution between 1981 and 1996 to assess position of fusion, radiographic evidence of fusion, complications, and patient satisfaction. A review of medical records identified 11 patients undergoing 13 shoulder arthrodesis procedures, with a mean age of 14.7 years at the time of the procedure. Internal fixation was achieved with large cancellous screws in 8 patients and a Dynamic Compression Plate (DCP) plate in 5 procedures. Average follow-up period was 41 months. Eight patients were placed into a spica cast and 5 used a sling postoperatively. Shoulder arthrodesis surgery in this cohort resulted in an average position of fusion with 42.3 degrees of abduction, 23.8 degrees of flexion, and 26.2 degrees of internal rotation. Twelve of the 13 procedures assessed for radiographic union demonstrated fusion. The most common complications were malrotation and nonunion. Of the 13 procedures, 2 underwent humeral osteotomies for malrotation, and 1 with 6.5 mm cancellous screws required revision with a DCP plate owing to nonunion. Six patients underwent hardware removal, 3 of which were specifically owing to complaints of painful hardware. At final follow-up, no patient reported pain and all expressed satisfaction with their results and improved shoulder function after repair. This study is the largest series of shoulder arthrodesis surgeries for treatment of patients with a flail shoulder from polio to date, providing a more thorough analysis of its efficacy as an indicated treatment. Level III-Retrospective Comparative Study.

Season-Ending Shoulder Injuries in the National Collegiate Athletic Association: Data From the NCAA Injury Surveillance Program, 2009-2010 Through 2013-2014.

PubMed

Goodman, Avi D; DeFroda, Steven F; Gil, Joseph A; Kleiner, Justin E; Li, Neill Y; Owens, Brett D

2018-05-01

Examination of the incidence of shoulder season-ending injury (SEI) in the collegiate athlete population is limited. To determine the incidence of shoulder SEI in the National Collegiate Athletic Association (NCAA) and to investigate the risk factors for a shoulder injury ending an athlete's season. Descriptive epidemiology study. All shoulder injuries from the NCAA Injury Surveillance Program database for the years 2009-2010 to 2013-2014 were extracted, and SEI status was noted. The incidences of SEI and non-SEI were calculated for athlete, activity, and injury characteristics and compared via univariable analysis and risk ratios to determine risk factors for an injury being season ending. Shoulder injuries were season ending in 4.3% of cases. The overall incidence of shoulder SEI was 0.31 per 10,000 athlete exposures (AEs), as opposed to 7.25 per 10,000 AEs for all shoulder injuries. Shoulder instability constituted 49.1% of SEI, with an incidence of 0.15 per 10,000 AEs, while fractures had the highest rate of being season ending (41.9%). Men's wrestling had the highest incidence of shoulder SEI (1.65 per 10,000 AEs), while men's soccer had the highest proportion of shoulder injuries that ended a season (14.6%). Overall, men had a 6.3-fold higher incidence of SEI than women and a 2.4-fold increased likelihood that an injury would be season ending. Injury to the shoulder of an NCAA athlete, while somewhat infrequent, can have significant implications on time lost from play. Incidence of these injuries varies widely by sport and injury, with a number of associated risk factors. Athletes sustaining potentially season-ending shoulder injuries, with their coaches and medical providers, may benefit from these data to best manage expectations and outcomes.

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.

Clinical outcomes after arthroscopic release for recalcitrant frozen shoulder.

PubMed

Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

2014-09-01

To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes.

Clinical Outcomes after Arthroscopic Release for Recalcitrant Frozen Shoulder

PubMed Central

Ebrahimzadeh, Mohammad H; Moradi, Ali; Pour, Mostafa Khalili; Moghadam, Mohammad Hallaj; Kachooei, Amir Reza

2014-01-01

Background: To explain the role of arthroscopic release in intractable frozen shoulders. We used different questionnaires and measuring tools to understand whether arthroscopic release is the superior modality to treat patients with intractable frozen shoulders. Methods: Between 2007 and 2013, in a prospective study, we enrolled 80 patients (52 females and 28 males) with recalcitrant frozen shoulder, who underwent arthroscopic release at Ghaem Hospital, a tertiary referral center, in Mashhad, Iran. Before operation, all patients filled out the Disability of Arm, Shoulder and Hand (DASH), Constant, University of California Los Angeles (UCLA), ROWE and Visual Analogue Scale (VAS) for pain questionnaires. We measured the difference in range of motion between both the normal and the frozen shoulders in each patient. Results: The average age of the patients was 50.8±7.1 years. In 49 patients, the right shoulder was affected and in the remaining 31 the left side was affected. Before surgery, the patients were suffering from this disease on average for 11.7±10.3 months. The average time to follow-up was 47.2±6.8 months (14 to 60 months). Diabetes mellitus (38%) and history of shoulder trauma (23%) were the most common comorbidities in our patients. We did not find any significant differences between baseline characteristics of diabetics patients with non-diabetics ones. After surgery, the average time to achieve maximum pain improvement and range of motion were 3.6±2.1 and 3.6±2 months, respectively. The VAS score, constant shoulder score, Rowe score, UCLA shoulder score, and DASH score showed significant improvement in shoulder function after surgery, and shoulder range of motion improved in all directions compared to pre-operation range of motion. Conclusions: According to our results, arthroscopic release of recalcitrant frozen shoulder is a valuable modality in treating this disease. This method could decrease pain and improve both subjective and objective mid-term outcomes. PMID:25386586

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players.

PubMed

Lubiatowski, Przemyslaw; Kaczmarek, Piotr; Cisowski, Pawel; Breborowicz, Ewa; Grygorowicz, Monika; Dzianach, Marcin; Krupecki, Tomasz; Laver, Lior; Romanowski, Leszek

2018-01-01

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes. Eighty-seven elite professional handball players and 41 healthy non-athlete volunteers participated in the study. Evaluations included measurement of range of internal and external rotation, total arch of motion, identification of shoulder pain and ultrasound scan for diagnosis of rotator cuff tears and internal impingement. Glenohumeral rotational deficits (>20-25°) were found among 11 players group (13%). The throwing shoulders in the players group showed a decrease in internal rotation and an increase in external rotation with significantly larger ranges among players compared to the non-athlete group. Internal rotation deficit >20° was associated with higher incidence of shoulder pain among players. Both internal rotation deficits (>25°) and total arch of motion deficit (>20°) co-existed with higher incidence of internal impingement. Shoulder pain was common (36/97-41%) and was associated with decreased external rotation and total arch of motion. Internal impingement (found in 13/87-15%) correlated with decreased rotation ranges and a greater deficit in total arch of motion, whereas higher gain in external rotation correlated with a partial rotator cuff tear (found in 12/87-14%). Shoulder pathologies and problems commonly affected the group of handball players. Greater glenohumeral rotational deficits in throwing shoulders of handball players correlate with shoulder pain and internal impingement, while increased external rotation with partial rotator cuff tears. Such deficits affect 13% of the athlete population. Major clinical relevance of the study is to monitor handball players' shoulders both clinically and by proper imaging. Evaluation of range of rotation seems to identify shoulders at risk of the pathology. Cross-Sectional study with control group, Level II.

Ipsilateral shoulder pain in patients following lung resection in the decubitus position.

PubMed

Bando, Takae; Kondo, Kazuya; Onishi, Chiemi; Kajiura, Koichiro; Takizawa, Hiromitsu; Yamada, Kazuyo; Sato, Hiromi; Imai, Yoshie

2018-03-01

To examine the frequency, influencing factors and clinical course of shoulder pain in patients following lung resection. Thoracoscopes have been introduced in the surgical treatment of lung cancer and allow for less invasive surgery with a minimal incision. However, decubitus position-related shoulder pain on the operated side has not yet been investigated. A longitudinal descriptive study. Patients who underwent lung resection in the decubitus position. Patients were interviewed 2 days before surgery and once daily for 5 days after surgery. Interview items included background data, the concomitant use of epidural anaesthesia, operative duration, the presence of preoperative shoulder stiffness (excluding shoulder pain), type of surgery and site of operation. The intensity of pain was approximately 5 on an 11-point numerical rating scale. Descriptive statistics on patient backgrounds were obtained using SPSS Statistics 22 for Windows. Of the 74 patients who underwent lung resection in a decubitus position, 30 (40.5%) developed shoulder pain on the operated side. The highest rating occurred 1 day after surgery and decreased over time. The following two factors were found to influence shoulder pain on the operated side: operative duration (Z = -2.63; p = .01) and the presence of preoperative shoulder stiffness (excluding shoulder pain) (χ 2  = 4.16; p = .04). This study demonstrated that approximately 40% of patients who underwent lung resection in the decubitus position developed shoulder pain. The presence of postoperative shoulder pain was related to both the duration of the operation and to the presence of preoperative shoulder stiffness. Although the shoulder pain resolves within 4 days, it causes the patient additional discomfort and distress. Therefore, further research is needed on positioning for thoracotomy in order to investigate ways to reduce or eliminate this complication of lung surgery. © 2017 John Wiley & Sons Ltd.

Chest cage angle difference and rotation of main thoracic curve are independent risk factors of postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis.

PubMed

Yagi, Mitsuru; Takemitsu, Masakazu; Machida, Masafumi

2013-09-01

Retrospective case series of surgically treated adolescent patients with scoliosis. To assess the prevalence and independent risk factors for postoperative shoulder imbalance in surgically treated adolescent patients with idiopathic scoliosis. Despite recent reports that have identified risk factors for postoperative shoulder imbalance, the relative risks remain unclear. A retrospective review of 85 consecutive patients treated with thoracic fusion with a minimum 2-year follow-up (mean, 3.1 yr) was conducted to investigate the patient radiographical measurements and demographics. Shoulder height difference (SHD) was measured as the graded height difference of the soft tissue shadows. A SHD more than 2 cm indicated an unbalanced shoulder. Patient demographics and radiographical data were studied to determine risk factors for postoperative SHD. The potential risk factors included age, sex, Risser sign, Cobb angle, flexibility, and apical vertebral rotation (AVR) of the main curve, upper-instrumented vertebra level, SHD, and clavicle chest cage angle difference (CCAD). Univariate and multivariate logistic regression analyses were performed to determine the independent risk factors for postoperative shoulder imbalance. Of the 85 patients, 21 patients presented postoperative shoulder imbalance. The univariate analysis indicated age, Risser sign, Cobb angle of the main curve, AVR of the main curve, and CCAD as risk factors, but the multivariate logistic regression analysis showed that only AVR of the main curve and CCAD were independent risk factors for postoperative shoulder imbalance (AVR, P = 0.04, odds ratio (OR): 3.54; CCAD, P = 0.01, OR: 5.10). Postoperative shoulder imbalance was observed in 25% of the surgically treated adolescent patients. The CCAD and AVR of the main thoracic curve were independent risk factors for postoperative shoulder imbalance in surgically treated patients with adolescent idiopathic scoliosis. The significant correlation between CCAD and postoperative shoulder imbalance seen in this study strongly suggests that the relationship of the shoulder girdle and chest cage has a role in maintaining shoulder balance.

Hemiplegic shoulder pain: implications for occupational therapy treatment.

PubMed

Gilmore, Paula E; Spaulding, Sandi J; Vandervoort, Anthony A

2004-02-01

Hemiplegic shoulder pain is common after stroke causing hemiplegia. It adversely affects the recovery of arm function and independence in activities of daily living. Subluxation, abnormal tone and limited range of motion or capsular constrictions have been reported as potential causes. Other factors such as rotator cuff tears, brachial plexus injury, shoulder-hand syndrome and other pre-existing pathological conditions may also be associated with hemiplegic shoulder pain. The etiology remains unclear, but hemiplegic shoulder pain may result from a combination of the above factors. This literature review examines the possible causes of hemiplegic shoulder pain and discusses the implications for occupational therapy treatment. Occupational therapy interventions include proper positioning, facilitation of movement through purposeful therapeutic activities, increasing passive range of motion, implementation of external supports and treatment of shoulder-hand syndrome. Understanding the processes involved will assist with effective assessment, treatment and prevention of hemiplegic shoulder pain. This will facilitate clients' participation in rehabilitation programs and move them towards attainment of optimal function.

Platelet-Rich Plasma for Frozen Shoulder: A Case Report.

PubMed

Aslani, Hamidreza; Nourbakhsh, Seyed Taghi; Zafarani, Zohreh; Ahmadi-Bani, Monireh; Ananloo, Mohammad Ebrahim Shahsavand; Beigy, Maani; Salehi, Shahin

2016-01-01

Frozen shoulder is a glenohumeral joint disorder that movement because of adhesion and the existence of fibrosis in the shoulder capsule. Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. To date, there is no evidence regarding the effectiveness of platelet-rich plasma in frozen shoulder. A 45-year-old man with shoulder adhesive capsulitis volunteered for this treatment. He underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. We measured pain, function, ROM by the visual analogue scale (VAS), scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and goniometer; respectively. After first injection, the patient reported 60% improvement regarding diurnal shoulder pain, and no night pain. Also, two-fold improvement for ROM and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in randomized trials.

Humeral retroversion and shoulder rotational mobility in young handball practitioners

PubMed Central

Quadros, Gustavo Aguiar; Döhnert, Marcelo Baptista

2015-01-01

ABSTRACT OBJECTIVE : To evaluate the prevalence of humeral retroversion and rotational mobility (RHH) in young handball practitioners and non-practitioners. METHODS : This is a cross-sectional study performed with two groups: the handball group, with 14 female students practicing handball and the control group, with 13 young participants non-practicing pitch sports. RESULTS : The handball group presented full rotational movement (FRM) hi-gher than the control group in both the dominant shoulder (p=0.001) and the non-dominant shoulder (p=0.0001). The mobility of active and passive internal rotation was significantly higher in handball players in both shoulders. The handball group presented lower internal rotation range of motion for the dominant shoulder as compared to the non-dominant shoul-der (p=0.001). CONCLUSION : Young handball practitioners, des-pite skeletally immature, showed a higher MRT than the control group. The handball group showed loss of internal rotation (medial) on the dominant shoulder as compared to the non--dominant shoulder. Level of Evidence II, Prospective Study. PMID:27057141

Shoulder dystocia: definitions and incidence.

PubMed

Hansen, Alexandra; Chauhan, Suneet P

2014-06-01

Though subjective in nature, both the American College of Obstetricians and Gynecologists practice bulletin and the Royal College of Obstetricians and Gynaecologists green guideline are in agreement on the descriptor of shoulder dystocia: requirement of additional obstetric maneuvers when gentle downward traction has failed to affect the delivery of the shoulders. The rate of shoulder dystocia is about 1.4% of all deliveries and 0.7% for vaginal births. Compared to non-diabetics (0.6%), among diabetics, the rate of impacted shoulders is 201% higher (1.9%); newborns delivered by vacuum or forceps have 254% higher likelihood of shoulder dystocia than those born spontaneously (2.0% vs. 0.6%, respectively). When the birthweight is categorized as <4000, 4000-4449, and >4500 g, the likelihood of shoulder dystocia in the US vs. other countries varies significantly. Future studies should focus on lowering the rate of shoulder dystocia and its associated morbidities, without concomitantly increasing the rate of cesarean delivery. Copyright © 2014 Elsevier Inc. All rights reserved.

Range of motion of diabetic frozen shoulder recovers to the contralateral level

PubMed Central

Vastamäki, Heidi; Ristolainen, Leena

2016-01-01

Objective To determine whether frozen shoulder heals equally well in patients with and without diabetes and whether dependency on insulin affects the outcome. Methods We retrospectively examined 178 patients with idiopathic frozen shoulder; 27 patients had diabetes. We evaluated range of motion, pain, and functional results. The mean follow-up was 9.7 years (SD, 7.1 years). Results In the presence of frozen shoulder, range of motion did not differ between patients with and without diabetes. At follow-up, range of motion in all directions of both the affected and unaffected shoulders of patients with diabetes was inferior to that of patients without diabetes. Among patients with diabetes, range of motion of the once-frozen shoulder reached the level of the unaffected shoulder. Patients with and without diabetes experienced similar pain except during exertion. The Constant–Murley score was not significantly different between the two groups, and insulin dependency did not lead to worse outcomes. Conclusion Frozen shoulder heals well in patients with diabetes. PMID:27856934

Humeral retroversion and shoulder rotational mobility in young handball practitioners.

PubMed

Quadros, Gustavo Aguiar; Döhnert, Marcelo Baptista

2015-01-01

: To evaluate the prevalence of humeral retroversion and rotational mobility (RHH) in young handball practitioners and non-practitioners. : This is a cross-sectional study performed with two groups: the handball group, with 14 female students practicing handball and the control group, with 13 young participants non-practicing pitch sports. : The handball group presented full rotational movement (FRM) hi-gher than the control group in both the dominant shoulder (p=0.001) and the non-dominant shoulder (p=0.0001). The mobility of active and passive internal rotation was significantly higher in handball players in both shoulders. The handball group presented lower internal rotation range of motion for the dominant shoulder as compared to the non-dominant shoul-der (p=0.001). : Young handball practitioners, des-pite skeletally immature, showed a higher MRT than the control group. The handball group showed loss of internal rotation (medial) on the dominant shoulder as compared to the non--dominant shoulder. Level of Evidence II, Prospective Study.

Manual adjustable probe tool for friction stir welding

NASA Technical Reports Server (NTRS)

Oelgoetz, Peter A. (Inventor); Ding, Jeff (Inventor)

2000-01-01

A friction stir welding tool is provided generally comprising three parts: a rotatable welding tool body (22) that has an outer threaded surface (32) and a probe (24) extending from a distal end of the body, a shoulder (26), which has a threaded inner surface (40) and a bore (36) at a distal end of the shoulder, and a jam nut (28), which has a threaded inner surface (42). The shoulder is threaded onto the tool body such that the probe extends from the shoulder through the bore by a preferred length. The jam nut is then threaded onto the tool body to secure the shoulder. The tool is operatively connected to a drive motor for rotating the tool body. The shoulder may include a knife edge projecting from the distal end (38) thereof adjacent the bore. The knife edge inhibits the weld material from migrating along the probe to intrude inside the shoulder, where it may prevent separation of the tool body and the shoulder when readjustment of the tool is necessary.

An examination of shoulder kinematics and kinetics when using a commercial trunk harness while sheep shearing.

PubMed

Gregory, Diane E; Milosavljevic, Stephan; Pal, Poonam; Callaghan, Jack P

2008-01-01

Sheep shearing is a very physically demanding occupation, especially on the low back, such that many commercial harnesses have been developed to help reduce the load on the back. Such harnesses have been shown to significantly reduce peak and cumulative low back loads; however, the effect that these harnesses have on the shoulders, which are also highly involved during sheep shearing, has not been previously examined. The purpose of this study was to examine the shoulder postures and cumulative shoulder moments of 12 New Zealand sheep shearers. The use of the trunk harness reduced the percentage of time spent in shoulder flexion greater than 90 degrees and the time spent in shoulder abduction greater than 45 degrees as well as reduced the cumulative net joint flexor, abductor, and adductor shoulder moments by a minimum of 21%, 14%, and 42%, respectively. Therefore, the use of a commercial trunk harness to reduce low back injury may also help to reduce the risk of shoulder injury while sheep shearing.

Effect of pitching consecutive days in youth softball tournaments on objective shoulder strength and subjective shoulder symptoms

PubMed Central

Skillington, S. Andrew; Brophy, Robert H.; Wright, Rick W.; Smith, Matthew V.

2017-01-01

Background The windmill pitching motion has been associated with risk for shoulder injury. Since there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated. Hypothesis Over the course of 2 and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days. Study Design Cross-Sectional Study. Methods Female fast-pitch softball pitchers between the ages of 14 and 18 who were pitching in 2 and 3-day tournaments were recruited for study participation. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a hand-held dynamometer. Results Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS shoulder fatigue (2.0, 95% CI: 1.3 to 3.0), and pain (1.3, 95% CI: 0.5 to 2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (3.5, 95% CI: 1.5 to 5.5), VAS shoulder pain (2.5, 95% CI: 1.0 to 4.5) and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated. Conclusion Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2 and 3-day tournaments without full recovery between consecutive days pitching. PMID:28298058

Shoulder range of motion measures as risk factors for shoulder and elbow injuries in high school softball and baseball players.

PubMed

Shanley, Ellen; Rauh, Mitchell J; Michener, Lori A; Ellenbecker, Todd S; Garrison, J Craig; Thigpen, Charles A

2011-09-01

Range of motion deficits in shoulder external rotation (ER), internal rotation (IR), total rotation range of motion (ER + IR), and horizontal adduction (HA) have been retrospectively associated with overhand athletes' arm injuries. The authors expected the incidence of upper extremity injury in high school softball and baseball players with side-to-side shoulder range of motion deficits to be greater than the incidence of upper extremity injury in players with normal shoulder range of motion. Cohort study (prognosis); Level of evidence, 2. High school softball and baseball players (N = 246) participated. Before the start of the season, passive shoulder ER, IR, and HA were assessed at 90° of abduction with the scapula stabilized. Relative risk (RR) was calculated to examine range of motion measure, by categorical criteria, and risk of upper extremity injury. Twenty-seven shoulder and elbow injuries (9 softball, 18 baseball) were observed during the season. The dominant shoulder of all injured players and baseball players displayed a significant decrease in HA (P = .05) and IR (P = .04). The dominant shoulder total rotation of injured baseball players displayed a significant decrease (mean difference = 8.0° ± 0.1°; P = .05) as compared with the dominant shoulder of uninjured baseball players. Players who displayed a decrease of ≥25° of IR in the dominant shoulder were at 4 times greater risk of upper extremity injury compared with players with a <25° decrease in IR, especially for baseball players. While we observed a 1.5 to 2 times increased risk of injury for the 10° to 20° loss in rotational range of motion for the overall sample and baseball, the risk estimates were not statistically significant (P > .05). There are large mean deficits in shoulder IR and HA between injured and noninjured players, but not in ER or total rotation. Passive shoulder IR loss ≥25° as compared bilaterally was predictive of arm injury. Shoulder range of motion deficits differed between sports and appeared more predictive of injury for baseball players.

Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms.

PubMed

Skillington, S Andrew; Brophy, Robert H; Wright, Rick W; Smith, Matthew V

2017-05-01

The windmill pitching motion has been associated with risk for shoulder injury. Because there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated. Over the course of 2- and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days. Cross-sectional study; Level of evidence, 3. Fourteen female fast-pitch softball pitchers between the ages of 14 and 18 years were evaluated for strength and fatigue changes across 2- and 3-day tournaments. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a handheld dynamometer. Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS scores for shoulder fatigue (median, 2.0; 95% CI, 1.3-3.0) and pain (median, 1.3; 95% CI, 0.5-2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (median, 3.5; 95% CI, 1.5-5.5), VAS shoulder pain (median, 2.5; 95% CI, 1.0-4.5), and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated. Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2- and 3-day tournaments without full recovery between consecutive days of pitching.

An Evaluation of Red Shoulders as a Bicycle and Pedestrian Facility

PubMed Central

Hunter, William W.

1999-01-01

Use of color has been popular in European bicycle facilities. As an innovative treatment, the community of Tavares, FL decided to add one mile of shoulders to a scenic roadway and paint the shoulders red to emphasize their use as a bicycle facility. The red shoulders were evaluated by examining: (1) motor vehicle speed data collected before and after the addition of the red shoulders, (2) the amount of use of the shoulder by bicyclists, (3) the lateral positioning of bicyclists being passed by motor vehicles, (4) the amount and severity of vehicular encroachment into the opposing lane of travel, and (5) conflicts between bicycles and motor vehicles.

Shoulder dystocia.

PubMed

Grobman, William

2013-03-01

The frequency of shoulder dystocia in different reports has varied, ranging 0.2-3% of all vaginal deliveries. Once a shoulder dystocia occurs, even if all actions are appropriately taken, there is an increased frequency of complications, including third- or fourth-degree perineal lacerations, postpartum hemorrhage, and neonatal brachial plexus palsies. Health care providers have a poor ability to predict shoulder dystocia for most patients and there remains no commonly accepted model to accurately predict this obstetric emergency. Consequently, optimal management of shoulder dystocia requires appropriate management at the time it occurs. Multiple investigators have attempted to enhance care of shoulder dystocia by utilizing protocols and simulation training. Copyright © 2013 Elsevier Inc. All rights reserved.

Shoulder Dystocia: Quality, Safety, and Risk Management Considerations.

PubMed

Moni, Saila; Lee, Colleen; Goffman, Dena

2016-12-01

Shoulder dystocia is a term that evokes terror and fear among many physicians, midwives, and health care providers as they recollect at least 1 episode of shoulder dystocia in their careers. Shoulder dystocia can result in significant maternal and neonatal complications. Because shoulder dystocia is an urgent, unanticipated, and uncommon event with potentially catastrophic consequences, all practitioners and health care teams must be well-trained to manage this obstetric emergency. Preparation for shoulder dystocia in a systematic way, through standardization of process, practicing team-training and communication, along with technical skills, through simulation education and ongoing quality improvement initiatives will result in improved outcomes.

The Primer for Sports Medicine Professionals on Imaging

PubMed Central

Farshad-Amacker, Nadja A.; Jain Palrecha, Sapna; Farshad, Mazda

2013-01-01

Because of its inherent superior soft tissue contrast and lack of ionizing radiation, magnetic resonance imaging (MRI) is highly suited to study the complex anatomy of the shoulder joint, particularly when assessing the relatively high incidence of shoulder injuries in young, athletic patients. This review aims to serve as a primer for understanding shoulder MRI in an algorithmical approach, including MRI protocol and technique, normal anatomy and anatomical variations of the shoulder, pathologic conditions of the rotator cuff tendons and muscles, the long head of the biceps tendon, shoulder impingement, labral and glenohumeral ligament pathology, MR findings in shoulder instability, adhesive capsulitis, and osteoarthritis. PMID:24381700

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.

Physical exam of the adolescent shoulder: tips for evaluating and diagnosing common shoulder disorders in the adolescent athlete.

PubMed

Lazaro, Lionel E; Cordasco, Frank A

2017-02-01

In the young athlete, the shoulder is one of the most frequently injured joints during sports activities. The injuries are either from an acute traumatic event or overuse. Shoulder examination can present some challenges; given the multiple joints involved, the difficulty palpating the underlying structures, and the potential to have both intra- and/or extra-articular problems. Many of the shoulder examination tests can be positive in multiple problems. They usually have high sensitivity but low specificity and therefore low predictive value. The medical history coupled with a detailed physical exam can usually provide the information necessary to obtain an accurate diagnosis. A proficient shoulder examination and the development of an adequate differential diagnosis are important before considering advanced imaging. The shoulder complex relies upon the integrity of multiple structures for normal function. A detailed history is of paramount importance when evaluating young athletes with shoulder problems. A systematic physical examination is extremely important to guiding an accurate diagnosis. The patient's age and activity level are very important when considering the differential diagnosis. Findings obtain through history and physical examination should dictate the decision to obtain advanced imaging of the shoulder.

Anatomical shoulder arthroplasty in epileptic patients with instability arthropathy and persistent seizures.

PubMed

Thangarajah, Tanujan; Falworth, Mark; Lambert, Simon M

2017-01-01

Epileptic seizures can cause shoulder dislocation, recurrent instability and eventually arthritis. The purpose of this study was to report the results, complications and rate of revision surgery following anatomical shoulder arthroplasty in epileptic patients with instability arthropathy. A consecutive series of eight patients with epilepsy underwent anatomical shoulder arthroplasty for recurrent shoulder instability and were retrospectively reviewed after a mean of 4.7 years (range, 2-7.5 years). These included three total shoulder replacements and five humeral resurfacing hemiarthroplasty procedures. Mean age of the cohort was 33 years (range, 17-44). All patients experienced post-operative grand mal seizures. Two patients with hemiarthroplasty required further surgery due to painful glenoid erosion. No residual cases of instability were noted. Mean active forward elevation and external rotation improved following surgery. The Oxford Shoulder Score improved from 15 pre-operatively (range, 7-22) to 26 post-operatively (range, 12-45) ( p = 0.031). This was accompanied by an increase in the mean Subjective Shoulder Value, which improved from 29 (range, 10-80) pre-operatively to 53 (range, 15-90) post-operatively ( p=0.042). Anatomical shoulder arthroplasty may offer a solution for the treatment of instability arthropathy in patients with epilepsy and persistent seizures.

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 biomechanical advantages attributed to the reverse shoulder design and show an increase in activity from the deltoid, teres minor, and coracobrachialis muscles. The glenohumeral joint reaction forces estimated for the reverse shoulder are up to 15% lower than those in the normal shoulder anatomy. The data presented here complements previous publications, which, all together, allow researchers to build a biomechanical model of the upper limb including a reverse shoulder prosthesis.

Definition of anatomical zero positions for assessing shoulder pose with 3D motion capture during bilateral abduction of the arms.

PubMed

Rettig, Oliver; Krautwurst, Britta; Maier, Michael W; Wolf, Sebastian I

2015-12-09

Surgical interventions at the shoulder may alter function of the shoulder complex. Clinically, the outcome can be assessed by universal goniometry. Marker-based motion capture may not resemble these results due to differing angle definitions. The clinical inspection of bilateral arm abduction for assessing shoulder dysfunction is performed with a marker based 3D optical measurement method. An anatomical zero position of shoulder pose is proposed to determine absolute angles according to the Neutral-0-Method as used in orthopedic context. Static shoulder positions are documented simultaneously by 3D marker tracking and universal goniometry in 8 young and healthy volunteers. Repetitive bilateral arm abduction movements of at least 150° range of motion are monitored. Similarly a subject with gleno-humeral osteoarthritis is monitored for demonstrating the feasibility of the method and to illustrate possible shoulder dysfunction effects. With mean differences of less than 2°, the proposed anatomical zero position results in good agreement between shoulder elevation/depression angles determined by 3D marker tracking and by universal goniometry in static positions. Lesser agreement is found for shoulder pro-/retraction with systematic deviations of up to 6°. In the bilateral arm abduction movements the volunteers perform a common and specific pattern in clavicula-thoracic and gleno-humeral motion with maximum shoulder angles of 32° elevation, 5° depression and 45° protraction, respectively, whereas retraction is hardly reached. Further, they all show relevant out of (frontal) plane motion with anteversion angles of 30° in overhead position (maximum abduction). With increasing arm anteversion the shoulder is increasingly retroverted, with a maximum of 20° retroversion. The subject with gleno-humeral osteoarthritis shows overall less shoulder abduction range of motion but with increased out-of-plane movement during abduction. The proposed anatomical zero definition for shoulder pose fills the missing link for determining absolute joint angles for shoulder elevation/depression and pro-/retraction. For elevation-/depression the accuracy suits clinical expectations very well with mean differences less than 2° and limits of agreement of 8.6° whereas for pro-/retraction the accuracy in individual cases may be inferior with limits of agreement of up to 24.6°. This has critically to be kept in mind when applying this concept to shoulder intervention studies.

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.

78 FR 36307 - Proposed Information Collection (Shoulder and Arm Conditions Disability Benefits Questionnaire...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-17

... (Shoulder and Arm Conditions Disability Benefits Questionnaire) Activity: Comment Request AGENCY: Veterans... ``OMB Control No. 2900--NEW (Shoulder and Arm Conditions Disability Benefits Questionnaire)'' in any...: Shoulder and Arm Conditions Disability Benefits Questionnaire, VA Form 21-0960M-12. OMB Control Number...

Integrating a hip belt with body armour reduces the magnitude and changes the location of shoulder pressure and perceived discomfort in soldiers.

PubMed

Lenton, Gavin K; Doyle, Tim L A; Saxby, David J; Billing, Dan; Higgs, Jeremy; Lloyd, David G

2018-04-01

Soldiers carry heavy loads that may cause general discomfort, shoulder pain and injury. This study assessed if new body armour designs that incorporated a hip belt reduced shoulder pressures and improved comfort. Twenty-one Australian soldiers completed treadmill walking trials wearing six different body armours with two different loads (15 and 30 kg). Contact pressures applied to the shoulders were measured using pressure pads, and qualitative assessment of comfort and usability were acquired from questionnaires administered after walking trials. Walking with hip belt compared to no hip belt armour resulted in decreased mean and maximum shoulder pressures (p < 0.005), and 30% fewer participants experiencing shoulder discomfort (p < 0.005) in best designs, although hip discomfort did increase. Laterally concentrated shoulder pressures were associated with 1.34-times greater likelihood of discomfort (p = 0.026). Results indicate body armour and backpack designs should integrate a hip belt and distribute load closer to shoulder midline to reduce load carriage discomfort and, potentially, injury risk. Practitioner Summary: Soldiers carry heavy loads that increase their risk of discomfort and injury. New body armour designs are thought to ease this burden by transferring the load to the hips. This study demonstrated that designs incorporating a hip belt reduced shoulder pressure and shoulder discomfort compared to the current armour design.

Can shoulder dystocia be reliably predicted?

PubMed

Dodd, Jodie M; Catcheside, Britt; Scheil, Wendy

2012-06-01

To evaluate factors reported to increase the risk of shoulder dystocia, and to evaluate their predictive value at a population level. The South Australian Pregnancy Outcome Unit's population database from 2005 to 2010 was accessed to determine the occurrence of shoulder dystocia in addition to reported risk factors, including age, parity, self-reported ethnicity, presence of diabetes and infant birth weight. Odds ratios (and 95% confidence interval) of shoulder dystocia was calculated for each risk factor, which were then incorporated into a logistic regression model. Test characteristics for each variable in predicting shoulder dystocia were calculated. As a proportion of all births, the reported rate of shoulder dystocia increased significantly from 0.95% in 2005 to 1.38% in 2010 (P = 0.0002). Using a logistic regression model, induction of labour and infant birth weight greater than both 4000 and 4500 g were identified as significant independent predictors of shoulder dystocia. The value of risk factors alone and when incorporated into the logistic regression model was poorly predictive of the occurrence of shoulder dystocia. While there are a number of factors associated with an increased risk of shoulder dystocia, none are of sufficient sensitivity or positive predictive value to allow their use clinically to reliably and accurately identify the occurrence of shoulder dystocia. © 2012 The Authors ANZJOG © 2012 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Septic shoulder presenting as a shoulder dislocation in the pediatric patient: a case report.

PubMed

Maguire, Kathleen J; Otsuka, Norman Y

2017-05-01

Shoulder dislocation is relatively uncommon in the younger pediatric population. Because of the relative strength of the surrounding soft tissue structures of the shoulder compared with the proximal humeral physis, subluxation or dislocation resulting from a traumatic event or application of force is rare and instead a proximal humeral physeal injury occurs. Case presentation - We present a 5-year-old male who presented to the office with post-traumatic left shoulder pain for about 1 week. Radiographs of the left shoulder indicated inferior subluxation of the humeral head. He was ultimately diagnosed and treated for a septic shoulder. Septic arthritis of the glenohumeral joint accounts for about 3% of all septic arthritis cases. About half of the pediatric patients with a septic arthritis will present with a concomitant osteomyelitis about the joint involved. Widening of the glenohumeral joint and subluxation clinically as well as radiographically have been described in cases of large joint effusions because of an increase in intra-articular fluid in adults. This inferior subluxation is often noted without a frank dislocation. The case described in this report is unique in that this is the first to describe a pediatric septic shoulder presenting as a shoulder subluxation. Given the rarity of pediatric shoulder dislocations and subluxations, the pediatric orthopaedist and pediatrician should maintain a suspicion for a septic joint. Level V.

Presentation of frozen shoulder among diabetic and non-diabetic patients☆

PubMed Central

Uddin, Mohammad Moin; Khan, Aminuddin A.; Haig, Andrew J.; Uddin, Mohammad Kafil

2014-01-01

Objective The literature is inconsistent regarding the level of pain and disability in frozen shoulder patients with or without diabetes mellitus. The aim of this study is to evaluate some demographic features of frozen shoulder patients and to look into the disparity of information by comparing the level of pain and disability due to frozen shoulder between diabetic and non-diabetic people. Design This is a prospective comparative study. People with frozen shoulder attending an outpatient department were selected by consecutive sampling. Disability levels were assessed by the Shoulder Pain & Disability Index (SPADI). Means of pain and disability scores were compared using unpaired t-test. Results Among 140 persons with shoulder pain 99 (71.4%) had frozen shoulder. From the participating 40 frozen shoulder patients, 26 (65%) were males and 14 (35%) were females. Seventeen participants (42.5%) were diabetic, two (5%) had impaired glucose tolerance and 21 (52.5%) patients were non-diabetic. Mean disability scores (SPADI) were 51 ± 15.5 in diabetic and 57 ± 16 in non-diabetic persons. The differences in pain and disability level were not statistically significance (respectively, p = 0.24 and p = 0.13 at 95% confidence interval). Conclusions No difference was found in level of pain and disability level between frozen shoulder patients with and without diabetes. PMID:25983497

Engineering of a multi-station shoulder simulator.

PubMed

Smith, Simon L; Li, Lisa; Joyce, Thomas J

2016-05-01

This work aimed to engineer a multi-station shoulder simulator in order to wear test shoulder prostheses using recognized shoulder activities of daily living. A bespoke simulator was designed, built and subject to commissioning trials before a first wear test was conducted. Five JRI Orthopaedics Reverse Shoulder VAIOS 42 mm prostheses were tested for 2.0 million cycles and a mean wear rate and standard deviation of 14.2 ± 2.1 mm(3)/10(6) cycles measured for the polymeric glenoid components. This result when adjusted for prostheses diameters and test conditions showed excellent agreement with results from hip simulator studies of similar materials in a lubricant of bovine serum. The Newcastle Shoulder Simulator is the first multi-station shoulder simulator capable of applying physiological motion and loading for typical activities of daily living. © IMechE 2016.

Shoulder Arthroplasty for Sequelae of Obstetrical Brachial Plexus Injury.

PubMed

Werthel, Jean-David; Schoch, Bradley; Frankle, Mark; Cofield, Robert; Elhassan, Bassem T

2018-03-29

Shoulder arthroplasty following obstetrical brachial plexus injury (OBPI) is technically challenging because glenoid morphology, muscle balance, and humeral version are substantially altered compared with the neurologically intact shoulder. The purpose of this study is to report the outcome of shoulder arthroplasty in a group of patients with end-stage arthritis secondary to OBPI. Seven patients with OBPI and secondary glenohumeral arthritis were treated with shoulder arthroplasty between 1976 and 2014. Two underwent hemiarthroplasty (HA), 2 underwent total shoulder arthroplasty (TSA), and 3 underwent reverse shoulder arthroplasty (RSA). One HA was lost to follow-up and was excluded. The remaining 6 patients (mean age, 62.5 years old at the time of surgery) were followed for a minimum of 2 years (mean, 7.5 years; range, 2-13 years) Outcome measures included pain, range of motion, and postoperative modified Neer ratings. Pain improved in all shoulders. Mean forward flexion was unchanged. No shoulders treated with HA/TSA regained forward elevation above 90°, compared with 1 out of the 3 RSAs. External rotation improved from a mean of -10° to 20°. Active internal rotation decreased from L1 to L5. Immediate postoperative radiographs showed either severe posterior or posterosuperior subluxation in all 3 patients treated with nonconstrained implants. Shoulder arthroplasty is an acceptable option to relieve pain in patients with symptomatic shoulder arthritis as a sequel of OBPI. However, range of motion improvements are not expected. Therapeutic V. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Evaluation of a Shoulder Injury Prevention Program in Wheelchair Basketball.

PubMed

Wilroy, Jereme; Hibberd, Elizabeth

2017-11-15

Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics. To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury. Pre and post-test. Home-based and controlled laboratory. Seven collegiate wheelchair athletes. Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a post-intervention screening was performed. Internal/external rotation ROM, retraction strength, and internal/external rotation strength. Participants experienced a significant improvement in dominant limb shoulder internal rotation ROM (t6=3.56,p=0.012) with an average increase of 11.4° of IR ROM, and a significant improvement in dominant limb shoulder external rotation (ER) ROM (t6=2.79,p=0.032) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (p>0.05). Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair athletics.

Shoulder injury in water polo: A systematic review of incidence and intrinsic risk factors.

PubMed

Miller, Andrea H; Evans, Kerrie; Adams, Roger; Waddington, Gordon; Witchalls, Jeremy

2018-04-01

Water polo is a popular water-based contact sport that involves swimming, throwing and defending. Cumulatively, these repetitive overhead activities are thought to increase the risk of shoulder injury and, subsequently to affect players' physical conditioning as well as team performance. The purpose of this review was to examine available evidence relating to shoulder injury rates and risk factors for shoulder injury in water polo. Systematic review METHODS: CINAHL, AUSPORT, Pubmed, Pedro and SPORTDiscus databases were searched for original research papers using the predefined terms ("water polo") AND (shoulder OR glenohumeral* OR arm OR "upper limb"). Twenty papers were identified as suitable for inclusion. Reported shoulder injury rates varied from 24% - 51%. Shoulder injuries were more likely to become chronic compared to all other reported injuries. Injury data during the last three World Championships indicates an increasing rate of shoulder injuries-per-year with participation in aquatic sports. Risk for shoulder injury in water polo is multi-factorial. Volume of shooting, range of motion, scapular dyskinesis, strength imbalance, proprioceptive deficit and altered throwing kinematics have been proposed to be associated with an increased risk of injury. Although this review showed water polo to have a high propensity for shoulder injury, the descriptive nature of the included papers limited the inferences that could be drawn from the pooled literature. Future directions for research include collecting normative data for shoulder range of motion, strength ratio and proprioception with prospective analysis of these attributes in relation to injury rates and time lost. Copyright © 2017 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain

PubMed Central

Ruivo, Rodrigo M.; Pezarat-Correia, Pedro; Carita, Ana I.

2014-01-01

Background: There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. Objectives: To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. Method: This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Results: Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. Conclusions: This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture. PMID:25054381

Cervical and shoulder postural assessment of adolescents between 15 and 17 years old and association with upper quadrant pain.

PubMed

Ruivo, Rodrigo M; Pezarat-Correia, Pedro; Carita, Ana I

2014-01-01

There is sparse literature that provides evidence of cervical and shoulder postural alignment of 15 to 17-year-old adolescents and that analyzes sex differences. To characterize the postural alignment of the head and shoulder in the sagittal plane of 15 to 17-year-old Portuguese adolescents in natural erect standing and explore the relationships between three postural angles and presence of neck and shoulder pain. This cross-sectional study was conducted in two secondary schools in Portugal. 275 adolescent students (153 females and 122 males) aged 15 to 17 were evaluated. Sagittal head, cervical, and shoulder angles were measured with photogrammetry and PAS software. The American Shoulder and Elbow Surgeons Shoulder Assessment (ASES) was used to assess shoulder pain, whereas neck pain was self-reported with a single question. Mean values of sagittal head, cervical, and shoulder angles were 17.2±5.7, 47.4±5.2, and 51.4±8.5º, respectively. 68% of the participants revealed protraction of the head, whereas 58% of them had protraction of the shoulder. The boys showed a significantly higher mean cervical angle, and adolescents with neck pain revealed lower mean cervical angle than adolescents without neck pain. 53% of the girls self-reported regular neck pain, contrasting with 19% of the boys. This data shows that forward head and protracted shoulder are common postural disorders in adolescents, especially in girls. Neck pain is prevalent in adolescents, especially girls, and it is associated with forward head posture.

Do patients with structural abnormalities of the shoulder experience pain after MR arthrography of the shoulder?

