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.

Unique Phrenic Nerve-Sparing Regional Anesthetic Technique for Pain Management after Shoulder Surgery

PubMed Central

Olsen, David A.; Amundson, Adam W.

2017-01-01

Background Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement. Conclusion This case report briefly reviews the important innervations to the shoulder joint and examines the utility of the infraclavicular brachial plexus block for postoperative pain management. PMID:29410922

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

Linked shoulder replacement: current design problems and a new design proposal.

PubMed

Mohammed, Ali Abdullah; Frostick, Simon Peter

2016-04-01

Totally constrained shoulder replacement with linked components is one of the surgical options in post-tumor resection shoulder reconstruction or in complex shoulder revision operations. In this paper, we intend to shed light on such an implant design, which provides a linked constrained connection between the humeral head and the glenoid, and to show some immediate postoperative complications, implant progression to decrease the chances of implant mechanical postinsertion failure, and a new design proposal. In our center, we use the linked prosthesis in complex revision situations; however, there have been some complications, which could be attributed mainly to the engineering and the implant design, and hence potentially avoidable by making a different design to cover for those mechanical issues. Two such complications are described in this paper. Early revisions after linked shoulder replacement implantation were needed in two occasions due to implant disconnection: one of them was due to dislodgement from the native glenoid, and the second one was due to the disengagement of the ringlet which secures the linkage mechanism between the humeral head and the implanted glenoid shell. There is a need for a more stable design construct to avoid the reported complications that needed early revision surgeries. The new design proposed is an attempt to help providing a better and more stable implant to decrease the chances of revision in those complex situations where the patient already had many major operations, and working to increase the durability of the implant is crucial.

Measurements of three-dimensional glenoid erosion when planning the prosthetic replacement of osteoarthritic shoulders.

PubMed

Terrier, A; Ston, J; Larrea, X; Farron, A

2014-04-01

The three-dimensional (3D) correction of glenoid erosion is critical to the long-term success of total shoulder replacement (TSR). In order to characterise the 3D morphology of eroded glenoid surfaces, we looked for a set of morphological parameters useful for TSR planning. We defined a scapular coordinates system based on non-eroded bony landmarks. The maximum glenoid version was measured and specified in 3D by its orientation angle. Medialisation was considered relative to the spino-glenoid notch. We analysed regular CT scans of 19 normal (N) and 86 osteoarthritic (OA) scapulae. When the maximum version of OA shoulders was higher than 10°, the orientation was not only posterior, but extended in postero-superior (35%), postero-inferior (6%) and anterior sectors (4%). The medialisation of the glenoid was higher in OA than normal shoulders. The orientation angle of maximum version appeared as a critical parameter to specify the glenoid shape in 3D. It will be very useful in planning the best position for the glenoid in TSR.

Patient perception of physician reimbursement in elective shoulder surgery.

PubMed

Nagda, Sameer; Wiesel, Brent; Abboud, Joseph; Salamone, Andrew; Sheth, Neil; Foran, Jared; Garstka, Johnny

2015-01-01

A previous study revealed that patients perceived physician reimbursement to be much higher than current Medicare schedules for hip and knee replacement. The purpose of this study was to evaluate patient perception of surgeon reimbursement for total shoulder replacement (TSA) and rotator cuff repair (RCR). The study surveyed 250 patients. Patients were asked what they believe a surgeon should be reimbursed for performing TSA and RCR. Patients were then asked to estimate what Medicare reimbursed for each of these procedures. We then revealed the Medicare reimbursement rate for TSA and RCR, and patients were asked to comment. Finally, patients were asked whether surgeons with advanced shoulder training should receive additional payments. Patients thought that surgeons should receive $13,178 for TSA and $8459 for RCR. Patients estimated actual Medicare reimbursement was $7177 for TSA and $4692 for RCR. Eighty percent of patients stated that Medicare reimbursement was too low for TSA, 75% thought that payment for RCR was lower than what it should be. Less than 1% of patients felt that it was higher than it should be. A total of 87% of patients thought that surgeons with advanced shoulder training should be reimbursed at a higher rate. Patients perceived the values of TSA and RCR were much higher than current Medicare schedules. This is in agreement with prior surveys. Continued decreases in Medicare reimbursements may force surgeons to not participate in Medicare and create a potential access issue. Further investigation should focus on identifying how many surgeons may opt out. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial.

PubMed

Bjørnholdt, Karen T; Jensen, Jan M; Bendtsen, Thomas F; Søballe, Kjeld; Nikolajsen, Lone

2015-12-01

Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. Patients scheduled for primary shoulder replacement under general anaesthesia were randomized to receive either local infiltration analgesia (LIA) (150 ml ropivacaine 0.2 % with epinephrine intra-operatively) or interscalene brachial plexus catheter (ISC) (ropivacaine 0.75 %, 7 ml bolus followed by 48-h 5 ml/h infusion). The primary outcome was opioid consumption during the first 24 post-operative hours. Secondary outcomes were pain ratings, supplementary analgesics, and side effects for 3 days, and complications until 3 months after surgery. Data were analysed for 61 patients (LIA 30, ISC 31). Twenty-four-hour opioid consumption was higher in the LIA group compared with the ISC group: median (IQR) 95 mg (70-150 mg) versus 40 mg (8-76 mg) (P = 0.0001). No significant difference in opioid consumption was found between groups during the following 3 days. The LIA group had higher pain scores at 0, 2, 4, and 8 h. Two patients in the ISC group had long-lasting complications. The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.

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.

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.

Anterior stability of the reverse shoulder arthroplasty depending on implant configuration and rotator cuff condition.

PubMed

Pastor, Marc-Frederic; Kraemer, Manuel; Wellmann, Mathias; Hurschler, Christof; Smith, Tomas

2016-11-01

The aim of this study was to investigate the stabilizing influence of the rotator cuff as well as the importance of glenosphere and onlay configuration on the anterior stability of the reverse total shoulder replacement (RTSR). A reverse total shoulder replacement was implanted into eight human cadaveric shoulders, and biomechanical testing was performed under three conditions: after implantation of the RTSR, after additional dissection of the subscapularis tendon, and after additional dissection of the infraspinatus and teres minor tendon. Testing was performed in 30° of abduction and three rotational positions: 30° internal rotation, neutral rotation, and 30° external rotation. Furthermore, the 38-mm and 42-mm glenospheres were tested in combination with a standard and a high-mobility humeral onlay. A gradually increased force was applied to the glenohumeral joint in anterior direction until the RTSR dislocated. The 42-mm glenosphere showed superior stability compared with the 38-mm glenosphere. The standard humeral onlay required significantly higher anterior dislocation forces than the more shallow high-mobility onlay. External rotation was the most stable position. Furthermore, isolated detachment of the subscapularis and combined dissection of the infraspinatus, teres minor, and subscapularis tendon increased anterior instability. This study showed superior stability with the 42-mm glenosphere and the more conforming standard onlay. External rotation was the most stable position. Detachment of the subscapularis as well as dissection of the complete rotator cuff decreased anterior stability.

Effects of cemented versus press-fit primary humeral stem fixation in the setting of revision shoulder arthroplasty.

PubMed

Salesky, Madeleine A; Grace, Trevor R; Feeley, Brian T; Ma, C Benjamin; Zhang, Alan L

2018-05-01

The influence of primary humeral stem fixation method (cemented or press fit) on intraoperative or postoperative outcomes in the setting of revision shoulder arthroplasty is unknown. A retrospective analysis of a prospectively collected cohort of revision shoulder arthroplasty patients from a single tertiary center was performed. Demographic variables, intraoperative data, and 90-day complication rates were compared between cemented and press-fit primary stem fixation cohorts. Follow-up radiographs were graded and compared using a modified Gruen system for humeral lucencies. Eighty-six primary shoulder replacements (34 hemiarthroplasties, 39 anatomic total shoulder arthroplasties, 13 reverse total shoulder arthroplasties) underwent revision arthroplasty with humeral stem removal between 2004 and 2017. Forty-five patients had cemented primary humeral fixation and 41 had press-fit fixation. The cemented cohort was older than the cementless cohort (66.6 vs. 61.4 years; P = .03) but otherwise demonstrated no difference in gender, body mass index, type of primary prosthesis (hemi, total, or reverse), or time between primary and revision operations. The cemented and cementless cohorts showed similar rates of humeral osteotomy (28.9% vs. 29.3%; P = .97), operative time (133.5  vs. 121.3 minutes; P = .16), and 90-day complication rates (13.3% vs. 9.8%; P = .61). Cemented vs. press-fit primary stems also had similar rates of humeral lucencies seen on follow-up radiographs after revision (77.1% vs. 60.6%; P = .14). Humeral stem fixation with or without cement during primary shoulder arthroplasty demonstrated similar operative time, need for intraoperative humeral osteotomy, and postoperative complication rates in the setting of revision arthroplasty. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier 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.

Return to Sport After Shoulder Arthroplasty in Recreational Athletes: A Systematic Review and Meta-analysis.