PubMed

Steurer-Dober, Isabelle; Rufibach, Kaspar; Hodler, Juerg; Saupe, Nadja; Zanetti, Marco; Fucentese, Sandro F; Pfirrmann, Christian W A

2010-09-01

To assess the pain course after intraarticular injection of a gadolinium-containing contrast material admixed with anesthetic for magnetic resonance (MR) arthrography of the shoulder in relation to internal derangements of the shoulder. Institutional review board approval and informed consent were obtained for this study. The study sample consisted of 655 consecutive patients (249 female, 406 male; median age, 54 years) referred for MR arthrography of the shoulder. Pain level was measured at baseline, directly after intraarticular injection of the gadolinium-containing contrast material admixed with anesthetic, 4 hours after injection, 1 day (18-30 hours) after injection, and 1 week (6-8 days) after injection with a visual analog scale (range, 0-10). MR arthrography was used to assess the following internal derangements: lesions of the rotator cuff tendons and long biceps tendon, adhesive capsulitis (frozen shoulder), fluid in the subacromial bursa, labral tears, and osteoarthritis of the glenohumeral joint. History of shoulder surgery was recorded. Linear regression models were calculated for the dependent variable (difference between follow-up pain and baseline pain), with the independent variable grouping adjusted for age and sex. There was no significant association between pain level over time and internal derangements of the shoulder, nor was there significant association between pain level over time in patients with a history of shoulder surgery and patients without a history of shoulder surgery. Neither internal derangements nor prior surgery have an apparent effect on the pain course after MR arthrography of the shoulder. (c) RSNA, 2010.

Is subscapularis recruited in a similar manner during shoulder internal rotation exercises and belly press and lift off tests?

PubMed

Ginn, Karen A; Reed, Darren; Jones, Chelsea; Downes, Anthony; Cathers, Ian; Halaki, Mark

2017-06-01

Although the belly press and lift off tests are recommended to assess subscapularis function, shoulder internal rotation (IR) exercises performed in other shoulder positions are more commonly used to restore subscapularis function. It is not known if shoulder IR exercises specifically activate subscapularis to the same degree as the lift off and belly press tests, and thus have the potential to effect subscapularis strength gains. Therefore, the aim was to compare subscapularis activation levels with those of other shoulder internal rotator muscles during the belly press and lift off tests and shoulder IR exercise positions. Original research. Twenty asymptomatic volunteers performed maximal isometric contractions during the belly press and lift off tests and shoulder IR performed at 90° and 0° abduction in an upright position and supported at 90° abduction in supine. Muscle activation levels were recorded using a combination of indwelling and surface electrodes. Data were normalized to maximum voluntary contractions and averaged. Moderate average subscapularis activation levels were recorded during all shoulder IR tasks examined with no significant difference between tasks (p=0.18). The belly press test was the only IR task in which subscapularis activation levels were significantly higher than all other shoulder internal rotator muscles (p<0.05). Shoulder IR exercises activate subscapularis to similar moderate levels as the belly press and lift off tests and therefore, have similar potential to strengthen subscapularis. However, the belly press test, with significantly higher subscapularis activation than other shoulder internal rotators, more specifically targets subscapularis. Copyright © 2016. Published by Elsevier Ltd.

Thickening of the inferior glenohumeral capsule: an ultrasound sign for shoulder capsular contracture.

PubMed

Michelin, Paul; Delarue, Yohann; Duparc, Fabrice; Dacher, Jean Nicolas

2013-10-01

The aim of this retrospective study was to measure the inferior glenohumeral capsule thickness of shoulders clinically affected by capsular contracture by comparison to the contralateral asymptomatic side. Bilateral shoulder ultrasound (US) examinations of 20 patients with clinically or MRI proven unilateral capsular contracture were retrospectively assessed. Inferior capsule evaluation was performed with a transducer placed within the axilla in maximally abducted shoulders. Measurements were symmetrically performed orthogonally to the inferior glenohumeral ligament (IGHL) in the axial plane; the coronal plane was used to ensure the tension of the IGHL. The significance of any difference in thickening was assessed with the Mann-Whitney test. The average thickness was 4.0 mm in shoulders with capsular contracture vs. 1.3 mm in asymptomatic contralateral shoulders (P < 0.0001). Twenty per cent of patients with capsular contracture and inferior capsule thickness increase showed US features of other painful diseases of the rotator cuff. The thickness of the inferior capsule is measurable through ultrasound examination and appears to be increased in shoulders with capsular contracture. Exploration of the inferior aspect of the shoulder joint could be added to shoulder US examination protocols for capsular contracture assessment even if other rotator cuff abnormalities are diagnosed by US. • Ultrasound is increasingly used to diagnose shoulder problems. • The thickness of the inferior glenohumeral ligament is measurable in the axilla. • The inferior glenohumeral ligament appears thickened in shoulders with capsular contracture. • Capsular contracture ultrasound features can be associated with other rotator cuff problems.

Human recognition based on head-shoulder contour extraction and BP neural network

NASA Astrophysics Data System (ADS)

Kong, Xiao-fang; Wang, Xiu-qin; Gu, Guohua; Chen, Qian; Qian, Wei-xian

2014-11-01

In practical application scenarios like video surveillance and human-computer interaction, human body movements are uncertain because the human body is a non-rigid object. Based on the fact that the head-shoulder part of human body can be less affected by the movement, and will seldom be obscured by other objects, in human detection and recognition, a head-shoulder model with its stable characteristics can be applied as a detection feature to describe the human body. In order to extract the head-shoulder contour accurately, a head-shoulder model establish method with combination of edge detection and the mean-shift algorithm in image clustering has been proposed in this paper. First, an adaptive method of mixture Gaussian background update has been used to extract targets from the video sequence. Second, edge detection has been used to extract the contour of moving objects, and the mean-shift algorithm has been combined to cluster parts of target's contour. Third, the head-shoulder model can be established, according to the width and height ratio of human head-shoulder combined with the projection histogram of the binary image, and the eigenvectors of the head-shoulder contour can be acquired. Finally, the relationship between head-shoulder contour eigenvectors and the moving objects will be formed by the training of back-propagation (BP) neural network classifier, and the human head-shoulder model can be clustered for human detection and recognition. Experiments have shown that the method combined with edge detection and mean-shift algorithm proposed in this paper can extract the complete head-shoulder contour, with low calculating complexity and high efficiency.

Differential activation of parts of the latissimus dorsi with various isometric shoulder exercises.

PubMed

Park, Se-yeon; Yoo, Won-gyu

2014-04-01

As no study has examined whether the branches of the latissimus dorsi are activated differently in different exercises, we investigated intramuscular differences of components of the latissimus dorsi during various shoulder isometric exercises. Seventeen male subjects performed four isometric exercises: shoulder extension, adduction, internal rotation, and shoulder depression. Surface electromyography (sEMG) was used to collect data from the medial and lateral components of the latissimus dorsi during the isometric exercises. Two-way repeated analysis of variance with two within-subject factors (exercise condition and muscle branch) was used to determine the significance of differences between the branches, and which branch was activated more with the exercise variation. The root mean squared sEMG values for the muscles were normalized using the modified isolation equation (%Isolation) and maximum voluntary isometric contraction (%MVIC). Neither the %MVIC nor %Isolation data differed significantly between muscle branches, while there was a significant difference with exercise. %MVIC was significantly higher with shoulder extension, compared to the other isometric exercises. There was a significant correlation between exercise condition and muscle branch in the %Isolation data. Shoulder extension and adduction and internal rotation increased %Isolation of the medial latissimus dorsi more than shoulder depression. Shoulder depression had the highest value of %Isolation of the lateral latissimus dorsi compared to the other isometric exercises. Comparing the medial and lateral latissimus dorsi, the medial component was predominantly activated with shoulder extension, adduction, and internal rotation, and the lateral component with shoulder depression. Shoulder extension is effective for activating the latissimus dorsi regardless of the intramuscular branch. Copyright © 2014 Elsevier Ltd. All rights reserved.

The use of shoulder scoring systems and outcome measures in the UK

PubMed Central

Lamb, J; Rambani, R; Venkateswaran, B

2014-01-01

Introduction In future, outcomes following shoulder surgery may be subject to public survey. Many outcome measures exist but we do not know whether there is a consensus between shoulder surgeons in the UK. The aim of this study was to survey the preferred outcome measures used by National Health Service (NHS) shoulder surgeons operating in the UK. Methods A total of 350 shoulder surgeons working in NHS hospitals were asked to complete a short written questionnaire regarding their use of scoring systems and outcome measures. Questionnaires were sent and responses were received by post. Results Overall, 217 responses were received (62%). Of the respondents, 171 (79%) use an outcome measure in their shoulder practice while 46 (21%) do not. There were 118 surgeons (69%) who use more than one outcome measure. The Oxford shoulder score was most commonly used by 150 surgeons (69%), followed by the Constant score with 106 (49%), the Oxford shoulder instability score with 82 (38%), and the Disabilities of the Arm, Shoulder and Hand score with 54 (25%). The less commonly used outcome measures were the SF-36® and SF-12® health questionnaires with 19 (9%), the University of California at Los Angeles activity score with 8 (4%), the American Shoulder and Elbow Surgeons shoulder assessment form with 8 (4%) and the EQ-5D™ with 10 (3%). Conclusions Validated outcome measures should be adopted by all practising surgeons in all specialties. This will allow better assessment of treatments in addition to assessment of surgical performance in a transparent way. PMID:25350180

The use of shoulder scoring systems and outcome measures in the UK.

PubMed

Varghese, M; Lamb, J; Rambani, R; Venkateswaran, B

2014-11-01

In future, outcomes following shoulder surgery may be subject to public survey. Many outcome measures exist but we do not know whether there is a consensus between shoulder surgeons in the UK. The aim of this study was to survey the preferred outcome measures used by National Health Service (NHS) shoulder surgeons operating in the UK. A total of 350 shoulder surgeons working in NHS hospitals were asked to complete a short written questionnaire regarding their use of scoring systems and outcome measures. Questionnaires were sent and responses were received by post. Overall, 217 responses were received (62%). Of the respondents, 171 (79%) use an outcome measure in their shoulder practice while 46 (21%) do not. There were 118 surgeons (69%) who use more than one outcome measure. The Oxford shoulder score was most commonly used by 150 surgeons (69%), followed by the Constant score with 106 (49%), the Oxford shoulder instability score with 82 (38%), and the Disabilities of the Arm, Shoulder and Hand score with 54 (25%). The less commonly used outcome measures were the SF-36® and SF-12® health questionnaires with 19 (9%), the University of California at Los Angeles activity score with 8 (4%), the American Shoulder and Elbow Surgeons shoulder assessment form with 8 (4%) and the EQ-5D™ with 10 (3%). Conclusions Validated outcome measures should be adopted by all practising surgeons in all specialties. This will allow better assessment of treatments in addition to assessment of surgical performance in a transparent way.

Reverse shoulder arthroplasty for deltoid-deficient shoulder following latissimus dorsi flap transfer. Case report.

PubMed

Dosari, Mohamed Al Ateeq Al; Hameed, Shamsi; Mukhtar, Khalid; Elmhiregh, Aissam

2017-01-01

The usual indication for reverse shoulder arthroplasty is glenohumeral arthritis with inadequate rotator cuff and intact deltoid muscle. We report here a case of reverse shoulder arthroplasty using a lattisimus dorsi flap in a patient with deltoid-deficient shoulder following a gunshot injury. The patient was an otherwise healthy 51-year-old male with a history of gunshot injury of the left shoulder 2006. Upon presentation in 2011, the patient had a loss of most of his shoulder bony and muscular structures. Due to deltoid muscle deficiency, the patient underwent Lattisimus Dorsi muscle flap followed by reverse shoulder arthroplasty in order to establish an upper limb function. Upon discharge, 11days after the surgery, the patient was able to achieve 150° flexion and 90° abduction while in the supine position and 45° in each direction, while sitting. He was able to perform internal rotation (behind back) up to the level of the L1 vertebra, assisted active abduction of 90°, and external rotation of 20°. Power tests showed power of grade 4/5 for both shoulder flexion and extension and grade 2+/5 for both abduction and adduction. At the last follow up one year after the operation, The patient still had passive pain-free full range of motion, but no progress in active range of motion beyond that upon discharge. Reverse shoulder arthroplasty after Latissmus dori flap in patient with deltoid deficient shoulders can be a successful and reproducible approach to treat such conditions. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

21 CFR 888.3660 - Shoulder joint metal/polymer semi-constrained 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 metal/polymer semi-constrained... Shoulder joint metal/polymer semi-constrained cemented prosthesis. (a) Identification. A shoulder joint metal/polymer semi-constrained cemented prosthesis is a device intended to be implanted to replace a...

21 CFR 888.3650 - Shoulder joint metal/polymer non-constrained 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 metal/polymer non-constrained... Shoulder joint metal/polymer non-constrained cemented prosthesis. (a) Identification. A shoulder joint metal/polymer non-constrained cemented prosthesis is a device intended to be implanted to replace a...

14 CFR 125.211 - Seat and safety belts.

Code of Federal Regulations, 2014 CFR

2014-01-01

... emergency exit. (f) Each occupant of a seat equipped with a shoulder harness must fasten the shoulder harness during takeoff and landing, except that, in the case of crewmembers, the shoulder harness need not be fastened if the crewmember cannot perform his required duties with the shoulder harness fastened...

9 CFR 319.106 - “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country Style Pork...

Code of Federal Regulations, 2014 CFR

2014-01-01

...Dry Cured Ham,â âCountry Pork Shoulder,â âCountry Style Pork Shoulder,â and âDry Cured Pork Shoulder.â 319.106 Section 319.106 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... Smoked § 319.106 “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country...

9 CFR 319.106 - “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country Style Pork...

Code of Federal Regulations, 2011 CFR

2011-01-01

...Dry Cured Ham,â âCountry Pork Shoulder,â âCountry Style Pork Shoulder,â and âDry Cured Pork Shoulder.â 319.106 Section 319.106 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... Smoked § 319.106 “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country...

9 CFR 319.106 - “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country Style Pork...

Code of Federal Regulations, 2012 CFR

2012-01-01

...Dry Cured Ham,â âCountry Pork Shoulder,â âCountry Style Pork Shoulder,â and âDry Cured Pork Shoulder.â 319.106 Section 319.106 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... Smoked § 319.106 “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country...

9 CFR 319.106 - “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country Style Pork...

Code of Federal Regulations, 2013 CFR

2013-01-01

...Dry Cured Ham,â âCountry Pork Shoulder,â âCountry Style Pork Shoulder,â and âDry Cured Pork Shoulder.â 319.106 Section 319.106 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... Smoked § 319.106 “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country...

9 CFR 319.106 - “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country Style Pork...

Code of Federal Regulations, 2010 CFR

2010-01-01

...Dry Cured Ham,â âCountry Pork Shoulder,â âCountry Style Pork Shoulder,â and âDry Cured Pork Shoulder.â 319.106 Section 319.106 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... Smoked § 319.106 “Country Ham,” “Country Style Ham,” “Dry Cured Ham,” “Country Pork Shoulder,” “Country...

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. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Environmental Assessment Supplement for C-17Southwest Landing Zone Articulated Concrete Block Shoulders Travis Air Force Base, Fairfield, California

DTIC Science & Technology

2012-03-01

shoulders in place of soil shoulders adjacent to the runway shoulder. The EA Supplement evaluates the potential impacts that could result from...potential impacts that could result from constructing and operating ACB in place of soil shoulders. Resources with the potential to be affected by...excavated and graded prior to installing ACB mats. Soil from grading activities will be used to fill the voids in the ACB, with any remaining soil being

Mounting for ceramic scroll

DOEpatents

Petty, Jack D.

1993-01-01

A mounting for a ceramic scroll on a metal engine block of a gas turbine engine includes a first ceramic ring and a pair of cross key connections between the first ceramic ring, the ceramic scroll, and the engine block. The cross key connections support the scroll on the engine block independent of relative radial thermal growth and for bodily movement toward an annular mounting shoulder on the engine. The scroll has an uninterrupted annular shoulder facing the mounting shoulder on the engine block. A second ceramic ring is captured between mounting shoulder and the uninterrupted shoulder on the scroll when the latter is bodily shifted toward the mouting shoulder to define a gas seal between the scroll and the engine block.

Restoration of Full Shoulder Range of Motion After Application of the Fascial Distortion Model.

PubMed

Boucher, Joshua D; Figueroa, Jose

2018-05-01

Decreased active and passive range of motion (ROM) accompanied by pain in the shoulder is a common presentation for patients with frozen shoulder, and it can be difficult to restore normal function. Through the fascial distortion model, physicians can apply a manual technique to rapidly and effectively increase ROM and decrease pain. A 28-year-old man presented 18 months after sustaining a shoulder hyperextension injury. On active and passive ROM examination, he had approximately 90° of shoulder abduction and moderately reduced internal rotation associated with 8/10 pain. After 2 applications of the fascial distortion model, his shoulder restored to full abduction and internal rotation with no pain.

Association of head circumference and shoulder dystocia in macrosomic neonates.

PubMed

Larson, Austin; Mandelbaum, David E

2013-04-01

To determine whether asymmetric macrosomia (disproportionately large body size in comparison to head circumference) could be demonstrated in a population of infants suffering shoulder dystocia during delivery relative to those that did not suffer from shoulder dystocia. A case-control study was conducted as a retrospective chart review over 3 years at a large maternity hospital in an urban setting. Among infants over 4,000 g, those that suffered from shoulder dystocia during delivery had a smaller mean head circumference than infants of a similar size that did not suffer from shoulder dystocia. A statistically significant difference was also present when cases of documented gestational diabetes were excluded. Asymmetric macrosomia is more likely to be present in a population of infants who suffered shoulder dystocia during delivery. This knowledge could be used in designing tools to predict which pregnancies are at highest risk for shoulder dystocia during delivery.

Complications of shoulder dystocia.

PubMed

Dajani, Nafisa K; Magann, Everett F

2014-06-01

Complications of shoulder dystocia are divided into fetal and maternal. Fetal brachial plexus injury (BPI) is the most common fetal complication occurring in 4-40% of cases. BPI has also been reported in abdominal deliveries and in deliveries not complicated by shoulder dystocia. Fractures of the fetal humerus and clavicle occur in about 10.6% of cases of shoulder dystocia and usually heal with no sequel. Hypoxic ischemic brain injury is reported in 0.5-23% of cases of shoulder dystocia. The risk correlates with the duration of head-to-body delivery and is especially increased when the duration is >5 min. Fetal death is rare and is reported in 0.4% of cases. Maternal complications of shoulder dystocia include post-partum hemorrhage, vaginal lacerations, anal tears, and uterine rupture. The psychological stress impact of shoulder dystocia is under-recognized and deserves counseling prior to home discharge. Copyright © 2014 Elsevier Inc. All rights reserved.

Prevalence of occupation-related pain among baristas and an examination of low back and shoulder demand during the preparation of espresso-based beverages.

PubMed

Dainty, R Scott; Alcorn, Eric; Ferguson, Chantelle A; Gregory, Diane E

2014-01-01

Many baristas complain of low back pain (LBP) and upper extremity discomfort while at work. This study documented the prevalence of LBP and shoulder pain, via questionnaire, among a population of baristas to determine whether cumulative low back loads and shoulder moments are associated with pain reporting. Fifty-nine baristas completed the questionnaire; ten were also video-recorded for biomechanical analysis while making espresso beverages and cumulative and peak low back loads and shoulder moments were calculated. Seventy-three percent of those who completed the questionnaire reported having experienced LBP, and half attributed this pain to their job as a barista. Furthermore, 68% reported having experienced shoulder pain and half also attributed this pain to their job. Those who suffered from LBP had higher peak low back compression and those with shoulder pain had, in general, higher moments about their dominant shoulder.

Musculoskeletal dysfunctions associated with swimmers' shoulder.

PubMed

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

2017-05-01

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. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Functional assessment using Constant's Shoulder Scale after modified radical and selective neck dissection.

PubMed

Chepeha, Douglas B; Taylor, Rodney J; Chepeha, Judith C; Teknos, Theodoros N; Bradford, Carol R; Sharma, Pramod K; Terrell, Jeffrey E; Wolf, Gregory T

2002-05-01

Constant's Shoulder Scale is a validated and widely applied instrument for assessment of shoulder function. We used this instrument to assess which treatment and demographic variables contribute to shoulder dysfunction after neck dissection in head and neck cancer patients. A convenience sample of 54 patients with 64 neck dissections and minimum follow-up of 11 months were evaluated. Thirty-two accessory nerve-sparing modified radical (MRND) and 32 selective neck (SND) dissections were performed. Multivariable regression analysis was used to determine the variables that were predictive for shoulder dysfunction. Clinical variables included age, time from surgery, handedness, weight, radiation therapy, neck dissection type, tumor stage, and site. Patients receiving MRND had significantly worse shoulder function than patients with SND (p =.0007). Radiation therapy contributed negatively, whereas weight contributed positively (p =.0001). The critical factors contributing to shoulder dysfunction after neck dissection were weight, radiation therapy, and neck dissection type. Copyright 2002 Wiley Periodicals, Inc.

Traumatic anterior shoulder dislocation: a case study of nonoperative management in a mixed martial arts athlete.

PubMed

Sims, Kevin; Spina, Andreo

2009-12-01

To present an evidence-informed approach to the nonoperative management of a first-time, traumatic anterior shoulder dislocation. A 30-year-old mixed martial arts athlete, with no prior shoulder injuries, presented one day following a first-time, traumatic anterior shoulder dislocation. An eight-week, individualized, intensive, nonoperative rehabilitation program was immediately begun upon presentation. Management consisted of immobilization of the shoulder in external rotation and a progressive rehabilitation program aimed at restoring range of motion, strength of the dynamic stabilizers, and proprioception of the shoulder. Eight weeks post-dislocation the patient had regained full range of motion and strength compared to the unaffected limb and apprehension and relocation tests for instability were negative. This case illustrates successful management of a first-time, traumatic, anterior shoulder dislocation using immobilization in external rotation combined with an intensive rehabilitation program.

Traumatic anterior shoulder dislocation: a case study of nonoperative management in a mixed martial arts athlete

PubMed Central

Sims, Kevin; Spina, Andreo

2009-01-01

Objective: To present an evidence-informed approach to the nonoperative management of a first-time, traumatic anterior shoulder dislocation. Clinical Features: A 30-year-old mixed martial arts athlete, with no prior shoulder injuries, presented one day following a first-time, traumatic anterior shoulder dislocation. An eight-week, individualized, intensive, nonoperative rehabilitation program was immediately begun upon presentation. Intervention and Outcome: Management consisted of immobilization of the shoulder in external rotation and a progressive rehabilitation program aimed at restoring range of motion, strength of the dynamic stabilizers, and proprioception of the shoulder. Eight weeks post-dislocation the patient had regained full range of motion and strength compared to the unaffected limb and apprehension and relocation tests for instability were negative. Conclusion: This case illustrates successful management of a first-time, traumatic, anterior shoulder dislocation using immobilization in external rotation combined with an intensive rehabilitation program. PMID:20037691

First-time anterior shoulder dislocations: should they be arthroscopically stabilised?

PubMed Central

Sedeek, Sedeek Mohamed; Bin Abd Razak, Hamid Rahmatullah; Ee, Gerard WW; Tan, Andrew HC

2014-01-01

The glenohumeral joint is inherently unstable because the large humeral head articulates with the small shadow glenoid fossa. Traumatic anterior dislocation of the shoulder is a relatively common athletic injury, and the high frequency of recurrent instability in young athletes after shoulder dislocation is discouraging to both the patient and the treating physician. Management of primary traumatic shoulder dislocation remains controversial. Traditionally, treatment involves initial immobilisation for 4–6 weeks, followed by functional rehabilitation. However, in view of the high recurrence rates associated with this traditional approach, there has been an escalating interest in determining whether immediate surgical intervention can lower the rate of recurrent shoulder dislocation, improving the patient’s quality of life. This review article aims to provide an overview of the nature and pathogenesis of first-time primary anterior shoulder dislocations, the widely accepted management modalities, and the efficacy of primary surgical intervention in first-time primary anterior shoulder dislocations. PMID:25631890

Neurological Complications Related to Elective Orthopedic Surgery: Part 1: Common Shoulder and Elbow Procedures.

PubMed

Dwyer, Tim; Henry, Patrick D G; Cholvisudhi, Phantila; Chan, Vincent W S; Theodoropoulos, John S; Brull, Richard

2015-01-01

Many anesthesiologists are unfamiliar with the rate of surgical neurological complications of the shoulder and elbow procedures for which they provide local anesthetic-based anesthesia and/or analgesia. Part 1 of this narrative review series on neurological complications of elective orthopedic surgery describes the mechanisms and likelihood of peripheral nerve injury associated with some of the most common shoulder and elbow procedures, including open and arthroscopic shoulder procedures, elbow arthroscopy, and total shoulder and elbow replacement. Despite the many articles available, the overall number of studied patients is relatively low. Large prospective trials are required to establish the true incidence of neurological complications following elective shoulder and elbow surgery. As the popularity of regional anesthesia increases with the development of ultrasound guidance, anesthesiologists should have a thoughtful understanding of the nerves at risk of surgical injury during elective shoulder and elbow procedures.

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…

21 CFR 888.3640 - Shoulder joint metal/metal or metal/polymer constrained 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 metal/metal or metal/polymer... § 888.3640 Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis. (a) Identification. A shoulder joint metal/metal or metal/polymer constrained cemented prosthesis is a device...

21 CFR 888.3670 - Shoulder joint metal/polymer/metal nonconstrained or semi-constrained porous-coated uncemented...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint metal/polymer/metal nonconstrained... ORTHOPEDIC DEVICES Prosthetic Devices § 888.3670 Shoulder joint metal/polymer/metal nonconstrained or semi-constrained porous-coated uncemented prosthesis. (a) Identification. A shoulder joint metal/polymer/metal...

14 CFR 121.311 - Seats, safety belts, and shoulder harnesses.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Seats, safety belts, and shoulder harnesses... § 121.311 Seats, safety belts, and shoulder harnesses. (a) No person may operate an airplane unless... belt and shoulder harness that meets the applicable requirements specified in § 25.785 of this chapter...

26 CFR 48.4071-1 - Imposition and rates of tax.

Code of Federal Regulations, 2011 CFR

2011-04-01

... manufacturer. (d) Recapped or retreaded tires. The recapping or retreading of a tire, whether from shoulder-to-shoulder or bead-to-bead, does not constitute manufacture of a taxable tire. The tax on tires imposed by... carcass not previously sold in the United States that is recapped or retreaded from shoulder-to-shoulder...

14 CFR 121.311 - Seats, safety belts, and shoulder harnesses.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Seats, safety belts, and shoulder harnesses... § 121.311 Seats, safety belts, and shoulder harnesses. (a) No person may operate an airplane unless... belt and shoulder harness that meets the applicable requirements specified in § 25.785 of this chapter...

14 CFR 121.311 - Seats, safety belts, and shoulder harnesses.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Seats, safety belts, and shoulder harnesses... § 121.311 Seats, safety belts, and shoulder harnesses. (a) No person may operate an airplane unless... belt and shoulder harness that meets the applicable requirements specified in § 25.785 of this chapter...

21 CFR 888.3640 - Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shoulder joint metal/metal or metal/polymer... § 888.3640 Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis. (a) Identification. A shoulder joint metal/metal or metal/polymer constrained cemented prosthesis is a device...

26 CFR 48.4071-1 - Imposition and rates of tax.

Code of Federal Regulations, 2013 CFR

2013-04-01

... manufacturer. (d) Recapped or retreaded tires. The recapping or retreading of a tire, whether from shoulder-to-shoulder or bead-to-bead, does not constitute manufacture of a taxable tire. The tax on tires imposed by... carcass not previously sold in the United States that is recapped or retreaded from shoulder-to-shoulder...

26 CFR 48.4071-1 - Imposition and rates of tax.

Code of Federal Regulations, 2010 CFR

2010-04-01

... manufacturer. (d) Recapped or retreaded tires. The recapping or retreading of a tire, whether from shoulder-to-shoulder or bead-to-bead, does not constitute manufacture of a taxable tire. The tax on tires imposed by... carcass not previously sold in the United States that is recapped or retreaded from shoulder-to-shoulder...

14 CFR 135.171 - Shoulder harness installation at flight crewmember stations.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Shoulder harness installation at flight... ON BOARD SUCH AIRCRAFT Aircraft and Equipment § 135.171 Shoulder harness installation at flight... configuration, excluding any pilot seat, of 10 seats or more unless it is equipped with an approved shoulder...

21 CFR 888.3640 - Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shoulder joint metal/metal or metal/polymer... § 888.3640 Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis. (a) Identification. A shoulder joint metal/metal or metal/polymer constrained cemented prosthesis is a device...

26 CFR 48.4071-1 - Imposition and rates of tax.

Code of Federal Regulations, 2012 CFR

2012-04-01

... manufacturer. (d) Recapped or retreaded tires. The recapping or retreading of a tire, whether from shoulder-to-shoulder or bead-to-bead, does not constitute manufacture of a taxable tire. The tax on tires imposed by... carcass not previously sold in the United States that is recapped or retreaded from shoulder-to-shoulder...

21 CFR 888.3640 - Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shoulder joint metal/metal or metal/polymer... § 888.3640 Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis. (a) Identification. A shoulder joint metal/metal or metal/polymer constrained cemented prosthesis is a device...

14 CFR 135.171 - Shoulder harness installation at flight crewmember stations.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 3 2012-01-01 2012-01-01 false Shoulder harness installation at flight... ON BOARD SUCH AIRCRAFT Aircraft and Equipment § 135.171 Shoulder harness installation at flight... configuration, excluding any pilot seat, of 10 seats or more unless it is equipped with an approved shoulder...

14 CFR 135.171 - Shoulder harness installation at flight crewmember stations.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 3 2013-01-01 2013-01-01 false Shoulder harness installation at flight... ON BOARD SUCH AIRCRAFT Aircraft and Equipment § 135.171 Shoulder harness installation at flight... configuration, excluding any pilot seat, of 10 seats or more unless it is equipped with an approved shoulder...

21 CFR 888.3640 - Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shoulder joint metal/metal or metal/polymer... § 888.3640 Shoulder joint metal/metal or metal/polymer constrained cemented prosthesis. (a) Identification. A shoulder joint metal/metal or metal/polymer constrained cemented prosthesis is a device...

14 CFR 121.311 - Seats, safety belts, and shoulder harnesses.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 3 2014-01-01 2014-01-01 false Seats, safety belts, and shoulder harnesses... § 121.311 Seats, safety belts, and shoulder harnesses. (a) No person may operate an airplane unless... belt and shoulder harness that meets the applicable requirements specified in § 25.785 of this chapter...

14 CFR 135.171 - Shoulder harness installation at flight crewmember stations.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Shoulder harness installation at flight... ON BOARD SUCH AIRCRAFT Aircraft and Equipment § 135.171 Shoulder harness installation at flight... configuration, excluding any pilot seat, of 10 seats or more unless it is equipped with an approved shoulder...

14 CFR 135.171 - Shoulder harness installation at flight crewmember stations.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 3 2010-01-01 2010-01-01 false Shoulder harness installation at flight... ON BOARD SUCH AIRCRAFT Aircraft and Equipment § 135.171 Shoulder harness installation at flight... configuration, excluding any pilot seat, of 10 seats or more unless it is equipped with an approved shoulder...

14 CFR 121.311 - Seats, safety belts, and shoulder harnesses.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 3 2011-01-01 2011-01-01 false Seats, safety belts, and shoulder harnesses... § 121.311 Seats, safety belts, and shoulder harnesses. (a) No person may operate an airplane unless... belt and shoulder harness that meets the applicable requirements specified in § 25.785 of this chapter...

History taking and clinical examination of the shoulder.

PubMed

Barratt, Julian

2009-04-01

Prompt and effective diagnosis and treatment for common shoulder problems depends on the ability of practitioners to distinguish between traumatic and non-traumatic shoulder conditions. This article aims to enable practitioners to make accurate assessments and carry out shoulder examinations, including the undertaking of selected special tests, before discharging or referring patients.

Association between Propionibacterium acnes and frozen shoulder: a pilot study.

PubMed

Bunker, Tim D; Boyd, Matthew; Gallacher, Sian; Auckland, Cressida R; Kitson, Jeff; Smith, Chris D

2014-10-01

Frozen shoulder has not previously been shown to be associated with infection. The present study set out to confirm the null hypothesis that there is no relationship between infection and frozen shoulder using two modern scientific methods, extended culture and polymerase chain reaction (PCR) for bacterial nucleic acids. A prospective cohort of 10 patients undergoing arthroscopic release for stage II idiopathic frozen shoulder had two biopsies of tissue taken from the affected shoulder joint capsule at the time of surgery, along with control biopsies of subdermal fat. The biopsies and controls were examined with extended culture and PCR for microbial nucleic acid. Eight of the 10 patients had positive findings on extended culture in their shoulder capsule and, in six of these, Propionibacterium acnes was present. The findings mean that we must reject the null hypothesis that there is no relationship between infection and frozen shoulder. More studies are urgently needed to confirm or refute these findings. If they are confirmed, this could potentially lead to new and effective treatments for this common, painful and disabling condition. Could P. acnes be the Helicobacter of frozen shoulder?

The intra-articular pressure of the shoulder: an experimental study on the role of the glenoid labrum in stabilizing the joint.

PubMed

Habermeyer, P; Schuller, U; Wiedemann, E

1992-01-01

It was shown on human corpses that the glenohumeral joint may be compared to a piston surrounded by a valve. The glenoid labrum, then, should work like the valve block, sealing the joint from atmospheric pressure. In order to test this hypothesis, 18 human shoulder preparations were studied. The mean stabilizing force obtained by atmospheric pressure was 146 N. Additionally, 15 patients without any sign of instability and 17 patients with an anterior instability of the shoulder were tested under general anesthesia. In stable shoulder joints, traction at the arm caused negative intra-articular pressure that could be correlated to the amount of force exerted. In contrast, unstable shoulder joints with a tear of the glenoid labrum (Bankart lesion) did not exhibit this phenomenon. For unstable shoulder joints, the piston-and-valve model is no longer valid. This enlarges the current concept of shoulder joint stability in two ways: (a) the absence of negative intra-articular pressure disturbs joint mechanics and (b) altered pressure receptors might disturb motor coordination that dynamically protects the shoulder from dislocating forces.

Electromyographical Comparison of Four Common Shoulder Exercises in Unstable and Stable Shoulders

PubMed Central

Sciascia, Aaron; Kuschinsky, Nina; Nitz, Arthur J.; Mair, Scott D.; Uhl, Tim L.

2012-01-01

This study examines if electromyographic (EMG) amplitude differences exist between patients with shoulder instability and healthy controls performing scaption, prone horizontal abduction, prone external rotation, and push-up plus shoulder rehabilitation exercises. Thirty nine subjects were categorized by a single orthopedic surgeon as having multidirectional instability (n = 10), anterior instability (n = 9), generalized laxity (n = 10), or a healthy shoulder (n = 10). Indwelling and surface electrodes were utilized to measure EMG activity (reported as a % of maximum voluntary isometric contraction (MVIC)) in various shoulder muscles during 4 common shoulder exercises. The exercises studied effectively activated the primary musculature targeted in each exercise equally among all groups. The serratus anterior generated high activity (50–80% MVIC) during a push-up plus, while the infraspinatus and teres major generated moderate-to-high activity (30–80% MVIC) during both the prone horizontal and prone external rotation exercises. Scaption exercise generated moderate activity (20–50% MVIC) in both rotator cuff and scapular musculature. Clinicians should feel confident in prescribing these shoulder-strengthening exercises in patients with shoulder instability as the activation levels are comparable to previous findings regarding EMG amplitudes and should improve the dynamic stabilization capability of both rotator cuff and scapular muscles using exercises designed to address glenohumeral joint instability. PMID:22919499

Women performing repetitive work: is there a difference in the prevalence of shoulder pain and pathology in supermarket cashiers compared to the general female population?

PubMed

Sansone, Valerio; Bonora, Cristina; Boria, Paola; Meroni, Roberto

2014-10-01

Shoulder disorders in the occupational environment have been widely studied, but the quality of research and methodology applied vary. Little has been done to ascertain whether shoulder pain in female repetitive workers is due to any verifiable pathology, or to compare findings with the general population. Therefore, we decided to evaluate the prevalence of self-reported shoulder pain in a group of female supermarket cashiers and in the general female population using a standardized questionnaire. Shoulder pain prevalence was then compared to imaging findings in order to assess specific and non-specific pain prevalence. 196 cashiers and 302 controls filled in a standardized shoulder questionnaire and underwent an imaging examination of a shoulder. The prevalence of shoulder pain was significantly higher in the group of cashiers (46.4%) than in the general population (25.5%) (OR = 1.821; 95% CI: 1.426-2.325). Specific pain prevalence was higher among the controls (19.5%) than among the cashiers (13.2%). The more frequent reports of shoulder pain in the supermarket cashiers are not correlated with a higher prevalence of imaging abnormalities. The causes of these more frequent complaints should be probably sought in the psycho-social and occupational environment.

Reduced fatalities related to rear seat shoulder belts

PubMed Central

Robertson, L.

1999-01-01

Methods—During 1988–96, fatalities to rear outboard seat occupants of passenger cars, classified by age of occupant and vehicle curb weight were matched to data on model year in which shoulder belts became standard equipment. The same data were obtained from the same years on back seat occupants in crashes from the Crashworthiness Data System. Weighted regression was performed on death rates per occupants in crashes by belt equipment, occupant age, and vehicle weight for all occupants and occupants who claimed to be restrained. Results—The risk of death is significantly lower in vehicles equipped with shoulder belts, midsized to larger cars, and among children. Claimed child restraint use is higher in cars with shoulder belts and claimed use of shoulder belts is higher among adolescents and young adults but lower among those 35 and older. However, older occupants have lower death rates in shoulder belt equipped cars. Conclusions—Shoulder belts substantially reduce risk of death relative to lap belts at prevalent use rates in each age group. Belt effectiveness when used cannot be estimated precisely because of invalid claimed use, but the lowered rates among vehicles with shoulder belts indicates that effectiveness given prevalent use is far more efficacious than lap belts without shoulder belts. PMID:10323573

Nerve stress during reverse total shoulder arthroplasty: a cadaveric study.

PubMed

Lenoir, Hubert; Dagneaux, Louis; Canovas, François; Waitzenegger, Thomas; Pham, Thuy Trang; Chammas, Michel

2017-02-01

Neurologic lesions are relatively common after total shoulder arthroplasty. These injuries are mostly due to traction. We aimed to identify the arm manipulations and steps during reverse total shoulder arthroplasty (RTSA) that affect nerve stress. Stress was measured in 10 shoulders of 5 cadavers by use of a tensiometer on each nerve from the brachial plexus, with shoulders in different arm positions and during different surgical steps of RTSA. When we studied shoulder position without prostheses, relative to the neutral position, internal rotation increased stress on the radial and axillary nerves and external rotation increased stress on the musculocutaneous, median, and ulnar nerves. Extension was correlated with increase in stress on all nerves. Abduction was correlated with increase in stress for the radial nerve. We identified 2 high-risk steps during RTSA: humeral exposition, particularly when the shoulder was in a position of more extension, and glenoid exposition. The thickness of polyethylene humeral cups used was associated with increased nerve stress in all but the ulnar nerve. During humeral preparation, the surgeon must be careful to limit shoulder extension. Care must be taken during exposure of the glenoid. Extreme rotation and oversized implants should be avoided to minimize stretch-induced neuropathies. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Shoulder pain in people with a stroke: a population-based study.

PubMed

Ratnasabapathy, Yogini; Broad, Joanna; Baskett, Jonathan; Pledger, Megan; Marshall, Jane; Bonita, Ruth

2003-05-01

To measure the occurrence of shoulder pain after stroke. To identify the factors that predict risk of shoulder pain after stroke. Auckland Stroke Study, population-based case-cohort study. All cases of stroke, including those managed outside hospital, over a 12-month period ending February 1992 were considered in Auckland. Self-reported shoulder pain at one week, one month and six months after the onset of stroke for each person. A total of 1,761 stroke events were identified. Self-reported shoulder pain among survivors increased from 256/1474 (17%) at one week, to 261/1,336 (20%) at one month and 284/1,201 (23%) at six months. Shoulder pain was positively associated with motor deficit, side of deficit and severity of deficit. In those surviving to six months after stroke, the risk of shoulder pain was higher in those with severe upper limb motor deficit (odds ratio (OR) 4.94; 95% confidence interval (CI) 3.06-7.98) and in diabetics (OR 1.57, 95% CI 1.15-2.14). Risk of shoulder pain increased with time and was lower for those in institutional care. Shoulder pain after stroke is common, especially in patients with severe sensorimotor deficits, diabetics and those living at home. Appropriate management may reduce the rate of occurrence.

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. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

Obesity Has Minimal Impact on Short-Term Functional Scores After Reverse Shoulder Arthroplasty for Rotator Cuff Tear Arthropathy.

PubMed

Morris, Brent J; Haigler, Richard E; Cochran, John M; Laughlin, Mitzi S; Elkousy, Hussein A; Gartsman, Gary M; Edwards, T Bradley

2016-01-01

The potential adverse effect of body mass index (BMI) on shoulder function scores after reverse shoulder arthroplasty (RSA) has not been investigated. We conducted a study to examine outcomes of RSA performed for rotator cuff tear arthropathy (RCTA) across BMI categories (normal weight, overweight, obese). We hypothesized that, compared with normal-weight patients, obese patients would have worse shoulder function scores, worse mobility, and more complications. Using a prospective shoulder arthroplasty registry, we identified 77 primary RSAs performed for RCTA with minimum 2-year follow-up. Thirty-four patients had normal weight (BMI <25 kg/m2), 21 were overweight (BMI 25-30 kg/m2), and 22 were obese (BMI >30 kg/m2). Shoulder function scores, mobility, and satisfaction were evaluated before surgery and at final follow-up. The 3 BMI groups were not significantly different on demographic factors, preoperative shoulder function scores, or preoperative mobility (P > .05). For each group, shoulder function scores and mobility significantly improved between the preoperative and final follow-up assessments (P < .001). Patient satisfaction was similar between groups (P = .967). Improved shoulder function scores, mobility, and patient satisfaction can be expected after RSA for RCTA in patients regardless of BMI.

Shoulder Arthroplasty, from Indications to Complications: What the Radiologist Needs to Know.

PubMed

Lin, Dana J; Wong, Tony T; Kazam, Jonathan K

2016-01-01

The replaced shoulder is increasingly encountered by the radiologist, both on a dedicated and incidental basis, in this era of the growing population of aging patients wishing to preserve their mobility and function. Knowledge of the normal biomechanics of the glenohumeral joint-particularly the function of the rotator cuff and the unique relationship of the humeral head to the glenoid-is essential for understanding the need for shoulder replacement and its subsequent complications, because the intent of shoulder arthroplasty is to approximate the normal joint as closely as possible. The most common indications for shoulder arthroplasty are osteoarthritis, inflammatory arthritis, proximal humerus fractures, irreparable rotator cuff tears, rotator cuff arthropathy, and avascular necrosis of the humeral head. Knowledge of the key imaging features of these indications helps facilitate a correlative understanding between the initial diagnosis and the choice of which type of arthroplasty is used-total shoulder arthroplasty, reverse total shoulder arthroplasty, or partial joint replacement (humeral head resurfacing arthroplasty or hemiarthroplasty). The preoperative requirements and usual postoperative appearance of each arthroplasty type are summarized, as well as the complications of shoulder arthroplasty, including those unique to or closely associated with each type of arthroplasty and those that can be encountered with any type of shoulder arthroplasty. ©RSNA, 2016.

Proposal for SICSeG guidelines for rehabilitation after anatomical shoulder prosthesis in concentric shoulder osteoarthritis.

PubMed

Fusaro, I; Orsini, S; Stignani, S; Creta, D; Cava, F C; Benedetti, M G

2013-06-01

The purpose of this paper is to provide up-to-date guidelines on rehabilitation after anatomical shoulder prosthesis for concentric shoulder osteoarthritis, as previous guidelines date back to late 1970s and are no longer adequate due to the evolution of prosthesis models and surgical techniques. The physiatric committee of the Italian Society of Shoulder and Elbow Surgery (SICSeG-Società Italiana di Chirurgia della Spalla e del Gomito) performed a search for all the existing literature related to rehabilitation after shoulder replacement. A total of 29 papers concerning shoulder rehabilitation were reviewed. In addition, the main Italian orthopedic surgeons and physiatrists dealing with shoulder surgery and rehabilitation were interviewed to obtain indications when literature was not conclusive. From literature evaluation and expert consultation, we produced guidelines concerning: patient evaluation by means of adequate rating scales, preoperative treatment, early intermediate and advanced postoperative phases, rehabilitation of scapulo-thoracic joint, return to work and sports, length of rehabilitation and follow-up. This proposal for guidelines was presented during the 11th SICSeG Congress on May 2012 and to the main scientific societies concerned in shoulder surgery and rehabilitation. A consensus conference is needed in order to formalize and make them usable from all the professional figures involved in this field.

Treatment of humeral shaft fractures using antegrade nailing: functional outcome in the shoulder.

PubMed

Patino, Juan Martin

2015-08-01

The purpose of this study was to evaluate shoulder outcomes and function after humeral shaft fractures treated with antegrade nailing. Thirty patients with acute humeral shaft fractures who underwent antegrade locked intramedullary nailing were retrospectively studied. Range of motion (ROM) of the affected shoulder was evaluated, comparing it with the nonaffected shoulder, radiologic position of the nails, complications, and need for a second surgery. The study enrolled 20 men and 10 women (average age, 41.9 years). The average follow-up was 35.8 months. The average shoulder elevation averaged 157°, internal rotation was variable (reaching the sacroiliac joint to T7), and external rotation averaged 75°. Elbow flexion-extension ROM averaged 133° (115°-145°). According to the Rodriguez-Merchan criteria, 12 patients achieved excellent results (40%), 7 good (20%), and 6 fair (23.3%); poor results were found in 5 cases (16.6%). Twelve patients achieved full mobility of the shoulder, whereas 18 had some loss of motion, with significant differences between the affected and nonaffected shoulders (P = .001). Decreased shoulder ROM is common after antegrade nailing of humeral shaft fractures. Avoidance of nail impingement can improve final outcomes. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Pain management of hemiplegic shoulder pain post stroke in patients from Nanjing, China

PubMed Central

Zhu, Yi; Su, Bin; Li, Ning; Jin, Hongzhu

2013-01-01

We selected 106 hemiplegic patients with shoulder pain hospitalized after stroke from three hospitals in Nanjing, China between February 2007 and January 2012. All patients had complete clinical data sets and accounted for 45.5% of the inpatients because of stroke. Results showed that the number of patients with hemiplegic shoulder pain post stroke increased yearly, attacking mainly males 50–69 years of age. Of 106 patients, there were 60 cases (56.6%) of adhesive capsulitis, 19 (17.9%) of shoulder subluxation, 14 (13.2%) of complex regional pain syndrome, and 13 (12.6%) of central pain. The main symptoms were shoulder pain (100%), limit of shoulder mobility (98.1%), and adhesion of the scapula (56.6%). MRI of the shoulder showed tendon and ligament lesions (57.1%) and rotator cuff tear (38.1%). 53.8% of central pain was related to the thalamus, in addition to the basal ganglia, brain stem, and cerebellopontine angle. Shoulder pain, upper limb motor function, and function independence were significantly improved after comprehensive rehabilitation. In particular, electroacupuncture based on basic physical therapy exhibited efficacy on shoulder tion and complex regional pain syndrome. Multiple linear regression results showed a negative relationship of efficacy of pain management with the attack period of shoulder pain, involvement of the posterior limb of the internal capsule, and duration between onset and rehabilitation treatment, but a positive correlation with pain-related education, pain regression period, and pain diagnosis. PMID:25206549

Shoulder dystocia: risk factors, predictability, and preventability.

PubMed

Mehta, Shobha H; Sokol, Robert J

2014-06-01

Shoulder dystocia remains an unpredictable obstetric emergency, striking fear in the hearts of obstetricians both novice and experienced. While outcomes that lead to permanent injury are rare, almost all obstetricians with enough years of practice have participated in a birth with a severe shoulder dystocia and are at least aware of cases that have resulted in significant neurologic injury or even neonatal death. This is despite many years of research trying to understand the risk factors associated with it, all in an attempt primarily to characterize when the risk is high enough to avoid vaginal delivery altogether and prevent a shoulder dystocia, whose attendant morbidities are estimated to be at a rate as high as 16-48%. The study of shoulder dystocia remains challenging due to its generally retrospective nature, as well as dependence on proper identification and documentation. As a result, the prediction of shoulder dystocia remains elusive, and the cost of trying to prevent one by performing a cesarean delivery remains high. While ultimately it is the injury that is the key concern, rather than the shoulder dystocia itself, it is in the presence of an identified shoulder dystocia that occurrence of injury is most common. The majority of shoulder dystocia cases occur without major risk factors. Moreover, even the best antenatal predictors have a low positive predictive value. Shoulder dystocia therefore cannot be reliably predicted, and the only preventative measure is cesarean delivery. Copyright © 2014 Elsevier Inc. All rights reserved.

[Results from the German shoulder- and elbow arthroplasty register (SEPR) : Anatomic or reverse shoulder arthroplasty in B2-glenoids?

PubMed

Magosch, P; Habermeyer, P; Lichtenberg, S; Tauber, M; Gohlke, F; Mauch, F; Boehm, D; Loew, M; Zeifang, F; Pötzl, W

2017-12-01

Anatomic shoulder arthroplasty in osteoarthritis with biconcave glenoid wear results in decreased functional results and a higher rate of early glenoid loosening. The aim of the data analysis of the German shoulder arthroplasty register was to clarify whether reverse shoulder arthroplasty can provide better functional results and a lower complication rate than anatomic arthroplasty in osteoarthritis with biconcave glenoid wear. The analysis included 1052 completely documented primary implanted arthroplasties with a minimum follow-up of 2 years. In 119 cases, a B2-type glenoid was present. Out of these cases, 86 were treated with an anatomic shoulder arthroplasty, and in 33 cases a reverse shoulder arthroplasty was implanted. The mean follow-up was 47.6 months. The Constant score with its subcategories, as well as the active range of movement improved significantly after anatomic and after reverse shoulder arthroplasty. We observed no difference in functional results between both types of arthroplasty; however, reverse arthroplasty showed a significant higher revision rate (21.2%) (3% glenoid loosening, 6% prosthetic instability) than anatomic shoulder arthroplasty (12.8%) (11.6% glenoid loosening, 1.2% prosthetic instability), whereas anatomic shoulder arthroplasty showed a higher rate of glenoid loosening. Functional and radiographic results of both types of arthroplasty are comparable with the results reported in the literature, although our analysis represents results from an implant registry (data pertaining to medical care quality).

Association of Shoulder Problems in Persons With Spinal Cord Injury at Discharge From Inpatient Rehabilitation With Activities and Participation 5 Years Later.

PubMed

Eriks-Hoogland, Inge; de Groot, Sonja; Snoek, Govert; Stucki, Gerold; Post, Marcel; van der Woude, Lucas

2016-01-01

To examine whether musculoskeletal shoulder pain and limitations in shoulder range of motion (ROM) at discharge from first rehabilitation are associated with activities and participation restrictions 5 years later in persons with spinal cord injury (SCI). Prospective cohort study. Eight specialized SCI rehabilitation centers. Subjects (N=138) with an SCI admitted for first rehabilitation. Not applicable. Peak power output (POpeak), Wheelchair Skills Test (WST), FIM motor score, ability to transfer, Physical Activity Scale for Individuals with Physical Disabilities (PASIPD), mobility range and social behavior subscales of the Sickness Impact Profile 68 (SIPSOC), and employment status. Mean age of the subjects at discharge was 39 years, 72% were men, 32% had tetraplegia, and in 65% the SCI was motor complete. At discharge, 39% reported shoulder pain and 32% had a limited shoulder ROM. In the analyses of variance, shoulder ROM limitation, but not shoulder pain, was associated with all but 1 outcome at 5 years. In the regression analyses, ROM limitations of the shoulder were negatively associated with the ability to transfer (P=.004), FIM motor scores (P<.001), and return to work (P= .027) 5 years after discharge. No significant associations were found with POpeak, WST performance time, SIPSOC, and PASIPD. The presence of limitations in shoulder ROM, but not shoulder pain, at discharge is associated with limitations in activities and employment status 5 years later. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

A longitudinal study on risk factors for neck and shoulder pain among young adults in the transition from technical school to working life.

PubMed

Hanvold, Therese N; Wærsted, Morten; Mengshoel, Anne Marit; Bjertness, Espen; Twisk, Jos; Veiersted, Kaj Bo

2014-11-01

The study examined the course of neck and shoulder pain among a cohort of technical school students entering working life. We also aimed to identify work-related and individual risk factors for neck and shoulder pain during this transition period. The study was designed as a prospective cohort study following 420 technical school students (167 student hairdressers, 118 student electricians, and 135 media/design students) from school, through their apprenticeship and into working life. Every 4 (th)month over a 6.5 year period (2002-2009), the participant`s neck and shoulder pain for the preceding four weeks was assessed. Mechanical and psychosocial workplace factors as well as individual factors were evaluated at baseline and/or during the follow-up period. Data were analyzed by generalized estimating equations (GEE). We found a significant increase in neck and shoulder pain over time in the transition from technical school to working life. High mechanical workload was associated with neck and shoulder pain among women, while a high level of shoulder muscle endurance capacity was associated with lower rates of neck and shoulder pain among men. Perceived muscle tension and ethnicity were the most consistent predictors for neck and shoulder pain, found among both women and men. Increased neck and shoulder pain was found in the transition from technical school to working life, and both work-related and individual factors were associated with pain development.

Long-latency reflexes of elbow and shoulder muscles suggest reciprocal excitation of flexors, reciprocal excitation of extensors, and reciprocal inhibition between flexors and extensors

PubMed Central

Meriggi, Jenna; Parikh, Nidhi; Saad, Kenneth

2016-01-01

Postural corrections of the upper limb are required in tasks ranging from handling an umbrella in the changing wind to securing a wriggling baby. One complication in this process is the mechanical interaction between the different segments of the arm where torque applied at one joint induces motion at multiple joints. Previous studies have shown the long-latency reflexes of shoulder muscles (50–100 ms after a limb perturbation) account for these mechanical interactions by integrating information about motion of both the shoulder and elbow. It is less clear whether long-latency reflexes of elbow muscles exhibit a similar capability and what is the relation between the responses of shoulder and elbow muscles. The present study utilized joint-based loads tailored to the subjects' arm dynamics to induce well-controlled displacements of their shoulder and elbow. Our results demonstrate that the long-latency reflexes of shoulder and elbow muscles integrate motion from both joints: the shoulder and elbow flexors respond to extension at both joints, whereas the shoulder and elbow extensors respond to flexion at both joints. This general pattern accounts for the inherent flexion-extension coupling of the two joints arising from the arm's intersegmental dynamics and is consistent with spindle-based reciprocal excitation of shoulder and elbow flexors, reciprocal excitation of shoulder and elbow extensors, and across-joint inhibition between the flexors and extensors. PMID:26864766

Effect of shoulder taping on maximum shoulder external and internal rotation range in uninjured and previously injured overhead athletes during a seated throw.

PubMed

McConnell, Jenny; Donnelly, Cyril; Hamner, Samuel; Dunne, James; Besier, Thor

2011-09-01

The purpose of our study was to investigate whether shoulder taping affects shoulder kinematics in injured and previously injured overhead athletes during a seated throw. Twenty-six overhead college athletes threw a handball three times with and without tape, while seated on a chair. An 8-camera Vicon Motion Capture system recorded markers placed on the upper limb and trunk during each of the throwing conditions. Scaled musculoskeletal models of the upper limb were created using OpenSim and inverse kinematics used to obtain relevant joint angles. Shoulder taping had no main effect on external (ER) and internal (IR) rotation range (ROM) of the shoulder, but a significant interaction effect was found (p = 0.003 and 0.02, respectively), depending on previous injury status, whereby both the ER and IR ROM of the shoulder in the group of previously injured athletes decreased when taped (143-138° and 54-51°, respectively), but increased in the group who had never been injured (131-135° and 42-44°, respectively). Maximum abduction range and ball velocity were not affected by the application of shoulder taping, regardless of previous injury status. Thus, application of shoulder taping has a differential effect on maximum shoulder ER and IR ROM during throwing depending on previous injury status. These findings have implications for returning athletes to sport after injury and for screening athletes at risk of injury. Copyright © 2011 Orthopaedic Research Society.

Shoulder pain in Iranian elite athletes: the prevalence and risk factors.

PubMed

Mohseni-Bandpei, Mohammad A; Keshavarz, Roshanak; Minoonejhad, Hooman; Mohsenifar, Holakoo; Shakeri, Hassan

2012-09-01

Shoulder sports injuries are relatively common in athletes who perform highly repetitive motions. The purposes of this study were to determine the prevalence of and risk factors for shoulder injuries and to analyze how individual and other sport characteristics contribute to the risk of shoulder injuries among 6 overhead sports, those being swimming, rowing, wrestling, basketball, volleyball, and handball. A cross-sectional study was carried out on 613 Iranian overhead sports athletes in different collegiate sport fields. Data were collected using different questionnaires. A structured questionnaire including demographics, sport characteristics, and also prevalence and risk factors of shoulder pain was used. Visual analogue scale and Disability of the Arm, Shoulder, and Hand questionnaires were used to determine the pain intensity and functional disability, respectively. Point, last 6-month, last year, and lifetime prevalences of shoulder pain were 21.4%, 29%, 38.8%, and 41.6%, respectively. The highest point prevalence was related to the rowing athletes with 31.9% and the lowest for swimming athletes (12.3%). Sex, body mass index, sport level, days of practice per week, and satisfaction with income were found to be significantly correlated with the prevalence of shoulder pain (P < .05 in all instances). For those with shoulder pain, the mean pain intensity and functional disability were 53.8 mm and 15.46%, respectively. The prevalence of shoulder pain in athletes with highly repetitive overhead motions seems to be high. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

A retrospective, descriptive study of shoulder outcomes in outpatient physical therapy.

PubMed

Millar, A Lynn; Lasheway, Philip A; Eaton, Wendy; Christensen, Frances

2006-06-01

A retrospective, descriptive study of clients with shoulder dysfunction referred to physical therapy. To (1) describe the clinical and functional outcomes of clients with shoulder dysfunction following outpatient physical therapy, and (2) to compare the outcomes by type of shoulder dysfunction. Although individuals with shoulder dysfunction are commonly referred to physical therapy few large descriptive studies regarding outcomes following physical therapy are available. Data for 878 clients (468 female, 410 male) were retrieved and analyzed. This database was developed between 1997 and 2000 and included 4 outpatient facilities from 1 healthcare system in the southwest corner of Michigan. Clients were classified by type of shoulder dysfunction, and standardized tests were performed upon admittance and discharge to physical therapy. Descriptive and inferential statistics were calculated for all data. Of all clients, 55.1% had shoulder impingement, while 18.3% had postoperative repair, 8.9% had a frozen shoulder, 7.6% had a rotator cuff tear, 3.0% had shoulder instability, 2.1% were post fracture, and the remaining 4.9% had miscellaneous diagnoses. The average (+/-SD) age of the patients was 53.6 +/- 16.4 years, with an average (+/-SD) number of treatment sessions of 13.7 +/- 11.0. All groups showed significant changes following physical therapy intervention. Clients with diverse types of shoulder dysfunction demonstrated improvement in both clinical and functional measures at the conclusion of physical therapy, although it is not possible to determine whether these changes were due to the interventions or due to time. The type of shoulder dysfunction appears to affect the prognosis, thus expected outcomes should be based upon initial diagnosis and specific measures.

Sonographic assessment of the subscapularis after reverse shoulder arthroplasty: impact of tendon integrity on shoulder function.

PubMed

Dedy, Nicolas J; Gouk, Conor J; Taylor, Fraser J; Thomas, Michael; Tan, S L Ezekiel

2018-06-01

The deltopectoral approach for reverse shoulder arthroplasty (RSA) requires subscapularis tenotomy or lesser tuberosity osteotomy. Whether the subscapularis should be repaired at the conclusion of the procedure remains controversial. The present study sonographically assessed the subscapularis after RSA and evaluated the effect of tendon integrity on functional outcome. All patients who had undergone RSA in the Gold Coast University Hospital between 2005 and 2016 were included. Sonography was performed by a blinded examiner. Function was assessed using the Disabilities of the Arm, Shoulder and Hand, the Constant-Murley, and Oxford Shoulder scores. Internal rotation ability was recorded on a 6-point scale. The study included 43 patients (48 shoulders). Median length of follow-up was 19 months (range, 4-132 months). On sonography, the subscapularis was graded intact in 6 shoulders (13%), intact with mild attenuation in 16 (33%), severely attenuated in 15 (31%), and not intact or absent in 11 (23%). Differences in Disabilities of the Arm, Shoulder and Hand, Constant-Murley, or Oxford Shoulder scores between intact and attenuated or absent subscapularis shoulders were not significant. Internal rotation scores were significantly higher in the intact and mildly attenuated tendon group than in the absent tendon group (U = 1.0, P = .001 and U = 28.5, P = .007, respectively). The present work is the first long-term outcome study of RSA using sonography to assess the subscapularis. Subscapularis integrity did not appear to have a measurable effect on patient outcome as measured by standard scores but was important for internal rotation ability after RSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

Prospective multifactorial analysis of preseason risk factors for shoulder and elbow injuries in high school baseball pitchers.

PubMed

Shitara, Hitoshi; Kobayashi, Tsutomu; Yamamoto, Atsushi; Shimoyama, Daisuke; Ichinose, Tsuyoshi; Tajika, Tsuyoshi; Osawa, Toshihisa; Iizuka, Haku; Takagishi, Kenji

2017-10-01

To prospectively identify preseason physical factors for shoulder and elbow injuries during the season in high school baseball pitchers. The study included 105 high school baseball pitchers [median age 16 (15-17) years]. The range of motion of the shoulder (90° abducted external and internal rotation) and elbow (extension/flexion), shoulder muscle strength (abduction and prone internal and external rotation), shoulder and elbow laxity, horizontal flexion, and scapular dyskinesis were assessed. After the season, the participants completed questionnaires regarding shoulder and/or elbow injuries, with injury defined as an inability to play for ≥1 week due to elbow/shoulder problems. The results of two groups (injured and noninjured) were compared using t tests and Chi-square analyses. Stepwise forward logistic regression models were developed to identify risk factors. Twenty-one injuries were observed. In univariate analysis, 90° abducted internal rotation and total arc of the dominant shoulder and the ratio of prone external rotation in the dominant to nondominant sides in the injured group were significantly less than those in the noninjured group (P = 0.02, 0.04, and 0.01, respectively). In logistic regression analysis, 90° abducted internal rotation in the dominant shoulder and prone external rotation ratio were significantly associated with injuries (P = 0.02 and 0.03, respectively). A low prone external rotation ratio and decreased 90° abducted internal rotation in the dominant shoulder in the preseason were significant risk factors for shoulder and elbow injuries in high school baseball pitchers. The results may contribute to reduce the incidence of these injuries. II.

Biceps tenodesis is a viable option for salvage of failed SLAP repair.

PubMed

Werner, Brian C; Pehlivan, Hakan C; Hart, Joseph M; Lyons, Matthew L; Gilmore, C Jan; Garrett, Cara B; Carson, Eric W; Diduch, David R; Miller, Mark D; Brockmeier, Stephen F

2014-08-01

Outcomes of arthroscopic superior labral anterior-posterior (SLAP) repairs have been well reported with generally favorable outcomes. Unfortunately, a percentage of patients remain dissatisfied or suffer further injury after SLAP repair and may seek additional treatment. The purpose of this study was to evaluate the surgical outcomes of biceps tenodesis for failed SLAP repairs. A retrospective review of all patients undergoing biceps tenodesis was completed. Inclusion criteria were previous SLAP repair and subsequent revision biceps tenodesis. Exclusion criteria were additional shoulder procedures including rotator cuff repair, instability procedures, and preoperative frozen shoulder. Objective outcomes were postoperative assessments with Constant score, American Shoulder and Elbow Surgeons score, Single Assessment Numeric Evaluation, Simple Shoulder Test, and Veterans RAND 36-Item Health Survey. Physical examination was conducted to determine postoperative range of motion and strength compared with the nonoperative shoulder. A cohort of 24 patients was identified, and of these, 17 patients (71%) completed the study at 2 years' follow-up. The average postoperative Constant score was 84.4; American Shoulder and Elbow Surgeons score, 75.5; Single Assessment Numeric Evaluation score, 73.1%; Simple Shoulder Test score, 9.2; and Veterans RAND 36-Item Health Survey score, 76.1. Postoperative range of motion of the operative shoulder returned to near that of the asymptomatic nonoperative shoulder. Workers' compensation status led to inferior results. Options for patients with a failed prior SLAP repair are limited. As a salvage operation for failed SLAP repair, biceps tenodesis serves the majority of patients well, with favorable outcomes by validated measures and excellent shoulder range of motion and elbow strength at 2 years' follow-up. Workers' compensation status may predispose patients to poorer outcomes. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Resurfacing shoulder arthroplasty for the treatment of severe rheumatoid arthritis: outcome in 167 patients from the Danish Shoulder Registry.

PubMed

Voorde, Pia C Ten; Rasmussen, Jeppe V; Olsen, Bo S; Brorson, Stig

2015-06-01

There is no consensus on which type of shoulder prosthesis should be used in patients with rheumatoid arthritis (RA). We describe patients with RA who were treated with shoulder replacement, regarding patient-reported outcome, prosthesis survival, and causes of revision, and we compare outcome after resurfacing hemi-arthroplasty (RHA) and stemmed hemi-arthroplasty (SHA). We used data from the national Danish Shoulder Arthroplasty Registry and included patients with RA who underwent shoulder arthroplasty in Denmark between 2006 and 2010. Patient-reported outcome was obtained 1-year postoperatively using the Western Ontario Osteoarthritis of the Shoulder index (WOOS), and rates of revision were calculated by checking revisions reported until December 2011. The patient-reported outcome of RHA was compared to that of SHA using regression analysis with adjustment for age, sex, and previous surgery. During the study period, 167 patients underwent shoulder arthroplasty because of rheumatoid arthritis, 80 (48%) of whom received RHA and 34 (26%) of whom received SHA. 16 patients were treated with total stemmed shoulder arthroplasty (TSA), and 24 were treated with reverse shoulder arthroplasty (rTSA). 130 patients returned a completed questionnaire, and the total mean WOOS score was 63. The cumulative 5-year revision rate was 7%. Most revisions occurred after RHA, with a revision rate of 14%. Mean WOOS score was similar for RHA and for SHA. This study shows that shoulder arthroplasty, regardless of design, is a good option in terms of reducing pain and improving function in RA patients. The high revision rate in the RHA group suggests that other designs may offer better implant survival. However, this should be confirmed in larger studies.

Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial.

PubMed

Zhang, Hufei; Liu, Xinhe; Jiang, Hongye; Liu, Zimeng; Zhang, Xu-Yu; Xie, Hong-Zhe

2016-01-01

Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P <0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P <0.001) and the intensity of bilateral shoulder pain (both P <0.01). Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

Do Current Recommendations for Upper Instrumented Vertebra Predict Shoulder Imbalance? An Attempted Validation of Level Selection for Adolescent Idiopathic Scoliosis.

PubMed

Bjerke, Benjamin T; Cheung, Zoe B; Shifflett, Grant D; Iyer, Sravisht; Derman, Peter B; Cunningham, Matthew E

2015-10-01

Shoulder balance for adolescent idiopathic scoliosis (AIS) patients is associated with patient satisfaction and self-image. However, few validated systems exist for selecting the upper instrumented vertebra (UIV) post-surgical shoulder balance. The purpose is to examine the existing UIV selection criteria and correlate with post-surgical shoulder balance in AIS patients. Patients who underwent spinal fusion at age 10-18 years for AIS over a 6-year period were reviewed. All patients with a minimum of 1-year radiographic follow-up were included. Imbalance was determined to be radiographic shoulder height |RSH| ≥ 15 mm at latest follow-up. Three UIV selection methods were considered: Lenke, Ilharreborde, and Trobisch. A recommended UIV was determined using each method from pre-surgical radiographs. The recommended UIV for each method was compared to the actual UIV instrumented for all three methods; concordance between these levels was defined as "Correct" UIV selection, and discordance was defined as "Incorrect" selection. One hundred seventy-one patients were included with 2.3 ± 1.1 year follow-up. For all methods, "Correct" UIV selection resulted in more shoulder imbalance than "Incorrect" UIV selection. Overall shoulder imbalance incidence was improved from 31.0% (53/171) to 15.2% (26/171). New shoulder imbalance incidence for patients with previously level shoulders was 8.8%. We could not identify a set of UIV selection criteria that accurately predicted post-surgical shoulder balance. Further validated measures are needed in this area. The complexity of proximal thoracic curve correction is underscored in a case example, where shoulder imbalance occurred despite "Correct" UIV selection by all methods.

Symptomatic rotator cuff tears show higher radioisotope uptake on bone scintigraphy compared with asymptomatic tears.

PubMed

Koike, Yoichi; Sano, Hirotaka; Kita, Atushi; Itoi, Eiji

2013-09-01

Some patients with rotator cuff tears complain of pain, whereas others are asymptomatic. Previous studies have pointed out the presence of active bone metabolism in the painful shoulder, identified with increased radioisotope uptake during bone scintigraphy. Shoulders with symptomatic rotator cuff tears will demonstrate higher radioisotope uptake than shoulders with asymptomatic tears with bone scintigraphy, reflecting active bone metabolism in symptomatic tears. Cross-sectional study; Level of evidence, 3. The study consisted of 3 groups: patients with symptomatic tears (symptomatic group), patients with asymptomatic tears (asymptomatic group), and controls (no tear group). The symptomatic group consisted of 28 shoulders from 28 patients with symptomatic rotator cuff tears (pain score ≤4 on the University of California, Los Angeles [UCLA] shoulder evaluation form) who underwent bone scintigraphy followed by rotator cuff repair. Of 70 volunteers who had previously undergone bone scintigraphy for diseases unrelated to their shoulder, 34 were selected for the asymptomatic group (pain score ≥8 on the UCLA shoulder form), and 32 were selected for the no tear group. The mean radioisotope uptake in the symptomatic group was significantly higher than that in the asymptomatic group (P = .02) and the no tear group (P = .02). Ten of 28 shoulders (36%) in the symptomatic group showed increased radioisotope uptake exceeding 2 standard deviations from the mean of the no tear group. This percentage was significantly higher when compared with the asymptomatic group (0%) (P < .01). Shoulders with a symptomatic rotator cuff tear showed higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear. The radioisotope uptake in shoulders with an asymptomatic tear was comparable with that in shoulders without a tear. Positive radioisotope uptake may be associated with pain in a subgroup of patients with rotator cuff tears.

Benzoyl peroxide and clindamycin topical skin preparation decreases Propionibacterium acnes colonization in shoulder arthroscopy.

PubMed

Dizay, Hailey H; Lau, Diana G; Nottage, Wesley M

2017-07-01

Propionibacterium acnes is a gram-positive anaerobe that can lead to devastating postoperative shoulder infections. The objective of this study was to investigate whether a benzoyl peroxide and clindamycin preoperative skin preparation reduces the incidence of P. acnes colonization during shoulder arthroscopy. Sixty-five shoulder arthroscopy patients were prospectively enrolled. A skin culture specimen was taken at the preoperative visit from standard arthroscopic portal sites. Topical benzoyl peroxide 5% and clindamycin 1.2% (BPO/C) gel was applied to the shoulder every night before surgery. Skin culture was repeated in the operating room before preparation with chlorhexidine gluconate. Shoulder arthroscopy proceeded, with final culture specimens obtained from within the shoulder. P. acnes skin colonization remained similar to prior studies at 47.7% (31 of 65 patients.) With >1 application, BPO/C was 78.9% (15 of 19 patients) effective in eliminating P. acnes superficial colonization. With 1 application, it was 66.7% (8 of 12 patients) effective in eliminating superficial colonization. Deep colonization was reduced to 3.1% (2 of 65 patients) compared with previous studies of 15% to 20% (P = .006). BPO/C was 100% effective at decreasing deep colonization with >1 application. P. acnes skin colonization is high at arthroscopic shoulder portals, especially in men. Despite standard skin preparation and prophylactic antibiotics, the rate of joint inoculation is much higher than the rate of infection reported in the literature. BPO/C effectively reduces P. acnes colonization in shoulder arthroscopy. It should be considered for use before shoulder procedures with a time-related trend of >1 application. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effect of forearm axially rotated posture on shoulder load and shoulder abduction / flexion angles in one-armed arrest of forward falls.

PubMed

Hsu, Hsiu-Hao; Chou, You-Li; Lou, Shu-Zon; Huang, Ming-Jer; Chou, Paul Pei-Hsi

2011-03-01

Falling onto the outstretched hand is the most common cause of upper extremity injury. This study develops an experimental model for evaluating the shoulder load during a simulated forward fall onto one hand with three different forearm axially rotated postures, and examines the shoulder abduction angle and shoulder flexion angle in each case. Fifteen healthy young male subjects with an average age of 23.7 years performed a series of one-armed arrests from a height of 5 cm onto a force plate. The kinematics and kinetics of the upper extremity were analyzed for three different forearm postures, namely 45° externally rotated, non-rotated, and 45° internally rotated. The shoulder joint load and shoulder abduction/flexion angles were significantly dependent on the rotational posture of the forearm. The shoulder medio-lateral shear forces in the externally rotated group were found to be 1.61 and 2.94 times higher than those in the non-rotated and internally rotated groups, respectively. The shoulder flexion angles in the externally rotated, non-rotated and internally rotated groups were 0.6°, 8.0° and 19.2°, respectively, while the corresponding shoulder abduction angles were 6.1°, 34.1° and 46.3°, respectively. In falls onto the outstretched hand, an externally rotated forearm posture should be avoided in order to reduce the medio-lateral shear force acting on the shoulder joint. In falls of this type, a 45° internally rotated forearm posture represents the most effective fall strategy in terms of minimizing the risk of upper extremity injuries. Copyright © 2010 Elsevier Ltd. All rights reserved.

Effectiveness of sustained stretching of the inferior capsule in the management of a frozen shoulder.

PubMed

Paul, Antony; Rajkumar, Joshua Samuel; Peter, Smita; Lambert, Litson

2014-07-01

Physiotherapy treatment of frozen shoulder is varied, but most lack specific focus on the underlying disorder, which is the adhered shoulder capsule. Although positive effects were found after physiotherapy, the recurrence and prolonged disability of a frozen shoulder are major factors to focus on to provide the appropriate treatment. We wished to study the effectiveness of a shoulder countertraction apparatus on ROM, pain, and function in patients with a frozen shoulder and compare their results with those of control subjects who received conventional physiotherapy. A total of 100 participants were randomly assigned to an experimental group and a control group, with each group having 50 participants. The control group received physiotherapy and the experimental group received countertraction and physiotherapy. The total treatment time was 20 minutes a day for 5 days per week for 2 weeks. The outcome measures used were goniometer measurements, VAS, and the Oxford Shoulder Score. Improvements were seen in the scores for shoulder flexion (94.1° ± 19.79° at baseline increased to 161.9° ± 13.05° after intervention), abduction ROM (90.4° ± 21.18° at baseline increased to 154.8° ± 13.21° after intervention), and pain (8.00 ± 0.78 at baseline decreased to 3.48 ± 0.71 after intervention) in the experimental group. Sixty percent of the participants (n = 30) were improved to the fourth stage of satisfactory joint function according to the Oxford Shoulder Score in the experimental group compared with 18% (n = 9) in the control group (p < 0.001). Incorporating shoulder countertraction along with physiotherapy improves shoulder function compared with physiotherapy alone for the treatment of a frozen shoulder. Additional studies are needed focusing on this concept to increase the generalizability of the counter-traction apparatus in various groups. Level II, prospective comparative study. See the Instructions for Authors for a complete description of levels of evidence.

Comparison of functional outcomes of reverse shoulder arthroplasty with those of hemiarthroplasty in the treatment of cuff-tear arthropathy: a matched-pair analysis.

PubMed

Young, Simon W; Zhu, Mark; Walker, Cameron G; Poon, Peter C

2013-05-15

Rotator cuff-tear arthropathy has traditionally represented a challenge to the shoulder arthroplasty surgeon. The poor results of conventional total shoulder arthroplasty in rotator-cuff-deficient shoulders due to glenoid component loosening have led to hemiarthroplasty being the traditional preferred surgical option. Recently, reverse total shoulder arthroplasty has gained increasing popularity because of a clinical perception of an improved functional outcome, despite the lack of comparative data. The aim of this study was to compare the early functional results of hemiarthroplasty with those of reverse shoulder arthroplasty in the management of cuff-tear arthropathy. The results of 102 primary hemiarthroplasties for rotator cuff-tear arthropathy were compared with those of 102 reverse shoulder arthroplasties performed for the same diagnosis. Patients were identified from the New Zealand Joint Registry and matched for age, sex, and American Society of Anesthesiologists (ASA) scores. Oxford Shoulder Scores (OSS) collected at six months postoperatively as well as mortality and revision rates were compared between the two groups. There were fifty-one men and fifty-one women in each group, with a mean age of 71.6 years in the hemiarthroplasty group and 72.6 years in the reverse shoulder arthroplasty group. The mean OSS at six months was 31.1 in the hemiarthroplasty group and 37.5 in the reverse shoulder arthroplasty group. At the time of follow-up, there were nine revisions in the hemiarthroplasty group and five in the reverse shoulder arthroplasty group. No difference in mortality rate was seen between the two groups. In this unselected population with rotator cuff-tear arthropathy, controlled for age, sex, and ASA score, reverse shoulder arthroplasty resulted in a functional outcome that was superior to that of hemiarthroplasty. Longer-term follow-up is needed to confirm these findings.

Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain.

PubMed

Shanahan, E M; Ahern, M; Smith, M; Wetherall, M; Bresnihan, B; FitzGerald, O

2003-05-01

Shoulder pain from inflammatory arthritis and/or degenerative disease is a common cause of morbidity in the community. It is difficult to treat and there are limited data on the efficacy of most interventions. Suprascapular nerve block has shown promise in limited trials in reducing shoulder pain. There have been no large randomised placebo controlled trials examining the efficacy of suprascapular nerve block for shoulder pain in arthritis and/or degenerative disease using pain and disability end points. To perform a randomised, double blind, placebo controlled trial of the efficacy of suprascapular nerve block for shoulder pain in rheumatoid arthritis (RA) and/or degenerative disease of the shoulder. 83 people with chronic shoulder pain from degenerative disease or RA took part in the trial. If a person had two painful shoulders, these were randomised separately. A total of 108 shoulders were randomised. Patients in the group receiving active treatment had a single suprascapular nerve block following the protocol described by Dangoisse et al, while those in the other group received a placebo injection of normal saline administered subcutaneously. The patients were followed up for 12 weeks by an observer who was unaware of the randomisation and reviewed at weeks 1, 4, and 12 after the injection. Pain, disability, and range of movement data were gathered. Clinically and statistically significant improvements in all pain scores, all disability scores, and some range of movement scores in the shoulders receiving suprascapular nerve block compared with those receiving placebo were seen at weeks 1, 4, and 12. There were no significant adverse effects in either group. Suprascapular nerve block is a safe and efficacious treatment for the treatment of shoulder pain in degenerative disease and/or arthritis. It improves pain, disability, and range of movement at the shoulder compared with placebo. It is a useful adjunct treatment for the practising clinician to assist in the management of a difficult and common clinical problem.

Shoulder Injuries in US Astronauts Related to EVA Suit Design

NASA Technical Reports Server (NTRS)

Scheuring, R. A.; McCulloch, P.; Van Baalen, Mary; Minard, Charles; Watson, Richard; Blatt, T.

2011-01-01

Introduction: For every one hour spent performing extravehicular activity (EVA) in space, astronauts in the US space program spend approximately six to ten hours training in the EVA spacesuit at NASA-Johnson Space Center's Neutral Buoyancy Lab (NBL). In 1997, NASA introduced the planar hard upper torso (HUT) EVA spacesuit which subsequently replaced the existing pivoted HUT. An extra joint in the pivoted shoulder allows increased mobility but also increased complexity. Over the next decade a number of astronauts developed shoulder problems requiring surgical intervention, many of whom performed EVA training in the NBL. This study investigated whether changing HUT designs led to shoulder injuries requiring surgical repair. Methods: US astronaut EVA training data and spacesuit design employed were analyzed from the NBL data. Shoulder surgery data was acquired from the medical record database, and causal mechanisms were obtained from personal interviews Analysis of the individual HUT designs was performed as it related to normal shoulder biomechanics. Results: To date, 23 US astronauts have required 25 shoulder surgeries. Approximately 48% (11/23) directly attributed their injury to training in the planar HUT, whereas none attributed their injury to training in the pivoted HUT. The planar HUT design limits shoulder abduction to 90 degrees compared to approximately 120 degrees in the pivoted HUT. The planar HUT also forces the shoulder into a forward flexed position requiring active retraction and extension to increase abduction beyond 90 degrees. Discussion: Multiple factors are associated with mechanisms leading to shoulder injury requiring surgical repair. Limitations to normal shoulder mechanics, suit fit, donning/doffing, body position, pre-existing injury, tool weight and configuration, age, in-suit activity, and HUT design have all been identified as potential sources of injury. Conclusion: Crewmembers with pre-existing or current shoulder injuries or certain anthropometric body types should conduct NBL EVA training in the pivoted HUT.

Posterior axilla sling traction for shoulder dystocia: case review and a new method of shoulder rotation with the sling.

PubMed

Cluver, Catherine Anne; Hofmeyr, G Justus

2015-06-01

The purpose of this study was to report on all cases in which posterior axilla sling traction (PAST) has been used to deliver cases of intractable shoulder dystocia and to describe a new method of shoulder rotation with the sling. A record of all published and known cases was collected that included information on preliminary obstetric techniques that were used and how the PAST technique was performed. Maternal outcomes that included maternal injury and length of hospital stay and fetal outcomes, which included birthweight, Apgar scores, nerve injuries, fractures, hospital stay, and outcome, were documented. We have recorded 19 cases where PAST has been used. In 5 cases, the babies had died in utero. Ten were assisted deliveries. PAST was successful in 18 cases. In one case, it was partially successful because it enabled delivery of the posterior shoulder with digital axillary traction. The most commonly used material was suction tubing. Once the posterior shoulder was delivered, the shoulder dystocia was resolved in all cases. Time from insertion to delivery was <3 minutes when recorded. The birthweights of the infants varied from 3200-4800 g. Posterior arm humerus fractures occurred in 3 cases. There was one case of a permanent Erb's palsy and 4 cases of transient Erb's palsies. None were of the posterior arm. During this review, we found that, when direct delivery of the posterior shoulder was difficult because of very severe impaction, the sling could be used to rotate the shoulders easily through 180 degrees assisted by counter pressure on the back of the anterior shoulder. This new method was used in 5 cases and may reduce fetal trauma further during difficult shoulder delivery. This review confirms that PAST can be a lifesaving technique when all another techniques for shoulder dystocia fail. Advantages are that it is easy to use (even by someone who has not seen it used previously), that the sling material is readily available, and that it is inserted quickly with 2 fingers. This is the first report of its use to rotate the posterior shoulder to the anterior position for delivery. Copyright © 2015 Elsevier Inc. All rights reserved.

Decreased Shoulder External Rotation and Flexion Are Greater Predictors of Injury Than Internal Rotation Deficits: Analysis of 132 Pitcher-Seasons in Professional Baseball.

PubMed

Camp, Christopher L; Zajac, John M; Pearson, David B; Sinatro, Alec M; Spiker, Andrea M; Werner, Brian C; Altchek, David W; Coleman, Struan H; Dines, Joshua S

2017-09-01

The primary aims of this work were to (1) describe normal range of motion (ROM) profiles for elite pitchers, (2) describe the characteristics of shoulder and elbow injuries in professional pitchers over a 6-year period in one Major League Baseball organization, and (3) identify ROM measures that were independently associated with a future shoulder or elbow injury. Over 6 seasons (2010-2015), a preseason assessment was performed on all pitchers invited to Major League Baseball Spring Training for a single organization. ROM measures included shoulder flexion, horizontal adduction, external rotation (ER), internal rotation, as well as elbow flexion and extension, were measured for both the dominant and nondominant arm, and total range of motion and deficits were calculated. All noncontact shoulder and elbow injuries were identified. Using multivariate binomial logistic regression analysis to control for age, height, weight, and all other ROM measures, the factors associated with an increased risk of subsequent shoulder or elbow injury were identified. A total of 53 shoulder (n = 25) and elbow (n = 28) injuries occurred during 132 pitcher seasons (n = 81 pitchers). The most significant categorical risk factor associated with increased elbow injury rates was the presence of a shoulder flexion deficit >5° (odds ratio [OR] 2.83; P = .042). For continuous variables, the risk of elbow injury increased by 7% for each degree of increased shoulder ER deficit (OR 1.07; P = .030) and 9% for each degree of decreased shoulder flexion (OR 1.09; P = .017). None of the measures significantly correlated with shoulder injuries. Preseason shoulder ER and flexion deficits are independent risk factors for the development of elbow injuries during the upcoming season. Although prior work has supported the importance of reducing glenohumeral internal rotation deficits in pitchers, this study demonstrates that deficits in shoulder ER and flexion are more significant predictors of subsequent elbow injury. Level III, retrospective comparative study. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

A prospective cohort study identifying risk factors for shoulder injuries in adolescent elite handball players: the Karolinska Handball Study (KHAST) study protocol.