PubMed

Aim, Florence; Werthel, Jean-David; Deranlot, Julien; Vigan, Marie; Nourissat, Geoffroy

2018-04-01

One of the most frequent demands from patients after shoulder replacement surgery is to return to sport. To determine the rate of return to sport after shoulder arthroplasty (total shoulder arthroplasty, reverse shoulder arthroplasty, hemiarthroplasty) in recreational athletes. Meta-analysis and systematic review. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature as well as the presentation of results. A search of the literature was performed in the electronic databases MEDLINE, Scopus, Embase, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) score. Inclusion criteria were studies in English evaluating return to sport after shoulder replacement surgery and on patients practicing a sport regularly, whatever the level, with all ages and sports included. The main criterion was the rate of patients who returned to a sport activity. Nine studies were selected among the 35 identified, including a total of 613 patients (39% male and 61% female) with a mean age of 71.7 years (range, 22.6-92.6 years). All the included patients practiced sports before surgery. The most common reported sports were golf (n = 140), swimming (n = 128), and tennis (n = 54). The mean rate of return to sport was 80.7% (range, 57.1%-97.3%). All patients who returned to sport were practicing in the 3 months before surgery. No radiological data were reported in the literature. The subgroup analysis for resuming golf after shoulder arthroplasty revealed a rate of return to sport of 79.2% (95% CI, 62.9%-89.5%). In the swimming subgroup, the rate was 75.6% (95% CI, 61.3%-85.8%) and in the tennis subgroup was 63.5% (95% CI, 34.1%-85.5%). The subgroup analysis for reverse shoulder arthroplasty reported a lower rate of return to sport than for all types of shoulder arthroplasty combined: 76.5% (95% CI, 60%-87%) versus 80.7% (95% CI, 70.9%-87.8%), respectively. Most patients returned to sport after surgery, and all who returned to sport were practicing their sport in the 3 months before surgery. No radiological data were reported in the literature.

Ranges of motion after reverse shoulder arthroplasty improve significantly the first year after surgery in patients with rheumatoid arthritis.

PubMed

Tiusanen, Hannu; Sarantsin, Pjotor; Stenholm, Miika; Mattie, Ryan; Saltychev, Mikhail

2016-07-01

To evaluate the trajectory of the change in range of motion after reverse shoulder joint replacement during 3-year follow-up among patients with rheumatoid arthritis. Retrospective cohort longitudinal study of 76 shoulder replacements performed in a university clinic. The range of shoulder motion was assessed by a physiotherapist using a manual goniometer with 5-degree precision before the surgery and 1, 3, 6, 12, and 36 months postoperatively. The shapes of the regression curves suggest that the improvement or decline observed in joint motion was happening mostly during the first year after surgery. After 1 year, the trajectories become flat and they remained unchanged until the end of follow-up. After shoulder joint replacement, the range of shoulder motion showed substantial changes during the first year only. This should be taken into account when scheduling control visits, planning rehabilitation, and predicting the use of community services after the surgery.

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.

The influence of critical shoulder angle on secondary rotator cuff insufficiency following shoulder arthroplasty.

PubMed

Cerciello, Simone; Monk, Andrew Paul; Visonà, Enrico; Carbone, Stefano; Edwards, Thomas Bradley; Maffulli, Nicola; Walch, Gilles

2017-07-01

Secondary cuff failure after shoulder replacement is disabling and often requires additional surgery. Increased critical shoulder angle (CSA) has been found in patients with cuff tear compared to normal subjects. The interobserver reliability of the CSA and the relationship between CSA and symptomatic secondary cuff failure after shoulder replacement were investigated. Nineteen patients with symptomatic cuff failure after anatomic shoulder replacement (mean FU 45 months) were compared to a control group of 29 patients showing no signs of symptomatic cuff failure (mean FU 105.7 months). The CSA was measured by two blinded surgeons at a mean follow-up of 45 and 105.7 months, respectively. Inter-observer reliability was calculated. The mean CSA in the study group in neutral, internal and external rotations were 33°, 34° and 34°, respectively. Corresponding values in the control group were 32°, 32° and 32°. The interclass correlation coefficient for the whole population between the two examiners were 0.956 (P < 0.01), 0.964 (P < 0.01) and 0.955 (P < 0.01), respectively. There were no significant differences of CSA values between patients who had undergone shoulder replacement and experienced late cuff failure and those in whom the same procedure had been successful. A good inter-observer reliability was found for the CSA method.

Mid-term shoulder functional and quality of life outcomes after shoulder replacement in obese patients.

PubMed

Vincent, Heather K; Struk, Aimee M; Reed, Austin; Wright, Thomas W

2016-01-01

Shoulder pain and loss of function are directly associated with obesity. We hypothesized that significant interactions would exist between total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (RSA) and obesity status on functional and quality of life (QOL) outcomes over the long term. Clinical and QOL outcomes (American Shoulder and Elbow Surgeons Evaluation form, Shoulder Pain and Disability Index, University of California at Los Angeles Shoulder Rating scale, Medical Outcomes Short Form 12 (SF-12), range of motion (ROM), and strength) were longitudinally compared in patients with low and high body mass index (BMI) after a TSA or a RSA. Prospectively collected data of patients with a TSA or RSA were reviewed (N = 310). Preoperative, 2-year, and final follow-up visits were included (range 3-17 years; mean 5.0 ± 2.5 years). Patient data were stratified for analysis using BMI. Morbidly obese patients had worse preoperative functional scores and QOL compared to the other groups. There were no significant interactions of BMI group by surgery type for any of the outcome variables except for active external rotation ROM. Morbidly obese patients attained lower SF-12 scores compared to the remaining groups at each time point. Both TSA and RSA can be expected to impart positive functional outcomes in patients irrespective of BMI. Morbidly obese patients do not attain the same gains in Medical Outcomes SF-12 scores as the non-morbidly obese patients. The lower improvements in active external ROM may be due to morphological limitations of excessive adiposity. This is a level II study.

Analysis of severely fractured glenoid components: clinical consequences of biomechanics, design, and materials selection on implant performance.

PubMed

Ansari, Farzana; Lee, Taylor; Malito, Louis; Martin, Audrey; Gunther, Stephen B; Harmsen, Samuel; Norris, Tom R; Ries, Mike; Van Citters, Douglas; Pruitt, Lisa

2016-07-01

The longevity of total shoulder replacement is primarily limited by the performance of the ultrahigh-molecular-weight polyethylene (UHMWPE) glenoid component in vivo. Variations in glenoid design (conformity, thickness), biomechanics (joint kinematics), and UHMWPE material selection (sterilization, cross-linking) distinguish total shoulder replacements from hip and knee arthroplasty devices. These variables can lead to severe mechanical failures, including gross fracture. Sixteen retrieved glenoids with severe fracture were analyzed. The explant cohort included 3 material groups (gamma-sterilized Hylamer; gamma-sterilized UHMWPE; and gas plasma-sterilized, remelted, highly cross-linked UHMWPE [HXL]) and a range of conformities (0- to 10-mm radial mismatch). Analysis included fractography (optical and scanning electron microscopy) and Fourier transform infrared spectroscopy for oxidative analysis. Fracture primarily occurred along the exterior rim for all 16 explants. Fourier transform infrared analysis and fractography revealed significant oxidative embrittlement for all gamma-sterilized glenoids. Fatigue striations and internal flaws were evident on the fracture surface of the HXL glenoid, with little oxidation detected. Fracture initiated at the external rim of all devices. Elevated oxidation levels and visible material distortion for representative gamma-sterilized conventional and Hylamer devices suggest oxidative embrittlement as a driving force for crack inception and subsequent fracture. Brittle fracture of theHXL glenoid resulted from a combination of elevated contact stress due to a nonconforming surface, an internal flaw, and reduced resistance to fatigue crack growth. This demonstrates that glenoid fracture associated with oxidation has not been eliminated with the advent of modern materials (HXL) in the shoulder domain. Basic Science Study; Implant Retrieval Study. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Do patients return to sports and work after total shoulder replacement surgery?

PubMed

Bülhoff, Matthias; Sattler, Peter; Bruckner, Thomas; Loew, Markus; Zeifang, Felix; Raiss, Patric

2015-02-01

Studies evaluating the return to sports and work after shoulder arthroplasty are rare, and there are no studies evaluating return to work after total shoulder arthroplasty (TSA). Patients undergoing TSA will be able to return to their preoperative sports levels and occupations. Case series; Level of evidence, 4. A total of 154 patients with 170 TSAs for primary glenohumeral arthritis were included. Two subgroups were formed: patients who had participated in sports during the 5 years before surgery (group 1; n = 105 [68%]) and patients who had never participated in sports (group 2; n = 49 [32%]). The return-to-work rate in patients who had not retired after surgery were also analyzed, as were responses to a survey. The mean age at the time of surgery was 71 years (range, 33-88 years) in group 1 and 76 years (range, 54-88 years) in group 2. Mean follow-up time was 6.2 years (range, 2.5-12.6 years). Fifty-seven patients (54%) in group 1 participated in sports right up to the time of surgery. All 57 (100%) returned to sports after surgery. A further 3 patients (3%) from group 1 resumed sporting activity after surgery; swimming was the most popular sport. No patient in group 2 started sports activity after shoulder replacement surgery. Many of the patients, 14% of the entire group, had retired by final follow-up because of TSA. Fourteen percent of patients in group 1 and group 2 were pursuing their work at the time of most recent follow-up. Thirty patients of the entire cohort (19.5%) had to change their occupations because of surgery. Patients who participated in sports before TSA were successfully able to return to sports activities after surgery. Patients who did not participate in sports just before surgery were unlikely to start sports after surgery. Fourteen percent of the entire cohort was able to return to work after surgery. © 2014 The Author(s).