PubMed

Asker, Martin; Waldén, Markus; Källberg, Henrik; Holm, Lena W; Skillgate, Eva

2017-11-22

Handball is a physical contact sport that includes frequent overhead throwing, and this combination leads to a high rate of shoulder injuries. Several factors have been associated with shoulder injuries in overhead athletes, but strong scientific evidence is lacking for most suggested risk factors. We therefore designed the Karolinska Handball Study (KHAST) with the aim to identify risk factors for shoulder injuries in adolescent male and female elite handball players studying at handball-profiled secondary schools in Sweden. Secondary objectives are to investigate whether shoulder function changes during the competition season and whether the physical profile of the players changes during their time in secondary school. Players aged 15 to 19 years were included during the pre-season period of the 2014-2015 and the 2015-2016 seasons. At inclusion, players signed informed consent and filled in a questionnaire regarding playing position, playing level, previous handball experience, history of shoulder problems and athletic identity. Players also completed a detailed test battery at baseline evaluating the shoulder, neck and trunk. Players were then prospectively monitored weekly during the 2014-2015 and/or 2015-2016 competitive seasons regarding injuries and training/match workload. Results from the annual routine physical tests in the secondary school curriculum including bench press, deep squat, hand grip strength, clean lifts, squat jumps, counter movement jumps, <30 m sprints, chins, dips and Cooper's test will be collected until the end of the competitive season 2017-2018. The primary outcome is the incidence of shoulder injuries and shoulder problems. The secondary outcome is the prevalence of shoulder injuries and shoulder problems. Shoulder problems are frequent among handball players and a reduction of these injuries is therefore warranted. However, in order to introduce appropriate preventive measures, a detailed understanding of the underlying risk factors is needed. Our study has a high potential to identify important risk factors for shoulder injuries in adolescent elite handball players owing to a large study sample, a high response rate, data collection during consecutive seasons, and recording of potential confounding factors.

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study

PubMed Central

Koorevaar, Rinco C. T.; van ‘t Riet, Esther; Gerritsen, Marleen J. J.; Madden, Kim; Bulstra, Sjoerd K.

2016-01-01

Background Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. Methods and Findings A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were associated with worse perceived improvement of function. Conclusions Preoperative symptoms of distress, depression, anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery. Symptoms of psychological disorders before shoulder surgery persisted in 56% of patients after surgery. Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome. PMID:27846296

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study.

PubMed

Koorevaar, Rinco C T; van 't Riet, Esther; Gerritsen, Marleen J J; Madden, Kim; Bulstra, Sjoerd K

2016-01-01

Psychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function. A prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were associated with worse perceived improvement of function. Preoperative symptoms of distress, depression, anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery. Symptoms of psychological disorders before shoulder surgery persisted in 56% of patients after surgery. Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome.

Two-year outcomes of open shoulder anterior capsular reconstruction for instability from severe capsular deficiency.

PubMed

Dewing, Christopher B; Horan, Marilee P; Millett, Peter J

2012-01-01

To document outcomes after anterior capsulolabral reconstruction for recurrent shoulder instability in 15 patients (20 shoulders) who have had multiple failed stabilizations or collagen disorders. Twenty shoulders with recurrent instability underwent revision stabilization with allograft reconstruction of anterior capsulolabral structures, which re-creates the labrum and capsular ligaments. The patients comprised 3 men and 12 women (mean age, 26 years [range, 18 to 38 years]) in whom multiple prior repairs failed and who had disability from continued pain and instability. Patients could choose to undergo either arthrodesis or salvage allograft reconstruction or to live with permanent disability. Of the patients, 5 had Ehlers-Danlos syndrome whereas 10 had hyperlaxity syndromes without genetic confirmation. Failure was defined as further instability surgery. Pain, shoulder function, instability (dislocations/subluxation), and American Shoulder and Elbow Surgeons scores were documented. At follow-up, 9 of 20 shoulders (45%) remained stable. Recurrent instability was reported in 5 shoulders (25%), but the patients chose not to undergo further surgery. In the 14 shoulders without further stabilization (nonfailures), the mean American Shoulder and Elbow Surgeons score increased 43 points at a mean of 3.8 years (range, 2 to 6 years) postoperatively (P < .05). Mean satisfaction with outcome in nonfailures was 7 of 10 points (range, 1 to 10). Six shoulders failed by progressing to instability surgery at a mean of 8.6 months (range, 2.8 to 24 months). In the 6 shoulders that failed, the mean number of prior surgeries was 8 (range, 3 to 15) compared with a mean of 4 prior surgeries (range, 1 to 16) for the 9 nonfailures. Treating patients in whom multiple stabilizations have failed remains challenging. In our series 9 shoulders (45%) remained completely stable at 3.8 years. Recurrent instability (3 reinjuries) requiring further stabilization occurred in 6 (30%). Subsequent treatment for non-instability reasons was performed in 3 (15%). Instability was reported but revision surgery was not performed in 5 (25%). In 8 nonfailures (64%), the patients were highly satisfied with their surgical outcomes. Our results support this salvage procedure as a viable alternative to arthrodesis in young patients with end-stage shoulder instability or collagen disorders. Level IV, therapeutic case series. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Influence of Bony Defects on Preoperative Shoulder Function in Recurrent Anteroinferior Shoulder Instability.

PubMed

Wolke, Julia; Herrmann, Diem Anh; Krannich, Alexander; Scheibel, Markus

2016-05-01

Recurrent anteroinferior shoulder dislocations are often associated with bony glenoid and humeral defects. The influence of those bony lesions on the postoperative outcomes after arthroscopic shoulder stabilization procedures has been the subject of many studies. Little is known about the influence of those lesions on preoperative function. To evaluate the influence of glenoid and humeral bony defects on preoperative shoulder function in recurrent anteroinferior shoulder instability. Cross-sectional study; Level of evidence, 3. Included in the study were 90 patients (70 men, 20 women; mean age, 27.1 years; 24 patients with prior failed stabilization) with posttraumatic recurrent anteroinferior shoulder instability who underwent preoperative computed tomography (CT) of both shoulders. The glenoid index was used to measure glenoid defect on a 3-dimensional CT. Humeral head defect was measured on a 2-dimensional CT with evaluation of the Hill-Sachs quotient, product, sum, and difference. Preoperative evaluation also included the Rowe score, Constant score, Walch-Duplay score, Melbourne Instability Shoulder Score (MISS), Western Ontario Shoulder Instability Index (WOSI), and Subjective Shoulder Value (SSV). There was a weak but significant correlation of the Hill-Sachs quotient and the glenoid index with the Rowe score (P = .03, r = -0.22 and P = .03, r = 0.23, respectively). Furthermore, the Hill-Sachs product significantly correlated with the WOSI (P = .02); in particular, the physical symptoms subscore showed a significant correlation (P = .04). The glenoid index showed a significant correlation with the SSV (P < .01). No significant correlation was found between the Walch-Duplay score, Constant score, or MISS and bony defects. The results of this study show that objective and subjective scoring systems correlate significantly with the clinical condition of patients with recurrent shoulder instability and associated bony defects. It is recommended that clinicians use the Rowe score, WOSI, and SSV for the clinical evaluation of patients with recurrent anteroinferior shoulder instability and associated bony defects. These evaluation systems may provide an early clinical indication of bony defects. Furthermore, very poor results on these evaluations could underline the necessity of a CT scan for the diagnosis of bony defects in recurrent shoulder instability and might be helpful for decision making concerning the indication of a CT. © 2016 The Author(s).

[Observation on the clinical efficacy of shoulder pain in post-stroke shoulder-hand syndrome treated with floating acupuncture and rehabilitation training].

PubMed

Wang, Jun; Cui, Xiao; Ni, Huan-Huan; Huang, Chun-Shui; Zhou, Cui-Xia; Wu, Ji; Shi, Jun-Chao; Wu, Yi

2013-04-01

To compare the efficacy difference in the treatment of shoulder pain in post-stroke shoulder-hand syndrome among floating acupuncture, oral administration of western medicine and local fumigation of Chinese herbs. Ninety cases of post-stroke shoulder-hand syndrome (stage I) were randomized into a floating acupuncture group, a western medicine group and a local Chinese herbs fumigation group, 30 cases in each one. In the floating acupuncture group, two obvious tender points were detected on the shoulder and the site 80-100 mm inferior to each tender point was taken as the inserting point and stimulated with floating needling technique. In the western medicine group, mobic 7.5 mg was prescribed for oral administration. In the local Chinese herbs fumigation group, the formula for activating blood circulation and relaxing tendon was used for local fumigation. All the patients in three groups received rehabilitation training. The floating acupuncture, oral administration of western medicine, local Chinese herbs fumigation and rehabilitation training were given once a day respectively in corresponding group and the cases were observed for 1 month. The visual analogue scale (VAS) and Takagishi shoulder joint function assessment were adopted to evaluate the dynamic change of the patients with shoulder pain before and after treatment in three groups. The modified Barthel index was used to evaluate the dynamic change of daily life activity of the patients in three groups. With floating acupuncture, shoulder pain was relieved and the daily life activity was improved in the patients with post-stroke shoulder-hand syndrome, which was superior to the oral administration of western medicine and local Chinese herbs fumigation (P < 0.01). With local Chinese herbs fumigation, the improvement of shoulder pain was superior to the oral administration of western medicine. The difference in the improvement of daily life activity was not significant statistically between the local Chinese herbs fumigation and oral administration of western medicine, the efficacy was similar between these two therapies (P > 0.05). The floating acupuncture relieves shoulder pain of the patients with post-stroke shoulder-hand syndrome promptly and effectively, and the effects on shoulder pain and the improvements of daily life activity are superior to that of the oral administration of western medicine and local Chinese herbs fumigation.

Risk Factors Associated With Shoulder Pain and Disability Across the Lifespan of Competitive Swimmers

PubMed Central

Tate, Angela; Turner, Gregory N.; Knab, Sarah E.; Jorgensen, Colbie; Strittmatter, Andrew; Michener, Lori A.

2012-01-01

Context: The prevalence of shoulder pain among competitive swimmers is high, but no guidelines exist to reduce shoulder injuries. Elucidating differences between swimmers with and without shoulder pain can serve as a basis for the development of a program to prevent shoulder injury that might lead to pain and dysfunction. Objective: To determine whether physical characteristics, exposure, or training variables differ between swimmers with and without shoulder pain or disability. Design: Cross-sectional study. Setting: Multisite swimming centers. Patients or Other Participants: A total of 236 competitive female swimmers aged 8 to 77 years. Data Collection and Analysis: Participants completed the Penn Shoulder Score and underwent testing of core endurance, range of motion, muscle force production, and pectoralis minor muscle length and the Scapular Dyskinesis Test. Swimmers were grouped by age for analysis: ages 8 to 11 years (n = 42), 12 to 14 years (n = 43), 15 to 19 years (high school, n = 84), and 23 to 77 years (masters, n = 67). Comparisons were made between groups with and without pain and disability using independent t tests for continuous data and χ2 analyses and Fisher exact tests for categorical data. Results: Nine (21.4%) swimmers aged 8 to 11 years, 8 (18.6%) swimmers aged 12 to 14 years, 19 (22.6%) high school swimmers, and 13 (19.4%) masters swimmers had shoulder pain and disability. Differences that were found in 2 or more age groups between athletes with and without shoulder pain and disability included greater swimming exposure, a higher incidence of previous traumatic injury and patient-rated shoulder instability, and reduced participation in another sport in the symptomatic groups (P < .05). Reduced shoulder flexion motion, weakness of the middle trapezius and internal rotation, shorter pectoralis minor and latissimus, participation in water polo, and decreased core endurance were found in symptomatic females in single varying age groups (P < .05). Conclusions: Female competitive swimmers have shoulder pain and disability throughout their lives. Given that exposure and physical examination findings varied between athletes with and without substantial pain and disability, a program to prevent shoulder injury that might lead to pain and dysfunction appears warranted and might include exposure reduction, cross-training, pectoral and posterior shoulder stretching, strengthening, and core endurance training. PMID:22488280

Bone fragment union and remodeling after arthroscopic bony bankart repair for traumatic anterior shoulder instability with a glenoid defect: influence on postoperative recurrence of instability.

PubMed

Nakagawa, Shigeto; Ozaki, Ritsuro; Take, Yasuhiro; Mae, Tatsuo; Hayashida, Kenji

2015-06-01

Although good clinical outcomes have been reported after arthroscopic bony Bankart repair, the extent of bone union is still unclear. To investigate bone union after arthroscopic bony Bankart repair and its influence on postoperative recurrence of instability. Cohort study; Level of evidence, 3. Among 113 consecutive shoulders that underwent arthroscopic bony Bankart repair, postoperative evaluation of bone union by computed tomography (CT) was performed at various times in 81 shoulders. Bone union was investigated during 3 periods: 3 to 6 months postoperatively (first period), 7 to 12 months postoperatively (second period), and 13 months or more postoperatively (third period). The influence of the size of the preoperative glenoid defect and the size of the bone fragment on bone union was investigated, as well as the influence of bone union on postoperative recurrence of instability. In shoulders with bone union, bone fragment remodeling and changes in the glenoid defect size were also investigated. The bone union rate was 30.5% in the first period, 55.3% in the second period, and 84.6% in the third period. Among 53 shoulders with CT evaluation in the second period or later and follow-up for a minimum of 1 year, there was complete union in 33 shoulders (62.3%), partial union in 3 (5.7%), nonunion in 8 (15.1%), and no fragment on CT in 9 (17.0%). The complete union rate was 50% for 22 shoulders with small bone fragments (<5% of the glenoid diameter), 56.3% for 16 shoulders with medium fragments (5%-10%), and 86.7% for 15 shoulders with large fragments (>10%). The recurrence rate for postoperative instability was only 6.1% for shoulders with complete union, while it was 50% for shoulders with partial union, nonunion, no fragment, and no fragment on CT. The recurrence rate was significantly higher (36.4%) in shoulders with small fragments, but it was significantly lower in shoulders with bone union. In shoulders with bone union, the bone fragment frequently became larger over time, while the size of the glenoid defect decreased significantly from 18.6% preoperatively to 4.7% postoperatively. Bone union was not always achieved after arthroscopic bony Bankart repair, and union was often delayed. Recurrence of instability was significantly more frequent when bone union failed. The size of the glenoid defect decreased significantly in shoulders with bone union. © 2015 The Author(s).

Imaging of the shoulder with arthroscopic correlation.

PubMed

Sharma, Pranshu; Morrison, William B; Cohen, Steven

2013-07-01

Shoulder pain with or without trauma is a common complaint. MRI is often the most useful imaging study for evaluating the shoulder. This review provides an overview of various modalities and their role in evaluating various clinical issues in shoulder pathologies. Imaging and arthroscopic correlation of common conditions are provided. Copyright © 2013 Elsevier Inc. All rights reserved.

14 CFR 91.107 - Use of safety belts, shoulder harnesses, and child restraint systems.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 14 Aeronautics and Space 2 2014-01-01 2014-01-01 false Use of safety belts, shoulder harnesses... OPERATING AND FLIGHT RULES Flight Rules General § 91.107 Use of safety belts, shoulder harnesses, and child... board is briefed on how to fasten and unfasten that person's safety belt and, if installed, shoulder...

14 CFR 91.107 - Use of safety belts, shoulder harnesses, and child restraint systems.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 14 Aeronautics and Space 2 2012-01-01 2012-01-01 false Use of safety belts, shoulder harnesses... OPERATING AND FLIGHT RULES Flight Rules General § 91.107 Use of safety belts, shoulder harnesses, and child... board is briefed on how to fasten and unfasten that person's safety belt and, if installed, shoulder...

14 CFR 91.107 - Use of safety belts, shoulder harnesses, and child restraint systems.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 14 Aeronautics and Space 2 2011-01-01 2011-01-01 false Use of safety belts, shoulder harnesses... OPERATING AND FLIGHT RULES Flight Rules General § 91.107 Use of safety belts, shoulder harnesses, and child... fasten and unfasten that person's safety belt and, if installed, shoulder harness. (2) No pilot may cause...

14 CFR 91.107 - Use of safety belts, shoulder harnesses, and child restraint systems.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 14 Aeronautics and Space 2 2013-01-01 2013-01-01 false Use of safety belts, shoulder harnesses... OPERATING AND FLIGHT RULES Flight Rules General § 91.107 Use of safety belts, shoulder harnesses, and child... board is briefed on how to fasten and unfasten that person's safety belt and, if installed, shoulder...

14 CFR 91.107 - Use of safety belts, shoulder harnesses, and child restraint systems.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 14 Aeronautics and Space 2 2010-01-01 2010-01-01 false Use of safety belts, shoulder harnesses... OPERATING AND FLIGHT RULES Flight Rules General § 91.107 Use of safety belts, shoulder harnesses, and child... board is briefed on how to fasten and unfasten that person's safety belt and, if installed, shoulder...

Shoulder dystocia: management and documentation.

PubMed

Stitely, Michael L; Gherman, Robert B

2014-06-01

Shoulder dystocia is an obstetric emergency that occurs when the fetal shoulders become impacted at the pelvic inlet. Management is based on performing maneuvers to alleviate this impaction. A number of protocols and training mnemonics have been developed to assist in managing shoulder dystocia when it occurs. This article reviews the evidence regarding the performance, timing, and sequence of these maneuvers; reviews the mechanism of fetal injury in relation to shoulder dystocia; and discusses issues concerning documentation of the care provided during this obstetric emergency. Copyright © 2014 Elsevier Inc. All rights reserved.

Constructing a simple parametric model of shoulder from medical images

NASA Astrophysics Data System (ADS)

Atmani, H.; Fofi, D.; Merienne, F.; Trouilloud, P.

2006-02-01

The modelling of the shoulder joint is an important step to set a Computer-Aided Surgery System for shoulder prosthesis placement. Our approach mainly concerns the bones structures of the scapulo-humeral joint. Our goal is to develop a tool that allows the surgeon to extract morphological data from medical images in order to interpret the biomechanical behaviour of a prosthesised shoulder for preoperative and peroperative virtual surgery. To provide a light and easy-handling representation of the shoulder, a geometrical model composed of quadrics, planes and other simple forms is proposed.

Reverse shoulder arthroplasty.

PubMed

Jarrett, Claudius D; Brown, Brandon T; Schmidt, Christopher C

2013-07-01

The reverse shoulder arthroplasty is considered to be one of the most significant technological advancements in shoulder reconstructive surgery over the past 30 years. It is able to successfully decrease pain and improve function for patients with rotator cuff-deficient shoulders. The glenoid is transformed into a sphere that articulates with a humeral socket. The current reverse prosthesis shifts the center of rotation more medial and distal, improving the deltoid's mechanical advantage. This design has resulted in successful improvement in both active shoulder elevation and in quality of life. Copyright © 2013 Elsevier Inc. All rights reserved.

The gymnast's shoulder MRI and clinical findings.

PubMed

De Carli, A; Mossa, L; Larciprete, M; Ferretti, M; Argento, G; Ferretti, A

2012-02-01

The aim of the study was to evaluate effects of shoulder overuse in elite symptomatic or asymptomatic gymnasts. This was a university-based sport traumatology research, a cohort study, with a control group comparison. Patients included were: 21 elite male gymnasts performing in the Italian National team for at least 10 years and a control group of 10 patients (20 shoulders) of the same age and sex, randomly selected among a healthy non-athletic population who underwent shoulder MRI. Magnetic resonance imaging without contrast were performed to all participants and clinical findings were summarized. Two experienced musculoskeletal radiologists interpreted each MRI scan for multiple variables (rotator cuff tendons, labral signal, capsule), including type of measurements performed on soft tissues (muscles, tendons) to assess global modifications of the shoulders. Signal abnormalities were detected in 36/36 (100%) gymnasts' shoulders, and in 4/20 (20%) of the controls. Sixteen of 36 (44.4%) shoulders had findings consistent with SLAP tears, bilateral in four patients; anteroinferior labrum lesions were identified in 10/36 (27.7%) shoulders, as compared with none (0%) in the controls. Eight of 36 (22%) shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the controls. Increased thickness of rotator cuff tendons and hypertrophy of rotator cuff muscles and deltoid muscles were recorded: such reports were symmetrical between dominant and non dominant arms, and increased when compared to controls. Gymnasts' shoulders are significantly different from those of the general population. MRI findings, especially SLAP tears, and hypertrophy are symmetrical. SLAP tears seem to be responsible of most early retirement.

Two-stage reimplantation for treating prosthetic shoulder infections.

PubMed

Sabesan, Vani J; Ho, Jason C; Kovacevic, David; Iannotti, Joseph P

2011-09-01

Two-stage reimplantation for prosthetic joint infection reportedly has the lowest risk for recurrent infection. Most studies to date have evaluated revision surgery for infection using an anatomic prosthetic. As compared with anatomic prostheses, reverse total shoulder arthroplasty is reported to have a higher rate of infection. We determined reinfection rates, functional improvement, types and rates of complications, and influence of rotator cuff tissue on function for two-stage reimplantation for prosthetic joint infection treated with reverse shoulder arthroplasty. We retrospectively reviewed 27 patients treated with a two-stage reimplantation for prosthetic shoulder infection using a uniform protocol for management of infection; of these, 17 had reverse shoulder arthroplasty at second-stage surgery. Types of organisms cultured, recurrence rates, complications, function, and radiographic followup were reviewed for all patients. One of the 17 patients had recurrence of infection. The mean (± SD) Penn shoulder scores for patients treated with reverse shoulder arthroplasty improved from 24.9 ± 22.3 to 66.4 ± 20.8. The average motion at last followup was 123° ± 33° of forward flexion and 26° ± 8° of external rotation in patients treated with a reverse shoulder arthroplasty. The major complication rate was 35% in reverse shoulder arthroplasty, with five dislocations and one reinfection. There was no difference in final Penn score between patients with and without external rotation weakness. Shoulder function and pain improved in patients treated with a second-stage reimplantation of a reverse prosthesis and the reinfection rate was low. Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Altered scapula position in elite young cricketers with shoulder problems.

PubMed

Green, Rodney A; Taylor, Nicholas F; Watson, Lyn; Ardern, Clare

2013-01-01

Shoulder injuries associated with the throwing and fielding demands of the game are common in elite cricketers. This study aimed to identify the factors associated with shoulder injuries in an elite junior squad. Cross-sectional study. Sixty players aged 15-19 years, from the Cricket Victoria elite junior male squads completed questionnaires and 46 completed clinical assessments conducted by a physiotherapist that included shoulder strength, range of movement and scapula position. Participants were classified into two groups; players currently reporting shoulder problems (SP) and those not reporting shoulder problems (NSP) on the basis of their response to the question 'Have you had any problems with your shoulder in the last 12 months that have affected you training for or playing cricket?'. Fifteen percent (9 of 60) of participants reported shoulder problems (SP). The level of shoulder disability in participants with SP, classified on standard self-report scales, was mild to moderate. The major difference between groups was that the SP group displayed a significant downward rotation of the scapula in almost all shoulder positions. There were no differences between the two groups for training factors, range of motion, or in clinical test results. However, contrary to expectations the SP group exhibited greater strength than the NSP group on some variables. A consistently downwardly rotated scapula associated with young cricketers with SP may predispose these cricketers to ongoing injury through impingement and also through increased load on the rotator cuff muscles acting at the glenohumeral joint during throwing. Copyright © 2012 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Shoulder muscle strength in paraplegics before and after kayak ergometer training.

PubMed

Bjerkefors, Anna; Jansson, Anna; Thorstensson, Alf

2006-07-01

The purpose was to investigate if shoulder muscle strength in post-rehabilitated persons with spinal cord injury (SCI) was affected by kayak ergometer training and to compare shoulder strength in persons with SCI and able-bodied persons. Ten persons with SCI (7 males and 3 females, injury levels T3-T12) performed 60 min kayak ergometer training three times a week for 10 weeks with progressively increased intensity. Maximal voluntary concentric contractions were performed during six shoulder movements: flexion and extension (range of motion 65 degrees ), abduction and adduction (65 degrees ), and external and internal rotation (60 degrees ), with an angular velocity of 30 degrees s(-1). Position specific strength was assessed at three shoulder angles (at the beginning, middle and end of the range of motion) in the respective movements. Test-retests were performed for all measurements before the training and the mean intraclass correlation coefficient was 0.941 (95% CI 0.928-0.954). There was a main effect of kayak ergometer training with increased shoulder muscle strength after training in persons with SCI. The improvements were independent of shoulder movement, and occurred in the beginning and middle positions. A tendency towards lower shoulder muscle strength was observed in the SCI group compared to a matched reference group of able-bodied persons. Thus, it appears that post-rehabilitated persons with SCI have not managed to fully regain/maintain their shoulder muscle strength on a similar level as that of able-bodied persons, and are able to improve their shoulder muscle strength after a period of kayak ergometer training.

Computer mouse use predicts acute pain but not prolonged or chronic pain in the neck and shoulder.

PubMed

Andersen, J H; Harhoff, M; Grimstrup, S; Vilstrup, I; Lassen, C F; Brandt, L P A; Kryger, A I; Overgaard, E; Hansen, K D; Mikkelsen, S

2008-02-01

Computer use may have an adverse effect on musculoskeletal outcomes. This study assessed the risk of neck and shoulder pain associated with objectively recorded professional computer use. A computer programme was used to collect data on mouse and keyboard usage and weekly reports of neck and shoulder pain among 2146 technical assistants. Questionnaires were also completed at baseline and at 12 months. The three outcome measures were: (1) acute pain (measured as weekly pain); (2) prolonged pain (no or minor pain in the neck and shoulder region over four consecutive weeks followed by three consecutive weeks with a high pain score); and (3) chronic pain (reported pain or discomfort lasting more than 30 days and "quite a lot of trouble" during the past 12 months). Risk for acute neck pain and shoulder pain increased linearly by 4% and 10%, respectively, for each quartile increase in weekly mouse usage time. Mouse and keyboard usage time did not predict the onset of prolonged or chronic pain in the neck or shoulder. Women had higher risks for neck and shoulder pain. Number of keystrokes and mouse clicks, length of the average activity period, and micro-pauses did not influence reports of acute or prolonged pain. A few psychosocial factors predicted the risk of prolonged pain. Most computer workers have no or minor neck and shoulder pain, few experience prolonged pain, and even fewer, chronic neck and shoulder pain. Moreover, there seems to be no relationship between computer use and prolonged and chronic neck and shoulder pain.

Neonatal injury at cephalic vaginal delivery: a retrospective analysis of extent of association with shoulder dystocia.

PubMed

Iskender, Cantekin; Kaymak, Oktay; Erkenekli, Kudret; Ustunyurt, Emin; Uygur, Dilek; Yakut, Halil Ibrahim; Danisman, Nuri

2014-01-01

To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34). BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae.

Glenoid bone grafting in primary reverse total shoulder arthroplasty.

PubMed

Ernstbrunner, Lukas; Werthel, Jean-David; Wagner, Eric; Hatta, Taku; Sperling, John W; Cofield, Robert H

2017-08-01

Severe glenoid bone loss remains a challenge in patients requiring shoulder arthroplasty and may necessitate glenoid bone grafting. The purpose of this study was to determine results, complications, and rates of failure of glenoid bone grafting in primary reverse shoulder arthroplasty. Forty-one shoulders that underwent primary reverse arthroplasty between 2006 and 2013 with a minimum follow-up of 2 years (mean, 2.8 years; range, 2-6 years) were reviewed. Thirty-four (83%) received corticocancellous grafts and 7 (17%) structural grafts. Active range of motion and pain levels were significantly improved (P < .001), with mean American Shoulder and Elbow Surgeons score of 77, Simple Shoulder Test score of 9, and patient satisfaction of 93% at the most recent follow-up. Preoperative severe glenoid erosion and increasing body mass index were significantly associated with worse American Shoulder and Elbow Surgeons scores (P = .04). On radiographic evaluation, 7 patients (18%) had grade 1 or grade 2 glenoid lucency. Glenoid bone graft incorporation was observed in 31 patients (78%). Twelve patients (30%) suffered from grade 1 or grade 2 scapular notching. All of the patients with structural grafts showed graft incorporation and no signs of glenoid lucency. Although glenoid lucency, glenoid graft resorption, and scapular notching were present at short-term to midterm follow-up, none of the patients needed revision surgery. Primary reverse shoulder arthroplasty with glenoid reconstruction using bone graft relieved pain and restored shoulder function and stability. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Posterior Shoulder Instability

PubMed Central

Antosh, Ivan J.; Tokish, John M.; Owens, Brett D.

2016-01-01

Context: Posterior shoulder instability has become more frequently recognized and treated as a unique subset of shoulder instability, especially in the military. Posterior shoulder pathology may be more difficult to accurately diagnose than its anterior counterpart, and commonly, patients present with complaints of pain rather than instability. “Posterior instability” may encompass both dislocation and subluxation, and the most common presentation is recurrent posterior subluxation. Arthroscopic and open treatment techniques have improved as understanding of posterior shoulder instability has evolved. Evidence Acquisition: Electronic databases including PubMed and MEDLINE were queried for articles relating to posterior shoulder instability. Study Design: Clinical review. Level of Evidence: Level 4. Results: In low-demand patients, nonoperative treatment of posterior shoulder instability should be considered a first line of treatment and is typically successful. Conservative treatment, however, is commonly unsuccessful in active patients, such as military members. Those patients with persistent shoulder pain, instability, or functional limitations after a trial of conservative treatment may be considered surgical candidates. Arthroscopic posterior shoulder stabilization has demonstrated excellent clinical outcomes, high patient satisfaction, and low complication rates. Advanced techniques may be required in select cases to address bone loss, glenoid dysplasia, or revision. Conclusion: Posterior instability represents about 10% of shoulder instability and has become increasingly recognized and treated in military members. Nonoperative treatment is commonly unsuccessful in active patients, and surgical stabilization can be considered in patients who do not respond. Isolated posterior labral repairs constitute up to 24% of operatively treated labral repairs in a military population. Arthroscopic posterior stabilization is typically considered as first-line surgical treatment, while open techniques may be required in complex or revision settings. PMID:27697889

Axial Plane Deformity of the Shoulder in Adolescent Idiopathic Scoliosis.

PubMed

Menon, Venugopal K; Tahasildar, Naveen; Pillay, Haroon M; M, Anbuselvam

2017-05-01

Prospective observational study. To study axial plane deformation of the shoulder in adolescent idiopathic scoliosis (AIS) and try to correlate it with curve type and surgical correction. It is established that AIS is a 3-dimensional deformity. The rib hump is the most common manifestation of axial plane deformations; the least common manifestation seems to be upper trunk and shoulder rotation, which has been hitherto undescribed. Fourteen consecutive, operated cases of AIS were analyzed prospectively. Preoperative and postoperative x-rays of the spine and clinical photographs were studied. Clinical photographs (top view) were taken with patients in the sitting position, to show shoulder level in relation to the axis of the head and pelvis. Chest computed tomography scans were also studied to determine the direction of apical vertebra and trunk torsion. All 14 patients in this series had their right shoulders anteriorly rotated preoperatively (anticlockwise). The direction of rotation seemed unrelated to the curve type and shoulder elevation, although most had rib humps on the right. This shoulder rotation was corrected postoperatively by routine maneuvers done for scoliosis correction. Minor residual rotation was seen in 6 patients who also had minimal persisting rib hump. In 1 case the axial plane rotation worsened, although the shoulder level and trunk symmetry improved significantly. The apical vertebral rotation on computed tomography had little bearing on the direction of shoulder rotation. Axial plane rotation of the shoulder is a hitherto un-described dimension of AIS deformity complex. Much of it corrects spontaneously with correction of the thoracic spinal deformity.

Reflexes in the shoulder muscles elicited from the human coracoacromial ligament.

PubMed

Diederichsen, Louise Pyndt; Nørregaard, Jesper; Krogsgaard, Michael; Fischer-Rasmussen, Torsten; Dyhre-Poulsen, Poul

2004-09-01

Morphological studies have demonstrated mechanoreceptors in the capsuloligamentous structures of the shoulder joint, however knowledge of the role these joint receptors play in the control of shoulder stability is limited. We therefore investigated the effect of electrically induced afferent activity from mechanoreceptors in the coracoacromial ligament (CAL) on the activity of voluntary activated shoulder muscles in healthy humans. In study I, wire electrodes, for electrical stimulation, were inserted into the CAL in eight normal shoulders. In study II, a needle electrode was inserted into the CAL in seven normal shoulders. Electric activity was recorded from eight shoulder muscles by surface and intramuscular electrodes. During isometric contractions, electrical stimulation was applied to the CAL at two different stimulus intensities, a weak stimulus (stim-1) and a stronger stimulus (stim-2). In both experiments, electrical stimulation of the CAL elicited a general inhibition in the voluntary activated shoulder muscles. In study I the average latencies (mean+/-SE) of the muscular inhibition were 66+/-4 ms (stim-1) and 62+/-4 ms (stim-2) during isometric flexion and 73+/-3 ms (stim-1) and 73+/-5 ms (stim-2) during isometric extension. In study II the average latency (mean+/-SE) of the response was 66+/-4 ms (stim-1) during isometric flexion. Our results demonstrated a response, probably of reflex origin, from mechanoreceptors in the CAL to the shoulder muscles. The existence of this synaptic connection between mechanoreceptors in CAL and the shoulder muscles suggest a role of these receptors in muscle coordination and in the functional joint stability.

Shoulder arthroscopy simulator training improves shoulder arthroscopy performance in a cadaveric model.

PubMed

Henn, R Frank; Shah, Neel; Warner, Jon J P; Gomoll, Andreas H

2013-06-01

The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaveric model of shoulder arthroscopy. Seventeen first-year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and 9 of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The 2 groups were compared by use of Student t tests, and change over time within groups was analyzed with paired t tests. There were no observed differences between the 2 groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (P < .05). Time to completion was significantly faster in the simulator group compared with controls at the final evaluation (P < .05). No difference was observed between the groups on the subjective scores at the final evaluation (P = .98). Shoulder arthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaveric model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. There may be a role for simulator training in shoulder arthroscopy education. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Shoulder Arthroscopy Simulator Training Improves Shoulder Arthroscopy Performance in a Cadaver Model

PubMed Central

Henn, R. Frank; Shah, Neel; Warner, Jon J.P.; Gomoll, Andreas H.

2013-01-01

Purpose The purpose of this study was to quantify the benefits of shoulder arthroscopy simulator training with a cadaver model of shoulder arthroscopy. Methods Seventeen first year medical students with no prior experience in shoulder arthroscopy were enrolled and completed this study. Each subject completed a baseline proctored arthroscopy on a cadaveric shoulder, which included controlling the camera and completing a standard series of tasks using the probe. The subjects were randomized, and nine of the subjects received training on a virtual reality simulator for shoulder arthroscopy. All subjects then repeated the same cadaveric arthroscopy. The arthroscopic videos were analyzed in a blinded fashion for time to task completion and subjective assessment of technical performance. The two groups were compared with students t-tests, and change over time within groups was analyzed with paired t-tests. Results There were no observed differences between the two groups on the baseline evaluation. The simulator group improved significantly from baseline with respect to time to completion and subjective performance (p<0.05). Time to completion was significantly faster in the simulator group compared to controls at final evaluation (p<0.05). No difference was observed between the groups on the subjective scores at final evaluation (p=0.98). Conclusions Shoulder arthroscopy simulator training resulted in significant benefits in clinical shoulder arthroscopy time to task completion in this cadaver model. This study provides important additional evidence of the benefit of simulators in orthopaedic surgical training. Clinical Relevance There may be a role for simulator training in shoulder arthroscopy education. PMID:23591380

Online resources for shoulder instability: what are patients reading?

PubMed

Garcia, Grant H; Taylor, Samuel A; Dy, Christopher J; Christ, Alexander; Patel, Ronak M; Dines, Joshua S

2014-10-15

Evaluations of the medical literature suggest that many online sites provide poor-quality information. The purpose of our study was to investigate the value of online resources for patient education about shoulder instability. Three search terms ("shoulder instability," "loose shoulder," and "shoulder dislocation") were entered into three Internet search engines. Three orthopaedic residents independently gauged the quality and accuracy of the information with use of a set of predetermined scoring criteria, in addition to noting whether or not four potential surgery options were mentioned. The readability of the web sites was evaluated with use of the Flesch-Kincaid score. Eighty-two unique web sites were evaluated. Quality and accuracy were significantly higher with use of the term "shoulder instability" compared with the term "loose shoulder" (quality, p < 0.001; accuracy, p = 0.001). However, the reading level was significantly more advanced for the "shoulder instability" web sites (p < 0.001). Quality was significantly higher on web sites with reading levels above the eighth grade level (p = 0.001) (88% of web sites). Only twenty-three sites (28%) mentioned surgical options for shoulder instability, and of these, only eight mentioned thermal capsulorrhaphy as a primary treatment. Online information regarding shoulder instability is often inaccurate and/or at an inappropriately high reading level. The quality of information is highly dependent on the specific search term used. Clinicians need to be aware of the information that is available online and should help direct patients to proper sites and guide Internet search terms. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

The Relationship Between Maximum Isometric Strength and Ball Velocity in the Tennis Serve.

PubMed

Baiget, Ernest; Corbi, Francisco; Fuentes, Juan Pedro; Fernández-Fernández, Jaime

2016-12-01

The aims of this study were to analyze the relationship between maximum isometric strength levels in different upper and lower limb joints and serve velocity in competitive tennis players as well as to develop a prediction model based on this information. Twelve male competitive tennis players (mean ± SD; age: 17.2 ± 1.0 years; body height: 180.1 ± 6.2 cm; body mass: 71.9 ± 5.6 kg) were tested using maximum isometric strength levels (i.e., wrist, elbow and shoulder flexion and extension; leg and back extension; shoulder external and internal rotation). Serve velocity was measured using a radar gun. Results showed a strong positive relationship between serve velocity and shoulder internal rotation (r = 0.67; p < 0.05). Low to moderate correlations were also found between serve velocity and wrist, elbow and shoulder flexion - extension, leg and back extension and shoulder external rotation (r = 0.36 - 0.53; p = 0.377 - 0.054). Bivariate and multivariate models for predicting serve velocity were developed, with shoulder flexion and internal rotation explaining 55% of the variance in serve velocity (r = 0.74; p < 0.001). The maximum isometric strength level in shoulder internal rotation was strongly related to serve velocity, and a large part of the variability in serve velocity was explained by the maximum isometric strength levels in shoulder internal rotation and shoulder flexion.

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. Copyright © 2014 Elsevier Ltd. All rights reserved.

Relationship between severity of shoulder subluxation and soft-tissue injury in hemiplegic stroke patients.

PubMed

Huang, Shih-Wei; Liu, Sen-Yung; Tang, Hao-Wei; Wei, Ta-Sen; Wang, Wei-Te; Yang, Chao-Pin

2012-09-01

The aims of this study were: (i) to determine whether the severity of post-hemiplegic shoulder subluxation in stroke patients correlates with soft-tissue injury; and (ii) to determine the shoulder subluxation measurement cut-off points that are indications for further ultrasound examination for soft-tissue injuries in these patients. Cross-sectional study. A total of 39 stroke patients with shoulder subluxation. Shoulder subluxation was evaluated by physical examination, radiography and ultrasound. Soft-tissue injuries were assessed by ultrasound. Subluxation parameters were entered into stepwise logistic regression analyses to predict biceps and supraspinatus tendonitis. With the assumption that shoulder subluxation can be a predisposing factor for tendonitis, receiver operating characteristic curves for shoulder subluxation parameters of the affected side were used to determine cut-off points for optimal sensitivity and specificity of biceps and supraspinatus tendonitis. Shoulder subluxation lateral distance, measured by physical examination, is a predictor for supraspinatus tendonitis (odds ratio = 34.9, p = 0.036). Further ultrasound investigation for soft-tissue injury is indicated when subluxation lateral distance, measured by physical examination is ≥ 2.25 cm or, measured by radiographic examination, ≥ 3.18 cm for lateral distance, ≥ 3.08 cm for vertical distance, or ≥ 2.65 cm for horizontal distance. When post-hemiplegic shoulder subluxation measurements exceed the above-mentioned cut-off points in physical or radiographic examinations, further ultrasound evaluation for soft-tissue injury is recommended.

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

Functional outcomes after shoulder resection: the patient's perspective.

PubMed

Stevens, Nicole M; Kim, H Mike; Armstrong, April D

2015-09-01

Resection arthroplasty is a salvage procedure used for the treatment of deep-seated infections after total shoulder arthroplasty, hemiarthroplasty, and reverse total shoulder arthroplasty. Previous studies have reported a 50% to 66% rate of pain relief after resection arthroplasty but with significant functional limitations. Our study aimed to qualify the perspective of the patients on their limitations and satisfaction with resection arthroplasty. A retrospective record review of resection arthroplasties performed between September 2003 and December 2012 yielded 14 patients, and 7 completed the survey. The patients completed surveys with the focus on the "patient perspective." Functional scores, including American Shoulder and Elbow Surgeons, Simple Shoulder Test, Disabilities of the Arm, Shoulder, and Hand (DASH), DASH work, and DASH sports, were determined. Pain reduction and functional outcomes were similar to past reports of resection arthroplasty. Five of the 7 patients (71%) reported satisfaction with their resection arthroplasty, and 6 of the 7 patients (86%) would undergo the procedure again if given the choice. Five of the 7 patients (71%) were able to most of activities of daily living. Patients in our study were generally satisfied with their resection arthroplasty. Resection arthroplasty is a reasonable option for treatment of deep-seated periprosthetic infections or for patients with multiple previous failed procedures for total shoulder arthroplasty, hemiarthroplasty. and reverse shoulder arthroplasty. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Myofascial involvement of supra- and infraspinatus muscles contributes to ipsilateral shoulder pain after muscle-sparing thoracotomy and video-assisted thoracic surgery.

PubMed

Ohmori, Aki; Iranami, Hiroshi; Fujii, Keisuke; Yamazaki, Akinori; Doko, Yukari

2013-12-01

This study examined the hypothesis that ipsilateral upper extremity elevation for muscle-sparing thoracotomy procedures contributes to the postoperative shoulder pain. Prospective observational study. Medical center. ASA physical status 1-2 patients undergoing elective lung surgeries including pneumonectomy, lobectomy, and segmentectomy performed through either the anterolateral approach or video-assisted thoracotomy surgery. Postoperative observation of ipsilateral shoulder pain. Postoperative examinations of sites of shoulder pain (clavicle, anterior, lateral,or posterior aspect of acromion, posterior neck, supraspinatus, infraspinatus, and these entire areas) with or without trigger points, visual analog scale score of wound pain, and requested counts of analgesics. The number of patients who suffered from postoperative shoulder pain was 37 of 70 (52.9%). Demographic data, anterolateral/VATS ratio, VAS scores, and requested counts of rescue analgesics requirement were similar in the groups of patients with and without postoperative shoulder pain. The segmentectomy caused a significantly higher incidence of postoperative shoulder pain compared with other procedures (p < 0.05). The supra- and infraspinatus were significantly higher areas of painful regions compared to the other sites. The 16 of 37 patients (43.2%) with shoulder pain showed defined trigger points in their painful areas. These results supported the hypothesis that myofascial involvement contributed, to some extent, to shoulder pain after muscle-sparing thoracotomy with ipsilateral upper extremity elevation. Copyright © 2013 Elsevier Inc. All rights reserved.

46 CFR 160.031-4 - Equipment for shoulder gun type line-throwing appliance.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 46 Shipping 6 2014-10-01 2014-10-01 false Equipment for shoulder gun type line-throwing appliance... Appliance, Shoulder Gun Type (and Equipment) § 160.031-4 Equipment for shoulder gun type line-throwing... the gun. The line canister shall be secured by clamps or brackets below the barrel of the gun. (c) One...

46 CFR 160.031-4 - Equipment for shoulder gun type line-throwing appliance.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 6 2010-10-01 2010-10-01 false Equipment for shoulder gun type line-throwing appliance... Appliance, Shoulder Gun Type (and Equipment) § 160.031-4 Equipment for shoulder gun type line-throwing... the gun. The line canister shall be secured by clamps or brackets below the barrel of the gun. (c) One...