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...

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.

Glenoid labrum ossification and mechanical restriction of joint motion: extraosseous manifestations of melorheostosis.

PubMed

Subhas, N; Sundaram, M; Bauer, T W; Seitz, W H; Recht, M P

2008-02-01

We report a case of a 47-year-old man who presented with progressive loss of motion and pain in the right shoulder. Radiographs of the shoulder demonstrated dense ossification in the glenoid and humeral head with extension into the periarticular soft tissues. CT and MRI scans confirmed the radiographic findings and also revealed ossification of the glenoid labrum. A radiographic diagnosis of melorheostosis, an uncommon benign sclerosing bone dysplasia, was made. Because of the patient's severe symptomatology, he underwent total shoulder arthroplasty. Histological analysis of the resected masses was consistent with melorheostosis with a few areas covered by a cartilage cap. This case illustrates several uncommon but important features of melorheostosis, including mechanical obstruction of joint motion requiring joint replacement, ossification of the glenoid labrum, and cartilage-covering portions of the intra-articular masses, not to be confused with cartilage-producing tumors.

Emerging technology in surgical education: combining real-time augmented reality and wearable computing devices.

PubMed

Ponce, Brent A; Menendez, Mariano E; Oladeji, Lasun O; Fryberger, Charles T; Dantuluri, Phani K

2014-11-01

The authors describe the first surgical case adopting the combination of real-time augmented reality and wearable computing devices such as Google Glass (Google Inc, Mountain View, California). A 66-year-old man presented to their institution for a total shoulder replacement after 5 years of progressive right shoulder pain and decreased range of motion. Throughout the surgical procedure, Google Glass was integrated with the Virtual Interactive Presence and Augmented Reality system (University of Alabama at Birmingham, Birmingham, Alabama), enabling the local surgeon to interact with the remote surgeon within the local surgical field. Surgery was well tolerated by the patient and early surgical results were encouraging, with an improvement of shoulder pain and greater range of motion. The combination of real-time augmented reality and wearable computing devices such as Google Glass holds much promise in the field of surgery. Copyright 2014, SLACK Incorporated.

Glenoid wear after shoulder hemiarthroplasty: quantitative radiographic analysis.

PubMed

Parsons, I M; Millett, Peter J; Warner, Jon J P

2004-04-01

Symptomatic glenoid arthrosis may limit the long-term success of shoulder hemiarthroplasty in patients who are young and functionally demanding. The principal objective of the current study was to quantify glenoid wear after proximal humeral replacement in young, active subjects. Eight patients, ages 21 to 60 years (mean, 45 years), met inclusion criteria. The mean followup was 43 months. Functional scores for the cohort averaged 60% of age and gender-adjusted healthy subjects (range, 28%-84%). Glenohumeral joint space was measured on serial axillary radiographs using a Microscribe 3-DX digitizing device (measurement accuracy, 0.23 mm). Progressive glenoid wear was found in all eight patients. The mean decrease was 2 mm (range, 1.3-2.8 mm), a 68% decrease in glenohumeral joint space. Glenoid cartilage wear also was correlated with Constant and Murley scores. Patients with residual joint spaces less than 1 mm had a mean score of 50%, compared with a score of 71% for patients with joint spaces greater than 1 mm. There were no correlations between wear and mechanism of injury, duration of symptoms, and prior surgery. This study suggests that glenoid cartilage erosion can be expected routinely after humeral head replacement in young, active individuals, and that such wear may adversely affect function or necessitate conversion to total shoulder arthroplasty.

Scapular allograft reconstruction after total scapulectomy: surgical technique and functional results.

PubMed

Capanna, Rodolfo; Totti, Francesca; Van der Geest, Ingrid C M; Müller, Daniel A

2015-08-01

Scapular allograft reconstruction after total scapulectomy preserving the rotator cuff muscles is an oncologically safe procedure and results in good functional outcome with a low complication rate. The data of 6 patients who underwent scapular allograft reconstruction after a total scapulectomy for tumor resection were retrospectively reviewed. At least 1 of the rotator cuff muscles was preserved and the size-matched scapular allograft fixed to the residual host acromion with a plate and screws. The periscapular muscles and the residual joint capsule were sutured to the corresponding insertions of the allograft. The mean follow-up was 5.5 years (range, 24-175 months). In all patients, a wide surgical margin was achieved. The average functional scores were 20 points for the International Society of Limb Salvage score and 60 points for the American Shoulder and Elbow Surgeons score. Mean active shoulder flexion of 60° (range, 30°-90°) and mean active abduction of 62° (range, 30°-90°) were achieved. During the follow-up, 1 patient (16.6%) had a local recurrence and lung metastasis, whereas the remaining 5 patients (83.3%) were disease free. Two breakages of the osteosynthesis and 2 allograft fractures were observed, necessitating a revision surgery in 2 cases (33.3%). In this series, no infection, allograft resorption, or shoulder instability occurred. Allograft substitution of a completely removed scapula is an oncologically safe procedure, with good functional results, avoiding common complications in prosthetic replacements such as infection and dislocation of the shoulder joint. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Stemless shoulder arthroplasty: current status.

PubMed

Churchill, R Sean

2014-09-01

Since the original Neer humeral replacement in the 1950s, the standard primary anatomic total shoulder arthroplasty design has slowly evolved. Most recently, the humeral stem has become progressively shorter to help combat stem-related complications. Currently, there are several companies who have developed and marketed a stemless humeral arthroplasty component. Manufacturers' data for 5 stemless shoulder arthroplasty components currently on the market were analyzed and reviewed. A literature review of short-term results for stemless shoulder arthroplasty was completed. Of the stemless shoulder arthroplasty systems available on the market, 3 are currently undergoing clinical trials in the United States. The Tornier Simpliciti (Tornier, Edina, MN, USA) clinical trial began in 2011. The study with 2-year minimum follow-up results is scheduled for completion in November 2014. The Arthrex Eclipse (Arthrex, Naples, FL, USA) clinical trial was started in January 2013. The tentative study completion date is 2017. The Biomet Nano (Biomet, Warsaw, IN, USA) clinical trial began in October 2013 and also has a tentative completion date of 2017. No other clinical trial is currently under way in the United States. Early results for stemless shoulder arthroplasty indicate clinical results similar to standard stemmed shoulder arthroplasty. Radiographic analysis indicates implant stability without migration or subsidence at 2- to 3-year minimum follow-up.. Several stemless shoulder arthroplasty implants are available outside the United States. Early clinical and radiographic results are promising, but well-designed clinical studies and midterm results are lacking. Three clinical trials are currently under way in the United States with initial availability for use anticipated in 2015. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Low rate of Propionibacterium acnes in arthritic shoulders undergoing primary total shoulder replacement surgery using a strict specimen collection technique.

PubMed

Maccioni, Cristobal B; Woodbridge, Adam B; Balestro, Jean-Christian Y; Figtree, Melanie C; Hudson, Bernard J; Cass, Benjamin; Young, Allan A

2015-08-01

Propionibacterium acnes is a recognized pathogen in postoperative shoulder infections. A recent study reported growth of P acnes in 42% of glenohumeral joints in primary shoulder arthroplasty, concluding that P acnes may cause shoulder osteoarthritis. Whether these results reflect true bacterial infection or specimen contamination is unclear. Our prospective study aimed to determine the rate of P acnes infection in arthritic shoulders using a strict specimen collection technique. We used modified Oxford protocol to collect tissue specimens from the glenohumeral joint of 32 consecutive patients undergoing primary shoulder arthroplasty. Specimens were cultured specifically for P acnes. Diagnosis of P acnes infection required 2 or more positive cultures and histopathology compatible with infection. Three of 32 patients had a positive culture for P acnes. Overall, 3.125% of specimens grew P acnes without histologic evidence of infection. There were no patients with P acnes infection. The difference in culture rates between patients with idiopathic osteoarthritis and those with a predisposing cause for osteoarthritis was not significant. We found a low rate of positive cultures for P acnes, but no P acnes infection and no difference between types of osteoarthritis. These results do not support a cause-and-effect relationship between P acnes and osteoarthritis. The differing results from previous studies are likely explained by our strict specimen collection technique, reflecting different rates of contamination rather than infection. That P acnes contamination occurs in primary shoulder arthroplasty is concerning. Further studies are needed to assess the rates of contamination in shoulder surgery, its clinical effect, and to determine optimal antibiotic prophylaxis. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

Linking of total elbow prosthesis during surgery; a biomechanical analysis.

PubMed

De Vos, Maarten J; Wagener, Marc L; Hendriks, Jan C M; Eygendaal, Denise; Verdonschot, Nico

2013-09-01

Presently, 2 types of elbow prostheses are used: unlinked and linked. The Latitude total elbow prosthesis allows the surgeon to decide during the implantation whether the prosthesis is placed unlinked or linked, and whether the native radial head is retained, resected, or replaced. The purpose of this study is to assess and to compare the varus and valgus laxity of the unlinked and linked version of the latitude total elbow prosthesis with: (1) the native radial head preserved, (2) the native radial head excised, and (3) the native radial head replaced by a radial head component. Biomechanical testing was performed on 14 fresh-frozen upper limb specimens. Linking the prosthesis predominantly influences the valgus laxity of the elbow. Linking the Latitude total elbow prosthesis results in increased valgus stability. In the linked version of the total elbow prosthesis, the radial head only plays a small part in both valgus and varus stability. An unlinked situation is not advised in absence of a native radial head or in case of inability to replace the radial head. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Using your shoulder after replacement surgery

MedlinePlus

... on the top of the stem. A plastic piece is used as the new surface of the shoulder blade. Now that you are home you will need to know how to protect your shoulder as it heals. What to Expect at Home You will need to wear a sling for the first 6 weeks after surgery. You may want to wear ...

Isokinetic strength differences between patients with primary reverse and total shoulder prostheses: muscle strength quantified with a dynamometer.

PubMed

Alta, Tjarco D W; Veeger, DirkJan H E J; de Toledo, Joelly M; Janssen, Thomas W J; Willems, W Jaap

2014-11-01

Range of motion after total shoulder arthroplasty is better than after reverse shoulder arthroplasty, however with similar clinical outcome. It is unclear if this difference can only be found in the different range of motion or also in the force generating capacity. (1) are isokinetically produced joint torques of reverse shoulder arthroplasty comparable to those of total shoulder arthroplasty? (2) Does this force-generating capacity correlate with functional outcome? Eighteen reverse shoulder arthroplasty patients (71years (SD 9years)) (21 shoulders, follow-up of 21months (SD 10months)) were recruited, 12 total shoulder arthroplasty patients (69years (SD 9years)) (14 shoulders, follow-up of 35months (SD 11months)). Pre- and post-operative Constant-Murley scores were obtained; two isokinetic protocols (ab-/adduction and ex-/internal rotations) at 60°/s were performed. Twelve of 18 reverse shoulder arthroplasty patients generated enough speed to perform the test (13 shoulders). Mean ab-/adduction torques are 16.3Nm (SD 5.6Nm) and 20.4Nm (SD 11.8Nm). All total shoulder arthroplasty patients generated enough speed (14 shoulders). Mean ab-/adduction torques are 32.1Nm (SD 13.3Nm) and 43.1Nm (SD 21.5Nm). Only 8 reverse shoulder arthroplasty patients (9 shoulders) could perform ex-/internal rotation tasks and all total shoulder arthroplasty patients. Mean ex-/internal rotation torques are 9.3Nm (SD 4.7Nm) and 9.2Nm (SD 2.1Nm) for reverse shoulder arthroplasty, and 17.9Nm (SD 7.7Nm) and 23.5Nm (SD 10.6Nm) for total shoulder arthroplasty. Significant correlations between sub-scores: activity, mobility and strength and external rotation torques for reverse shoulder arthroplasty. Moderate to strong correlation for sub-scores: strength in relation to abduction, adduction and internal rotation torques for total shoulder arthroplasty. Shoulders with a total shoulder arthroplasty are stronger. This can be explained by the absence of rotator cuff muscles and (probably) medialized center of rotation in reverse shoulder arthroplasty. The strong correlation between external rotation torques and post-operative Constant-Murley sub-scores demonstrates that external rotation is essential for good clinical functioning in reverse shoulder arthroplasty. Copyright © 2014 Elsevier Ltd. All rights reserved.

Sports after shoulder arthroplasty: a comparative analysis of hemiarthroplasty and reverse total shoulder replacement.

PubMed

Liu, Joseph N; Garcia, Grant H; Mahony, Gregory; Wu, Hao-Hua; Dines, David M; Warren, Russell F; Gulotta, Lawrence V

2016-06-01

Traditionally, fewer postoperative sport restrictions are imposed on hemiarthroplasty (HHA) patients on than reverse total shoulder arthroplasty (RTSA) patients. However, functional outcomes have been shown to be superior in RTSA. No direct comparison of RTSA vs HHA has been done on rates of return to sports in patients with glenohumeral arthritis and rotator cuff dysfunction, proximal humeral fractures, or rheumatoid arthritis. This is a retrospective review of consecutive RTSA and HHA patients collected from our institution's shoulder arthroplasty registry. All patients playing sports preoperatively with minimum 1-year follow-up were included. Final follow-up included an additional patient-reported questionnaire with questions regarding physical fitness and sport activities. The study included 102 RTSA and 71 HHA patients. Average age at surgery was 72.3 years for RTSA compared with 65.6 years for HHA (P < .001). Patients undergoing RTSA had improved visual analog scale scores compared with HHA (-5.6 vs -4.2, P = .007), returned to sports after RTSA at a significantly higher rate (85.9% vs 66.7%, P = .02), and were more likely to be satisfied with their ability to play sports (P = .013). HHA patients were also more likely to have postoperative complaints than RTSA patients (63% vs 29%, P < .0001). No sports-related complications occurred. Female sex, age <70 years, surgery on the dominant extremity, and a preoperative diagnosis of arthritis with rotator cuff dysfunction predicted a higher likelihood of return to sports for patients undergoing RTSA compared with HHA. Despite traditional sport restrictions placed on RTSA, patients undergoing RTSA can return to sports at rates higher than those undergoing HHA, with fewer postoperative complaints. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Improvements in survival of the uncemented Nottingham Total Shoulder prosthesis: a prospective comparative study

PubMed Central

Rosenberg, Nahum; Neumann, Lars; Modi, Amit; Mersich, Istvan J; Wallace, Angus W

2007-01-01

Background The uncemented Nottingham Total Shoulder Replacement prosthesis system (Nottingham TSR) was developed from the previous BioModular® shoulder prosthesis taking into consideration the causes of the initial implant's failure. We investigated the impact of changes in the design of Nottingham TSR prosthesis on its survivorship rate. Methods Survivorship analyses of three types of uncemented total shoulder arthroplasty prostheses (BioModular®, initial Nottingham TSR and current Nottingham TSR systems with 11, 8 and 4 year survivorship data respectively) were compared. All these prostheses were implanted for the treatment of disabling pain in the shoulder due to primary and secondary osteoarthritis or rheumatoid arthritis. Each type of the prosthesis studied was implanted in consecutive group of patients – 90 patients with BioModular® system, 103 with the initial Nottingham TSR and 34 patients with the current Nottingham TSR system. The comparison of the annual cumulative survivorship values in the compatible time range between the three groups was done according to the paired t test. Results The 8-year and 11-year survivorship rates for the initially used modified BioModular® uncemented prosthesis were relatively low (75.6% and 71.7% respectively) comparing to the reported survivorship of the conventional cemented implants. The 8-year survivorship for the uncemented Nottingham TSR prosthesis was significantly higher (81.8%), but still not in the desired range of above 90%, that is found in other cemented designs. Glenoid component loosening was the main factor of prosthesis failure in both prostheses and mainly occurred in the first 4 postoperative years. The 4-year survivorship of the currently re-designed Nottingham TSR prosthesis, with hydroxylapatite coating of the glenoid baseplate, was significantly higher, 93.1% as compared to 85.1% of the previous Nottingham TSR. Conclusion The initial Nottingham shoulder prosthesis showed significantly higher survivorship than the BioModular® uncemented prosthesis, but lower than expected. Subsequently re-designed Nottingham TSR system presented a high short term survivorship rate that encourages its ongoing use PMID:17683577

Prosthetic replacement for proximal humeral fractures.

PubMed

Kontakis, George; Tosounidis, Theodoros; Galanakis, Ioannis; Megas, Panagiotis

2008-12-01

The ideal management of complex proximal humeral fractures continues to be debatable. Evolution of proximal humeral fracture management, during the past decade, led to the implementation of many innovations in surgical treatment. Even though the pendulum of treatment seems to swing towards new trends such as locked plating, hemiarthroplasty remains a valid and reliable option that serves the patient's needs well. Hemiarthroplasty is indicated for complex proximal humeral fractures in elderly patients with poor bone stock and when internal fixation is difficult or unreliable. Hemiarthroplasty provides a better result when it is performed early post-injury. Stem height, retroversion and tuberosity positioning are technical aspects of utmost importance. Additionally reverse total shoulder arthroplasty is an alternative new modality that can be used as a primary solution in selected patients with proximal humeral fracture treatment. Failed hemiarthroplasty and fracture sequelae can be successfully managed with reverse total shoulder arthroplasty. Individual decision-making and tailored treatment that takes into consideration the personality of the fracture and the patient's characteristics should be used.

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).

Regional analgesia for improvement of long-term functional outcome after elective large joint replacement.