46 CFR 160.031-4 - Equipment for shoulder gun type line-throwing appliance.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 46 Shipping 6 2013-10-01 2013-10-01 false Equipment for shoulder gun type line-throwing appliance... Appliance, Shoulder Gun Type (and Equipment) § 160.031-4 Equipment for shoulder gun type line-throwing... the gun. The line canister shall be secured by clamps or brackets below the barrel of the gun. (c) One...

46 CFR 160.031-4 - Equipment for shoulder gun type line-throwing appliance.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 46 Shipping 6 2012-10-01 2012-10-01 false Equipment for shoulder gun type line-throwing appliance... Appliance, Shoulder Gun Type (and Equipment) § 160.031-4 Equipment for shoulder gun type line-throwing... the gun. The line canister shall be secured by clamps or brackets below the barrel of the gun. (c) One...

46 CFR 160.031-4 - Equipment for shoulder gun type line-throwing appliance.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 46 Shipping 6 2011-10-01 2011-10-01 false Equipment for shoulder gun type line-throwing appliance... Appliance, Shoulder Gun Type (and Equipment) § 160.031-4 Equipment for shoulder gun type line-throwing... the gun. The line canister shall be secured by clamps or brackets below the barrel of the gun. (c) One...

[Shoulder disability questionnaires: a systematic review].

PubMed

Fayad, F; Mace, Y; Lefevre-Colau, M M

2005-07-01

To identify all available shoulder disability questionnaires designed to measure physical functioning and to examine those with satisfactory clinimetric quality. We used the Medline database and the "Guide des outils de mesure de l'évaluation en médecine physique et de réadaptation" textbook to search for questionnaires. Analysis took into account the development methodology, clinimetric quality of the instruments and frequency of their utilization. We classified the instruments according to the International Classification of Functioning, Disability and Health. Thirty-eight instruments have been developed to measure disease-, shoulder- or upper extremity-specific outcome. Four scales assess upper-extremity disability and 3 others shoulder disability. We found 6 scales evaluating disability and shoulder pain, 7 scales measuring the quality of life in patients with various conditions of the shoulder, 14 scales combining objective and subjective measures, 2 pain scales and 2 unclassified scales. Older instruments developed before the advent of modern measurement development methodology usually combine objective and subjective measures. Recent instruments were designed with appropriate methodology. Most are self-administered questionnaires. Numerous shoulder outcome measure instruments are available. There is no "gold standard" for assessing shoulder function outcome in the general population.

Sex, shoulder pain, and range of motion in manual wheelchair users.

PubMed

Wessels, Karla K; Brown, Jennifer L; Ebersole, Kyle T; Sosnoff, Jacob J

2013-01-01

Upwards of 70% of manual wheelchair users (MWUs) experience shoulder pain. Pain is more prevalent among females than males. The causes of this sex discrepancy are not understood. Decreased range of motion (ROM) has been suggested as a major contributor, but the interaction of sex, ROM, and shoulder pain has not been investigated, thus the purpose of this investigation. We divided 30 MWUs (18 males, 12 females; 21.93 +/- 3.77 yr) into two groups based on self-reported shoulder pain: pain group (n = 14; 9 males, 5 females) and no pain group (n = 16; 9 males, 7 females). We used a digital goniometer to assess ROM. Participants' shoulder active and passive ROMs were tested bilaterally on the following joint motions: flexion, extension, abduction, adduction, internal rotation, and external rotation. We used a visual analog scale to assess shoulder pain. Of the participants, 47% reported shoulder pain. Overall, the no pain group had greater ROM than the pain group, with further analysis revealing this association was only significant in females during extension (p < 0.05). ROM impairments were only present in extension in females with shoulder pain. The mechanism underlying this sex difference is not clear.

Effect of reverse shoulder design philosophy on muscle moment arms.

PubMed

Hamilton, Matthew A; Diep, Phong; Roche, Chris; Flurin, Pierre Henri; Wright, Thomas W; Zuckerman, Joseph D; Routman, Howard

2015-04-01

This study analyzes the muscle moment arms of three different reverse shoulder design philosophies using a previously published method. Digital bone models of the shoulder were imported into a 3D modeling software and markers placed for the origin and insertion of relevant muscles. The anatomic model was used as a baseline for moment arm calculations. Subsequently, three different reverse shoulder designs were virtually implanted and moment arms were analyzed in abduction and external rotation. The results indicate that the lateral offset between the joint center and the axis of the humerus specific to one reverse shoulder design increased the external rotation moment arms of the posterior deltoid relative to the other reverse shoulder designs. The other muscles analyzed demonstrated differences in the moment arms, but none of the differences reached statistical significance. This study demonstrated how the combination of variables making up different reverse shoulder designs can affect the moment arms of the muscles in different and statistically significant ways. The role of humeral offset in reverse shoulder design has not been previously reported and could have an impact on external rotation and stability achieved post-operatively. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Association between Propionibacterium acnes and frozen shoulder: a pilot study

PubMed Central

Bunker, Tim D; Gallacher, Sian; Auckland, Cressida R; Kitson, Jeff; Smith, Chris D

2014-01-01

Background Frozen shoulder has not previously been shown to be associated with infection. The present study set out to confirm the null hypothesis that there is no relationship between infection and frozen shoulder using two modern scientific methods, extended culture and polymerase chain reaction (PCR) for bacterial nucleic acids. Methods A prospective cohort of 10 patients undergoing arthroscopic release for stage II idiopathic frozen shoulder had two biopsies of tissue taken from the affected shoulder joint capsule at the time of surgery, along with control biopsies of subdermal fat. The biopsies and controls were examined with extended culture and PCR for microbial nucleic acid. Results Eight of the 10 patients had positive findings on extended culture in their shoulder capsule and, in six of these, Propionibacterium acnes was present. Conclusions The findings mean that we must reject the null hypothesis that there is no relationship between infection and frozen shoulder. More studies are urgently needed to confirm or refute these findings. If they are confirmed, this could potentially lead to new and effective treatments for this common, painful and disabling condition. Could P. acnes be the Helicobacter of frozen shoulder? PMID:27582943

Design and evaluation of prosthetic shoulder controller

PubMed Central

Barton, Joseph E.; Sorkin, John D.

2015-01-01

We developed a 2-degree-of-freedom (DOF) shoulder position transducer (sensing shoulder protraction-retraction and elevation-depression) that can be used to control two of a powered prosthetic humerus' DOFs. We also developed an evaluation protocol based on Fitts' law to assess the performance of our device. The primary motivation for this work was to support development of powered prosthetic shoulder joints of a new generation of prosthetic arms for people with shoulder disarticulation and very high-level transhumeral amputation. We found that transducers that provided resistance to shoulder movement performed better than those providing no resistance. We also found that a position control scheme, where effector position is proportional to shoulder position, performed better than a velocity control scheme, where effector velocity is proportional to shoulder position. More generally, our transducer can be used to control motion along any two DOFs. It can also be used in a more general 4-DOF control scheme by sequentially controlling two DOFs at a time. The evaluation protocol has general applicability for researchers and practitioners. Researchers can employ it to compare different prosthesis designs and control schemes, while practitioners may find the evaluation protocol useful in evaluating and training people with amputation in the use of prostheses. PMID:25357185

An entropy-assisted musculoskeletal shoulder model.

PubMed

Xu, Xu; Lin, Jia-Hua; McGorry, Raymond W

2017-04-01

Optimization combined with a musculoskeletal shoulder model has been used to estimate mechanical loading of musculoskeletal elements around the shoulder. Traditionally, the objective function is to minimize the summation of the total activities of the muscles with forces, moments, and stability constraints. Such an objective function, however, tends to neglect the antagonist muscle co-contraction. In this study, an objective function including an entropy term is proposed to address muscle co-contractions. A musculoskeletal shoulder model is developed to apply the proposed objective function. To find the optimal weight for the entropy term, an experiment was conducted. In the experiment, participants generated various 3-D shoulder moments in six shoulder postures. The surface EMG of 8 shoulder muscles was measured and compared with the predicted muscle activities based on the proposed objective function using Bhattacharyya distance and concordance ratio under different weight of the entropy term. The results show that a small weight of the entropy term can improve the predictability of the model in terms of muscle activities. Such a result suggests that the concept of entropy could be helpful for further understanding the mechanism of muscle co-contractions as well as developing a shoulder biomechanical model with greater validity. Copyright © 2017 Elsevier Ltd. All rights reserved.

Rates of surgery for frozen shoulder: an experience in England.

PubMed

Kwaees, Tariq A; Charalambous, Charalambos P

2015-01-01

the aim of this study was to identify the incidence of surgical treatment for frozen shoulder in a western population. patients included in this study all resided within a well-defined area in the North West of England, all had surgery for frozen shoulder over a 3-year period and were identified from theatre logbooks of two local hospitals. Cases having surgery for shoulder stiffness other than frozen shoulder were excluded. Local and national population size estimates were based on data obtained from the UK Office for National Statistics. 117 patients underwent surgery for frozen shoulder during the period examined; of these 101 had arthroscopic arthrolysis and 16 had manipulation under anaesthesia. The overall incidence of frozen shoulder surgery was calculated at 2.67 procedures per 10,000 general population per year, and at 7.55 for those aged 40-60. surgical intervention for frozen shoulder is common, estimated at over 14,180 cases per year in England. Given the variation in costs associated with arthroscopic arthrolysis and manipulation under anaesthesia, comparative studies of the cost effectiveness of the two procedures would be of great value. 2C (outcome research).

Effects of shoulder dystocia training on the incidence of brachial plexus injury.

PubMed

Inglis, Steven R; Feier, Nikolaus; Chetiyaar, Jyothi B; Naylor, Margaret H; Sumersille, Melanie; Cervellione, Kelly L; Predanic, Mladen

2011-04-01

We sought to determine whether implementation of shoulder dystocia training reduces the incidence of obstetric brachial plexus injury (OBPI). After implementing training for maternity staff, the incidence of OBPI was compared between pretraining and posttraining periods using both univariate and multivariate analyses in deliveries complicated by shoulder dystocia. The overall incidence of OBPI in vaginal deliveries decreased from 0.40% pretraining to 0.14% posttraining (P < .01). OBPI after shoulder dystocia dropped from 30% to 10.67% posttraining (P < .01). Maternal body mass index (P < .01) and neonatal weight (P = .02) decreased and head-to-body delivery interval increased in the posttraining period (P = .03). Only shoulder dystocia training remained associated with reduced OBPI (P = .02) after logistic regression analysis. OBPI remained less in the posttraining period (P = .01), even after excluding all neonates with birthweights >2 SD above the mean. Shoulder dystocia training was associated with a lower incidence of OBPI and the incidence of OBPI in births complicated by shoulder dystocia. Copyright © 2011 Mosby, Inc. All rights reserved.

Comparison Between Neck and Shoulder Stiffness Determined by Shear Wave Ultrasound Elastography and a Muscle Hardness Meter.

PubMed

Akagi, Ryota; Kusama, Saki

2015-08-01

The goals of this study were to compare neck and shoulder stiffness values determined by shear wave ultrasound elastography with those obtained with a muscle hardness meter and to verify the correspondence between objective and subjective stiffness in the neck and shoulder. Twenty-four young men and women participated in the study. Their neck and shoulder stiffness was determined at six sites. Before the start of the measurements, patients rated their present subjective symptoms of neck and shoulder stiffness on a 6-point verbal scale. At all measurement sites, the correlation coefficients between the values of muscle hardness indices determined by the muscle hardness meter and shear wave ultrasound elastography were not significant. Furthermore, individuals' subjective neck and shoulder stiffness did not correspond to their objective symptoms. These results suggest that the use of shear wave ultrasound elastography is essential to more precisely assess neck and shoulder stiffness. Copyright © 2015 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Cryotherapy does not impair shoulder joint position sense.

PubMed

Dover, Geoffrey; Powers, Michael E

2004-08-01

To determine the effects of a cryotherapy treatment on shoulder proprioception. Crossover design with repeated measures. University athletic training and sports medicine research laboratory. Thirty healthy subjects (15 women, 15 men). A 30-minute cryotherapy treatment. Joint position sense was measured in the dominant shoulder by using an inclinometer before and after receiving 30 minutes of either no ice or a 1-kg ice bag application. Skin temperature was measured below the tip of the acromion process and recorded every 5 minutes for the entire 30 minutes and immediately after testing. Three different types of error scores were calculated for data analyses and used to determine proprioception. Separate analyses of absolute, constant, and variable error failed to identify changes in shoulder joint proprioception as a function of the cryotherapy application. Application of an ice bag to the shoulder does not impair joint position sense. The control of proprioception at the shoulder may be more complex than at other joints in the body. Clinical implications may involve modifying rehabilitation considerations when managing shoulder injuries.

Complications of shoulder arthroscopy.

PubMed

Moen, Todd C; Rudolph, Glen H; Caswell, Kyle; Espinoza, Christopher; Burkhead, Wayne Z; Krishnan, Sumant G

2014-07-01

Over the past 20 to 30 years, arthroscopic shoulder techniques have become increasingly popular. Although these techniques have several advantages over open surgery, surgical complications are no less prevalent or devastating than those associated with open techniques. Some of the complications associated with arthroscopic shoulder surgery include recurrent instability, soft-tissue injury, and neurapraxia. These complications can be minimized with thoughtful consideration of the surgical indications, careful patient selection and positioning, and a thorough knowledge of the shoulder anatomy. Deep infection following arthroscopic shoulder surgery is rare; however, the shoulder is particularly susceptible to Propionibacterium acnes infection, which is mildly virulent and has a benign presentation. The surgeon must maintain a high index of suspicion for this infection. Thromboemoblic complications associated with arthroscopic shoulder techniques are also rare, and studies have shown that pharmacologic prophylaxis has minimal efficacy in preventing these complications. Because high-quality studies on the subject are lacking, minimal evidence is available to suggest strategies for prevention. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

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 ( ...

Shoulder pain in hemiplegia.

PubMed

Andersen, L T

1985-01-01

Development of a painful shoulder in the hemiplegic patient is a significant and serious problem, because it can limit the patient's ability to reach his or her maximum functional potential. Several etiologies of shoulder pain have been identified, such as immobilization of the upper extremity, trauma to the joint structures, including brachial plexus injuries, and subluxation of the gleno-humeral joint. A review of the literature explains the basic anatomy and kinesiology of the shoulder complex, the various etiologies of hemiplegic shoulder pain, and the pros and cons of specific treatment techniques. This knowledge is essential for the occupational therapist to evaluate effectively techniques used to treat the patient with hemiplegic shoulder pain. More effective management of this problem will facilitate the patient's ability to reach his or her maximum functional potential.

Advanced servo manipulator

DOEpatents

Holt, W.E.; Kuban, D.P.; Martin, H.L.

1988-10-25

An advanced servo manipulator has modular parts. Modular motor members drive individual input gears to control shoulder roll, shoulder pitch, elbow pitch, wrist yaw, wrist pitch, wrist roll, and tong spacing. The modules include a support member, a shoulder module for controlling shoulder roll, and a sleeve module attached to the shoulder module in fixed relation thereto. The shoulder roll sleeve module has an inner cylindrical member rotatable relative to the outer cylindrical member, and upon which a gear pod assembly is mounted. A plurality of shafts are driven by the gears, which are in turn driven by individual motor modules to transmit rotary power to control elbow pitch as well as to provide four different rotary shafts across the bendable elbow joint to supply rotary motive power to a wrist member and tong member. 41 figs.

Advanced servo manipulator

DOEpatents

Holt, William E.; Kuban, Daniel P.; Martin, H. Lee

1988-01-01

An advanced servo manipulator has modular parts. Modular motor members drive individual input gears to control shoulder roll, shoulder pitch, elbow pitch, wrist yaw, wrist pitch, wrist roll, and tong spacing. The modules include a support member, a shoulder module for controlling shoulder roll, and a sleeve module attached to the shoulder module in fixed relation thereto. The shoulder roll sleeve module has an inner cylindrical member rotatable relative to the outer cylindrical member, and upon which a gear pod assembly is mounted. A plurality of shafts are driven by the gears, which are in turn driven by individual motor modules to transmit rotary power to control elbow pitch as well as to provide four different rotary shafts across the bendable elbow joint to supply rotary motive power to a wrist member and tong member.

Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis.

PubMed

Kim, Moon-Hwan; Oh, Jae-Seop

2015-01-01

[Purpose] The purpose of this study was to examine the effects of humeral head compression taping (HHCT) on the strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator cuff tendinitis were recruited. The shoulder external rotator strength was measured using a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate within-group differences in the strength of the shoulder external rotator muscle. [Results] Significantly higher shoulder external rotator peak torque and peak torque per body weight were found in the HHCT condition than in the no-taping condition. [Conclusion] HHCT may effectively increase the shoulder external rotator muscle strength in patients with rotator cuff tendinitis.

Shoulder balance in Lenke type 2 adolescent idiopathic scoliosis: Should we fuse to the second thoracic vertebra?

PubMed

Yang, Huiliang; Im, Gi Hye; Hu, Bowen; Wang, Lei; Zhou, Chunguang; Liu, Limin; Song, Yueming

2017-12-01

There are many different systems recommending upper instrumented vertebra (UIV) for Lenke type 2 adolescent idiopathic scoliosis (AIS), several of which suggest that all Lenke type 2 AIS patients should be fused to the second thoracic vertebra (T2). However, all previously proposed UIV selecting systems do not accurately predict postoperative shoulder balance. We investigated whether fusing to T2 could prevent postoperative shoulder imbalance and identified circumstances under which to fuse up to T2. We retrospectively collected all patients with typical Lenke type 2 AIS who received surgery by one spine surgeon in our hospital from 2010 to 2014. Lateral shoulder balance was assessed utilizing radiographic shoulder height difference (RSH), coracoid height difference (CHD), clavicle-rib intersection difference (CRID), and clavicle angle (CA). Medial shoulder balance was assessed by T1 tilt angle and first rib angle (FRA). Lateral shoulders were considered to be level if the absolute value of RSH was less than 10 millimeters. All patients were divided into two groups as follows: 1) T2 group: UIV of T2 (n=49); and 2) below-T2 group: UIV of T3 (n=24) or T4 (n=6). Patients were assessed before surgery and at final follow-up with a minimum follow-up duration of 24 months. Seventy-nine typical Lenke type 2 AIS patients were identified. Preoperative CHD and CA were significantly associated with postoperative lateral shoulder imbalance (both p=0.045), whereas the UIV level was not significantly associated with it. Both fusing to T2 and to below T2 could improve RSH (p<0.001 and p=0.001, respectively). Fusing to T2 slightly worsened CHD, CRID, and CA at last follow-up (all p<0.001), while fusing to below T2 improved these lateral shoulder balance parameters (p=0.042, p<0.001, and p=0.007, respectively). For medial shoulder balance, fusing to below T2 worsened T1 tilt angle and FRA at last follow-up (p=0.025 and p<0.001, respectively), while fusing to T2 effectively kept these medial shoulder parameters in balance. In addition, for patients with an elevated left border of T1, the T2 group had worse preoperative T1 tilt angle but gained better postoperative T1 tilt angle than the below-T2 group (p<0.001 and p=0.040, respectively). Preoperative lateral shoulder balance, more so than the UIV level, can strongly influence postoperative lateral shoulder balance. Fusing to T2 can only effectively improve medial shoulder balance, not lateral shoulder balance (CHD, CRID, and CA). Moreover, a positive T1 tilt angle is an indicator for fusing to T2 to improve medial shoulder balance. Copyright © 2017 Elsevier B.V. All rights reserved.

Underlying pathology and associated factors of hemiplegic shoulder pain.

PubMed

Kalichman, Leonid; Ratmansky, Motti

2011-09-01

The prevalence of hemiplegic shoulder pain is approximately 22%-23% in the general population of stroke survivors and approximately 54%-55% among stroke patients in rehabilitation settings. Hemiplegic shoulder pain causes a reduced quality-of-life, poor functional recovery, depression, disturbed sleep, and prolonged hospitalization. Herein, we attempted to understand, based on a literature review and experts' opinion, the pathologic processes underlying hemiplegic shoulder pain and the major associated factors contributing to its development. The systematization of underlying pathologies was proposed, which might eventually enable a more constructive clinical approach in evaluating and treating patients with hemiplegic shoulder pain.

Hemiplegic shoulder pain: a common clinical consequence of stroke.

PubMed

Coskun Benlidayi, Ilke; Basaran, Sibel

2014-04-01

Hemiplegic shoulder pain is common in stroke survivors, developing in up to 54% of patients. The underlying mechanisms include soft tissue lesions, impaired motor function and central nervous system-related phenomena. Hemiplegic shoulder pain has many underlying causes and is challenging to manage, requiring a team approach, including physicians, therapists and caregivers. The management strategy must target the underlying causes. Preventative measures, such as positioning and handling, can reduce the risk of developing hemiplegic shoulder pain. We have reviewed the literature on hemiplegic shoulder pain, and used this to categorise the underlying mechanisms, and to explore the best management strategies.

Emergency department management of shoulder dystocia.

PubMed

Del Portal, Daniel A; Horn, Amanda E; Vilke, Gary M; Chan, Theodore C; Ufberg, Jacob W

2014-03-01

Precipitous obstetric deliveries can occur outside of the labor and delivery suite, often in the emergency department (ED). Shoulder dystocia is an obstetric emergency with significant risk of adverse outcome. To review multiple techniques for managing a shoulder dystocia in the ED. We review various techniques and approaches for achieving delivery in the setting of shoulder dystocia. These include common maneuvers, controversial interventions, and interventions of last resort. Emergency physicians should be familiar with multiple techniques for managing a shoulder dystocia to reduce the chances of fetal and maternal morbidity and mortality. Copyright © 2014 Elsevier Inc. All rights reserved.

Sonographic Examination of The Fetus Vis-à-Vis Shoulder Dystocia: A Vexing Promise.

PubMed

Doty, Morgen S; Al-Hafez, Leen; Chauhan, Suneet P

2016-12-01

Since antepartum and intrapartum risk factors are poor at identifying women whose labor is complicated by shoulder dystocia, sonographic examination of the fetus holds promise. Though there are several measurements of biometric parameters to identify the parturient who will have shoulder dystocia, none are currently clinically useful. Three national guidelines confirm that sonographic measurements do not serve as appropriate diagnostic tests to identify women who will have shoulder dystocia with or without concurrent injury. In summary, biometric measurements of the fetus should not be used to alter clinical management with the aim of averting shoulder dystocia.

Shoulder injuries - management in general practice.

PubMed

Brun, Shane

2012-04-01

Shoulder injuries are common in the primary care setting, yet general practitioners may feel unequipped to confidently assess the patient presenting with shoulder pain. This article provides a framework for the initial assessment of a patient presenting with an injured shoulder. A solid understanding of the anatomy and unique features of the shoulder is important to adequately assess any injury. A focused history needs to particularly explore the mechanism of injury, the type of dysfunction and the nature of the pain. On examination, particular attention should be paid to loss of symmetry, localisation of tenderness and the range of movement.

Posterior shoulder instability in the athletic population: Variations in assessment, clinical outcomes, and return to sport.

PubMed

DeLong, Jeffrey M; Bradley, James P

2015-12-18

Posterior instability of the shoulder is becoming an increasingly recognized shoulder injury in the athletic population. Diagnostic elements, such as etiology, directionality, and degree of instability are essential factors to assess in the unstable athletic shoulder. Concomitant injuries and associated pathologic lesions continue to be a significant challenge in the surgical management of posterior shoulder instability. Return to sport and previous level of play is ultimately the goal for every committed athlete and surgeon, thus subpopulations of athletes should be recognized as distinct entities requiring unique diagnostic, functional outcome measures, and surgical approaches.

Shoulder Dystocia: Incidence and Risk Factors.

PubMed

Ouzounian, Joseph G

2016-12-01

Shoulder dystocia complicates ∼1% of vaginal births. Although fetal macrosomia and maternal diabetes are risk factors for shoulder dystocia, for the most part its occurrence remains largely unpredictable and unpreventable.

Shoulder separation - aftercare

MedlinePlus

... collarbone (clavicle) meets the top of the shoulder blade (acromion of the scapula). It is not the ... connects the collarbone and top of the shoulder blade. These tears can also come from car accidents ...

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 ...

Shoulder dystocia: prediction and management.

PubMed

Hill, Meghan G; Cohen, Wayne R

2016-01-01

Shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. In this review, we discuss the risk factors for shoulder dystocia and propose a framework for the prediction and prevention of the complication. A recommended approach to management when shoulder dystocia occurs is outlined, with review of the maneuvers used to relieve the obstruction with minimal risk of fetal and maternal injury.

How competent are you (or your staff) with shoulder dystocia?

PubMed

Wright, M; Higgins, P G

1999-01-01

Shoulder dystocia-when the fetal head retracts or recoils against the maternal perineum ("turtle sign") and external rotation is not accomplished-occurs in approximately 1 of every 200 deliveries. It's often diagnosed after the emergence of the fetal head when delivery is prevented by impaction of the fetal shoulders within or above the maternal pelvis. When it occurs, shoulder dystocia is an obstetric emergency.

Sensorimotor control and neuromuscular activity of the shoulder in adolescent competitive swimmers with generalized joint hypermobility.

PubMed

Frydendal, Thomas; Eshøj, Henrik; Liaghat, Behnam; Edouard, Pascal; Søgaard, Karen; Juul-Kristensen, Birgit

2018-05-05

Shoulder pain is highly prevalent in competitive swimmers, and generalized joint hypermobility (GJH) is considered a risk factor. Sensorimotor control deficiencies and altered neuromuscular activation of the shoulder may represent underlying factors. To investigate whether competitive swimmers with GJH including shoulder hypermobility (GJHS) differ in shoulder sensorimotor control and muscle activity from those without GJH and no shoulder hypermobility (NGJH). Competitive swimmers (aged 13-17) were recruited. GJHS or NGJH status was determined using the Beighton score (0-9) and Rotès-Quérol test (positive/negative). Inclusion criteria for GJHS were a Beighton score ≥5 and minimum one hypermobile shoulder, while NGJH was defined as a Beighton score ≤3 and no shoulder hypermobility. Three prone lying, upper-extremity weight-bearing shoulder stabilometric tests were performed on a force platform: Bilateral upper-extremity support eyes open (BL-EO) and eyes closed (BL-EC) and unilateral upper-extremity support eyes open (UL-EO). Surface electromyography (SEMG) was measured from the upper trapezius, lower trapezius, serratus anterior, infraspinatus and pectoralis major muscles. SEMG was normalized using maximal voluntary isometric contractions and presented relative to maximal voluntary SEMG (%MVE). Co-contraction index (CCI) was calculated for the following muscle pairs: upper trapezius-lower trapezius, upper trapezius-serratus anterior, and infraspinatus-pectoralis major. Between-group differences in stabilometric parameters, %MVE, and CCI were analyzed with a mixed effects model. Thirty-eight swimmers were enrolled as GJHS (n = 19) or NGJH (n = 19). There were no group differences in stabilometric parameters or CCI. GJHS displayed significantly decreased (29%) pectoralis major activity during BL-EO compared to NGJH (5.35 ± 1.77%MVE vs. 7.51 ± 1.96%MVE; p = 0.043). Adolescent competitive swimmers with GJHS displayed no shoulder sensorimotor control deficiencies and no generally altered shoulder muscle activity pattern, except for decreased pectoralis major activity in BL-EO. Longitudinal studies are needed to investigate whether decreased pectoralis major activation contributes to the development of shoulder pain in swimmers with GJHS. Copyright © 2018 Elsevier B.V. All rights reserved.

Preventing overuse shoulder injuries among throwing athletes: a cluster-randomised controlled trial in 660 elite handball players.

PubMed

Andersson, Stig Haugsboe; Bahr, Roald; Clarsen, Benjamin; Myklebust, Grethe

2017-07-01

Shoulder problems are highly prevalent among elite handball players. Reduced glenohumeral rotation, external rotation weakness and scapula dyskinesis have been identified as risk factors. Evaluate the effect of an exercise programme designed to reduce the prevalence of shoulder problems in elite handball. 45 elite handball teams (22 female teams, 23 male teams, 660 players) were cluster randomised (22 teams, 331 players in the intervention group, 23 teams, 329 players in the control group) and followed for 1 competitive season (7 months). The Oslo Sports Trauma Research Center (OSTRC) Shoulder Injury Prevention Programme, an exercise programme to increase glenohumeral internal rotation, external rotation strength and scapular muscle strength, as well as improve kinetic chain and thoracic mobility, was delivered by coaches and captains 3 times per week as a part of the handball warm-up. The main outcome measures, prevalence of shoulder problems and substantial shoulder problems, were measured monthly. The average prevalence of shoulder problems during the season was 17% (95% CI 16% to 19%) in the intervention group and 23% (95% CI 21% to 26%) in the control group (mean difference 6%). The average prevalence of substantial shoulder problems was 5% (95% CI 4% to 6%) in the intervention group and 8% (95% CI 7% to 9%) in the control group (mean difference 3%). Using generalised estimating equation models, a 28% lower risk of shoulder problems (OR 0.72, 95% CI 0.52 to 0.98, p=0.038) and 22% lower risk of substantial shoulder problems (OR 0.78, 95% CI 0.53 to 1.16, p=0.23) were observed in the intervention group compared with the control group. The OSTRC Shoulder Injury Prevention Programme reduced the prevalence of shoulder problems in elite handball and should be included as a part of the warm-up. ISRCTN96217107. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Patient self-assessed shoulder comfort and function and active motion are not closely related to surgically documented rotator cuff tear integrity.

PubMed

Hsu, Jason E; Tang, Anna; Matsen, Frederick A

2017-11-01

The rationale for rotator cuff repair surgery is that better integrity of the cuff should be associated with better comfort and function. However, in patients with cuff disease, there is not good evidence that the degree of rotator cuff integrity is closely associated with the shoulder's comfort, function, or active motion. The goal of this study was to explore these relationships in shoulders with surgically documented cuff disease. In 55 shoulders having surgery for cuff-related symptoms, we correlated the preoperative Simple Shoulder Test score with the objectively measured preoperative active shoulder motion and with the integrity of the cuff observed at surgery. The 16 shoulders with tendinosis or partial-thickness tears had an average Simple Shoulder Test score of 3.7 ± 3.3, active abduction of 111° ± 38°, and active flexion of 115° ± 36°. The corresponding values were 3.6 ± 2.8, 94° ± 47°, and 94° ± 52° for the 22 full-thickness supraspinatus tears and 3.9 ± 2.7, 89° ± 39°, and 100° ± 39° for the 17 supraspinatus and infraspinatus tears. In this study, surgically observed cuff integrity was not strongly associated with the shoulder's comfort or function. Whereas surgeons often seek to improve the integrity of the rotator cuff, the management of patients with rotator cuff disorders needs to be informed by a better understanding of the factors other than cuff integrity that influence the comfort and functioning of shoulders with cuff disease. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Radiographic evaluation of short-stem press-fit total shoulder arthroplasty: short-term follow-up.

PubMed

Casagrande, Danielle J; Parks, Di L; Torngren, Travis; Schrumpf, Mark A; Harmsen, Samuel M; Norris, Tom R; Kelly, James D

2016-07-01

Humeral loosening is an uncommon etiology for revision shoulder arthroplasty. We aimed to evaluate the radiographic and clinical outcomes of a short-stem press-fit humeral component after primary total shoulder arthroplasty. We reviewed our patient database, from January 2008 to December 2011, for primary total shoulder arthroplasties performed with a short-stem press-fit humeral component. Radiographs and clinical outcomes were evaluated in the immediate postoperative period and at the most recent follow-up, with at least 24 months of data for all patients. There were 73 shoulders that met our inclusion criteria, but 4 underwent revision before 2 years' follow-up. Only 1 of these 4 was revised for aseptic humeral loosening. Sixty-nine shoulders had at least 24 months of radiographic follow-up, and 62 had radiographic and clinical follow-up. Of the 69 shoulders, 5 underwent revision for humeral loosening: 1 for aseptic loosening and 4 for infection. Two other shoulders with humeral loosening were asymptomatic, and the patients refused revision surgery. The overall revision rate for humeral loosening was 8.2% (6 of 73 shoulders). Radiolucent zones of any size were seen in 71.0%, with 8.7% of these shoulders identified as having humeral stems at risk of future loosening. Significant improvements were made in most of the measured clinical outcomes. A high percentage of radiolucency was seen around the short-stem press-fit humeral components evaluated in this study at short-term follow-up. The overall rates of loosening and revision for the humeral implant examined in this study are higher than those noted in other recent studies evaluating press-fit stems. The cause of radiolucency and humeral loosening for this implant is not fully understood. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Pregnancy week at delivery and the risk of shoulder dystocia: a population study of 2,014,956 deliveries.

PubMed

Øverland, E A; Vatten, L J; Eskild, A

2014-01-01

To study whether pregnancy week at delivery is an independent risk factor for shoulder dystocia. Population study. Medical Birth Registry of Norway. All vaginal deliveries of singleton offspring in cephalic presentation in Norway during 1967 through 2009 (n = 2,014,956). The incidence of shoulder dystocia was calculated according to pregnancy week at delivery. The associations of pregnancy week at delivery with shoulder dystocia were estimated as crude and adjusted odds ratios using logistic regression analyses. We repeated the analyses in pregnancies with and without maternal diabetes. Shoulder dystocia at delivery. The overall incidence of shoulder dystocia was 0.73% (n = 14,820), and the incidence increased by increasing pregnancy week at delivery. Birthweight was strongly associated with shoulder dystocia. After adjustment for birthweight, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity, period of delivery and maternal age in multivariable analyses, the adjusted odds ratios for shoulder dystocia were 1.77 (1.42-2.20) for deliveries at 32-35 weeks of gestation, and 0.84 (0.79-0.88) at 42-43 weeks of gestation, using weeks 40-41 as the reference. In pregnancies affected by diabetes (n = 11,188), the incidence of shoulder dystocia was 3.95%, and after adjustment for birthweight the adjusted odds ratio for shoulder dystocia was 2.92 (95% CI 1.54-5.52) for deliveries at weeks 32-35 of gestation, and 0.91 (95% CI 0.50-1.66) at 42-43 weeks of gestation. The risk of shoulder dystocia was associated with increased birthweight, diabetes, induction of labour, use of epidural analgesia at delivery, prolonged labour, forceps-assisted and vacuum-assisted delivery, parity and period of delivery but not with post-term delivery. © 2013 Royal College of Obstetricians and Gynaecologists.

[Clinical Trial of Treatment of Cervicogenic Scapulohumeral Periarthritis by Red-hot Needle Therapy Combined with Cupping].

PubMed

Yuan, Tao; Wang, Fen

2015-10-01

To observe the therapeutic effect of red-hot needle therapy combined with cupping for cervicogenic periarthritis of shoulder. Forty-two cases of cervicogenic periarthritis of shoulder were randomized into red-hot needle group and routine acupuncture group (n = 21). For patients of the routine acupuncture group, the filiform needles were applied to Tianzhu (BL 10), Jianjing (GB 21), Jianzhongshu (SI 15), Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Jianqian, Tianzong (SI 11) and Ashi-points on the affected side, followed by conducting cupping at the anterior and posterior regions of the affected shoulder, SI 11, GB 21 and SI 15. For patients of the red-hot needle group, the Ashi-points on the affected shoulder were punctured with cauterized filiform needles, following by performing cupping. The treatment was performed once daily and once every other day respectively for two weeks. The shoulder motor function was assessed according to the adjusted Constant-Murley test. After the treatment, the integrated scores of shoulder pain, shoulder-joint activities in daily living and shoulder-joint motion range were significantly increased in both groups compared with pre-treatment in the same one group (P < 0.05) and obviously higher in the red-hot needle group than in the routine acupuncture group (P < 0.05). Of the two 21 cases of shoulder periarthritis patients in the routine acupuncture and red-hot needle groups, 4 and 8 were cured, 14 and 12 experienced improvement, 3 and 1 was invalid, with the effective rates being 85.71% and 95.24%, respectively. The therapeutic effect of the red-hot needle therapy was significantly superior to that of the routine acupuncture (P < 0.05). The red-hot needle therapy combined with cupping is effective in relieving cervicogenic shoulder periarthritis and is remarkably superior to routine acupuncture combined with cupping in improving shoulder periarthritis patients' symptoms.

Shoulder abduction and external rotation restoration with nerve transfer.

PubMed

Kostas-Agnantis, Ioannis; Korompilias, Anastasios; Vekris, Marios; Lykissas, Marios; Gkiatas, Ioannis; Mitsionis, Gregory; Beris, Alexander

2013-03-01

In upper brachial plexus palsy patients, loss of shoulder function and elbow flexion is obvious as the result of paralysed muscles innervated by the suprascapular, axillary and musculocutaneus nerve. Shoulder stabilisation, restoration of abduction and external rotation are important as more distal functions will be affected by the shoulder situation. Between 2005 and 2011, eleven patients with upper type brachial plexus palsy were operated on with triceps nerve branch transfer to anterior axillary nerve branch and spinal accessory nerve transfer to the suprascapular nerve for shoulder abduction and external rotation restoration. Nine patients met the inclusion criteria for the study. All patients were men with ages ranged from 21 to 35 years (average, 27.4 years). The interval between injury and surgery ranged from 4 to 11 months (average, 7.2 months). Atrophy of the supraspinatus, infraspinatus and deltoid muscle and subluxation at the glenohumeral joint was obvious in all patients preoperatively. During the pre-op examination all patients had at least muscle grading 4 on the triceps muscle. The mean post-operative value of shoulder abduction was 112.2° (range: 60-170°) while preoperatively none of the patients was able for abduction (p<0.001). The mean post-operative value of shoulder external rotation was 66° (range: 35-110°) while preoperatively none of them was able for external rotation (p<0.001). Postoperative values of shoulder abduction were significantly better that those of external rotation (p=0.0004). The postoperative average muscle grading for shoulder abduction according the MRC scale was 3.6±0.5 and for the shoulder external rotation was 3.2±0.4. Combined nerve transfer by using the spinal accessory nerve for suprascapular nerve neurotisation and one of the triceps nerve branches for axillary nerve and teres minor branch neurotisation is an excellent choice for shoulder abduction and external rotation restoration. Copyright © 2013 Elsevier Ltd. All rights reserved.

Anal sphincter injury in vaginal deliveries complicated by shoulder dystocia.

PubMed

Hehir, Mark P; Rubeo, Zachary; Flood, Karen; Mardy, Anne H; O'Herlihy, Colm; Boylan, Peter C; D'Alton, Mary E

2018-03-01

Shoulder dystocia is an obstetric emergency that occurs in 0.2-3% of all cephalic vaginal deliveries. We hypothesized that because of the difficult nature of deliveries complicated by shoulder dystocia, the condition may be associated with anal sphincter injury. We sought to identify risk factors for obstetric anal sphincter injury in women with shoulder dystocia. This retrospective analysis included all cases of shoulder dystocia from 2007 to 2011 at two large tertiary referral centers, in the USA and Ireland. Details of maternal demographics, intrapartum characteristics, and delivery outcomes in cases of shoulder dystocia were analyzed. Univariate and multivariate analyses were used to describe the association between shoulder dystocia and anal sphincter injury. There were 685 cases of shoulder dystocia, and the rate of shoulder dystocia was similar at both institutions. The incidence of anal sphincter injury was 8.8% (60 out of 685). The rate was 14% (45 out of 324) in nulliparas and 4.2% (15 out of 361) in multiparas. Women with sphincter injury were more likely to be nulliparous (75% [45 out of 60] vs 45% [279 out of 625]; p < 0.0001), have had an operative vaginal delivery (50% [30 out of 60] vs 36% [226 out of 625]; p = 0.03) and require internal maneuvers (50% [30 out of 60] vs 32% [198 out of 625], p = 0.004) than those with an intact sphincter. On multivariate regression analysis, these predictors of sphincter injury remained significant when adjusted for other risk factors. Episiotomy was negatively associated with sphincter injury on multivariate regression analysis. In a retrospective cohort of 685 women with shoulder dystocia, the risk of anal sphincter injury is 9%. Risk factors include nulliparity, operative vaginal delivery, and use of internal maneuvers, whereas episiotomy was found to have a protective effect against anal sphincter injury during cases of shoulder dystocia.

Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study.

PubMed

Juel, Niels Gunnar; Brox, Jens Ivar; Brunborg, Cathrine; Holte, Kristine Bech; Berg, Tore Julsrud

2017-08-01

To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and to explore the association between the long-term glycemic burden and shoulder disability in the diabetes group. Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic burden in patients with diabetes. Diabetics center and a university hospital. Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since 1970 or earlier were eligible (N=136). One hundred and five patients were included, and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free subjects (55% women; mean age, 62.5y). Not applicable. Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria. Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the diabetes-free subjects. Patients with diabetes had higher disability and higher mean QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference of -14.2 (95% confidence interval, -19.3 to -9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores, with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin A 1c (HbA 1c ) (P=.014). The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder disability than diabetes-free subjects. The historical HbA 1c level was associated with increased shoulder disability. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

In Vivo Shoulder Function After Surgical Repair of a Torn Rotator Cuff

PubMed Central

Bey, Michael J.; Peltz, Cathryn D.; Ciarelli, Kristin; Kline, Stephanie K.; Divine, George W.; van Holsbeeck, Marnix; Muh, Stephanie; Kolowich, Patricia A.; Lock, Terrence R.; Moutzouros, Vasilios

2015-01-01

Background Surgical repair of a torn rotator cuff is based on the belief that repairing the tear is necessary to restore normal glenohumeral joint (GHJ) mechanics and achieve a satisfactory clinical outcome. Hypothesis Dynamic joint function is not completely restored by rotator cuff repair, thus compromising shoulder function and potentially leading to long-term disability. Study Design Controlled laboratory study and Case series; Level of evidence, 4. Methods Twenty-one rotator cuff patients and 35 control participants enrolled in the study. Biplane radiographic images were acquired bilaterally from each patient during coronal-plane abduction. Rotator cuff patients were tested at 3, 12, and 24 months after repair of a supraspinatus tendon tear. Control participants were tested once. Glenohumeral joint kinematics and joint contact patterns were accurately determined from the biplane radiographic images. Isometric shoulder strength and patient-reported outcomes were measured at each time point. Ultrasound imaging assessed rotator cuff integrity at 24 months after surgery. Results Twenty of 21 rotator cuff repairs appeared intact at 24 months after surgery. The humerus of the patients’ repaired shoulder was positioned more superiorly on the glenoid than both the patients’ contralateral shoulder and the dominant shoulder of control participants. Patient-reported outcomes improved significantly over time. Shoulder strength also increased over time, although strength deficits persisted at 24 months for most patients. Changes over time in GHJ mechanics were not detected for either the rotator cuff patients’ repaired or contralateral shoulders. Clinical outcome was associated with shoulder strength but not GHJ mechanics. Conclusion Surgical repair of an isolated supraspinatus tear may be sufficient to keep the torn rotator cuff intact and achieve satisfactory patient-reported outcomes, but GHJ mechanics and shoulder strength are not fully restored with current repair techniques. Clinical Relevance The study suggests that current surgical repair techniques may be effective for reducing pain but have not yet been optimized for restoring long-term shoulder function. PMID:21737834

Sensorimotor Control of the Shoulder in Professional Volleyball Players with Isolated Infraspinatus Muscle Atrophy.