PubMed

Atchabahian, Arthur; Schwartz, Gary; Hall, Charles B; Lajam, Claudette M; Andreae, Michael H

2015-08-13

Regional analgesia is more effective than conventional analgesia for controlling pain and may facilitate rehabilitation after large joint replacement in the short term. It remains unclear if regional anaesthesia improves functional outcomes after joint replacement beyond three months after surgery. To assess the effects of regional anaesthesia and analgesia on long-term functional outcomes 3, 6 and 12 months after elective major joint (knee, shoulder and hip) replacement surgery. We performed an electronic search of several databases (CENTRAL, MEDLINE, EMBASE, CINAHL), and handsearched reference lists and conference abstracts. We updated our search in June 2015. We included randomized controlled trials (RCTs) comparing regional analgesia versus conventional analgesia in patients undergoing total shoulder, hip or knee replacement. We included studies that reported a functional outcome with a follow-up of at least three months after surgery. We used standard methodological procedures expected by Cochrane. We contacted study authors for additional information. We included six studies with 350 participants followed for at least three months. All of these studies enrolled participants undergoing total knee replacement. Studies were at least partially blinded. Three studies had a high risk of performance bias and one a high risk of attrition bias, but the risk of bias was otherwise unclear or low.Only one study assessed joint function using a global score. Due to heterogeneity in outcome and reporting, we could only pool three out of six RCTs, with range of motion assessed at three months after surgery used as a surrogate for joint function. All studies had a high risk of detection bias. Using the random-effects model, there was no statistically significant difference between the experimental and control groups (mean difference 3.99 degrees, 95% confidence interval (CI) - 2.23 to 10.21; P value = 0.21, 3 studies, 140 participants, very low quality evidence).We did not perform further analyses because immediate adverse effects were not part of the explicit outcomes of any of these typically small studies, and long-term adverse events after regional anaesthesia are rare.None of the included studies elicited or reported long-term adverse effects like persistent nerve damage. More high-quality studies are needed to establish the effects of regional analgesia on function after major joint replacement, as well as on the risk of adverse events (falls).

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

[Endoprostheses in geriatric traumatology].

PubMed

Buecking, B; Eschbach, D; Bliemel, C; Knobe, M; Aigner, R; Ruchholtz, S

2017-01-01

Geriatric traumatology is increasing in importance due to the demographic transition. In cases of fractures close to large joints it is questionable whether primary joint replacement is advantageous compared to joint-preserving internal fixation. The aim of this study was to describe the importance of prosthetic joint replacement in the treatment of geriatric patients suffering from frequent periarticular fractures in comparison to osteosynthetic joint reconstruction and conservative methods. A selective search of the literature was carried out to identify studies and recommendations concerned with primary arthroplasty of fractures in the region of the various joints (hip, shoulder, elbow and knee). The importance of primary arthroplasty in geriatric traumatology differs greatly between the various joints. Implantation of a prosthesis has now become the gold standard for displaced fractures of the femoral neck. In addition, reverse shoulder arthroplasty has become an established alternative option to osteosynthesis in the treatment of complex proximal humeral fractures. Due to a lack of large studies definitive recommendations cannot yet be given for fractures around the elbow and the knee. Nowadays, joint replacement for these fractures is recommended only if reconstruction of the joint surface is not possible. The importance of primary joint replacement for geriatric fractures will probably increase in the future. Further studies with larger patient numbers must be conducted to achieve more confidence in decision making between joint replacement and internal fixation especially for shoulder, elbow and knee joints.

[Reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus].

PubMed

Wu, Xing; Lou, Lie-ming; Chen, Zheng-rong; Zhang, Guang-jian

2008-10-01

To explore the effective skills of reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement. From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint reparation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue. The mean duration of follow-up was 2.3 years (ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or subluxation occurred due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%. In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.

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.

Effect of dietary replacement of sunflower oil with linseed oil on intramuscular fatty acids of lamb meat.

PubMed

Jerónimo, Eliana; Alves, Susana P; Prates, José A M; Santos-Silva, José; Bessa, Rui J B

2009-11-01

The effect of stepwise replacement of dietary sunflower oil (SO) with linseed oil (LO) on carcass composition, meat colour and fatty acid (FA) composition of intramuscular lipids of lamb meat was investigated. Thirty-six lambs were fed one of four diets consisting of pellets of lucerne with oil (60g/kg): the diet varied in the composition of oil added and were: 100% SO; 66.6% SO plus 33.3% LO; 33.3% SO plus 66.6% LO and 100% LO. The experimental period was 7weeks. Live slaughter weight, hot carcass weight and intermuscular fat percentage of chump and shoulder increased linearly with replacement of SO by LO. Total FA content of longissimus dorsi muscle and polar and neutral lipids were not affected by the treatments. Replacement of SO with LO increased the content of 18:3n-3 and total n-3 long chain (⩾C(20)) PUFA (LC-PUFA) and decreased the 18:2n-6, total n-6 LC-PUFA and 18:2 cis-9, trans-11 in meat lipids. Maximum CLA concentration (42.9mg/100g fresh muscle) was observed with 100% of SO, decreasing linearly by SO with LO replacement. Maximum n-3 LC-PUFA was predicted to be 27mg/100g of fresh muscle at 78% of SO with LO replacement. Considering both CLA and n-3 LC-PUFA, the maximum levels were estimated to be reached at 52% of replacement of SO with LO. The utilization of blends of SO and LO is a good approach for obtaining lamb meat enriched with both CLA and n-3 LC-PUFA.

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.

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.

Reverse shoulder arthroplasty with a cementless short metaphyseal humeral implant without a stem: clinical and radiologic outcomes in prospective 2- to 7-year follow-up study.

PubMed

Levy, Ofer; Narvani, Ali; Hous, Nir; Abraham, Ruben; Relwani, Jai; Pradhan, Riten; Bruguera, Juan; Sforza, Giuseppe; Atoun, Ehud

2016-08-01

Reverse shoulder prostheses are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff. Bone preservation is becoming a major goal in shoulder replacement surgery. Metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone. This study evaluated the clinical and radiologic outcomes at 2 to 7 years using a novel short metaphyseal reverse total shoulder arthroplasty (rTSA) prosthesis without a diaphyseal stem. Between 2005 and 2010, 102 consecutive patients underwent rTSA with this implant, and 98 (20 men, 78 women) were available for follow-up. Mean age was 74.4 years (range, 38-93 years). Indications were cuff tear arthropathy, 65; fracture sequelae, 12; rheumatoid arthritis, 13; failed rotator cuff repair, 3; cuff deficiency with loosening of anatomic prosthesis, 3; and acute trauma, 2; with 17 of these as revisions. Patients' satisfaction (Subjective Shoulder Value) improved from 8 of 100 to 85 of 100. The Constant score improved from 14 to 59 (age- and sex-adjusted, 86; P < .0001). Range of motion improved from 47° to 129° in elevation, 10° to 51° in external rotation, and 21° to 65° in internal rotation. Radiographic analysis showed no lucencies, subsidence, or stress shielding around the humeral or glenoid components. Glenoid notching was found in 21 patients (18 grade 1-2; 3 grade 3). The short metaphyseal rTSA design without a diaphyseal stem shows encouraging short- to midterm results, with excellent pain relief and shoulder function, restoration of good active range of motion, and high patient satisfaction scores. The design of this implant seems to result in improved rotational movements, low incidence of glenoid notching, and no implant loosening, subsidence, or stress shielding. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Regional analgesia for improvement of long-term functional outcome after elective large joint replacement

PubMed Central

Atchabahian, Arthur; Schwartz, Gary; Hall, Charles B; Lajam, Claudette M; Andreae, Michael H

2015-01-01

Background Regional analgesia is more effective than conventional analgesia for controlling pain and may facilitate rehabilitation after large joint replacement in the short term. It remains unclear if regional anaesthesia improves functional outcomes after joint replacement beyond three months after surgery. Objectives To assess the effects of regional anaesthesia and analgesia on long-term functional outcomes 3, 6 and 12 months after elective major joint (knee, shoulder and hip) replacement surgery. Search methods We performed an electronic search of several databases (CENTRAL, MEDLINE, EMBASE, CINAHL), and handsearched reference lists and conference abstracts. We updated our search in June 2015. Selection criteria We included randomized controlled trials (RCTs) comparing regional analgesia versus conventional analgesia in patients undergoing total shoulder, hip or knee replacement. We included studies that reported a functional outcome with a follow-up of at least three months after surgery. Data collection and analysis We used standard methodological procedures expected by Cochrane. We contacted study authors for additional information. Main results We included six studies with 350 participants followed for at least three months. All of these studies enrolled participants undergoing total knee replacement. Studies were at least partially blinded. Three studies had a high risk of performance bias and one a high risk of attrition bias, but the risk of bias was otherwise unclear or low. Only one study assessed joint function using a global score. Due to heterogeneity in outcome and reporting, we could only pool three out of six RCTs, with range of motion assessed at three months after surgery used as a surrogate for joint function. All studies had a high risk of detection bias. Using the random-effects model, there was no statistically significant difference between the experimental and control groups (mean difference 3.99 degrees, 95% confidence interval (CI) − 2.23 to 10.21; P value = 0.21, 3 studies, 140 participants, very low quality evidence). We did not perform further analyses because immediate adverse effects were not part of the explicit outcomes of any of these typically small studies, and long-term adverse events after regional anaesthesia are rare. None of the included studies elicited or reported long-term adverse effects like persistent nerve damage. Authors’ conclusions More high-quality studies are needed to establish the effects of regional analgesia on function after major joint replacement, as well as on the risk of adverse events (falls). PMID:26269416

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

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).

Cost-Effectiveness of Reverse Total Shoulder Arthroplasty Versus Arthroscopic Rotator Cuff Repair for Symptomatic Large and Massive Rotator Cuff Tears.

PubMed

Makhni, Eric C; Swart, Eric; Steinhaus, Michael E; Mather, Richard C; Levine, William N; Bach, Bernard R; Romeo, Anthony A; Verma, Nikhil N

2016-09-01

To compare the cost-effectiveness within the United States health care system of arthroscopic rotator cuff repair versus reverse total shoulder arthroplasty in patients with symptomatic large and massive rotator cuff tears without cuff-tear arthropathy. An expected-value decision analysis was constructed comparing the costs and outcomes of patients undergoing arthroscopic rotator cuff repair and reverse total shoulder arthroplasty for large and massive rotator cuff tears (and excluding cases of cuff-tear arthropathy). Comprehensive literature search provided input data to extrapolate costs and health utility states for these outcomes. The primary outcome assessed was that of incremental cost-effectiveness ratio (ICER) of reverse total shoulder arthroplasty versus rotator cuff repair. For the base case, both arthroscopic rotator cuff repair and reverse total shoulder were superior to nonoperative care, with an ICER of $15,500/quality-adjusted life year (QALY) and $37,400/QALY, respectively. Arthroscopic rotator cuff repair was dominant over primary reverse total shoulder arthroplasty, with lower costs and slightly improved clinical outcomes. Arthroscopic rotator cuff repair was the preferred strategy as long as the lifetime progression rate from retear to end-stage cuff-tear arthropathy was less than 89%. However, when the model was modified to account for worse outcomes when reverse shoulder arthroplasty was performed after a failed attempted rotator cuff repair, primary reverse total shoulder had superior outcomes with an ICER of $90,000/QALY. Arthroscopic rotator cuff repair-despite high rates of tendon retearing-for patients with large and massive rotator cuff tears may be a more cost-effective initial treatment strategy when compared with primary reverse total shoulder arthroplasty and when assuming no detrimental impact of previous surgery on outcomes after arthroplasty. Clinical judgment should still be prioritized when formulating treatment plans for these patients. LEVEL OF EVIDENCE: Level II, economic decision analysis. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Patient and implant survival following joint replacement because of metastatic bone disease

PubMed Central

2013-01-01

Background Patients suffering from a pathological fracture or painful bony lesion because of metastatic bone disease often benefit from a total joint replacement. However, these are large operations in patients who are often weak. We examined the patient survival and complication rates after total joint replacement as the treatment for bone metastasis or hematological diseases of the extremities. Patients and methods 130 patients (mean age 64 (30–85) years, 76 females) received 140 joint replacements due to skeletal metastases (n = 114) or hematological disease (n = 16) during the period 2003–2008. 21 replaced joints were located in the upper extremities and 119 in the lower extremities. Clinical and survival data were extracted from patient files and various registers. Results The probability of patient survival was 51% (95% CI: 42–59) after 6 months, 39% (CI: 31–48) after 12 months, and 29% (CI: 21–37) after 24 months. The following surgical complications were seen (8 of which led to additional surgery): 2–5 hip dislocations (n = 8), deep infection (n = 3), peroneal palsy (n = 2), a shoulder prosthesis penetrating the skin (n = 1), and disassembly of an elbow prosthesis (n = 1). The probability of avoiding all kinds of surgery related to the implanted prosthesis was 94% (CI: 89–99) after 1 year and 92% (CI: 85–98) after 2 years. Conclusion Joint replacement operations because of metastatic bone disease do not appear to have given a poorer rate of patient survival than other types of surgical treatment, and the reoperation rate was low. PMID:23530874

Outcomes Study of the TM Reverse Shoulder System Used in Primary or Revision Reverse Total Shoulder Arthroplasty

ClinicalTrials.gov

2018-02-13

Osteoarthritis; Rheumatoid Arthritis; Post-traumatic Arthritis; Ununited Humeral Head Fracture; Irreducible 3-and 4-part Proximal Humeral Fractures; Avascular Necrosis; Gross Rotator Cuff Deficiency; Failed Total Shoulder Arthroplasty (Both Glenoid and Humeral Components Require Revision

CT measurement of glenoid erosion in arthritis.

PubMed

Mullaji, A B; Beddow, F H; Lamb, G H

1994-05-01

We studied serial CT scans of 45 arthritic shoulders (34 rheumatoid, 11 osteoarthritic) and 19 normal shoulders, making measurements at three levels on axial images. The maximum anteroposterior diameter of the glenoid was increased in rheumatoid glenoids at the upper and middle levels by 6 mm and in osteoarthritic glenoids at all levels by 5 to 8 mm as compared with normal. In rheumatoid cases, nearly half the available surface of the glenoid was of unsupported bone, mainly posteriorly at the upper and middle levels. In osteoarthritic glenoids, the best supported bone was anterior at the upper level and central at the middle and lower levels. The depth of the rheumatoid glenoid was reduced by a mean of 6 mm at the upper and middle levels and by 3 mm at the lower level. This inclined the surface of the glenoid superiorly. The depth at the middle level in osteoarthritis was reduced by a mean of 5 mm, suggesting central protrusion. Osteoarthritic glenoids were retroverted by a mean of 12.5 degrees, but of rheumatoid glenoids two-thirds were retroverted (mean 15.1 degrees) and one-third anteverted (mean 8.2 degrees). Our findings have important implications for the planning and placement of the glenoid component of total shoulder replacements; CT can provide useful information.

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.

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.

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).

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.

Early results of Latitude primary total elbow replacement with a minimum follow-up of 2 years.

PubMed

Mehta, Saurabh S; Watts, Adam C; Talwalkar, Sumedh C; Birch, Ann; Nuttall, David; Trail, Ian A

2017-10-01

The aim of this study was to present outcomes of primary Latitude total elbow replacement (TER) with a minimum follow-up of 2 years. A retrospective cohort study was undertaken with prospective outcome data collection for the latest outcome. Included were 63 consecutive primary Latitude TERs in 58 patients performed during a period of 5 years at a specialist orthopedic hospital. The mean age of the patients was 62 years (33-85 years). Five primary TERs (4 patients) were lost to follow-up. The primary diagnosis was rheumatoid arthritis in 49, osteoarthritis in 8, and trauma in 6 elbows. The mean flexion-extension arc was 75° preoperatively and 97° postoperatively. Mean postoperative Elbex pain score was 19/100, and function score was 37/100. Mean postoperative scores were 42/100 for the Quick Disabilities of the Arm, Shoulder, and Hand and 38/50 for the elbow-specific American Shoulder and Elbow Surgeons assessment. Four patients died of unrelated causes, and 8 of 63 underwent further surgical intervention, including explantation and conversion from unlinked to linked implant. On radiographic review of 41 surviving TERs, aseptic radiologic loosening was observed of the humeral component in 4 elbows and of the ulnar component in 9. Seven elbows had no radial component, and of the remaining 34 elbows, 16 (47%) had signs of loosening of the radial implant. Complications included 1 heterotopic ossification, 1 olecranon fracture, and 3 further procedures for ulnar nerve entrapment. The results indicate that the early outcome of Latitude TER is comparable to that of other prostheses. There is concern about early radiologic loosening of the radial component. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

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 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

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.

Prevalence of neurologic lesions after total shoulder arthroplasty.

PubMed

Lädermann, A; Lübbeke, A; Mélis, B; Stern, R; Christofilopoulos, P; Bacle, G; Walch, G

2011-07-20

Clinically evident neurologic injury of the involved limb after total shoulder arthroplasty is not uncommon, but the subclinical prevalence is unknown. The purposes of this prospective study were to determine the subclinical prevalence of neurologic lesions after reverse shoulder arthroplasty and anatomic shoulder arthroplasty, and to evaluate the correlation of neurologic injury to postoperative lengthening of the arm. All patients undergoing either a reverse or an anatomic shoulder arthroplasty were included during the period studied. This study focused on the clinical, radiographic, and preoperative and postoperative electromyographic evaluation, with measurement of arm lengthening in patients who had reverse shoulder arthroplasty according to a previously validated protocol. Between November 2007 and February 2009, forty-one patients (forty-two shoulders) underwent reverse shoulder arthroplasty (nineteen shoulders) or anatomic primary shoulder arthroplasty (twenty-three shoulders). The two groups were similar with respect to sex distribution, preoperative neurologic lesions, and Constant score. Electromyography performed at a mean of 3.6 weeks postoperatively in the reverse shoulder arthroplasty group showed subclinical electromyographic changes in nine shoulders, involving mainly the axillary nerve; eight resolved in less than six months. In the anatomic shoulder arthroplasty group, a brachial plexus lesion was evident in one shoulder. The prevalence of acute postoperative nerve injury was significantly more frequent in the reverse shoulder arthroplasty group (p = 0.002), with a 10.9 times higher risk (95% confidence interval, 1.5 to 78.5). Mean lengthening (and standard deviation) of the arm after reverse shoulder arthroplasty was 2.7 ± 1.8 cm (range, 0 to 5.9 cm) compared with the normal, contralateral side. The occurrence of peripheral neurologic lesions following reverse shoulder arthroplasty is relatively common, but usually transient. Arm lengthening with a reverse shoulder arthroplasty may be responsible for these nerve injuries.

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.

A Scott bench with ergonomic thorax stabilisation pad improves body posture during preacher arm curl exercise.