PubMed

Contemori, Samuele; Biscarini, Andrea; Botti, Fabio Massimo; Busti, Daniele; Panichi, Roberto; Pettorossi, Vito Enrico

2017-06-12

Isolated infraspinatus muscle atrophy (IIMA) only affects the hitting shoulder of overhead-activity athletes, and is caused by suprascapular nerve neuropathy. No study has assessed the static and dynamic stability of the shoulder in overhead professional athletes with IIMA to reveal possible shoulder sensorimotor alterations. To assess the shoulder static stability, dynamic stability, and strength in professional volleyball players with IIMA and in healthy control players. Cross-sectional study. Research laboratory. Twenty-four male professional volleyball players (12 players with diagnosed IIMA and 12 healthy players) recruited from local volleyball teams. Static stability was evaluated with two independent force platforms and dynamic stability was assessed with the "Upper Quarter Y Balance Test". The static stability assessment was conducted in different support (single hand and both hand) and vision (open and closed eyes) conditions. Data from each test were analyzed with ANOVA and paired t-test models, to highlight statistical differences within and between groups. In addition to reduced abduction and external rotation strength, athletes with IIMA consistently demonstrated significant less static (P < 0.001) and dynamic stability (P < 0,001), compared with the contralateral shoulder and with healthy athletes. Closed eyes condition significantly enhanced the static stability deficit of the shoulder with IIMA (P = 0.039 and P = 0.034 for both hand and single hand support, respectively), but had no effect in healthy contralateral and healthy players' shoulders. This study highlights an impairment of the sensorimotor control system of the shoulder with IIMA, which likely results from both proprioceptive and strength deficits. This condition could yield subtle alteration in the functional use of the shoulder and predispose it to acute or overuse injuries. The results of this study may help athletic trainers and physical/physiotherapists to prevent shoulder injuries and create specific proprioceptive and neuromuscular training programs.

Eldercare at Home: Mobility Problems

MedlinePlus

... your shoulders back. You should feel your shoulder blades pull together. Cervical Range of Motion Purpose: To ... ahead. Keep your chin tucked and your shoulder blades back. Tighten your stomach muscles. First, rise up ...

Statewide shoulders study.

DOT National Transportation Integrated Search

2015-08-01

With the ultimate purpose of enhancing safety and improving mobility, the Statewide Shoulders Study was initiated to : develop a prioritized list of candidate locations for shoulder improvements. The need for this study stems directly from : ADOTs...

Preseason screening of shoulder range of motion and humeral retrotorsion does not predict injury in high school baseball players.

PubMed

Oyama, Sakiko; Hibberd, Elizabeth E; Myers, Joseph B

2017-07-01

Shoulder and elbow injuries are commonplace in high school baseball. Although altered shoulder range of motion (ROM) and humeral retrotorsion angles have been associated with injuries, the efficacy of preseason screening of these characteristics remains controversial. We conducted preseason screenings for shoulder internal and external rotation ROM and humeral retrotorsion on 832 high school baseball players and tracked their exposure and incidence on throwing-related shoulder and elbow injuries during a subsequent season. Poisson regression with robust error variance was used to determine whether preseason screening could identify injury risk in baseball players and whether the injury risk was higher for pitchers compared with players who do not pitch. Shoulder rotation ROM or humeral retrotorsion at preseason did not predict the risk of throwing-related upper extremity injury (P = .15-.89). Injury risk was 3.84 higher for baseball players who pitched compared with those who did not (95% confidence interval, 1.72-8.56; P = .001). Preseason measures of shoulder ROM and humeral retrotorsion may not be effective in identifying players who are at increased injury risk. Because shoulder ROM is a measure that fluctuates under a variety of influences, future study should investigate whether taking multiple measurements during a season can identify at-risk players. The usefulness of preseason screening may also depend on rigor of participation in sports. Future studies should investigate how preseason shoulder characteristics and participation factors (ie, pitch count and frequency, competitive level, pitching in multiple leagues) interact to predict injury risk in baseball players. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Neonatal Injury at Cephalic Vaginal Delivery: A Retrospective Analysis of Extent of Association with Shoulder Dystocia

PubMed Central

Iskender, Cantekin; Kaymak, Oktay; Erkenekli, Kudret; Ustunyurt, Emin; Uygur, Dilek; Yakut, Halil Ibrahim; Danisman, Nuri

2014-01-01

Purpose To describe the risk factors and labor characteristics of Clavicular fracture (CF) and brachial plexus injury (BPI); and compare antenatal and labor characteristics and prognosis of obstetrical BPI associated with shoulder dystocia with obstetrical BPI not associated with shoulder dystocia. Methods This retrospective study consisted of women who gave birth to an infant with a fractured clavicle or BPI between January 2009 and June 2013. Antenatal and neonatal data were compared between groups. The control group (1300) was composed of the four singleton vaginal deliveries that immediately followed each birth injury. A multivariable logistic regression model, with backward elimination, was constructed in order to find independent risk factors associated with BPI and CF. A subgroup analysis involved comparison of features of BPI cases with or without associated shoulder dystocia. Results During the study period, the total number of vaginal deliveries was 44092. The rates of CF, BPI and shoulder dystocia during the study period were 0,6%, 0,16% and 0,29%, respectively. In the logistic regression model, shoulder dystocia, GDM, multiparity, gestational age >42 weeks, protracted labor, short second stage of labor and fetal birth weight greater than 4250 grams increased the risk of CF independently. Shoulder dystocia and protracted labor were independently associated with BPI when controlled for other factors. Among neonates with BPI whose injury was not associated with shoulder dystocia, five (12.2%) sustained permanent injury, whereas one neonate (4.5%) with BPI following shoulder dystocia sustained permanent injury (p = 0.34). Conclusion BPI not associated with shoulder dystocia might have a higher rate of concomitant CF and permanent sequelae. PMID:25144234

Reverse shoulder arthroplasty in patients with os acromiale.

PubMed

Aibinder, William R; Schoch, Bradley S; Cofield, Robert H; Sperling, John W; Sánchez-Sotelo, Joaquin

2017-09-01

Os acromiale has been reported in up to 15% of the general population. Reverse total shoulder arthroplasty (RTSA) increases deltoid tension, which could potentially lead to excessive stress on a pre-existent os acromiale. The purpose of this study was to determine the outcome and complications of primary RTSA in patients with radiographic evidence of an os acromiale. Between 2005 and 2013, 25 shoulders underwent primary RTSA with an associated os acromiale, which was classified preacromion (3), mesoacromion (20), and meta-acromion (2). All patients were observed for a minimum of 2 years or until reoperation. Mean follow-up time was 30.8 (range, 1-81.4) months. Outcomes included pain scores, range of motion, patient satisfaction, American Shoulder and Elbow Surgeons scores, and radiographic outcomes. RTSA led to an improvement in pain scores in 24 of 25 shoulders. Mean elevation, external rotation, and internal rotation were improved at final follow-up (124°, 46°, and L4, respectively). Three patients required reoperation, including revision surgery for dislocation (2) and excision of a painful os acromiale (1). Postoperative tilting of the os acromiale was noted in 7 shoulders (28%). There was no statistically significant difference in any outcome measures between shoulders with and shoulders without postoperative tilt of the os acromiale. The outcome of RTSA does not seem to be negatively affected by the presence of an os acromiale. Pain around an os acromiale after RTSA is rare. Inferior tilting is observed in approximately one-third of the shoulders after RTSA and does not seem to change the overall outcome. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The anterior deltoid's importance in reverse shoulder arthroplasty: a cadaveric biomechanical study.

PubMed

Schwartz, Daniel G; Kang, Sang Hoon; Lynch, T Sean; Edwards, Sara; Nuber, Gordon; Zhang, Li-Qun; Saltzman, Matthew

2013-03-01

Frequently, patients who are candidates for reverse shoulder arthroplasty have had prior surgery that may compromise the anterior deltoid muscle. There have been conflicting reports on the necessity of the anterior deltoid thus it is unclear whether a dysfunctional anterior deltoid muscle is a contraindication to reverse shoulder arthroplasty. The purpose of this study was to determine the 3-dimensional (3D) moment arms for all 6 deltoid segments, and determine the biomechanical significance of the anterior deltoid before and after reverse shoulder arthroplasty. Eight cadaveric shoulders were evaluated with a 6-axis force/torque sensor to assess the direction of rotation and 3D moment arms for all 6 segments of the deltoid both before and after placement of a reverse shoulder prosthesis. The 2 segments of anterior deltoid were unloaded sequentially to determine their functional role. The 3D moment arms of the deltoid were significantly altered by placement of the reverse shoulder prosthesis. The anterior and middle deltoid abduction moment arms significantly increased after placement of the reverse prosthesis (P < .05). Furthermore, the loss of the anterior deltoid resulted in a significant decrease in both abduction and flexion moments (P < .05). The anterior deltoid is important biomechanically for balanced function after a reverse total shoulder arthroplasty. Losing 1 segment of the anterior deltoid may still allow abduction; however, losing both segments of the anterior deltoid may disrupt balanced abduction. Surgeons should be cautious about performing reverse shoulder arthroplasty in patients who do not have a functioning anterior deltoid muscle. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

A neuromuscular exercise programme versus standard care for patients with traumatic anterior shoulder instability: study protocol for a randomised controlled trial (the SINEX study).

PubMed

Eshoj, Henrik; Rasmussen, Sten; Frich, Lars Henrik; Hvass, Inge; Christensen, Robin; Jensen, Steen Lund; Søndergaard, Jens; Søgaard, Karen; Juul-Kristensen, Birgit

2017-02-28

Anterior shoulder dislocation is a common injury and may have considerable impact on shoulder-related quality of life (QoL). If not warranted for initial stabilising surgery, patients are mostly left with little to no post-traumatic rehabilitation. This may be due to lack of evidence-based exercise programmes. In similar, high-impact injuries (e.g. anterior cruciate ligament tears in the knee) neuromuscular exercise has shown large success in improving physical function and QoL. Thus, the objective of this trial is to compare a nonoperative neuromuscular exercise shoulder programme with standard care in patients with traumatic anterior shoulder dislocations (TASD). Randomised, assessor-blinded, controlled, multicentre trial. Eighty patients with a TASD will be recruited from three orthopaedic departments in Denmark. Patients with primary or recurrent anterior shoulder dislocations due to at least one traumatic event will be randomised to 12 weeks of either a standardised, individualised or physiotherapist-supervised neuromuscular shoulder exercise programme or standard care (self-managed shoulder exercise programme). Patients will be stratified according to injury status (primary or recurrent). Primary outcome will be change from baseline to 12 weeks in the patient-reported QoL outcome questionnaire, the Western Ontario Shoulder Instability Index (WOSI). This trial will be the first study to compare the efficacy and safety of two different nonoperative exercise treatment strategies for patients with TASD. Moreover, this is also the first study to investigate nonoperative treatment effects in patients with recurrent shoulder dislocations. Lastly, this study will add knowledge to the shared decision-making process of treatment strategies for clinical practice. ClinicalTrials.gov, identifier: NCT02371928 . Registered on 9 February 2015 at the National Institutes of Health Clinical Trials Protocol Registration System.

Prevalence and variance of shoulder injuries in elite collegiate football players.

PubMed

Kaplan, Lee D; Flanigan, David C; Norwig, John; Jost, Patrick; Bradley, James

2005-08-01

Shoulder injuries are the fourth most common musculoskeletal injury encountered in American football players. There is little information in the literature on the role of playing position in the type of shoulder injuries seen. There is a high prevalence of shoulder injuries in elite collegiate American football players, with type of injury varying by playing position. Cohort study (prevalence); Level of evidence, 3. A total of 336 elite collegiate American football players were invited to the National Football League Combine for physical testing and medical evaluation. Current and historical data were evaluated for the purpose of this study, and all players underwent radiographic examinations, including plain radiographs and/or magnetic resonance imaging when necessary. All shoulder pathological conditions and shoulder surgical procedures were recorded. Players were categorized by position for the analysis of position-specific trends. Of the players, 50% had a history of shoulder injuries, with a total of 226 shoulder injuries (1.3 injuries per player injured); 56 players (34%) had a total of 73 surgeries. The most common injuries were acromioclavicular separation (41%), anterior instability (20%), rotator cuff injury (12%), clavicle fracture (4%), and posterior instability (4%). The most common surgeries performed were anterior instability reconstruction (48%), Mumford/Weaver-Dunn surgery (15%), posterior instability surgery (10%), and rotator cuff surgery (10%). Shoulder injuries were more common in quarterbacks and defensive backs. Surgery was more common in linebackers or linemen. A history of anterior instability was more common in defensive players, with surgery required 76% of the time. Linemen had more rotator cuff injuries and posterior instability than players in other positions. Shoulder injuries are common injuries in elite collegiate football players, with one-third undergoing surgical procedures. There are definitive trends in the types of injuries per player position.

Outcome of triple-tendon transfer, an Eden-Lange variant, to reconstruct trapezius paralysis.

PubMed

Elhassan, Bassem T; Wagner, Eric R

2015-08-01

This study describes the technique and evaluates the outcome of the triple-tendon (T3) transfer, an Eden-Lange variant, to the scapula to stabilize the scapulothoracic articulation in the treatment of symptomatic trapezius paralysis. T3 transfers were performed in 22 patients with a history of persistent trapezius paralysis secondary to spinal accessory nerve injury. The indications for surgery included shoulder pain and weakness and limited range of motion of the shoulder. The T3 transfer included transfer of the levator scapulae to the lateral aspect of the spine of the scapula, the rhomboid minor to the spine of the scapula just medial to the levator scapulae insertion, and the rhomboid major to the medial spine of the scapula, including all muscles bony insertions. At an average follow-up of 35 months, winging was corrected in all patients, with improvement of shoulder asymmetry. All patients had significant improvement of pain (P < .01) and range of motion, including active shoulder abduction that improved from an average of 71° preoperatively to 118° postoperatively (P < .02) and shoulder flexion from an average of 102° to 150° (P < .01). There were also significant improvements in aggregate Constant Shoulder Score (P < .01), subjective shoulder value (P < .01), and Disabilities of the Arm, Shoulder and Hand score (P < .01). All patients were very satisfied with the outcome of surgery. This study shows that the T3 transfer is effective in stabilizing the scapulothoracic articulation and restoring the function of the trapezius, and thus, in improving pain and shoulder function in patients with symptomatic trapezius paralysis. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Bony increased-offset reversed shoulder arthroplasty: minimizing scapular impingement while maximizing glenoid fixation.

PubMed

Boileau, Pascal; Moineau, Grégory; Roussanne, Yannick; O'Shea, Kieran

2011-09-01

Scapular notching, prosthetic instability, limited shoulder rotation and loss of shoulder contour are associated with conventional medialized design reverse shoulder arthroplasty. Prosthetic (ie, metallic) lateralization increases torque at the baseplate-glenoid interface potentially leading to failure. We asked whether bony lateralization of reverse shoulder arthroplasty would avoid the problems caused by humeral medialization without increasing torque or shear force applied to the glenoid component. We prospectively followed 42 patients with rotator cuff deficiency treated with bony increased-offset reverse shoulder arthroplasty. A cylinder of autologous cancellous bone graft, harvested from the humeral head, was placed between the reamed glenoid surface and baseplate. Graft and baseplate fixation was achieved using a lengthened central peg (25 mm) and four screws. Patients underwent clinical, radiographic, and CT assessment at a minimum of 2 years after surgery. The humeral graft incorporated completely in 98% of cases (41 of 42) and partially in one. At a mean of 28 months postoperatively, no graft resorption, glenoid loosening, or postoperative instability was observed. Inferior scapular notching occurred in 19% (eight of 42). The absolute Constant-Murley score improved from 31 to 67. Thirty-six patients (86%) were able to internally rotate sufficiently to reach their back over the sacrum. Grafting of the glenoid surface during reverse shoulder arthroplasty effectively creates a long-necked scapula, providing the benefits of lateralization. Bony increased-offset reverse shoulder arthroplasty is associated with low rates of inferior scapular notching, improved shoulder rotation, no prosthetic instability and improved shoulder contour. In contrast to metallic lateralization, bony lateralization has the advantage of maintaining the prosthetic center of rotation at the prosthesis-bone interface, thus minimizing torque on the glenoid component. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain

PubMed Central

2011-01-01

Background Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Methods Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. Results In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. Conclusions A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. Trial Registration ISRCTN60264809 PMID:21777478

Current management and prognostic factors in physiotherapy practice for patients with shoulder pain: design of a prospective cohort study.

PubMed

Karel, Yasmaine H J M; Scholten-Peeters, Wendy G M; Thoomes-de Graaf, Marloes; Duijn, Edwin; Ottenheijm, Ramon P G; van den Borne, Maaike P J; Koes, Bart W; Verhagen, Arianne P; Dinant, Geert-Jan; Tetteroo, Eric; Beumer, Annechien; van Broekhoven, Joost B; Heijmans, Marcel

2013-02-11

Shoulder pain is disabling and has a considerable socio-economic impact. Over 50% of patients presenting in primary care still have symptoms after 6 months; moreover, prognostic factors such as pain intensity, age, disability level and duration of complaints are associated with poor outcome. Most shoulder complaints in this group are categorized as non-specific. Musculoskeletal ultrasound might be a useful imaging method to detect subgroups of patients with subacromial disorders.This article describes the design of a prospective cohort study evaluating the influence of known prognostic and possible prognostic factors, such as findings from musculoskeletal ultrasound outcome and working alliance, on the recovery of shoulder pain. Also, to assess the usual physiotherapy care for shoulder pain and examine the inter-rater reliability of musculoskeletal ultrasound between radiologists and physiotherapists for patients with shoulder pain. A prospective cohort study including an inter-rater reliability study. Patients presenting in primary care physiotherapy practice with shoulder pain are enrolled. At baseline validated questionnaires are used to measure patient characteristics, disease-specific characteristics and social factors. Physical examination is performed according to the expertise of the physiotherapists. Follow-up measurements will be performed 6, 12 and 26 weeks after inclusion. Primary outcome measure is perceived recovery, measured on a 7-point Likert scale. Logistic regression analysis will be used to evaluate the association between prognostic factors and recovery. The ShoCoDiP (Shoulder Complaints and using Diagnostic ultrasound in Physiotherapy practice) cohort study will provide information on current management of patients with shoulder pain in primary care, provide data to develop a prediction model for shoulder pain in primary care and to evaluate whether musculoskeletal ultrasound can improve prognosis.

Age-Related Degenerative Functional, Radiographic, and Histological Changes of the Shoulder in Non-Human Primates

PubMed Central

Plate, Johannes F.; Bates, Christopher M.; Mannava, Sandeep; Smith, Thomas L.; Jorgensen, Matthew J.; Register, Thomas C.; Stehle, John R.; High, Kevin P.; Shively, Carol A.; Kaplan, Jay R.; Saul, Katherine R.; Tuohy, Christopher J.

2013-01-01

Background Non-human primates have similar shoulder anatomy and physiology compared to humans and may represent a previously underutilized model for shoulder research. This study sought to identify naturally occurring bony and muscular degeneration in the shoulder of non-human primates and to assess relationships between structural and functional aspects of the shoulder and measures of physical function of the animals. We hypothesized that age-related degenerative changes in the shoulders of non-human primates would resemble those observed in aging humans. Methods Middle-aged (n=5, ages 9.4 to 11.8 years) and elderly (n=6, ages 19.8 to 26.4 years) female vervet monkeys were studied for changes in mobility and shoulder function, and radiographic and histologic signs of age-related degeneration. Results Four out of six (4/6) elderly animals had degenerative changes of the glenoid compared to 0/5 of the middle-aged animals (p=0.005). Elderly animals had glenoid retroversion, decreased joint space, walked slower and spent less time climbing and hanging than middle-aged vervets (p<0.05). Physical mobility and shoulder function correlated with glenoid version angle (p<0.05). Supraspinatus muscles of elderly animals were less dense (p=0.001), had decreased fiber cross-sectional area (p<0.001), but similar amounts of nuclear material (p=0.085). Degenerative rotator cuff tears were not observed in any of the eleven animals. Discussion and Conclusion The vervet monkey naturally undergoes age-related functional, radiographic and histological changes of the shoulder and may qualify as an animal model for selected translational research of shoulder osteoarthritis. Level of evidence Basic Science Study, in-vivo Animal Model PMID:23352182

Calcific tendinopathy of the rotator cuff: the correlation between pain and imaging features in symptomatic and asymptomatic female shoulders.

PubMed

Sansone, Valerio; Consonni, Olmo; Maiorano, Emanuele; Meroni, Roberto; Goddi, Alfredo

2016-01-01

To provide new epidemiological data regarding the prevalence, distribution and macroscopic features of shoulder rotator cuff calcific tendinopathy (calcific tendinopathy), and to identify the characteristics of calcific deposits associated with shoulder pain. Three hundred and two female volunteers (604 shoulders) who had been referred to a gynaecological clinic participated in the study. The subjects underwent a high-resolution ultrasonography of both shoulders, and those with a diagnosis of calcific tendinopathy compiled a standardized questionnaire relating to shoulder symptoms. We determined the prevalence of symptomatic and asymptomatic rotator cuff calcific tendinopathy, and compared differences in distribution and macroscopic features of the symptomatic and asymptomatic calcifications. The prevalence of calcific tendinopathy was 17.8% (103 shoulders). Ninety-five shoulders (15.7%) were symptomatic; of these, calcific tendinopathy was found in 34 shoulders (33%) on imaging. Of the 509 asymptomatic (84.3%) shoulders, calcific tendinopathy was observed in 69 cases (67%). Among tendons, supraspinatus (53.4%) and infraspinatus (54.6%) were the most frequently involved. The majority of calcific deposits were of maximum diameter between 2 and 5 mm (77.9%), and were linear in form (69.9%). The involvement of multiple tendons and a location in the supraspinatus tendon were found to be significantly correlated with pain (p = 0.023, p = 0.043 respectively), as were age (p = 0.041) and an excessive body mass index (p = 0.024). In this sample from the general population of working age females, both intrinsic factors (location in supraspinatus, multiple tendon involvement) and extrinsic variables (age, abnormally high BMI) were correlated with pain in calcific tendinopathy. Level III, cross-sectional study, prevalence study.

One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review.

PubMed

Sabzevari, Soheil; Kachooei, Amir Reza; Giugale, Juan; Lin, Albert

2017-08-01

Addressing preoperative shoulder stiffness before rotator cuff repair (RCR) is advocated, but the effectiveness of this approach is debatable. We hypothesized that 1-stage treatment of concomitant rotator cuff tear (RCT) with shoulder stiffness has comparable results with isolated RCT. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the databases including MEDLINE, Embase, Cochrane Library, and Scopus were searched using the keywords of "shoulder stiffness" OR "adhesive capsulitis" OR "frozen shoulder" AND "rotator cuff." Studies that met all the criteria compared the 2 arms of isolated RCT vs. RCT with concomitant shoulder stiffness, received no physical therapy before surgery, and reported data of preoperative and postoperative range of motion (ROM) and functional outcomes after surgery. Four level III studies met the inclusion criteria. The non-stiff group (isolated RCT) included 460 patients who underwent RCR; the stiff group (RCT with concomitant shoulder stiffness) included 111 patients who underwent RCR and manipulation under anesthesia with or without capsular release. There were significant differences in preoperative ROM between stiff and non-stiff groups. At final follow-up, there were no statistical differences in all ROM between the 2 groups. There was no significant difference in comparing preoperative and postoperative outcome scores including visual analog scale for pain, Constant, modified American Shoulder and Elbow Surgeons, and University of California-Los Angeles scores. Concomitant surgical treatment of nonmassive RCT and moderate shoulder stiffness in 1 stage may have comparable results to the surgical treatment of RCT in patients without preoperative stiffness. Therefore, a physical therapy regimen before surgical intervention may not be necessary. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: A repeated measures study on asymptomatic shoulders.

PubMed

Ribeiro, Daniel Cury; de Castro, Marcelo Peduzzi; Sole, Gisela; Vicenzino, Bill

2016-04-01

Manual therapy enhances pain-free range of motion and reduces pain levels, but its effect on shoulder muscle activity is unclear. This study aimed to assess the effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity. Thirty asymptomatic individuals participated in a repeated measures study of the electromyographic activity of the supraspinatus, infraspinatus, posterior deltoid, and middle deltoid. Participants performed four sets of 10 repetitions of shoulder scaption and abduction with and without a glide of the glenohumeral joint. Repeated-measures multivariate analysis of variance (MANOVA) was used to assess the effects of movement direction (scaption and abduction), and condition (with and without glide) (within-subject factors) on activity level of each muscle (dependent variables). Significant MANOVAs were followed-up with repeated-measures one-way analysis of variance. During shoulder scaption with glide, the supraspinatus showed a reduction of 4.1% maximal isometric voluntary contraction (MVIC) (95% CI 2.4, 5.8); and infraspinatus 1.3% MVIC (95% CI 0.5, 2.1). During shoulder abduction with a glide, supraspinatus presented a reduction of 2.5% MVIC (95% CI 1.1, 4.0), infraspinatus 2.1% MVIC (95% CI 1.0, 3.2), middle deltoid 2.2% MVIC (95% CI = 0.4, 4.1), posterior deltoid 2.1% MVIC (95% CI 1.3, 2.8). In asymptomatic individuals, sustained glide reduced shoulder muscle activity compared to control conditions. This might be useful in enhancing shoulder movement in clinical populations. Reductions in muscle activity might result from altered joint mechanics, including simply helping to lift the arm, and/or through changing afferent sensory input about the shoulder. Copyright © 2015 Elsevier Ltd. All rights reserved.

Arthroscopic rotator cuff repair in the weight-bearing shoulder.

PubMed

Kerr, Jacek; Borbas, Paul; Meyer, Dominik C; Gerber, Christian; Buitrago Téllez, Carlos; Wieser, Karl

2015-12-01

In wheelchair-dependent individuals, pain often develops because of rotator cuff tendon failure and/or osteoarthritis of the glenohumeral joint. The purposes of this study were to investigate (1) specific rotator cuff tear patterns, (2) structural healing, and (3) clinical outcomes after arthroscopic rotator cuff repair in a cohort of wheelchair-dependent patients. Forty-six shoulders with a mean follow-up of 46 months (range, 24-82 months; SD, 13 months) from a consecutive series of 61 shoulders in 56 patients (46 men and 10 women) undergoing arthroscopic rotator cuff repair were available for analysis. Clinical outcome analysis was performed using the Constant-Murley score, the Subjective Shoulder Value, and the American Shoulder and Elbow Surgeons score. The integrity of the repair was analyzed by ultrasound. Of the shoulders, 87% had supraspinatus involvement, 70% had subscapularis involvement, and 57% had an anterosuperior lesion involving both the supraspinatus and subscapularis. Despite an overall structural failure rate of 33%, the patients showed improvements in the Constant-Murley score from 50 points (range, 22-86 points; SD, 16 points) preoperatively to 80 points (range, 40-98 points; SD, 12 points) postoperatively and in the American Shoulder and Elbow Surgeons score from 56 points (range, 20-92 points; SD, 20 points) preoperatively to 92 points (range, 53-100 points; SD, 10 points) postoperatively, with a mean postoperative Subjective Shoulder Value of 84% (range, 25%-100%; SD, 17%). Failure of the rotator cuff in weight-bearing shoulders occurs primarily anterosuperiorly. Arthroscopic rotator cuff repair leads to a structural failure rate of 33% but satisfactory functional results with high patient satisfaction at midterm follow-up. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Functional outcomes after bilateral arthroscopic rotator cuff repair.

PubMed

Aleem, Alexander W; Syed, Usman Ali M; Wascher, Jocelyn; Zoga, Adam C; Close, Koby; Abboud, Joseph A; Cohen, Steven B

2016-10-01

Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Clavicle hook plate fixation for distal-third clavicle fracture (Neer type II): comparison of clinical and radiologic outcomes between Neer types IIA and IIB.

PubMed

Lee, Wonyong; Choi, Chong-Hyuk; Choi, Yun-Rak; Lim, Kyung-Han; Chun, Yong-Min

2017-07-01

The purpose of this study was to investigate clinical and radiologic outcomes of clavicle hook plate fixation for distal-third clavicle fracture (Neer type II) and to compare the clinical and radiologic outcomes and complications between Neer type IIA and type IIB. We retrospectively reviewed 35 patients who underwent open reduction and internal fixation with AO hook locking compression plate (LCP) for distal clavicle fracture, including 13 patients with Neer type IIA and 22 patients with type IIB. Visual analog scale pain score, shoulder scores (subjective shoulder value, University of California-Los Angeles shoulder score, American Shoulder and Elbow Surgeons score), and active range of motion were evaluated to determine clinical outcome. Coracoclavicular distance was measured, and that of the injured side at last follow-up was compared with that of the uninjured side to evaluate radiologic outcomes. AO hook LCP fixation for distal-third clavicle fracture (Neer type II) produced satisfactory radiologic outcomes, including high union rates (100%) and coracoclavicular distance maintenance, as well as satisfactory clinical outcomes, including visual analog scale score for pain, shoulder scores (subjective shoulder value, University of California-Los Angeles shoulder score, American Shoulder and Elbow Surgeons score), and active range of motion. There were no significant differences between Neer type IIA and type IIB. With regard to complications, 22.9% of patients experienced shoulder stiffness and 17.1% had subacromial erosion; however, there were no significant differences between the 2 groups. The AO hook LCP is a suitable choice for Neer type IIA and type IIB distal-third clavicle fracture fixation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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.

Prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain.

PubMed

Andersen, Lars L; Hansen, Klaus; Mortensen, Ole S; Zebis, Mette K

2011-07-22

Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain. Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'. In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations. A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius. ISRCTN60264809.

Genetics Home Reference: facioscapulohumeral muscular dystrophy

MedlinePlus

... those of the face (facio-), around the shoulder blades (scapulo-), and in the upper arms (humeral). The ... Weak shoulder muscles tend to make the shoulder blades (scapulae) protrude from the back, a common sign ...

34. Detail of neck and shoulder connection showing toga clasp ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

34. Detail of neck and shoulder connection showing toga clasp and shoulder lights that improved nighttime illumination of head. May 1984. - Statue of Liberty, Liberty Island, Manhattan, New York County, NY

Ergonomic Strategies for Using a Purse

MedlinePlus

... a Heavy Purse • Heavy purses worn over one shoulder cause uneven weight distribution across the back muscles and may restrict blood flow at the shoulder. • Heavy purses and shoulder straps without padding place ...

Statewide shoulders study : executive summary.

DOT National Transportation Integrated Search

2015-08-01

With the ultimate purpose of enhancing safety and improving mobility, the Statewide Shoulders Study was initiated to : develop a prioritized list of candidate locations for shoulder improvements. The need for this study stems directly from : ADOTs...

Occupational therapy interventions for shoulder conditions: a systematic review.

PubMed

von der Heyde, Rebecca L

2011-01-01

The objectives of this systematic review were (1) to identify, evaluate, and synthesize the research literature of relevance to occupational therapy regarding interventions for work-related shoulder conditions and (2) to interpret and apply the research literature to occupational therapy. Twenty-two studies were reviewed for this study-16 of Level I evidence, 2 of Level II evidence, and 4 of Level III evidence. In this systematic review, limited evidence from Level I studies was found to support exercise for shoulder pain; manual therapy and laser for adhesive capsulitis; conservative management of shoulder instability; early intervention without immobilization for specific, nondisplaced proximal humerus fractures; and exercise, joint mobilizations, and laser for patients with shoulder impingement. Further prospective studies are necessary for the delineation of specific surgical and therapeutic variables that facilitate positive outcomes in the treatment of patients with shoulder conditions.

Don't aim too high: Avoiding shoulder injury related to vaccine administration.

PubMed

Cross, Gail B; Moghaddas, Jason; Buttery, Jim; Ayoub, Sally; Korman, Tony M

2016-05-01

Shoulder injury related to vaccine administration (SIRVA) is a previously described phenomenon that is the result of improper vaccine delivery. Appropriate injection technique for administration of intramuscular vaccinations can reduce the risk of shoulder injury. In this article, we describe the cases of two patients who developed SIRVA. A literature review was conducted to find and describe other cases of shoulder injury that developed post-vaccination. SIRVA has previously been described in the world literature. Seventeen cases in women and five cases in men were found. Pain and reduction in the range of movement within a few hours of vaccination were cardinal signs of a shoulder injury. This included injuries to the soft tissues of the shoulder as well as injuries to bone and joint. SIRVA can be avoided with correct vaccination technique as described.

The role of episiotomy in prevention and management of shoulder dystocia: a systematic review.

PubMed

Sagi-Dain, Lena; Sagi, Shlomi

2015-05-01

Shoulder dystocia is an obstetric emergency with potential catastrophic outcomes. To perform a systematic literature review examining the effectiveness of episiotomy in the prevention and management of shoulder dystocia during vaginal birth. Search was conducted by a research librarian in MEDLINE, Web of Science, Cochrane Library, and SCOPUS databases using the terms "episiotomy" and "shoulder dystocia," with no language or time restrictions. Two investigators independently selected original researches examining the effects of episiotomy on shoulder dystocia and its neonatal andmaternal outcomes. Relevant articles were accessed in full text, including manual search of the references. We contacted authors of studies with insufficient or unclear data. Because of clinical and methodological diversity of the studies, meta-analysis was not performed. Fourteen articles met the inclusion criteria, encompassing a total of 9769 shoulder dystocia cases. Only 1 study effectively evaluated the role of episiotomy in shoulder dystocia prevention, yielding a nonsignificant result. Three articles assessed neonatal consequences of shoulder dystocia, one of them linking episiotomy to higher risk of neonatal injury. Two of the 3 studies evaluating maternal outcomes showed that episiotomy is related to increased risk of advanced perineal tears. Overall quality of evidence was rated as very low. Our systematic review found no evidence supporting the use of episiotomy in the prevention and management of shoulder dystocia. This observation carries major clinical and legal implications for the obstetricians. Higher-quality studies are needed to evaluate this important issue.

The Relationship Between Maximum Isometric Strength and Ball Velocity in the Tennis Serve

PubMed Central

Corbi, Francisco; Fuentes, Juan Pedro; Fernández-Fernández, Jaime

2016-01-01

Abstract The aims of this study were to analyze the relationship between maximum isometric strength levels in different upper and lower limb joints and serve velocity in competitive tennis players as well as to develop a prediction model based on this information. Twelve male competitive tennis players (mean ± SD; age: 17.2 ± 1.0 years; body height: 180.1 ± 6.2 cm; body mass: 71.9 ± 5.6 kg) were tested using maximum isometric strength levels (i.e., wrist, elbow and shoulder flexion and extension; leg and back extension; shoulder external and internal rotation). Serve velocity was measured using a radar gun. Results showed a strong positive relationship between serve velocity and shoulder internal rotation (r = 0.67; p < 0.05). Low to moderate correlations were also found between serve velocity and wrist, elbow and shoulder flexion – extension, leg and back extension and shoulder external rotation (r = 0.36 – 0.53; p = 0.377 – 0.054). Bivariate and multivariate models for predicting serve velocity were developed, with shoulder flexion and internal rotation explaining 55% of the variance in serve velocity (r = 0.74; p < 0.001). The maximum isometric strength level in shoulder internal rotation was strongly related to serve velocity, and a large part of the variability in serve velocity was explained by the maximum isometric strength levels in shoulder internal rotation and shoulder flexion. PMID:28149411

Active stiffness and strength in people with unilateral anterior shoulder instability: a bilateral comparison.

PubMed

Olds, Margie; McNair, Peter; Nordez, Antoine; Cornu, Christophe

2011-01-01

Active muscle stiffness might protect the unstable shoulder from recurrent dislocation. To compare strength and active stiffness in participants with unilateral anterior shoulder instability and to examine the relationship between active stiffness and functional ability. Cross-sectional study. University research laboratory. Participants included 16 males (age range, 16-40 years; height = 179.4 ± 6.1 cm; mass = 79.1 ± 6.8 kg) with 2 or more episodes of unilateral traumatic anterior shoulder instability. Active stiffness and maximal voluntary strength were measured bilaterally in participants. In addition, quality of life, function, and perceived instability were measured using the Western Ontario Stability Index, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, and Single Alpha Numeric Evaluation, respectively. We found less horizontal adduction strength (t(15) = -4.092, P = .001) and less stiffness at 30% (t(14) = -3.796, P = .002) and 50% (t(12) = -2.341, P = .04) maximal voluntary strength in the unstable than stable shoulder. Active stiffness was not correlated with quality of life, function, or perceived instability (r range, 0.0-0.25; P > .05). The observed reduction in stiffness in the unstable shoulder warrants inclusion of exercises in the rehabilitation program to protect the joint from perturbations that might lead to dislocation. The lack of association between active stiffness and quality of life, function, or perceived instability might indicate that stiffness plays a less direct role in shoulder stability.

Comparative outcomes of extracorporeal shockwave therapy for shoulder tendinitis or partial tears of the rotator cuff in athletes and non-athletes: Retrospective study.

PubMed

Chou, Wen-Yi; Wang, Ching-Jen; Wu, Kuan-Ting; Yang, Ya-Ju; Cheng, Jai-Hong; Wang, Shih-Wei

2018-03-01

Refractory shoulder tendinitis or partial thickness rotator cuff tears (PTRCTs) are common findings in overhead athletes. Previous studies have examined the effectiveness of extracorporeal shockwave therapy (ESWT) for shoulder tendinitis. In the current study, we recruited 36 shoulders and performed a comparison between the professional athletes (13 shoulders, athletic group; AG) and the non-athletic population (23 shoulders, non-athletic group, NAG) with PTRCTs or shoulder tendinitis of the shoulder after ESWT. Patients with symptomatic tendinitis of the shoulder with or without a partial tear of the rotator cuff tendon and failed oral medication and physical therapy for more than 3 months were treated with electrohydraulic mode of ESWT. All patients that met the inclusion criteria were categorized into two groups according to their pre-treatment activity level. We found that NAG exhibited significant aging and degenerative change around the glenohumeral joint and subacromial space. After ESWT treatment, the patients in AG were with 53.8% high satisfaction rating and patients in NAG were 52.1% by one-year followed up. The results showed ESWT was equally effective treatment in both AG and NAG. In light of its efficacy and less-invasive nature, we suggest ESWT can be used to treat athletes with refractory tendinitis or PTRCTs before proceeding to arthroscopic intervention. Copyright © 2018 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Internal- and External-Rotation Peak Toque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training.

PubMed

Lee, Dong-Rour; Kim, Laurentius Jongsoon

2016-08-01

Many studies have explored closed kinetic chain (CKC) shoulder exercises (SEs) with a sling because they are safer and more effective than open-chain exercises, especially in early stages of treatment. However, the application of CKC SE in youth baseball players has rarely been attempted, although teenage baseball players also experience shoulder pain. To investigate the effects of CKC SE on the peak torque of shoulder internal rotation (IR) and external rotation (ER) in youth baseball players. Single-group pretest, posttest. Biomechanics laboratory. 23 Little League Baseball players with subacromial impingement syndrome. The CKC SE with a sling was CKC shoulder-flexion exercise, extension exercise, IR exercise, and ER exercise. This exercise regimen was conducted 2 or 3 times/wk for 8 wk. The peak torque of shoulder IR and ER was measured using an isokinetic dynamometer. Concentric shoulder rotation was performed, with 5 repetitions at an angular velocity of 60°/s and 15 at 180°/s. The IR and ER peak torque significantly increased at each angular velocity after the exercise program. In particular, the increase in IR and ER peak torque values was statistically significant at an angular velocity of 180°/s. CKC SE was effective in increasing shoulder IR and ER strength, demonstrating its potential benefits in the prevention and treatment of shoulder injury. In addition, increased IR peak torque appears to improve throwing velocity in baseball players.

Effects of hand grip exercise on shoulder joint internal rotation and external rotation peak torque.

PubMed

Lee, Dong-Rour; Jong-Soon Kim, Laurentius

2016-08-10

The goal of this study is to analyze the effects of hand grip training on shoulder joint internal rotation (IR)/external rotation (ER) peak torque for healthy people. The research was conducted on 23 healthy adults in their 20 s-30 s who volunteered to participate in the experiment. Hand grip power test was performed on both hands of the research subjects before/after the test to study changes in hand grip power. Isokinetic machine was used to measure the concentric IRPT (internal rotation peak torque) and concentric ERPT (external rotation peak torque) at the velocity of 60°/sec, 90°/sec, and 180°/sec before/after the test. Hand grip training was performed daily on the subject's right hand only for four weeks according to exercise program. Finally, hand grip power of both hands and the maximum torque values of shoulder joint IR/ER were measured before/after the test and analyzed. There was a statistically significant difference in the hand grip power of the right hand, which was subject to hand grip training, after the experiment. Also, statistically significant difference for shoulder ERPT was found at 60°/sec. Hand grip training has a positive effect on shoulder joint IRPT/ERPT and therefore can help strengthen muscles around the shoulder without using weight on the shoulder. Consequently, hand grip training would help maintain strengthen the muscles around the shoulder in the early phase of rehabilitation process after shoulder surgery.

[Shoulder dystocia: Guidelines for clinical practice--Short text].

PubMed

Sentilhes, L; Sénat, M-V; Boulogne, A-I; Deneux-Tharaux, C; Fuchs, F; Legendre, G; Le Ray, C; Lopez, E; Schmitz, T; Lejeune-Saada, V

2015-12-01

To determine the available evidence to prevent and treat shoulder dystocia to attempt to decrease its related neonatal and maternal morbidity. The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted. Shoulder dystocia, defined as a vaginal delivery that requires additional obstetric maneuvers to deliver the fetus after the head has delivered and gentle traction has failed, complicates 0.5-1 % of vaginal deliveries. Risks of brachial plexus birth injury (LE3), clavicle and humeral fracture (LE3), perinatal asphyxia (LE2), hypoxic-ischemic encephalopathy (LE3) and perinatal mortality (LE2) are increased after shoulder dystocia. Its main risk factors are previous shoulder dystocia and macrosomia, but they are poorly predictive; 50 % to 70 % of shoulder dystocia cases occur in their absence, and the great majority of deliveries when they are present are not associated with shoulder dystocia. No study has proven that the correction of these risk factors (except gestational diabetes) would reduce the risk of shoulder dystocia (SD). Physical activity is recommended before and during pregnancy to reduce the occurrence of some risk factors for shoulder dystocia (grade C). In obese patients, physical activity should be coupled with dietary measures to reduce fetal macrosomia and weight gain during pregnancy (grade A). In case of gestational diabetes, diabetes care is recommended (diabetic diet, glucose monitoring, insulin if needed) (grade A) as it reduces the risk of macrosomia and shoulder dystocia (LE1). In order to avoid shoulder dystocia and its complications, only two measures are proposed. Induction of labor is recommended in case of impending macrosomia if the cervix is favourable and gestational age greater than 39 weeks of gestation (professional consensus). Cesarean delivery is recommended before labor in case of EFW greater than 4500g if associated with maternal diabetes (grade C), EFW greater than 5000g in the absence of maternal diabetes (grade C), history of shoulder dystocia associated with severe neonatal or maternal complications (Professional consensus), and finally during labor, in case of fetal macrosomia and failure to progress in the second stage, when the fetal head is above a +2 station (grade C). In case of shoulder dystocia, it is recommended not to pull excessively on the fetal head (grade C), do not perform uterine expression (grade C) and do not realize inverse rotation of the fetal head (professional consensus). McRoberts' maneuver, with or without a suprapubic pressure, is recommended in the first line (grade C). In case of failure, if the posterior shoulder is engaged, Wood's maneuver should be performed preferentially; if the posterior shoulder is not engaged, delivery of the posterior arm should be performed preferentially (professional consensus). It seems necessary to know at least two maneuvers to perform in case of shoulder dystocia unresolved by the maneuver of McRoberts (professional consensus). Pediatrician should be immediately informed in case of shoulder dystocia. The initial clinical examination should search complications such as brachial plexus birth injury or clavicle fracture (professional consensus). In absence of neonatal complication, monitoring of the neonate is not modified (professional consensus). The implementation of a practical training using simulation and concerning all caregivers of the delivery room is associated with a significant reduction in neonatal (LE3) but not maternal (LE3) injury. Shoulder dystocia remains a non-predictable obstetrics emergency. All physicians and midwives should know and perform obstetric maneuvers if needed quickly but without precipitation. A training program using simulation for the management of shoulder dystocia is encouraged for the initial and continuing formation of different actors in the delivery room (professional consensus). Copyright © 2015. Published by Elsevier Masson SAS.

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.

Evaluation of a Shoulder Fragmentation Protection Brassard Design

DTIC Science & Technology

2008-03-01

compatibility assessments. There were slight advantages of the shoulder caps over the brassard with regards to chaffing and thermal comfort during the fire...and movement task. Even though there were significant differences between the shoulder caps and brassard with respect to chaffing and thermal comfort , the...the brassard’s increased coverage design. The shoulder caps were preferred in areas such as thermal comfort and ease of attachment and removing

Shoulder Dystocia: Prediction and Management

PubMed Central

Hill, Meghan G; Cohen, Wayne R

2016-01-01

Shoulder dystocia is a complication of vaginal delivery and the primary factor associated with brachial plexus injury. In this review, we discuss the risk factors for shoulder dystocia and propose a framework for the prediction and prevention of the complication. A recommended approach to management when shoulder dystocia occurs is outlined, with review of the maneuvers used to relieve the obstruction with minimal risk of fetal and maternal injury. PMID:26901875

Outpatient Shoulder Arthroplasty.

PubMed

Brolin, Tyler J; Throckmorton, Thomas W

2018-01-01

Health care policy makers have placed increased attention on the cost of health care making outpatient joint arthroplasty an attractive alternative to routine hospital admission. Recent studies have shown outpatient shoulder arthroplasty is a safe and cost-effective alternative to inpatient shoulder arthroplasty. Proper patient selection, patient education, effective pain management strategies, and attention to intraoperative blood loss are keys in the success of outpatient shoulder arthroplasty. Copyright © 2017 Elsevier Inc. All rights reserved.

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder.

PubMed

Kılıçaslan, Ömer Faruk; Acar, Baver; Atik, Aziz; Kose, Ozkan

2017-08-19

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively.

Simultaneous Anterior Glenohumeral Dislocation and Ipsilateral Acromioclavicular Separation: A Dual Injury of the Shoulder

PubMed Central

Acar, Baver; Atik, Aziz; Kose, Ozkan

2017-01-01

Isolated acromioclavicular separations or shoulder dislocations are common injuries. However, a combination of complete acromioclavicular separation and anterior shoulder dislocation is extremely rare. Herein we present a combination of anterior shoulder dislocation and type III acromioclavicular separation that was succesfully treated conservatively. Orthopaedic surgeons should have a high clinical suspicion in daily practice. We believe that both pathologies can be treated conservatively. PMID:29062614

[Impact of simulation to reduce neonatal and maternal morbidity of shoulder dystocia].

PubMed

Legendre, G; Bouet, P-E; Sentilhes, L

2015-12-01

To assess the role of simulation in reducing morbidity and mortality of shoulder dystocia. A systematic literature review was conducted in the Medline database. Regarding the prevention of complications of shoulder dystocia, practical training using mannequin is associated with improvements in management shoulder dystocia than training using video tutorial (EL2). Practical training using simulation for shoulder dystocia allows an improvement for manoeuvres mainly for trainees, but simulation seems to benefit to all caregivers for the communication (EL3). The effect of training sessions using simulation for learning writing the medical observation allows only a modest improvement in the medical record transcription (EL3). The interest of a specific grid for reporting shoulder dystocia seems interesting to increase the amount of information transcribed by the caregiver (EL3). The establishment of a practical training using simulation and concerning all caregivers of the delivery room is associated with a significant reduction in neonatal injury (EL3). The establishment of a training program using simulation does not seem to decrease maternal morbidity in case of shoulder dystocia (EL3). A teaching using simulation for the management of shoulder dystocia is encouraged for the initial and continuing formation of different actors in the delivery room (professional agreement). Copyright © 2015 Elsevier Masson SAS. All rights reserved.

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

PubMed Central

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

2015-01-01

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

Isometric Shoulder Strength Reference Values for Physically Active Collegiate Males and Females

PubMed Central

Westrick, Richard B.; Duffey, Michele L.; Cameron, Kenneth L.; Gerber, J. Parry; Owens, Brett D.

2013-01-01

Background: It is common clinical practice to assess muscle strength during examination of patients following shoulder injury or surgery. Strength comparisons are often made between the patient’s injured and uninjured shoulders, with the uninjured side used as a reference without regard to upper extremity dominance. Despite the importance of strength measurements, little is known about expected normal baselines of the uninjured shoulder. The purpose of this study was to report normative values for isometric shoulder strength for physically active college-age men and women without history of shoulder injury. Methods: University students—546 males (18.8 ± 1.0 years, 75.3 ± 12.2 kg) and 73 females (18.7 ± 0.9 years, 62.6 ± 7.0 kg)—underwent thorough shoulder evaluations by an orthopaedic surgeon and completed bilateral isometric strength measurements with a handheld dynamometer. Variables measured included internal rotation, external rotation, abduction, supine internal rotation and external rotation at 45°, and lower trapezius in prone flexion. Results: Significant differences were found between the dominant and nondominant shoulder for internal rotation, internal rotation at 45°, abduction, and prone flexion in males and in internal rotation at 45° and prone flexion for females (P ≤ 0.01). PMID:24381696

Acromiohumeral Distance Change Relates to Middle Trapezius Muscle Activation During Shoulder Elevation With Scapular Retraction.

PubMed

Guney-Deniz, Hande; Harput, Gulcan; Toprak, Ugur; Duzgun, Irem

2018-05-29

The scapular retraction exercises are widely used among clinicians to balance the activity of the scapular muscles as well as the rotator cuff muscles in different shoulder abduction positions. The aim of this study was to investigate the relationship between scapular (middle and upper trapezius) and shoulder muscles (middle deltoid and infraspinatus) activation level differences and acromiohumeral distance changes during shoulder abduction with scapular retraction. Cross-sectional study. University research laboratory. Nineteen asymptomatic individuals were included (mean ± SD age, 22.4 ± 1.8 years). The acromiohumeral distance was measured at 0° and 90° shoulder abduction when scapula was in non-retracted and retracted position with ultrasound imaging. The relationship between muscle activation level changes and acromiohumeral distance difference was analyzed with Pearson correlation test. Middle trapezius muscle activity change correlated with acromiohumeral distance difference (r=0.55, p=0.018) from 0º to 90º shoulder abduction when scapula was retracted. For both non-retracted and retracted scapular positions, no correlations were found between middle deltoid, infraspinatus and upper trapezius muscle activity changes with acromiohumeral distance differences during shoulder abduction (p>0.05). Active scapular retraction exercise especially focusing on the middle trapezius muscle activation seems to be an effective treatment option to optimize the acromiohumeral distance during shoulder abduction.

Correlation of shoulder range of motion limitations at discharge with limitations in activities and participation one year later in persons with spinal cord injury.

PubMed

Eriks-Hoogland, Inge E; de Groot, Sonja; Post, Marcel W M; van der Woude, Lucas H V

2011-02-01

To study the correlation between limited shoulder range of motion in persons with spinal cord injury at discharge and the performance of activities, wheeling performance, transfers and participation one year later. Multicentre prospective cohort study. A total of 146 newly injured subjects with spinal cord injury. Shoulder range of motion was measured at discharge. One year later, Functional Independence Measure (FIM), transfer ability, wheelchair circuit and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) were assessed. Corrections were made for possible confounding factors (age, gender, level and completeness of injury, time since injury and shoulder pain). All subjects with limited shoulder range of motion at discharge had a lower FIM motor score and were less likely (total group 5 times, and subjects with tetraplegia 10 times less likely) to be able to perform an independent transfer one year later. Subjects with limited shoulder range of motion in the total group needed more time to complete the wheelchair circuit. No significant associations with the PASIPD were found in either group. Persons with spinal cord injury and limited shoulder range of motion at discharge are more limited in their activities one year later than those without limited shoulder range of motion.

Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects.

PubMed

Lin, Yin-Liang; Karduna, Andrew

2016-10-01

Proprioception is essential for shoulder neuromuscular control and shoulder stability. Exercise of the rotator cuff and scapulothoracic muscles is an important part of shoulder rehabilitation. The purpose of this study was to investigate the effect of rotator cuff and scapulothoracic muscle exercises on shoulder joint position sense. Thirty-six healthy subjects were recruited and randomly assigned into either a control or training group. The subjects in the training group received closed-chain and open-chain exercises focusing on rotator cuff and scapulothoracic muscles for four weeks. Shoulder joint position sense errors in elevation, including the humerothoracic, glenohumeral and scapulothoracic joints, was measured. After four weeks of exercise training, strength increased overall in the training group, which demonstrated the effect of exercise on the muscular system. However, the changes in shoulder joint position sense errors in any individual joint of the subjects in the training group were not different from those of the control subjects. Therefore, exercises specifically targeting individual muscles with low intensity may not be sufficient to improve shoulder joint position sense in healthy subjects. Future work is needed to further investigate which types of exercise are more effective in improving joint position sense, and the mechanisms associated with those changes. Copyright © 2016 Elsevier B.V. All rights reserved.

Effects of whole-body cryotherapy in the management of adhesive capsulitis of the shoulder.

PubMed

Ma, Sang-Yeol; Je, Hyun Dong; Jeong, Ji Hoon; Kim, Hae-Young; Kim, Hyeong-Dong

2013-01-01

To compare 2 different treatment approaches, physical therapy modalities, and joint mobilization versus whole-body cryotherapy (WBC) combined with physical therapy modalities and joint mobilization, for symptoms of adhesive capsulitis (AC) of the shoulder. A randomized trial. Hospital. Patients with AC of the shoulder (N=30). Patients were randomly assigned to 2 groups. The WBC group received physical therapy modalities, passive joint mobilization of the shoulder, and WBC, whereas the non-WBC group received only physical therapy modalities and passive joint mobilization of the shoulder. Visual analog scale (VAS), active range of motion (ROM) of flexion, abduction, internal and external rotation of the shoulder, and the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) were measured before and after the intervention. A statistically significant difference between groups was found for the VAS, active ROM of flexion, abduction, internal rotation, and external rotation, and the ASES with greater improvements in the WBC group (Ps<.01). Overall, both groups showed a significant improvement in all outcome measures and ROM measures from pre to post at a level of P<.01. There is significant improvement with the addition of WBC to treatment interventions in this sample of patients. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

The incidence and causative organisms of infection in elective shoulder surgery.

PubMed

Mayne, Alistair I W; Bidwai, Amit S; Clifford, Rachael; Smith, Matthew G; Guisasola, Inigo; Brownson, Peter

2018-07-01

Deep infection remains a serious complication of orthopaedic surgery. Knowledge of infection rates and causative organisms is important to guide infection control measures. The aim of the present study was to determine infection rates and causative organisms in elective shoulder surgery. Cases complicated by infection were identified and prospectively recorded over a 2-year period. All patients undergoing elective shoulder surgery in the concurrent period at a single Specialist Upper Limb Unit in the UK were identified from the hospital electronic database. In total, 1574 elective shoulder cases were performed: 1359 arthroscopic (540 with implant insertion) and 215 open (197 with implant insertion). The overall infection rate in open surgery of 2.5% was significantly higher than arthroscopic implant cases at 0.7% ( p  < 0.005). The overall infection rate in implant arthroscopic surgery was significantly higher at 0.7% compared to 0% in non-implant related surgery. ( p  < 0.05). Patients undergoing open shoulder surgery have a significantly higher risk of infection compared to arthroscopic shoulder surgery. Arthroscopic surgery with implant insertion has a statistically significantly higher risk of developing deep infection compared to procedures with no implant insertion. We recommend prophylactic antibiotics in open shoulder surgery and arthroscopic shoulder surgery with implant insertion.

The effect of deep shoulder infections on patient outcomes after arthroscopic rotator cuff repair: a retrospective comparative study.

PubMed

Atesok, Kivanc; MacDonald, Peter; Leiter, Jeff; McRae, Sheila; Singh, Mandip; Stranges, Greg; Old, Jason

2017-01-01

The purpose of this study was to evaluate the effects of deep shoulder infections after RCR on patient outcomes. A retrospective chart review was conducted involving all patients with deep shoulder infections after arthroscopic RCR (study group). Another group of patients who were matched with the study group by age, gender and rotator cuff tear size, and did not develop deep shoulder infections after arthroscopic RCR were randomly identified (control group). The two groups were compared in terms of time to start physiotherapy, shoulder function, and delay in return to work. There were 10 patients in each group. The mean time to start physiotherapy after surgery was 145.3 (SD=158.8) days for the study group and 40.0 (SD=13.7) days for the control group (p=.051). The average forward elevation of the operated shoulder was 133 (SD=33.4) degrees for the study group, and 172 (SD=12.0) degrees for the control group (p=0.003). The average time to return to work at preoperative level was 5.6 months for the study group and 3 months for the control group. Deep shoulder infections after RCR significantly impedes time to start physiotherapy, shoulder function, and patients' ability to return to work. III b [retrospective comparative (case-control) study].

Exercises focusing on rotator cuff and scapular muscles do not improve shoulder joint position sense in healthy subjects

PubMed Central

Lin, Yin-Liang; Karduna, Andrew

2016-01-01

Proprioception is essential for shoulder neuromuscular control and shoulder stability. Exercise of the rotator cuff and scapulothoracic muscles is an important part of shoulder rehabilitation. The purpose of this study was to investigate the effect of rotator cuff and scapulothoracic muscle exercises on shoulder joint position sense. Thirty-six healthy subjects were recruited and randomly assigned into either a control or training group. The subjects in the training group received closed-chain and open-chain exercises focusing on rotator cuff and scapulothoracic muscles for four weeks. Shoulder joint position sense errors in elevation, including the humerothoracic, glenohumeral and scapulothoracic joints, was measured. After four weeks of exercise training, strength increased overall in the training group, which demonstrated the effect of exercise on the muscular system. However, the changes in shoulder joint position sense errors in any individual joint of the subjects in the training group were not different from those of the control subjects. Therefore, exercises specifically targeting individual muscles with low intensity may not be sufficient to improve shoulder joint position sense in healthy subjects. Future work is needed to further investigate which types of exercise are more effective in improving joint position sense, and the mechanisms associated with those changes. PMID:27475714

Research priorities for shoulder surgery: results of the 2015 James Lind Alliance patient and clinician priority setting partnership.

PubMed

Rangan, Amar; Upadhaya, Sheela; Regan, Sandra; Toye, Francine; Rees, Jonathan L

2016-04-11

To run a UK based James Lind Alliance Priority Setting Partnership for 'Surgery for Common Shoulder Problems'. This was a nationally funded and conducted process. It was organised from a musculoskeletal research centre and Biomedical Research Unit in Oxford. UK shoulder patients, carers and clinicians, involved in treating patients with shoulder pain and shoulder problems that might require surgery. These were national electronic and paper surveys capturing treatment uncertainties that are important to shoulder patients, carers and clinicians. The outcomes relevant to this study were the survey results and rankings. The process took 18 months to complete, with 371 participants contributing 404 in scope questions. The James Lind process then produced a final 10 research priorities and uncertainties that relate to the scope of 'Surgery for Common Shoulder Problems'. The final top 10 UK research priorities have been produced and are now being disseminated to partner organisations and funders to guide funding of shoulder research for the next 5-10 years on topics that are important to patients, their carers and clinicians. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Circuit For Control Of Electromechanical Prosthetic Hand

NASA Technical Reports Server (NTRS)

Bozeman, Richard J., Jr.

1995-01-01

Proposed circuit for control of electromechanical prosthetic hand derives electrical control signals from shoulder movements. Updated, electronic version of prosthesis, that includes two hooklike fingers actuated via cables from shoulder harness. Circuit built around favored shoulder harness, provides more dexterous movement, without incurring complexity of computer-controlled "bionic" or hydraulically actuated devices. Additional harness and potentiometer connected to similar control circuit mounted on other shoulder. Used to control stepping motor rotating hand about prosthetic wrist to one of number of angles consistent with number of digital outputs. Finger-control signals developed by circuit connected to first shoulder harness transmitted to prosthetic hand via sliprings at prosthetic wrist joint.

Obstetric Emergencies: Shoulder Dystocia and Postpartum Hemorrhage.

PubMed

Dahlke, Joshua D; Bhalwal, Asha; Chauhan, Suneet P

2017-06-01

Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and management to avoid significant morbidity or mortality. Shoulder dystocia is an uncommon, unpredictable, and unpreventable obstetric emergency and can be managed with appropriate intervention. Postpartum hemorrhage occurs more commonly and carries significant risk of maternal morbidity. Institutional protocols and algorithms for the prevention and management of shoulder dystocia and postpartum hemorrhage have become mainstays for clinicians. The goal of this review is to summarize the diagnosis, incidence, risk factors, and management of shoulder dystocia and postpartum hemorrhage. Copyright © 2017 Elsevier Inc. All rights reserved.

Shoulder Injuries and Disorders - Multiple Languages

MedlinePlus

... Af-Soomaali (Somali) Bilingual PDF Health Information Translations Pendulum Exercises for Shoulder - Af-Soomaali (Somali) Bilingual PDF ... Exercises - español (Spanish) Bilingual PDF Health Information Translations Pendulum Exercises for Shoulder - English PDF Pendulum Exercises for ...

Shoulder arthroscopy

MedlinePlus

... you very sleepy during the operation. During the procedure, the surgeon: Inserts the arthroscope into your shoulder through a small incision. The scope is connected to a video monitor in the operating room. Inspects all the tissues of your shoulder ...

75 FR 54114 - Procurement List Additions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-03

...--Shoulder Rest, Telephone, Black, Softak II. NSN: 7520-00-NIB-2085--Shoulder Rest, Telephone, Black... Administration. NSN: 7520-01-253-1283--Shoulder Rest, Telephone, Beige, 2\\1/4\\'' W x 7'' L. NSN: 7520-01-377-9533...

Psychosocial work factors and shoulder pain in hotel room cleaners.

PubMed

Burgel, Barbara J; White, Mary C; Gillen, Marion; Krause, Niklas

2010-07-01

Hotel room cleaners have physically demanding jobs that place them at high risk for shoulder pain. Psychosocial work factors may also play a role in shoulder pain, but their independent role has not been studied in this group. Seventy-four percent (941 of 1,276) of hotel room cleaners from five Las Vegas hotels completed a 29-page survey assessing health status, working conditions, and psychosocial work factors. For this study, 493 of the 941 (52%) with complete data for 21 variables were included in multivariate logistic regression analyses. Fifty-six percent reported shoulder pain in the prior four weeks. Room cleaners with effort-reward imbalance (ERI) were three times as likely to report shoulder pain (OR 2.99, 95% CI 1.95-4.59, P = 0.000) even after adjustment for physical workload and other factors. After adjustment for physical workload, job strain and iso-strain were not significantly associated with shoulder pain. ERI is independently associated with shoulder pain in hotel room cleaners even after adjustment for physical workload and other risk factors. 2010 Wiley-Liss, Inc.

Neck and shoulder disorders in medical secretaries. Part I. Pain prevalence and risk factors.

PubMed

Kamwendo, K; Linton, S J; Moritz, U

1991-01-01

420 medical secretaries took part in a cross-sectional study at examining the prevalence of musculoskeletal disorders as well as the relationship between neck and shoulder pain and possible risk factors. Sixty-three percent had experienced neck pain sometime during the previous year and while 15% had suffered almost constant pain 32% had experienced neck pain only occasionally. Shoulder pain during the previous year had been experienced by 62%, 17% had suffered almost constant pain while 29% experienced pain only occasionally. Fifty-one percent had experienced low back pain. Age and length of employment were significantly related to neck and shoulder pain. Furthermore, working with office machines 5 hours or more per day was associated with a significantly increased risk for neck pain (OR 1.7), shoulder pain (OR 1.9) and headache (OR 1.8). Finally, a poorly experienced psychosocial work environment was significantly related to headache, neck, shoulder and low back pain. The results of this study suggest that work with office machines as well as the psychosocial work environment are important factors in neck and shoulder pain.

The Kaiser Permanente shoulder arthroplasty registry: results from 6,336 primary shoulder arthroplasties.

PubMed

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

2015-06-01

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. 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. 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. 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.

The relationship of strength and muscle balance to shoulder pain and impingement syndrome in elite quadriplegic wheelchair rugby players.

PubMed

Miyahara, M; Sleivert, G G; Gerrard, D F

1998-04-01

Wheelchair athletes are susceptible to injuries related to overuse of the shoulder, in particular shoulder impingement syndrome. The present study examined the relationship of shoulder pain to demographic details, isokinetic strength and muscle balance in 8 elite quadriplegic rugby players. Demographic data were collected using personal interviews and each subject was clinically examined for signs of impingement syndrome by a physician. In addition each subject underwent bilateral isokinetic strength testing of the shoulder at 60 and 180 deg/s for abduction/adduction and internal/external rotation. A series of step-wise multiple discriminant analysis successfully predicted clinical symptoms from demographic, muscular strength and balance data. In particular, there was a significant deficit in adductor strength and this was related to shoulder pain and wasting of the scapular muscles. This strength deficit may be due to the high level of spinal lesions in the quadriplegic population. The level of spinal lesion may contribute to the aetiology of shoulder pathology in quadriplegia, and differentiate it from that observed in able-bodied athletes who exhibit weak abductors.

Putting the shoulder to the wheel: a new biomechanical model for the shoulder girdle.

PubMed

Levin, S M

1997-01-01

The least successfully modeled joint complex has been the shoulder. In multi-segmented mathematical shoulder models rigid beams (the bones) act as a series of columns or levers to transmit forces or loads to the axial skeleton. Forces passing through the almost frictionless joints must, somehow, always be directed perfectly perpendicular to the joints as only loads directed at right angles to the surfaces could transfer across frictionless joints. Loads transmitted to the axial skeleton would have to pass through the moving ribs or the weak jointed clavicle and then through the ribs. A new model of the shoulder girdle, based on the tension icosahedron described by Buckminster Fuller, is proposed that permits the compression loads passing through the arm and shoulder to be transferred to the axial skeleton through its soft tissues. In this model the scapula 'floats' in the tension network of shoulder girdle muscles just as the hub of the wire wheel is suspended in its tension network of spokes. With this construct inefficient beams and levers are eliminated. A more energy efficient, load distributing, integrated, hierarchical system is created.

Adhesive capsulitis of the shoulder: the rate of manipulation following distension arthrogram.

PubMed

Ibrahim, T; Rahbi, H; Beiri, A; Jeyapalan, K; Taylor, G J S

2006-11-01

To determine the rate of manipulation under anaesthesia (MUA) following distension arthrogram for adhesive capsulitis of the shoulder. Thirty-nine patients (42 shoulders) between 1998 and 2004 were treated with distension arthrogram for adhesive capsulitis diagnosed by the clinical picture of progressive pain and stiffness. Capsular disruption into the subscapular bursa was demonstrated in 40 of the 42 shoulders (95%). Thirty-seven of 42 (88%) shoulders were painfree following distension arthrogram. 15 of 42 (36%) shoulders underwent MUA following distension arthrogram for stiffness although 10 of these (67%) were painfree. Prior to distension arthrogram, the range of external rotation (ER) was no different between those that had MUA and those that did not (P = 0.36). The improvement in ER was 33% (P = 0.28) in those that had MUA and 50% (P = 0.001) in those that did not. The only complication was a vasovagal episode during the procedure. Distension arthrogram can be used as a therapeutic procedure for achieving symptomatic pain relief in the majority of adhesive capsulitis and decrease the rate of MUA of the shoulder.

Humeral Torsion as a Risk Factor for Shoulder and Elbow Injury in Professional Baseball Pitchers.

PubMed

Noonan, Thomas J; Thigpen, Charles A; Bailey, Lane B; Wyland, Douglas J; Kissenberth, Michael; Hawkins, Richard J; Shanley, Ellen

2016-09-01

Numerous studies have demonstrated that humeral retrotorsion is increased in the dominant arms of throwing athletes. No study has clearly defined the relationship between humeral retrotorsion and shoulder and elbow injury. Uninjured professional pitchers will display more dominant humeral torsion (HT) than professional pitchers who sustain shoulder injuries but less than pitchers who sustain elbow injuries. Case-control study; Level of evidence, 3. Pitchers from the Colorado Rockies professional baseball organization were recruited for participation for this prospective injury study from 2009 to 2013. HT was assessed using indirect ultrasonographic techniques and was measured prospectively in 255 pitchers before each spring training (average of 2 trials). From the beginning of the preseason to the end of the postseason, overuse upper extremity injuries (shoulder or elbow) were tracked for each participating athlete. All athletes who reported pain or injury to their coach were referred to the organization's athletic trainer for evaluation and classification of each injury. The difference in HT was calculated by subtracting measurement of the dominant arm from the nondominant arm, and 3 separate mixed-model analyses of variance (side × injury group) were used to compare the dominant and nondominant HT between all pitchers who developed an arm injury (shoulder and elbow combined), as well as comparing pitchers who developed a shoulder or elbow injury to those who did not miss games due to shoulder or elbow injury (α = .05). During the course of the study, 60 arm (30 shoulder; 30 elbow) injuries were observed; 195 pitchers did not suffer an injury. There were no differences when HT was compared between all injured (shoulder and elbow injuries combined) and uninjured pitchers (P = .13; effect size 0.14). There was a significant interaction effect showing that pitchers who suffered a shoulder injury displayed 4° less dominant humeral retrotorsion compared with pitchers without injury (P = .04) and that pitchers with elbow injury displayed 5° greater humeral retrotorsion (P = .04). In addition, those who suffered an ulnar collateral ligament injury requiring reconstruction (n = 17) also displayed 4(o) greater dominant retrotorsion and 5° less nondominant humeral retrotorsion compared with pitchers who did not suffer an injury (n = 195; P = .05). There was not a significant difference between nondominant HT among pitchers who sustained shoulder and elbow injuries and pitchers without injury. The results of this study show a contrast in dominant humeral retrotorsion between pitchers who suffered shoulder and elbow injuries compared with those without an injury. Pitchers who sustained shoulder injuries had less dominant humeral retrotorsion compared with noninjured pitchers. In contrast, pitchers who sustained time-loss elbow injuries displayed increased humeral retrotorsion compared with noninjured pitchers. Together, these results suggest that increased adaptive humeral retrotorsion is protective against shoulder injuries but a harmful contributor for elbow injuries in professional pitchers. This is the first study to show differing injury risk profiles for shoulder and elbow injury. © 2016 The Author(s).

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)

Formation of a physiological reverse shoulder joint.

PubMed

Lerner, Markus; Turkmen, Ismail; Bernd, Ludger

2016-01-20

Congenital shoulder deformities are rarely seen in orthopaedic practice. Proximal humeral defects and glenoid hypoplasia have been reported separately in the literature. We present a case involving a 31-year-old woman having a cosmetic problem with her upper arm who was diagnosed with reverse shoulder joint deformity. This article presents the clinical, radiological and biomechanical findings of a physiological reverse shoulder joint. This is the first such reported case. 2016 BMJ Publishing Group Ltd.

Personality in frozen shoulder

PubMed Central

Fleming, A.; Dodman, Sally; Beer, T. C.; Crown, S.

1976-01-01

Fleming, A., Dodman, S., Beer, T. C., and Crown, S. (1976).Annals of the Rheumatic Diseases, 35, 456-457. Personality in frozen shoulder. Fifty-six patients with frozen shoulder have had their personality profiles investigated by means of the Middlesex Hospital Questionnaire. Females showed significantly increased somatic anxiety compared with controls. It is suggested that this may be important both to aetiology and treatment. Males and females should be assessed separately in future studies of frozen shoulder. PMID:1234412

A novel dynamic mechanical testing technique for reverse shoulder replacements.

PubMed

Dabirrahmani, Danè; Bokor, Desmond; Appleyard, Richard

2014-04-01

In vitro mechanical testing of orthopedic implants provides information regarding their mechanical performance under simulated biomechanical conditions. Current in vitro component stability testing methods for reverse shoulder implants are based on anatomical shoulder designs, which do not capture the dynamic nature of these loads. With glenoid component loosening as one of the most prevalent modes of failure in reverse shoulder replacements, it is important to establish a testing protocol with a more realistic loading regime. This paper introduces a novel method of mechanically testing reverse shoulder implants, using more realistic load magnitudes and vectors, than is currently practiced. Using a custom made jig setup within an Instron mechanical testing system, it is possible to simulate the change in magnitude and direction of the joint load during arm abduction. This method is a step towards a more realistic testing protocol for measuring reverse shoulder implant stability.

No correlation between stroke specialty and rate of shoulder pain in NCAA men swimmers

PubMed Central

Wymore, Lucas; Reeve, Robert E.; Chaput, Christopher D.

2012-01-01

Purpose: To established an association between shoulder pain and the stroke specialization among NCAA men swimmers. Materials and Methods: All members of the top 25 NCAA men's swim teams were invited to complete the survey. Eleven teams with a total of 187 participants completed the study survey. The teams were mailed surveys that included multiple choice questions regarding their primary stroke and their incidence of shoulder pain. Additionally, the survey included questions about risk factors including distance trained, type of equipment, weight training, and stretching. Results: The analysis showed that there was no significant difference in the rates of shoulder pain among the four strokes and individual medley specialists. The other risk factors did not show a significant correlation with shoulder pain. Conclusions: This study found no significant correlation between stroke specialty and shoulder pain in male collegiate swimmers. Level of Evidence: Level 3. Clinical Relevance: Descriptive epidemiology study. PMID:23204760

[Shoulder injuries in golf].

PubMed

Liem, D; Gosheger, G; Schmidt, C

2014-03-01

Due to its growing popularity golf has now come into the focus of orthopedic sports medicine. With a wide range of age groups and playing levels, orthopedic surgeons will encounter a wide range of musculoskeletal problems which are usually the result of overuse rather than trauma. The shoulder joint plays an important role in the golf swing whereby not only the muscles around the glenohumeral joint but also the scapula stabilizing muscles are extremely important for an effective golf swing. Golf is strictly not considered to be an overhead sport; however, the extreme peak positions of the golf swing involve placing the shoulder joint in maximum abduction and adduction positions which can provoke impingement, lesions of the pulley system or even a special form of posterior shoulder instability. Even after complex shoulder operations, such as rotator cuff repair or shoulder arthroplasty, a return to the golf course at nearly the same level of play can be expected.

Effects of Shoulder Flexion Loaded by an Elastic Tubing Band on EMG Activity of the Gluteal Muscles during Squat Exercises

PubMed Central

Kang, Min-Hyeok; Jang, Jun-Hyeok; Kim, Tae-Hoon; Oh, Jae-Seop

2014-01-01

[Purpose] We investigated the effects of shoulder flexion loaded by an elastic tubing band during squat exercises, by assessing electromyographic activities of the gluteus maximus and gluteus medius. [Subjects] In total, 17 healthy males were recruited. [Methods] Participants performed squat exercises with and without shoulder flexion loaded by a tubing band. Gluteal muscle activities during the downward and upward phases of the squat exercises were recorded using a surface electromyography (EMG) system. The mean electromyographic activities of the gluteal muscles during squat exercises with and without loaded shoulder flexion were compared using the paired t-test. [Results] Electromyographic activities of the gluteus maximus and gluteus medius were greater in both the upward and downward phases of the squat with loaded shoulder flexion. [Conclusions] The combination of squat and loaded shoulder flexion can be an effective exercise for increasing gluteal muscle activity. PMID:25435701

Status of the contralateral rotator cuff in patients undergoing rotator cuff repair.

PubMed

Ro, Kyung-Han; Park, Jong-Hoon; Lee, Soon-Hyuck; Song, Dong-Ik; Jeong, Ha-Joon; Jeong, Woong-Kyo

2015-05-01

Although the prevalence of rotator cuff tear (RCT) in the general population has been analyzed, little information is available on the status of the opposite-side rotator cuff in patients who have undergone arthroscopic rotator cuff repair. To identify the characteristics of the contralateral shoulder and to identify factors associated with RCT of the contralateral shoulder in patients who underwent surgery for symptomatic RCT. The hypothesis was that the prevalence of RCT in the contralateral shoulder would be higher in patients with increasingly larger cuff tears requiring surgical intervention. Case series; Level of evidence, 4. The study cohort consisted of 140 patients with RCT who underwent arthroscopic rotator cuff repair. Opposite-shoulder rotator cuff tendons of all patients were evaluated by ultrasonography. Demographic information and factors related to contralateral RCT were investigated, and risk factors associated with contralateral RCT were assessed. Of the 140 patients who underwent arthroscopic rotator cuff repair, 54 (38.6%) had an RCT of the contralateral shoulder. Of 51 patients with partial-thickness and small-sized full-thickness tears of the operated shoulder, 35 (68.6%) had no tears; 14 (27.5%) had partial-thickness tears; and 2 (3.9%) had small-sized full-thickness tears of the contralateral shoulder. Of 75 patients with medium-sized full-thickness tears, 43 (57.3%) had no tears; 12 (16%) had partial-thickness tears; and 20 (26.7%) had full-thickness tears of the contralateral shoulder. Of 14 patients with large to massive full-thickness tears, 8 (57.1%) had no tears; 1 (7.1%) had a partial-thickness tear; and 5 (35.7%) had full-thickness tears of the contralateral shoulder. The prevalence of RCT of the contralateral shoulder differed significantly among groups classified by tear size (P=.007). The mean American Shoulder and Elbow Surgeons score was significantly lower in the RCT than in the nontear group (55.8±16.9 vs 61.6±13.3; P=.03). Of 29 subjects with symptomatic tears involving the nondominant arm, 17 (58.6%) had contralateral asymptomatic RCT, compared with 37 of 111 (33.3%) subjects with symptomatic tears involving the dominant arm (P=.007). The prevalence of RCT of the contralateral asymptomatic shoulder tends to be higher in patients with more symptomatic RCT on one side, in patients with medium-sized or larger RCT in the operated shoulder, and in patients with symptomatic RCT in the nondominant arm. © 2015 The Author(s).

Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: A population-based study

PubMed Central

2010-01-01

Background Shoulder pain is a common health problem. The purpose of this study was to assess the associations of lifestyle factors, metabolic factors and carotid intima-media thickness with shoulder pain and chronic (> 3 months) rotator cuff tendinitis. Methods In this cross-sectional study, the target population consisted of subjects aged 30 years or older participating in a national Finnish Health Survey during 2000-2001. Of the 7,977 eligible subjects, 6,237 (78.2%) participated in a structured interview and clinical examination. Chronic rotator cuff tendinitis was diagnosed clinically. Weight-related factors, C-reactive protein and carotid intima-media thickness were measured. Results The prevalence of shoulder joint pain during the preceding 30 days was 16% and that of chronic rotator cuff tendinitis 2.8%. Smoking, waist circumference and waist-to-hip ratio were related to an increased prevalence of shoulder pain in both genders. Metabolic syndrome, type 2 diabetes mellitus and carotid intima-media thickness were associated with shoulder pain in men, whereas high level of C-reactive protein was associated with shoulder pain in women. Increased waist circumference and type 1 diabetes mellitus were associated with chronic rotator cuff tendinitis in men. Conclusions Our findings showed associations of abdominal obesity, some other metabolic factors and carotid intima-media thickness with shoulder pain. Disturbed glucose metabolism and atherosclerosis may be underlying mechanisms, although not fully supported by the findings of this study. Prospective studies are needed to further investigate the role of lifestyle and metabolic factors in shoulder disorders. PMID:20646281

Hemiplegic shoulder pain: associated factors and rehabilitation outcomes of hemiplegic patients with and without shoulder pain.

PubMed

Karaahmet, Ozgur Zeliha; Eksioglu, Emel; Gurcay, Eda; Karsli, Pınar Bora; Tamkan, Ugur; Bal, Ajda; Cakcı, Aytul

2014-01-01

To analyze the incidence of and the factors associated with shoulder pain in people with hemiplegia and to understand the effect of rehabilitation programs on the parameters of motor function and activity limitations in patients with and without hemiplegic shoulder pain. Patients in the initial 6-month period after stroke who were hospitalized in the physical medicine and rehabilitation clinic were included in the study. Patients were considered early rehabilitation entrants if they were admitted in the first 0 to 30 days after a stroke and late rehabilitation entrants if they were admitted 30 to 120 days after a stroke. Demographic and clinical features, complications, and medical histories of the patients were recorded. Upper extremity Fugl-Meyer Motor Assessment (FMA), Frenchay Arm Test (FAT), and Functional Independence Measure (FIM) were applied to the patients on admission, at discharge, and after 1 month of follow-up. Twenty-one (38%) patients did not have shoulder pain, and 34 (62%) patients had decreased shoulder pain. Immobilization, duration of disease, and late rehabilitation were shown to be effective treatments for shoulder pain. The major risk factors were disease duration and poor initial motor function. In both groups, the FMA, FAT, and FIM scores showed significant changes. This improvement did not differ between the 2 groups. Duration of disease and low motor functional capacities have the most important impact on shoulder pain. In patients with and without shoulder pain, a systematic rehabilitation program is beneficial with respect to motor function and daily living activities.

Prevalence, incidence, and risk factors for shoulder and neck dysfunction after neck dissection: A systematic review.

PubMed

Gane, E M; Michaleff, Z A; Cottrell, M A; McPhail, S M; Hatton, A L; Panizza, B J; O'Leary, S P

2017-07-01

Shoulder pain and dysfunction may occur following neck dissection among people being treated for head and neck cancer. This systematic review aims to examine the prevalence and incidence of shoulder and neck dysfunction after neck dissection and identify risk factors for these post-operative complications. Electronic databases (Pubmed, CINAHL, EMBASE, Cochrane) were searched for articles including adults undergoing neck dissection for head and neck cancer. Studies that reported prevalence, incidence or risk factors for an outcome of the shoulder or neck were eligible and assessed using the Critical Review Form - Quantitative Studies. Seventy-five articles were included in the final review. Prevalence rates for shoulder pain were slightly higher after RND (range, 10-100%) compared with MRND (range, 0-100%) and SND (range, 9-25%). The incidence of reduced shoulder active range of motion depended on surgery type (range, 5-20%). The prevalence of reduced neck active range of motion after neck dissection was 1-13%. Type of neck dissection was a risk factor for shoulder pain, reduced function and health-related quality of life. The prevalence and incidence of shoulder and neck dysfunction after neck dissection varies by type of surgery performed and measure of dysfunction used. Pre-operative education for patients undergoing neck dissection should acknowledge the potential for post-operative shoulder and neck problems to occur and inform patients that accessory nerve preservation lowers, but does not eliminate, the risk of developing musculoskeletal complications. Copyright © 2016 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

Hip and Shoulder Range of Motion in Youth Baseball Pitchers.

PubMed

Oliver, Gretchen D; Weimar, Wendi H

2016-10-01

Oliver, GD and Weimar, WH. Hip and shoulder range of motion in youth baseball pitchers. J Strength Cond Res 30(10): 2823-2827, 2016-Lack of range of motion (ROM) has long been suspected as contributing to injury in baseball pitchers. However, all previous ROM research has focused on collegiate and professional pitchers. It was thus the purpose of this study to measure and evaluate bilateral hip and throwing shoulder rotational passive range of motion (PROM) in youth baseball pitchers. Twenty-six youth baseball pitchers (11.3 ± 1.0 years; 152.4 ± 9.0 cm; 47.5 ± 11.3 kg) with no history of injury participated. Bilateral hip and throwing shoulder rotational PROM was measured. There were no significant side-to-side differences for the hip variables (p ≥ 0.05). Shoulder external rotation (ER) was significantly greater than shoulder internal rotation (IR). And the lead leg hip had significantly greater ER than IR. Shoulder ER revealed significant correlations with both lead and stance hip IR (r = 0.45, p = 0.02 and r = 0.48, p = 0.01, respectively). The youth baseball pitchers in this study displayed similar PROM patterns as collegiate and professional baseball pitchers. Additionally, our youth baseball pitchers also presented strong relationships between hip and shoulder PROM. This study reveals that the PROM patterns displayed by these youth may indicate that their available ROM could survive maturation. It is therefore suggested that clinical focus be directed to maintaining hip and shoulder rotational ROM throughout maturation in attempt to determine a possible relations between injurious mechanisms and performance enhancement.

A Comparison of Obstetric Maneuvers for the Acute Management of Shoulder Dystocia

PubMed Central

Hoffman, Matthew K; Bailit, Jennifer L; Branch, D. Ware; Burkman, Ronald T; Van Veldhusien, Paul; Lu, Li; Kominiarek, Michelle A.; Hibbard, Judith U; Landy, Helain J; Haberman, Shoshana; Wilkins, Isabelle; Gonzalez Quintero, Victor H; Gregory, Kimberly D; Hatjis, Christos G; Ramirez, Mildred M; Reddy, Uma M.; Troendle, James; Zhang, Jun

2011-01-01

Objective To assess the efficacy of obstetric maneuvers for resolving shoulder dystocia, and the effect that these maneuvers have on neonatal injury when shoulder dystocia occurs. Methods Using an electronic database encompassing 206,969 deliveries, we identified all women with a vertex fetus beyond 34 0/7 weeks of gestation who incurred a shoulder dystocia during the process of delivery. Women whose fetuses had a congenital anomaly and women with an antepartum stillbirth were excluded. Medical records of all cases were reviewed by trained abstractors. Cases involving neonatal injury (defined as brachial plexus injury, clavicular or humerus fracture, or hypoxic ischemic encephalopathy or intrapartum neonatal death attributed to the shoulder dystocia) were compared to those without injury. RESULTS Among 132,098 women who delivered a term cephalic liveborn fetus vaginally, 2,018 incurred a shoulder dystocia (1.5%), and 101 (5.2%) of these incurred a neonatal injury. Delivery of the posterior shoulder was associated with the highest rate of delivery when compared to other maneuvers (84.4% compared with 24.3% to 72.0% for other maneuvers; P<.005 to P<.001) and similar rates of neonatal injury (8.4% compared with 6.1% to 14.0%; P=.23 to P=.7). The total number of maneuvers performed significantly correlated with the rate of neonatal injury (P<.001). CONCLUSIONS Delivery of the posterior shoulder should be considered following McRoberts maneuver and suprapubic pressure in the management of shoulder dystocia. The need for additional maneuvers was associated with higher rates of neonatal injury. PMID:21555962

Do isometric pull-down exercises increase the acromio-humeral distance?