PubMed

Biscarini, Andrea; Benvenuti, Paolo; Busti, Daniele; Zanuso, Silvano

2016-05-01

We assessed whether the use of an ergonomic thorax stabilisation pad, during the preacher arm curl exercise, could significantly reduce the excessive shoulder protraction and thoracic kyphosis induced by the standard flat pad built into the existing preacher arm curl equipment. A 3D motion capture system and inclinometers were used to measure shoulder protraction and thoracic kyphosis in 15 subjects performing preacher arm curl with a plate-loaded machine provided with the standard flat pad. The same measures were repeated after replacing the flat pad with a new ergonomic pad, specifically designed to accommodate the thorax profile and improve body posture. Pad replacement significantly (p < 0.001) reduced shoulder protraction (from [Formula: see text] to [Formula: see text]) and thoracic kyphosis (from [Formula: see text] to [Formula: see text]), enabling postural and functional improvements within the entire spine, shoulder girdle and rib cage. The ergonomic pad may potentially allow a more effective training, prevent musculoskeletal discomfort and reduce the risk of injury. Practitioner summary: We have designed an ergonomic thorax stabilisation pad for the preacher arm curl exercise. The new ergonomic pad improves the poor posture conditions induced by the standard flat pad and may potentially allow a more effective training, prevent musculoskeletal discomfort, improve the breathing function and reduce the risk of injury.

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.

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.

Reverse total shoulder arthroplasty: research models

PubMed Central

PETRILLO, STEFANO; LONGO, UMILE GIUSEPPE; GULOTTA, LAWRENCE V.; BERTON, ALESSANDRA; KONTAXIS, ANDREAS; WRIGHT, TIMOTHY; DENARO, VINCENZO

2016-01-01

Purpose the past decade has seen a considerable increase in the use of research models to study reverse total shoulder arthroplasty (RTSA). Nevertheless, none of these models has been shown to completely reflect real in vivo conditions. Methods we performed a systematic review of the literature matching the following key words: “reverse total shoulder arthroplasty” or “reverse total shoulder replacement” or “reverse total shoulder prosthesis” and “research models” or “biomechanical models” or “physical simulators” or “virtual simulators”. The following databases were screened: Medline, Google Scholar, EMBASE, CINAHIL and Ovid. We identified and included all articles reporting research models of any kind, such as physical or virtual simulators, in which RTSA and the glenohumeral joint were reproduced. Results computer models and cadaveric models are the most commonly used, and they were shown to be reliable in simulating in vivo conditions. Bone substitute models have been used in a few studies. Mechanical testing machines provided useful information on stability factors in RTSA. Conclusion because of the limitations of each individual model, additional research is required to develop a research model of RTSA that may reduce the limitations of those presently available, and increase the reproducibility of this technique in the clinical setting. PMID:28217660

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.

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

PubMed

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

2016-04-01

Restoration of joint stability during total shoulder arthroplasty can be challenging in the face of severe glenoid retroversion. A novel technique of humeral head component anterior-offsetting has been proposed to address posterior instability. We evaluated the biomechanical benefits of this technique in cadaveric specimens. Total shoulder arthroplasty was performed in 14 cadaveric shoulders from 7 donors. Complementary shoulders were assigned to either 10° or 20° glenoid retroversion, with retroversion created by eccentric reaming. Two humeral head component offset positions were tested in each specimen: The anatomic (posterior) and anterior (reverse). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. The force and energy required to displace the humeral head posteriorly increased significantly with the anterior offset position compared to the anatomic offset position. The joint contact pressures were significantly shifted anteriorly, and the joint contact area significantly increased with the anterior offset position. Anterior offsetting of the humeral head component increased the resistance to posterior humeral head translation, shifted joint contact pressures anteriorly, and increased joint contact area, thus, potentially increasing the joint stability in total shoulder arthroplasty with simulated glenoid retroversion. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Fretting and Corrosion in Modular Shoulder Arthroplasty: A Retrieval Analysis

PubMed Central

Panzram, Benjamin

2016-01-01

Tribocorrosion in taper junctions of retrieved anatomic shoulder arthroplasty implants was evaluated. A comparison of the tribocorrosion between cobalt-chromium and titanium alloy stems was conducted and the observations were correlated with the individual's clinical data. Adverse effects caused by metal debris and subsequent elevated serum metal ion levels are frequently reported in total hip arthroplasty. In total shoulder arthroplasty, to date only a small number of retrieval analyses are available and even fewer address the issue of tribocorrosion at the taper junctions. A total of 36 retrieved hemiarthroplasties and total shoulder arthroplasties were assessed using the modified Goldberg score. The prevalence of fretting and corrosion was confirmed in this cohort. Titanium stems seem to be more susceptible to damage caused by tribocorrosion than cobalt-chromium stems. Furthermore, stemless designs offered less tribocorrosion at the taper junction than stemmed designs. A weak correlation between time to revision and increased levels of tribocorrosion was seen. Whether or not tribocorrosion can lead to adverse clinical reactions and causes failure of shoulder arthroplasties remains to be examined. PMID:27433471

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.

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.

Biomechanical comparison of reverse total shoulder arthroplasty systems in soft tissue-constrained shoulders.

PubMed

Henninger, Heath B; King, Frank K; Tashjian, Robert Z; Burks, Robert T

2014-05-01

Numerous studies have examined the biomechanics of isolated variables in reverse total shoulder arthroplasty. This study directly compared the composite performance of two reverse total shoulder arthroplasty systems; each system was designed around either a medialized or a lateralized glenohumeral center of rotation. Seven pairs of shoulders were tested on a biomechanical simulator. Center of rotation, position of the humerus, passive and active range of motion, and force to abduct the arm were quantified. Native arms were tested, implanted with a Tornier Aequalis or DJO Surgical Reverse Shoulder Prosthesis (RSP), and then retested. Differences from the native state were then documented. Both systems shifted the center of rotation medially and inferiorly relative to native. Medial shifts were greater in the Aequalis implant (P < .037). All humeri shifted inferior compared with native but moved medially with the Aequalis (P < .001). Peak passive abduction, internal rotation, and external rotation did not differ between systems (P > .05). Both reverse total shoulder arthroplasty systems exhibited adduction deficits, but the RSP implant deficit was smaller (P = .046 between implants). Both systems reduced forces to abduct the arm compared with native, although the Aequalis required more force to initiate motion from the resting position (P = .022). Given the differences in system designs and configurations, outcome variables were generally comparable. The RSP implant allowed slightly more adduction, had a more lateralized humeral position, and required less force to initiate elevation. These factors may play roles in limiting scapular notching, improving active external rotation by normalizing the residual rotator cuff length, and limiting excessive stress on the deltoid. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Revision of failed hemiarthroplasty for painful glenoid arthrosis to anatomic total shoulder arthroplasty.

PubMed

Sheth, Mihir M; Sholder, Daniel; Abboud, Joseph; Lazarus, Mark D; Ramsey, Matthew L; Williams, Gerald R; Namdari, Surena

2018-05-10

The impending burden of revision shoulder arthroplasty has increased interest in outcomes of revision procedures. Painful glenoid arthrosis following hemiarthroplasty is a common cause of reoperation, and conversion to anatomic total shoulder arthroplasty is one option. We identified patients who underwent revision of painful hemiarthroplasty to total shoulder arthroplasty over a 15-year period in a single tertiary-care health system. Presurgical and operative data were analyzed for 28 patients who met the inclusion and exclusion criteria. Patients were contacted at a minimum of 2 years' follow-up after revision surgery for functional outcome scores, reoperations, and implant survival. The 2- and 5-year implant survival rates were 93% and 86%, respectively. Functional outcomes were obtained from 21 patients with surviving implants. The mean American Shoulder and Elbow Surgeons score, visual analog scale score for pain, and Single Assessment Numerical Evaluation score were 78 ± 20, 2.3 ± 2.6, and 71 ± 24, respectively. The mean Short Form 12 mental and physical scores were 49 ± 10 and 43 ± 9, respectively. Of the patients, 17 (81%) were either satisfied or very satisfied with their outcome. Complications were seen in 10 patients (36%), and 6 patients (21%) required reoperation. Anatomic total shoulder arthroplasty following hemiarthroplasty can achieve successful outcomes and implant survival rates. Given our poor understanding of reverse shoulder arthroplasty longevity, this procedure should remain an option for patients with glenoid arthrosis and an intact rotator cuff. Copyright © 2018 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.

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.

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.

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.

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

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.

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.

Shoulder-Rotator Strength, Range of Motion, and Acromiohumeral Distance in Asymptomatic Adolescent Volleyball Attackers

PubMed Central

Harput, Gulcan; Guney, Hande; Toprak, Ugur; Kaya, Tunca; Colakoglu, Fatma Filiz; Baltaci, Gul

2016-01-01

Context: Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood. Objective: To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury. Design: Cross-sectional study. Setting: University laboratory. Participants: Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m2). Main Outcome Measure(s): Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally. Results: External-rotation ROM was greater (t38 = 4.92, P < .001), but IR ROM (t38 = −8.61, P < .001) and total ROM (t38 = −3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t38 = 2.89, P = .006) and eccentric external-rotator (t38 = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t38 = −3.60, P < .001). Conclusions: Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries. PMID:27813683

Shoulder-Rotator Strength, Range of Motion, and Acromiohumeral Distance in Asymptomatic Adolescent Volleyball Attackers.