PubMed

Sealey, P; Critchley, D

2017-06-01

To evaluate the effect of isometric shoulder extension in 90° shoulder flexion on the acromio-humeral distance, to establish the force required to achieve a clinically important increase in the acromio-humeral distance, and to investigate the practicality and reliability of real-time ultrasound measurement of the acromio-humeral distance in 90° shoulder forward flexion. Prospective single-group intervention. King's College London, Guy's Campus. Twenty healthy volunteers [five males and 15 females (40 shoulders)] with a mean age of 32 (standard deviation 10, range 19 to 55) years were recruited from the faculty and staff at King's College London. The acromio-humeral distance in asymptomatic participants was measured using real-time ultrasound in the neutral position at rest, at 90° shoulder flexion at rest, and while performing an isometric pull-down exercise at 100%, 50%, 30% and 10% maximal voluntary isometric contraction. Real-time ultrasound measures of the acromio-humeral distance. Of the 20 participants, 38 shoulders were imaged. In 90° shoulder flexion, pull-down exercises at all levels of force increased the acromio-humeral distance compared with no pull-down (P<0.05), but this was only clinically significant in males. Measures had excellent short-term intra-operator reliability. Isometric pull-down exercises lead to an increase in the acromio-humeral distance in asymptomatic males that may be clinically important, and therefore may be an appropriate exercise for patients with shoulder pathology. Ultrasound measurement of the acromio-humeral distance in 90° shoulder flexion is practical and reliable. Copyright © 2016 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Loose glenoid components in revision shoulder arthroplasty: is there an association with positive cultures?

PubMed

Lucas, Robert M; Hsu, Jason E; Whitney, Ian J; Wasserburger, Jory; Matsen, Frederick A

2016-08-01

Glenoid loosening is one of the most common causes of total shoulder failure. High rates of positive cultures of Propionibacterium and coagulase-negative staphylococcus have been found among shoulders having surgical revision for glenoid loosening. This study reviewed the culture results in a series of surgical revisions for failed total shoulder arthroplasty to determine the relationship between glenoid loosening and positive cultures. The medical records of 221 patients without obvious evidence of infection who underwent revision total shoulder arthroplasty were reviewed to examine the association between the security of fixation of the glenoid component and the results of cultures obtained at revision surgery. Of the revised shoulders, 53% had positive cultures; 153 of the shoulders (69%) had a loose glenoid component, whereas 68 (31%) had secure glenoid component fixation. Of the 153 loose glenoid components, 82 (54%) had at least 1 positive culture and 44 (29%) had 2 or more positive cultures of the same microorganism. Similarly, of the 68 secure glenoid components, 35 (51%) had at least 1 positive culture (P = .77) and 14 (21%) had 2 or more positive cultures of the same microorganism (P = .25). Explanted glenoid components that were loose had a higher rate of culture positivity (56% [24/43]) in comparison to explanted glenoid components that were well fixed (13% [1/8]) (P = .05). Propionibacterium and coagulase-negative staphylococcus are commonly recovered in revision shoulder arthroplasty, whether or not the glenoid components are loose. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The utility of international shoulder joint replacement registries and databases: a comparative analytic review of two hundred and sixty one thousand, four hundred and eighty four cases.

PubMed

Bayona, Carlos Eduardo Afanador; Somerson, Jeremy S; Matsen, Frederick A

2018-02-01

National registries are valuable tools for understanding the results of shoulder arthroplasty across populations. These databases provide an unselected view of shoulder joint replacement within geographical areas that cannot be obtained from case series or prospective studies. They can be particularly helpful in determining which diagnoses, patients, procedures, and prostheses have higher than expected rates of revision. In an attempt to determine the generalizability of registry data, we asked, 'how similar are the patients and procedures among the different national registries?' We analyzed national shoulder arthroplasty registries and databases accessed via Internet portals and through a PubMed literature search. Seven national/regional registries and five publications regarding national shoulder arthroplasty data were identified; these sources contained a combined total of 261,484 shoulder arthroplasty cases. The percentages of hemiarthroplasty, anatomic (aTSA) and reverse total shoulders (rTSA), the diagnoses leading to arthroplasty, the mean patient age, and the distribution of patient gender varied significantly among these different databases. This study indicates that the indications for and application of shoulder arthroplasty have important geographical variations and that these variations must be considered when comparing outcomes of shoulder arthroplasty from different locations. Without controlling for age, gender, diagnosis and procedure type, the results from one national registry may not be applicable to patients from a different location. In that national data provide the opportunity to reduce costs by identifying implants and procedures with higher failure rates, the funding of registries needs to be free of conflicts of interest.

Asymptomatic rotator cuff tears: Patient demographics and baseline shoulder function

PubMed Central

Keener, Jay D.; Steger-May, Karen; Stobbs, Georgia; Yamaguchi, Ken

2010-01-01

Background The purpose of this study is to characterize the demographic features and physical function of subjects with asymptomatic rotator cuff tears and to compare their shoulder function to controls with an intact rotator cuff. Materials and Methods 196 subjects with an asymptomatic rotator cuff tear and 54 subjects with an intact rotator cuff presenting with a painful rotator cuff tear in the contralateral shoulder were enrolled. Various demographic features, shoulder function (ASES score and SST score), range of motion and strength were compared. Results The demographic features of the study and control groups were similar. Hand dominance was associated with the presence of shoulder pain (p < .05). Subjects with an intact rotator cuff had greater but clinically insignificant ASES (p < .05) and SST scores (p < .05) than those with an asymptomatic tear. No differences in functional scores, range of motion or strength were seen between partial (n=61) and full-thickness tears (n=135). Of the full-thickness tears, 36 (27%) were classified as small, 85 (63%) as medium and 14 (10%) as large tears. No differences were seen in functional scores between full-thickness tears of various sizes. Conclusions When asymptomatic, a rotator cuff tear is associated with a clinically insignificant loss of shoulder function compared to those with an intact rotator cuff. Therefore, a clinically detectable decline in shoulder function may indicate an “at-risk” asymptomatic tear. The presence of pain is important in cuff deficient shoulders for creating a measurable loss of shoulder function. Hand dominance appears to be an important risk factor for pain. PMID:21030274

Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function.

PubMed

Oliveira, Valéria M A de; Pitangui, Ana C R; Gomes, Mayra R A; Silva, Hítalo A da; Passos, Muana H P Dos; Araújo, Rodrigo C de

Sports that require the constant use of an upper limb demand the maximum kinetic chain efficiency in this segment. Immaturity of the musculoskeletal system, followed by failure in motor skills can expose adolescents to major reports of pain complaints, particularly for the shoulder. To evaluate the prevalence of shoulder pain in adolescent athletes and identify possible factors associated with the complaint. A total of 310 athletes, of both sexes and aged between 10 and 19 years old participated on this study. The subjects filled out a questionnaire with personal, sports and upper limb function (Quick-DASH) questions. We evaluated the height, body mass, shoulder rotation range and stability of the upper limb using the CKCUES-test. The association between pain and the variables was analyzed using multilevel modeling logistic regression. We used the Mann-Whitney test for comparing between pain and function. The prevalence of shoulder pain was 43.5%. Athletes between 15 and 19 years, handball and judo practitioners, are 1.86, 2.14 and 3.07 more likely to report shoulder pain, respectively, when compared with other sports and ages. Shoulder pain reduced function scores (p<0.001) and increased changes in the range of motion (p<0.04). Shoulder pain is highly prevalent and is associated especially with older adolescent athletes of handball and judo, and affects the levels of function and the range of the shoulder. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Acute effects of scapular mobilization in shoulder dysfunction: a double-blind randomized placebo-controlled trial.

PubMed

Surenkok, Ozgur; Aytar, Aydan; Baltaci, Gul

2009-11-01

The aim of this study was to evaluate the initial effects of scapular mobilization (SM) on shoulder range of motion (ROM), scapular upward rotation, pain, and function. Pretest-posttest for 3 groups (SM, sham, and control). A double-blinded, randomized, placebo-controlled trial was conducted to evaluate the initial effect of the SM at a sports physiotherapy clinic. 39 subjects (22 women, 17 men; mean age 54.30 +/- 14.16 y, age range 20-77 y). A visual analog scale, ROM, scapular upward rotation, and function were assessed before and just after SM. SM (n = 13) consisted of the application of superoinferior gliding, rotations, and distraction to the scapula. The sham (n = 13) condition replicated the treatment condition except for the hand positioning. The control group (n = 13) did not undergo any physiotherapy and rehabilitation program. Pain severity was assessed with a visual analog scale. Scapular upward rotation was measured with a baseline digital inclinometer. Constant Shoulder Score (CSS) was used to measure shoulder function. After SM, we found significant improvements for shoulder ROM, scapular upward rotation, and CSS between pretreatment and posttreatment compared with the sham and control groups. In the sham group, shoulder-ROM values increased or decreased for the shoulder and scapular upward rotation was not changed. Pain, ROM, and physical function of the shoulder were not significantly different in the sham group than in controls (P > .05). SM may be a useful manual therapy technique to apply to participants with a painful limitation of the shoulder. SM increases ROM and decreases pain intensity.

Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study.

PubMed

Rechardt, Martti; Shiri, Rahman; Karppinen, Jaro; Jula, Antti; Heliövaara, Markku; Viikari-Juntura, Eira

2010-07-20

Shoulder pain is a common health problem. The purpose of this study was to assess the associations of lifestyle factors, metabolic factors and carotid intima-media thickness with shoulder pain and chronic (> 3 months) rotator cuff tendinitis. In this cross-sectional study, the target population consisted of subjects aged 30 years or older participating in a national Finnish Health Survey during 2000-2001. Of the 7,977 eligible subjects, 6,237 (78.2%) participated in a structured interview and clinical examination. Chronic rotator cuff tendinitis was diagnosed clinically. Weight-related factors, C-reactive protein and carotid intima-media thickness were measured. The prevalence of shoulder joint pain during the preceding 30 days was 16% and that of chronic rotator cuff tendinitis 2.8%. Smoking, waist circumference and waist-to-hip ratio were related to an increased prevalence of shoulder pain in both genders. Metabolic syndrome, type 2 diabetes mellitus and carotid intima-media thickness were associated with shoulder pain in men, whereas high level of C-reactive protein was associated with shoulder pain in women. Increased waist circumference and type 1 diabetes mellitus were associated with chronic rotator cuff tendinitis in men. Our findings showed associations of abdominal obesity, some other metabolic factors and carotid intima-media thickness with shoulder pain. Disturbed glucose metabolism and atherosclerosis may be underlying mechanisms, although not fully supported by the findings of this study. Prospective studies are needed to further investigate the role of lifestyle and metabolic factors in shoulder disorders.

Immediate Effects of Mirror Therapy in Patients With Shoulder Pain and Decreased Range of Motion.

PubMed

Louw, Adriaan; Puentedura, Emilio J; Reese, Dave; Parker, Paula; Miller, Terra; Mintken, Paul E

2017-10-01

To determine the effects of a brief single component of the graded motor imagery (GMI) sequence (mirror therapy) on active range of motion (AROM), pain, fear avoidance, and pain catastrophization in patients with shoulder pain. Single-blind case series. Three outpatient physical therapy clinics. Patients with shoulder pain and limited AROM (N=69). Patients moved their unaffected shoulder through comfortable AROM in front of a mirror so that it appeared that they were moving their affected shoulder. We measured pain, pain catastrophization, fear avoidance, and AROM in 69 consecutive patients with shoulder pain and limited AROM before and immediately after mirror therapy. There were significant differences in self-reported pain (P=.014), pain catastrophization (P<.001), and the Tampa Scale of Kinesiophobia (P=.012) immediately after mirror therapy; however, the means did not meet or exceed the minimal detectable change (MDC) for each outcome measure. There was a significant increase (mean, 14.5°) in affected shoulder flexion AROM immediately postmirror therapy (P<.001), which exceeded the MDC of 8°. A brief mirror therapy intervention can result in statistically significant improvements in pain, pain catastrophization, fear avoidance, and shoulder flexion AROM in patients presenting with shoulder pain with limited AROM. The immediate changes may allow a quicker transition to multimodal treatment, including manual therapy and exercise in these patients. Further studies, including randomized controlled trials, are needed to investigate these findings and determine longer-term effects. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Evaluation of Post Flooding Shoulder Reconditioning : final report.

DOT National Transportation Integrated Search

2017-02-01

The Ohio Department of Transportation (ODOT) Holmes County Garage has to frequently maintain the shoulders of the hilly and curvy highways, which are prone to shoulder erosion and material loss due to floods or heavy rain. Currently, the problematic ...

Use of soil stabilizers on highway shoulders.

DOT National Transportation Integrated Search

2005-01-01

This study evaluated soil additives as stabilizers for aggregate and topsoil shoulders. Its purpose was to determine (1) the effect soil stabilizers have on the strength and stability of soil shoulders, and (2) the costs and benefits of using stabili...

Questions and Answers About Shoulder Problems

MedlinePlus

... months your shoulder is not better. Rotator Cuff Tear Treatment for a rotator cuff tear may also include: Heat or cold to the ... into your shoulder joint. Surgery to repair the tear if you don’t see improvement with other ...

Bicycle-Friendly Shoulder Rumble Strips

DOT National Transportation Integrated Search

2000-03-01

Shoulder rumble strips have proven to be an effective way to reduce run-off-the-road (ROR) crashes on urban and rural freeways. As the use of shoulder rumble strips is being extended to non-freeway facilities, bicyclists will encounter rumble strips ...

Pilot Construction Project for Granular Shoulder Stabilization

DOT National Transportation Integrated Search

2013-09-30

Granular shoulders need to be maintained on a regular basis because edge ruts and potholes develop, posing a safety hazard to motorists. The successful mitigation of edge-rut issues for granular shoulders would increase safety and reduce the number o...

Reliability of magnetic resonance imaging assessment of rotator cuff: the ROW study.

PubMed

Jain, Nitin B; Collins, Jamie; Newman, Joel S; Katz, Jeffrey N; Losina, Elena; Higgins, Laurence D

2015-03-01

Physiatrists encounter patients with rotator cuff disorders, and imaging is frequently an important component of their diagnostic assessment. However, there is a paucity of literature on the reliability of magnetic resonance imaging (MRI) assessment between shoulder specialists and musculoskeletal radiologists. We assessed inter- and intrarater reliability of MRI characteristics of the rotator cuff. Cross-sectional secondary analyses in a prospective cohort study. Academic tertiary care centers. Subjects with shoulder pain were recruited from orthopedic and physiatry clinics. Two shoulder-fellowship-trained physicians (a physiatrist and a shoulder surgeon) jointly performed a blinded composite MRI review by consensus of 31 subjects with shoulder pain. Subsequently, MRI was reviewed by one fellowship-trained musculoskeletal radiologist. We calculated the Cohen kappa coefficients and percentage agreement among the 2 reviews (composite review of 2 shoulder specialists versus that of the musculoskeletal radiologist). Intrarater reliability was assessed among the shoulder specialists by performing a repeated blinded composite MRI review. In addition to this repeated composite review, only one of the physiatry shoulder specialists performed an additional review. Interrater reliability (shoulder specialists versus musculoskeletal radiologist) was substantial for the presence or absence of tear (kappa 0.90 [95% confidence interval {CI}, 0.72-1.00]), tear thickness (kappa 0.84 [95% CI, 0.70-0.99]), longitudinal size of tear (kappa 0.75 [95% CI, 0.44-1.00]), fatty infiltration (kappa 0.62 [95% CI, 0.45-0.79]), and muscle atrophy (kappa 0.68 [95% CI, 0.50-0.86]). There was only fair interrater reliability of the transverse size of tear (kappa 0.20 [95% CI, 0.00-0.51]). The kappa for intrarater reliability was high for tear thickness (0.88 [95% CI, 0.72-1.00]), longitudinal tear size (0.61 [95% CI, 0.22-0.99]), fatty infiltration (0.89 [95% CI, 0.80,-0.98]), and muscle atrophy (0.87 [95% CI, 0.76-0.98]). Intrarater reliability for the individual shoulder specialist was similar to that of the composite reviews. There was high interrater and intrarater reliability for most findings on shoulder MRI. Analysis of our data supports the reliability of MRI assessment by shoulder specialists for rotator cuff disorders. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Uncemented glenoid component in total shoulder arthroplasty. Survivorship and outcomes.

PubMed

Martin, Scott David; Zurakowski, David; Thornhill, Thomas S

2005-06-01

Glenoid component loosening continues to be a major factor affecting the long-term survivorship of total shoulder replacements. Radiolucent lines, cement fracture, migration, and loosening requiring revision are common problems with cemented glenoid components. The purpose of this study was to evaluate the results of total shoulder arthroplasty with an uncemented glenoid component and to identify predictors of glenoid component failure. One hundred and forty-seven consecutive total shoulder arthroplasties were performed in 132 patients (mean age, 63.3 years) with use of an uncemented glenoid component fixed with screws between 1988 and 1996. One hundred and forty shoulders in 124 patients were available for follow-up at an average of 7.5 years. One shoulder in which the arthroplasty had failed at 2.4 years and for which the duration of follow-up was four years was also included for completeness. The preoperative diagnoses included osteoarthritis in seventy-two shoulders and rheumatoid arthritis in fifty-five. Radiolucency was noted around the glenoid component and/or screws in fifty-three of the 140 shoulders. The mean modified ASES (American Shoulder and Elbow Surgeons) score (and standard deviation) improved from 15.6 +/- 11.8 points preoperatively to 75.8 +/- 17.5 points at the time of follow-up. Eighty-five shoulders were not painful, forty-two were slightly or mildly painful, ten were moderately painful, and three were severely painful. Fifteen (11%) of the glenoid components failed clinically, and ten of them also had radiographic signs of failure. Eleven other shoulders had radiographic signs of failure but no symptoms at the time of writing. Three factors had a significant independent association with clinical failure: male gender (p = 0.02), pain (p < 0.01), and radiolucency adjacent to the flat tray (p < 0.001). In addition, the annual risk of implant revision was nearly seven times higher for patients with radiographic signs of failure. Clinical survivorship was 95% at five years and 85% at ten years. The failure rates of the total shoulder arthroplasties in this study were higher than those in previously reported studies of cemented polyethylene components with similar durations of follow-up. Screw breakage and excessive polyethylene wear were common problems that may lead to additional failures of these uncemented glenoid components in the future.

Correlations of Neck/Shoulder Perfusion Characteristics and Pain Symptoms of the Female Office Workers with Sedentary Lifestyle.

PubMed

Bau, Jian-Guo; Chia, Taipau; Wei, Shan-Hua; Li, Yung-Hui; Kuo, Fun-Chie

2017-01-01

Modern office workers are often impacted by chronic neck/shoulder pain. Most of the previous studies which investigated the relationship of the occupational factors and musculoskeletal symptoms had adopted questionnaire survey. In this study the microcirculatory characteristics and perceived symptoms in neck/shoulder region were compared among office workers with sedentary lifestyle. Thirty-seven female office workers were recruited in this study. Microcirculatory flow in neck/shoulder region characterized by the mean blood flow (MMBF value), pulsatile blood flow (PMBF value), and the PMBF/MMBF ratio (perfusion pulsatility, PP) were investigated using Laser Doppler Flowmetry (LDF). A Chinese version of the Standardized Nordic Musculoskeletal Questionnaire (NMQ) were also administered to collect the information of perceived neck/shoulder symptoms. Correlations between the perfusion characteristics and the individual/occupational factors were analyzed using the Spearman test. The difference of the MMBF values between the low-pain group (pain level≤2) and the high-pain group (pain level>2) were compared using the Mann-Whitney U test. There were 81% participants reported neck or shoulder pain symptoms. The duration of shoulder pain was significantly correlated with the workers' age and the duration of employment (p<0.01) (n = 37). While both the MMBF and PMBF values in shoulder region were significantly reduced with the workers' age and the duration of employment (p<0.05) (n = 27). And there was a 54% reduction in the MMBF value of the workers from age of 23 to 47. And the MMBF value of the high-pain group (n = 15) was significantly lower than the value of the low-pain group (n = 15) (p<0.05). The duration of shoulder pain showed a moderately negative correlation with PMBF values (n = 19). Besides, the PP value was moderately correlated with shoulder pain level attributed by the rapid reduction of MMBF values (p = 0.07). In this study, the LDF method was used for the first time in the workplace in Taiwan. It was demonstrated that the MMBF in shoulder region were affected by aging effect and towards lower value at higher pain level. Impaired microcirculation caused by age effect, when coupled with sedentary lifestyle, was found to be more likely to evoke ischemia shoulder pain. Further studies are needed to assess current indicator, PP value, and the underlying mechanism of pain caused by sedentary lifestyle.

Can shoulder range of movement be measured accurately using the Microsoft Kinect sensor plus Medical Interactive Recovery Assistant (MIRA) software?

PubMed

Wilson, James D; Khan-Perez, Jennifer; Marley, Dominic; Buttress, Susan; Walton, Michael; Li, Baihua; Roy, Bibhas

2017-12-01

This study compared the accuracy of measuring shoulder range of movement (ROM) with a simple laptop-sensor combination vs. trained observers (shoulder physiotherapists and shoulder surgeons) using motion capture (MoCap) laboratory equipment as the gold standard. The Microsoft Kinect sensor (Microsoft Corp., Redmond, WA, USA) tracks 3-dimensional human motion. Ordinarily used with an Xbox (Microsoft Corp.) video game console, Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab Ltd., London, UK) allows this small sensor to measure shoulder movement with a standard computer. Shoulder movements of 49 healthy volunteers were simultaneously measured by trained observers, MoCap, and the MIRA device. Internal rotation was assessed with the shoulder abducted 90° and external rotation with the shoulder adducted. Visual estimation and MIRA measurements were compared with gold standard MoCap measurements for agreement using Bland-Altman methods. There were 1670 measurements analyzed. The MIRA evaluations of all 4 cardinal shoulder movements were significantly more precise, with narrower limits of agreement, than the measurements of trained observers. MIRA achieved ±11° (95% confidence interval [CI], 8.7°-12.6°) for forward flexion vs. ±16° (95% CI, 14.6°-17.6°) by trained observers. For abduction, MIRA showed ±11° (95% CI, 8.7°-12.8°) against ±15° (95% CI, 13.4°-16.2°) for trained observers. MIRA attained ±10° (95% CI, 8.1°-11.9°) during external rotation measurement, whereas trained observers only reached ±21° (95% CI, 18.7°-22.6°). For internal rotation, MIRA achieved ±9° (95% CI, 7.2°-10.4°), which was again better than TOs at ±18° (95% CI, 16.0°-19.3°). A laptop combined with a Microsoft Kinect sensor and the MIRA software can measure shoulder movements with acceptable levels of accuracy. This technology, which can be easily set up, may also allow precise shoulder ROM measurement outside the clinic setting. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Stochastic estimation of human shoulder impedance with robots: an experimental design.

PubMed

Park, Kyungbin; Chang, Pyung Hun

2011-01-01

Previous studies assumed the shoulder as a hinge joint during human arm impedance measurement. This is obviously a vast simplification since the shoulder is a complex of several joints with multiple degrees of freedom. In the present work, a practical methodology for more general and realistic estimation of human shoulder impedance is proposed and validated with a spring array. It includes a gravity compensation scheme, which is developed and used for the experiments with a spatial three degrees of freedom PUMA-type robot. The experimental results were accurate and reliable, and thus it has shown a strong potential of the proposed methodology in the estimation of human shoulder impedance. © 2011 IEEE

Chronic shoulder pain referred from thymic carcinoma: a case report and review of literature

PubMed Central

Dee, Shu-Wei; Kao, Mu-Jung; Hong, Chang-Zern; Chou, Li-Wei; Lew, Henry L

2012-01-01

We report a case of thymic carcinoma presenting as unilateral shoulder pain for 13 months. Before an accurate diagnosis was made, the patient received conservative treatment, cervical discectomies, and myofascial trigger point injection, none of which relieved his pain. When thymic carcinoma was eventually diagnosed, he received total resection of the tumor and the shoulder pain subsided completely. Thymic carcinoma is a rare carcinoma, and our review of the literature did not show shoulder pain as its initial presentation except for one case report. The purpose of this report is to document our clinical experience so that other physiatrists can include thymic carcinoma in their differential diagnosis of shoulder pain. PMID:22969299

Rare Inferior Shoulder Dislocation (Luxatio Erecta)

PubMed Central

Cift, Hakan; Soylemez, Salih; Demiroglu, Murat; Ozkan, Korhan; Ozden, Vahit Emre; Ozkut, Afsar T.

2015-01-01

Although shoulder dislocations have been seen very frequently, inferior dislocation of shoulder constitutes only 0.5% of all shoulder dislocations. We share our 4 patients with luxatio erecta and present their last clinical control. 2 male and 2 female Caucasian patients were diagnosed as luxatio erecta. Patients' ages were 78, 62, 65, and 76. All patients' reduction was done by traction-abduction and contour traction maneuver in the operating room. The patients had no symptoms and no limitation of range of motion of their shoulder at their last control. Luxatio erecta is seen rarely, and these patients may have neurovascular injury. These patients should be carefully examined and treated by the orthopaedic and traumatology surgeons. PMID:25883820

[The Throwing Shoulder].

PubMed

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

2016-02-03

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

Humanoid Robot

NASA Technical Reports Server (NTRS)

Linn, Douglas M. (Inventor); Mehling, Joshua S. (Inventor); Radford, Nicolaus A. (Inventor); Bridgwater, Lyndon (Inventor); Wampler, II, Charles W. (Inventor); Abdallah, Muhammad E. (Inventor); Sanders, Adam M. (Inventor); Davis, Donald R. (Inventor); Diftler, Myron A. (Inventor); Platt, Robert (Inventor);

Do Astronauts Havbe a Higher Rate of Orthopedic Shoulder Conditions Than a Cohort of Working Professionals

NASA Technical Reports Server (NTRS)

Laughlin, M. S.; Murray, J. D.; Young, M.; Wear, M. L.; Van Baalen, M.; Tarver, W. J.

2016-01-01

Occupational surveillance of astronaut shoulder injuries began with operational concerns at the Neutral Buoyancy Laboratory (NBL) during Extra Vehicular Activity (EVA) training. Orthopedic shoulder injury and surgery rates were calculated [1], but classifying the rates as normal, high or low was highly dependent on the comparison group. Thus, the purpose of this study was to identify a population of working professionals and compare orthopedic shoulder consultation and surgery rates.

[Muscle efficiency in total shoulder prosthesis implantation: dependence on position of the humeral head and rotator cuff function].

PubMed

Klages, A; Hurschler, C; Wülker, N; Windhagen, H

2001-09-01

Modern shoulder prostheses permit an anatomic reconstruction of the joint, although the biomechanical advantages are not proven. The goal of this study was to investigate the relationship between position of the humeral head and function of the shoulder prosthesis (muscle efficiency). Shoulder elevation-motion and rotator cuff defects were simulated in vitro in a robot-assisted shoulder simulator. The EPOCA Custom Offset shoulder prosthesis (Argomedical AG, Cham, CH) was implanted in seven normal shoulders (77 +/- 20 kg, 55 +/- 14 years). Active elevation was simulated by hydraulic cylinders, and scapulothoratic motion by a specially programmed industrial robot. Muscle efficiency (elevation-angle/muscle-force of the deltoid muscle) was measured in anatomic (ANA), medialised (MED) and lateralised (LAT) positions of the humeral head, with or without rotator cuff muscle deficiency. Medialisation increased efficiency by 0.03 +/- 0.04 deg/N (p = 0.022), lateralisation decreased it by 0.04 +/- 0.06 deg/N (p = 0.009). Supraspinatus muscle deficiency increased the deltoid force required to elevate the arm, and thus decreased efficiency (ANA p = 0.091, MED p = 0.018, LAT p = 0.028). The data confirm that the position of the humeral head affects the mechanics of total shoulder arthroplasty. Medialisation increases efficiency of the deltoid muscle and may prove useful in compensating isolated supraspinatus muscle deficiency. Lateralisation, in contrast, leads to an unfavorable situation.

The potential role of angiogenesis in the development of shoulder pain, shoulder dysfunction, and lymphedema after breast cancer treatment.

PubMed

Mafu, Trevor S; September, Alison V; Shamley, Delva

2018-01-01

Shoulder morbidity is a well-documented sequela of breast cancer treatment, which includes various manifestations such as pain, reduced range of motion, and lymphedema, among others. The multifactorial nature of such morbidities has long been appreciated, and research on reliable risk predictors of development thereof still continues. Previous studies have demonstrated the potential of different types of physical therapy to treat such shoulder problems, and the integration of such interventions into routine care for breast cancer survivors is a requirement in most high-income countries. Although patients at risk for developing shoulder problems would most likely benefit from posttreatment physical therapy, currently, there is no gold standard for identifying this patient group. This is particularly important in low- and middle-income countries where scarce monetary resources need to be directed specifically to those most in need. Modulators of the angiogenesis pathway have been implicated in noncancer shoulder conditions such as rotator cuff disease, adhesive capsulitis, and tendon injuries. The present review summarizes the role of angiogenesis in the development of shoulder morbidity among breast cancer survivors and sets forth the rationale for our belief that angiogenesis signaling may help explain a proportion of the reported clinical variability noted in the development of shoulder pain and dysfunction and upper-limb lymphedema after breast cancer treatment.

Management of shoulder instability in a military population.

PubMed

Pimple, M K; DaCosta, A; Clasper, J C

2008-03-01

Recurrent instability is common after shoulder dislocation in the young, particularly those engaged in physical jobs or sport. The management of recurrent traumatic shoulder instability is predominantly operative. However, the best method of surgery i.e. open or arthroscopic is still a matter of debate. We have developed an algorithm to decide on the choice of surgery and the aim of this study is to report this and compare the two different groups of military patients. A retrospective review of all shoulder stabilisations performed on military personnel, by a single surgeon, between August 2004 and August 2005 at a district general hospital serving both military and civilian population was undertaken. The presentation, clinical and operative findings were noted and compared in the groups treated by arthroscopic or open stabilisation. Using our protocol 39 shoulder stabilisations were performed in military personnel. Of the shoulders, 25 (64%) underwent arthroscopic and 14 (36%) underwent open stabilisation. The indication for surgery was more than 2 episodes of shoulder dislocation. Open surgery was found to be more common in those who had their first dislocation at a younger age. Bilateral shoulder laxity was the most common indication to choose the open method. Both open and arthroscopic stabilisation gave good results in the high demand military population. Only one patient had recurrent instability after arthroscopic procedure. However, this was not statistically significant when compared with open stabilisation.

Shoulder pain and time dependent structure in wheelchair propulsion variability

PubMed Central

Jayaraman, Chandrasekaran; Moon, Yaejin; Sosnoff, Jacob J.

2016-01-01

Manual wheelchair propulsion places considerable repetitive mechanical strain on the upper limbs leading to shoulder injury and pain. While recent research indicates that the amount of variability in wheelchair propulsion and shoulder pain may be related. There has been minimal inquiry into the fluctuation over time (i.e. time-dependent structure) in wheelchair propulsion variability. Consequently the purpose of this investigation was to examine if the time-dependent structure in the wheelchair propulsion parameters are related to shoulder pain. 27 experienced wheelchair users manually propelled their own wheelchair fitted with a SMARTWheel on a roller at 1.1 m/s for 3 minutes. Time-dependent structure of cycle-to-cycle fluctuations in contact angle and inter push time interval was quantified using sample entropy (SampEn) and compared between the groups with/without shoulder pain using non-parametric statistics. Overall findings were, (1) variability observed in contact angle fluctuations during manual wheelchair propulsion is structured (Z=3.15;p<0.05), (2) individuals with shoulder pain exhibited higher SampEn magnitude for contact angle during wheelchair propulsion than those without pain (χ2(1)=6.12;p<0.05); and (3) SampEn of contact angle correlated significantly with self-reported shoulder pain (rs (WUSPI) =0.41;rs (VAS)=0.56;p<0.05). It was concluded that the time-dependent structure in wheelchair propulsion may provide novel information for tracking and monitoring shoulder pain. PMID:27134151

Kinematics and kinetics of elite windmill softball pitching.

PubMed

Werner, Sherry L; Jones, Deryk G; Guido, John A; Brunet, Michael E

2006-04-01

A significant number of time-loss injuries to the upper extremity in elite windmill softball pitchers has been documented. The number of outings and pitches thrown in 1 week for a softball pitcher is typically far in excess of those seen in baseball pitchers. Shoulder stress in professional baseball pitching has been reported to be high and has been linked to pitching injuries. Shoulder distraction has not been studied in an elite softball pitching population. The stresses on the throwing shoulder of elite windmill pitchers are similar to those found for professional baseball pitchers. Descriptive laboratory study. Three-dimensional, high-speed (120 Hz) video data were collected on rise balls from 24 elite softball pitchers during the 1996 Olympic Games. Kinematic parameters related to pitching mechanics and resultant kinetics on the throwing shoulder were calculated. Multiple linear regression analysis was used to relate shoulder stress and pitching mechanics. Shoulder distraction stress averaged 80% of body weight for the Olympic pitchers. Sixty-nine percent of the variability in shoulder distraction can be explained by a combination of 7 parameters related to pitching mechanics. Excessive distraction stress at the throwing shoulder is similar to that found in baseball pitchers, which suggests that windmill softball pitchers are at risk for overuse injuries. Normative information regarding upper extremity kinematics and kinetics for elite softball pitchers has been established.

[Macrosomia, shoulder dystocia and elongation of the brachial plexus: what is the role of caesarean section?

PubMed

Kehila, Mehdi; Derouich, Sadok; Touhami, Omar; Belghith, Sirine; Abouda, Hassine Saber; Cheour, Mariem; Chanoufi, Mohamed Badis

2016-01-01

The delivery of a macrosomic infant is associated with a higher risk for maternofoetal complications. Shoulder dystocia is the most feared fetal complication, leading sometimes to a disproportionate use of caesarean section. This study aims to evaluate the interest of preventive caesarean section. We conducted a retrospective study of 400 macrosomic births between February 2010 and December 2012. We also identified cases of infants with shoulder dystocia occurred in 2012 as well as their respective birthweight. Macrosomic infants weighed between 4000g and 4500g in 86.25% of cases and between 4500 and 5000 in 12.25% of cases. Vaginal delivery was performed in 68% of cases. Out of 400 macrosomic births, 9 cases with shoulder dystocia were recorded (2.25%). All of these cases occurred during vaginal delivery. The risk for shoulder dystocia invaginal delivery has increased significantly with the increase in birth weight (p <10-4). The risk for elongation of the brachial plexus was 11 per thousand vaginal deliveries of macrosomic infants. This risk was not correlated with birthweight (p = 0.38). The risk for post-traumatic sequelae was 0.71%. Shoulder dystocia affectd macrosoic infants in 58% of cases. Shoulder dystocia is not a complication exclusively associated with macrosomia. Screening for risky deliveries and increasing training of obstetricians on maneuvers in shoulder dystocia seem to be the best way to avoid complications.

Use of birth weight threshold for macrosomia to identify fetuses at risk of shoulder dystocia among Chinese populations.

PubMed

Cheng, Yvonne K-Y; Lao, Terence T; Sahota, Daljit S; Leung, Viola K-T; Leung, Tak Y

2013-03-01

To assess the incidence of macrosomia and the influence of birth weight on shoulder dystocia risk among a cohort of Chinese women. A retrospective analysis was conducted of 80953 singleton deliveries recorded at the Prince of Wales Hospital, Hong Kong, between 1995 and 2009. The incidences of macrosomia (birth weight ≥ 4000 g) and shoulder dystocia were assessed by birth weight; risk factors for shoulder dystocia were examined by multiple logistic regression analysis. The incidence of macrosomia was 3.4%. The overall incidence of shoulder dystocia was 0.3%; however, the incidence rose with increasing birth weight. The odds ratio (OR) for a birth weight of 4000-4199 g was 22.40, while the OR for a birth weight of 4200 g or above was 76.10. Other independent risk factors for shoulder dystocia included instrumental delivery (OR 12.11), short stature (OR 2.16), maternal diabetes mellitus (OR 1.78), and obesity (OR 1.58). Although the overall incidences of macrosomia and shoulder dystocia were low, the risk of shoulder dystocia was strongly linked to increasing birth weight. International guidelines for elective cesarean delivery in suspected cases of macrosomia may not, therefore, apply to Chinese women. Copyright © 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Structured reporting of MRI of the shoulder - improvement of report quality?

PubMed

Gassenmaier, Sebastian; Armbruster, Marco; Haasters, Florian; Helfen, Tobias; Henzler, Thomas; Alibek, Sedat; Pförringer, Dominik; Sommer, Wieland H; Sommer, Nora N

2017-10-01

To evaluate the effect of structured reports (SRs) in comparison to non-structured narrative free text (NRs) shoulder MRI reports and potential effects of both types of reporting on completeness, readability, linguistic quality and referring surgeons' satisfaction. Thirty patients after trauma or with suspected degenerative changes of the shoulder were included in this study (2012-2015). All patients underwent shoulder MRI for further assessment and possible surgical planning. NRs were generated during clinical routine. Corresponding SRs were created using a dedicated template. All 60 reports were evaluated by two experienced orthopaedic shoulder surgeons using a questionnaire that included eight questions. Eighty per cent of the SRs were fully complete without any missing key features whereas only 45% of the NRs were fully complete (p < 0.001). The extraction of information was regarded to be easy in 92% of the SRs and 63% of the NRs. The overall quality of the SRs was rated better than that of the NRs (p < 0.001). Structured reporting of shoulder MRI improves the readability as well as the linguistic quality of radiological reports, and potentially leads to a higher satisfaction of referring physicians. • Structured MRI reports of the shoulder improve readability. • Structured reporting facilitates information extraction. • Referring physicians prefer structured reports to narrative free text reports. • Structured MRI reports of the shoulder can reduce radiologist re-consultations.

Interrater reliability of the cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain.

PubMed

Burns, Scott A; Cleland, Joshua A; Carpenter, Kristin; Mintken, Paul E

2016-03-01

Examine the interrater reliability of cervicothoracic and shoulder physical examination in patients with a primary complaint of shoulder pain. Single-group repeated-measures design for interrater reliability. Orthopaedic physical therapy clinics. Twenty-one patients with a primary complaint of shoulder pain underwent a standardized examination by a physical therapist (PT). A PT conducted the first examination and one of two additional PTs conducted the 2nd examination. The Cohen κ and weighted κ were used to calculate the interrater reliability of ordinal level data. Intraclass correlation coefficients model 2,1 (ICC2,1) and the 95% confidence intervals were calculated to determine the interrater reliability. The kappa coefficients ranged from -.24 to .83 for the mobility assessment of the glenohumeral, acromioclavicular and sternoclavicular joints. The kappa coefficients ranged from -.20 to .58 for joint mobility assessment of the cervical and thoracic spine. The kappa coefficients ranged from .23 to 1.0 for special tests of the shoulder and cervical spine. The present study reported the reliability of a comprehensive upper quarter physical examination for a group of patients with a primary report of shoulder pain. The reliability varied considerably for the cervical and shoulder examination and was significantly higher for the examination of muscle length and cervical range of motion. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

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. Copyright © 2015 IPEM. Published by Elsevier Ltd. All rights reserved.

Shoulder kinematics during the wall push-up plus exercise.

PubMed

Lunden, Jason B; Braman, Jonathan P; Laprade, Robert F; Ludewig, Paula M

2010-03-01

The push-up plus exercise is a common therapeutic exercise for improving shoulder function and treating shoulder pathology. To date, the kinematics of the push-up plus exercise have not been studied. Our hypothesis was that the wall push-up plus exercise would demonstrate increased scapular internal rotation and increased humeral anterior translation during the plus phase of the exercise, thereby potentially impacting the subacromial space. Bone pins were inserted in the humerus and scapula in 12 healthy volunteers with no history of shoulder pathology. In vivo motion during the wall push-up plus exercise was tracked using an electromagnetic tracking system. During the wall push-up plus exercise, from a starting position to the push-up plus position, there was a significant increase in scapular downward rotation (P < .05) and internal rotation (P < .05). The pattern of glenohumeral motion was humeral elevation (P < .05) and movement anterior to the scapular plane (P < .05), with humeral external rotation remaining relatively constant. We found that during a wall push-up plus exercise in healthy volunteers, the scapula was placed in a position potentially associated with shoulder impingement. Because of the shoulder kinematics of the wall push-up plus exercise, utilization of this exercise without modification early on in shoulder rehabilitation, especially in patients with subacromial impingement, should be considered cautiously. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Psychosocial factors and shoulder symptom development among workers.

PubMed

Smith, Caroline K; Silverstein, Barbara A; Fan, Z Joyce; Bao, Stephen; Johnson, Peter W

2009-01-01

Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand-control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand-control model and the incidence of shoulder symptoms in a working population. After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand-control model quadrants. Cases were more likely to be female and report other upper extremity symptoms at baseline (P < 0.05). From the hazard models, being in either a passive or high strain job quadrant was associated with the incidence of shoulder symptoms. Hazard ratios were 2.17, 95% CI 1.02-4.66 and 2.19, 95% CI 1.08-4.42, respectively. Using self-reporting to determine demand-control quadrants was successful in identifying subjects at risk of developing work-related shoulder symptoms. Research is needed to determine if this relationship holds with clinically diagnosed shoulder and other upper extremity musculoskeletal disorders. This may be part of a simple tool for assessing risk of developing these UEMSDs. (c) 2008 Wiley-Liss, Inc.

Magnetic resonance imaging-controlled results of the pectoralis major tendon transfer for irreparable anterosuperior rotator cuff tears performed with standard and modified fixation techniques.

PubMed

Lederer, Stefan; Auffarth, Alexander; Bogner, Robert; Tauber, Mark; Mayer, Michael; Karpik, Stefanie; Matis, Nicholas; Resch, Herbert

2011-10-01

Irreparable ruptures of the subscapularis tendon lead to impaired function of the shoulder joint. In such cases, transfer of the pectoralis major tendon has led to encouraging results. The procedure fails periodically, typically associated with insufficient in-growth of the transferred tissue. We hypothesized that tendon harvest with chips of cancellous bone would improve the tendon-bone interface. Of 62 consecutive pectoralis tendon transfers, 54 shoulders were followed-up at an average of 35 months. In all shoulders, the transferred tendon was rerouted behind the conjoint tendon and fixed by transosseous sutures. In 29 shoulders, the tendon was harvested with a cuff of cancellous bone. In 25 shoulders, the conventional technique with sharp detachment of the tendon was used. Apart from detailed clinical examination of all shoulders, a magnetic resonance image (MRI) was available in 52 shoulders. The overall Constant score had improved from an average of 38.8 points preoperatively to 63.4 points at follow-up. Shoulders treated with the new fixation technique scored 64.4 compared with 62.2 for the conventional fixations. The MRI showed intact tendons and muscles in 80.8% of shoulders. In 7 shoulders (13.5%), the transferred tendon was ruptured. Two of these were treated with the new fixation technique. Mean patient satisfaction score was 8.2 points. A secure method of fixation that avoids secondary ruptures despite insufficiency of the transferred tendon is of great importance. Also the rerouting of the transferred tendon under the conjoined tendon is essential to imitate the natural force vector and the function of an intact subscapularis tendon. Patients in this investigation were also monitored by MRI to verify the integrity of the transferred tendon. As a salvage procedure, the pectoralis major tendon transfer provides good results in most cases. Sufficient in-growth of the transferred tissue is essential for the success of the procedure. This seems to be facilitated by both methods. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.