PubMed

Harput, Gulcan; Guney, Hande; Toprak, Ugur; Kaya, Tunca; Colakoglu, Fatma Filiz; Baltaci, Gul

2016-09-01

Sport-specific adaptations at the glenohumeral joint could occur in adolescent athletes because they start participating in high-performance sports in early childhood. To investigate shoulder-rotator strength, internal-rotation (IR) and external-rotation (ER) range of motion (ROM), and acromiohumeral distance (AHD) in asymptomatic adolescent volleyball attackers to determine if they have risk factors for injury. Cross-sectional study. University laboratory. Thirty-nine adolescent high school-aged volleyball attackers (22 boys, 17 girls; age = 16.0 ± 1.4 years, height = 179.2 ± 9.0 cm, mass = 67.1 ± 10.9 kg, body mass index = 20.7 ± 2.6 kg/m 2 ). Shoulder IR and ER ROM, total-rotation ROM, glenohumeral IR deficit, AHD, and concentric and eccentric strength of the shoulder internal and external rotators were tested bilaterally. External-rotation ROM was greater (t 38 = 4.92, P < .001), but IR ROM (t 38 = -8.61, P < .001) and total ROM (t 38 = -3.55, P = .01) were less in the dominant shoulder, and 15 athletes had a glenohumeral IR deficit (IR ROM loss > 18°). We observed greater concentric internal-rotator (t 38 = 2.89, P = .006) and eccentric external-rotator (t 38 = 2.65, P = .01) strength in the dominant than in the nondominant shoulder. The AHD was less in the dominant shoulder (t 38 = -3.60, P < .001). Adolescent volleyball attackers demonstrated decreased IR ROM, total ROM, and AHD and increased ER ROM in their dominant shoulder. Therefore, routine screening of adolescent athletes and designing training programs for hazardous adaptive changes could be important in preventing shoulder injuries.

Return to sport after shoulder arthroplasty: a systematic review and meta-analysis.

PubMed

Liu, Joseph N; Steinhaus, Michael E; Garcia, Grant H; Chang, Brenda; Fields, Kara; Dines, David M; Warren, Russell F; Gulotta, Lawrence V

2018-01-01

With increasing incidence and indications for shoulder arthroplasty, there is an increasing emphasis on the ability to return to sports. The main goal of this study was to determine the rate of return to sport after shoulder arthroplasty. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to perform this systematic review and meta-analysis. A search was performed on MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the Methodological Index for Nonrandomized Studies checklist. The main judgement outcome was the rate of return to sports activity after shoulder arthroplasty and the level of play upon return (identical or higher/lower level). Thirteen studies were reviewed, including 944 patients (506 athletes), treated with shoulder arthroplasty at an average follow-up of 5.1 years (range, 0.5-12.6 years). The most common sports were swimming (n = 169), golf (n = 144), fitness sports (n = 71), and tennis (n = 63). The overall rate of return to sport was 85.1% (95% CI, 76.5-92.3%), including 72.3% (95% CI, 60.6-82.8%) returning to an equivalent or improved level of play, after 1-36 months. Patients undergoing anatomic total shoulder arthroplasty returned at a significantly higher rate (92.6%) compared to hemiarthroplasty (71.1%, p = 0.02) or reverse total shoulder arthroplasty (74.9%, p = 0.003). Most patients are able to return to one or more sports following shoulder arthroplasty, with anatomic total shoulder arthroplasty having the highest rate of return. IV.

Is the American Society of Shoulder and Elbow Therapists' rehabilitation guideline better than standard care when applied to Bankart-operated patients? A controlled study.

PubMed

Damkjær, Lars; Petersen, Tom; Juul-Kristensen, Birgit

2015-02-01

To determine whether there is a difference in shoulder-related physical function and quality of life between postoperative rehabilitation patients receiving standard care and those receiving care according to the American Society of Shoulder and Elbow Therapists' rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. Descriptive studies with comparison between a retrospective and a prospective cohort. Municipal outpatient rehabilitation centre. A total of 96 arthroscopic Bankart-operated patients. A total of 52 patients received standard care; 44 patients underwent rehabilitation according to the American Society of Shoulder and Elbow Therapists' rehabilitation guideline. Primary outcome variable was Western Ontario Shoulder Instability Index. Secondary outcome measures were Patient-Specific Functional Scale, shoulder range of motion, return to work, return to sports, and costs. There was no significant difference in adjusted mean change scores between the standard care group and the guideline group in the primary outcome variable (Western Ontario Shoulder Instability Index total = 574.85 vs. 644.48) or the secondary outcomes (Patient-Specific Functional Scale = 4.6 vs. 5.0; range of motion in forward flexion = 46.49° vs. 49.58°; external rotation in adduction = 28.58° vs. 34.18°; external rotation in abduction = 51.29° vs. 47.55°; weeks until return to work = 5.2 vs. 6.9; weeks until return to sports =13.9 vs. 13.1; costs = number of visits; 18.5 vs. 15.9). There were no significant between-group differences in shoulder-related physical function and quality of life between the standard care group and the guideline group, following Bankart operations. © The Author(s) 2014.

Post-treatment glenoid classification system for total shoulder arthroplasty.

PubMed

Churchill, R Sean

2012-04-01

Over the past 10 years, numerous advancements in glenoid preparation and resurfacing have occurred. Current glenoid classification systems are either focused solely on the patient's preoperative glenoid bone configuration or on the available glenoid bone stock in revision arthroplasty cases. While these systems provide value in preoperative planning, they fail to properly classify the surgical reconstruction completed. A literature review of common bone preparation methods and sources of glenoid prosthetic failure was performed. Based upon this review, a classification system for grading the status of the glenoid after prosthetic implantation was developed. A 6 category, post-treatment, glenoid classification system is proposed: type 0: no reaming; type I: glenoid reaming into but not through the subchondral bone; type II: glenoid reaming which perforates through <50% of the subchondral bone surface area; type III: glenoid reaming which perforates through >50% of the subchondral bone surface area; type IV: use of structural bone graft; and type V: use of a posterior augmented glenoid prosthesis. Types I-III are further subdivided into subtype A which have 100% bone support of the prosthesis, and subtype B which have a region of unsupported prosthesis. The classification system proposed addresses the surgical management of the glenoid during prosthetic replacement. This unique approach to classifying the glenoid following surgical intervention will allow direct follow-up comparison of similarly treated glenoid replacements. Future multicenter studies, possibly through joint registry databases, could then determine the long-term efficacy of the various glenoid preparation methods. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

75 FR 38467 - Procurement List: Proposed Additions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-02

.../Rotator, Telephone, Twisstop, Black. NSN: 7520-00-NIB-2084--Shoulder Rest, Telephone, Black, Softak II. NSN: 7520-00-NIB-2085--Shoulder Rest, Telephone, Black. Coverage: A--List for the Total Government Requirement as aggregated by the General Services Administration. NSN: 7520-01-253-1283--Shoulder Rest...

Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study.

PubMed

Gulotta, Lawrence V; Choi, Dan; Marinello, Patrick; Knutson, Zakary; Lipman, Joseph; Wright, Timothy; Cordasco, Frank A; Craig, Edward V; Warren, Russell F

2012-09-01

Reverse total shoulder arthroplasty offers pain relief and functional improvement for patients with rotator cuff-deficient shoulders. The purpose of this study was to determine the optimal amount of humeral retroversion for this prosthesis. Six cadaveric shoulders underwent computed tomography (CT) imaging and were then dissected of soft tissues, except for their tendinous attachments. A reverse total shoulder arthroplasty was implanted in 0°, 20°, 30°, and 40° of retroversion, and the shoulders were mounted on a simulator to determine the muscle forces required to achieve 30° and 60° of scaption. CT images were converted into 3-dimensional models, and the amount of internal and external rotation was determined with computer modeling at various scaption angles. No differences were found in the forces required for 30° or 60° of scaption for any muscle, at any retroversion. With increasing retroversion, more impingement-free external rotation was obtained, with a concomitant decrease in the amount of internal rotation. Above 60°, the humerus was allowed to rotate around the glenosphere unencumbered. Increasing retroversion did not affect the muscle force requirements for scaption across the shoulder. Placing the humeral component in 0° to 20° of retroversion allows maximum internal rotation with the arm at the side, a movement that is required for daily activities. This limits external rotation with the arm at the side, but has no effect on external rotation with the arm elevated. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Conversion to Reverse Total Shoulder Arthroplasty with and without Humeral Stem Retention: The Role of a Convertible-Platform Stem.

PubMed

Crosby, Lynn A; Wright, Thomas W; Yu, Stephen; Zuckerman, Joseph D

2017-05-03

Revision shoulder arthroplasty is a technically challenging procedure. It is associated with increased blood loss and operative time, and it frequently necessitates revision implants, augments, and bone-grafting. Shoulder arthroplasty systems with a convertible-platform humeral stem have been developed to reduce the complexity of revision procedures by eliminating the need for humeral component explantation when converting from anatomic shoulder arthroplasty (hemiarthroplasty or total shoulder arthroplasty) to reverse total shoulder arthroplasty (rTSA). A multicenter, retrospective analysis involving 102 consecutive shoulders (102 patients) that underwent revision of an anatomic shoulder arthroplasty to an rTSA was conducted. During the revision, 73 of the shoulders needed exchange of the humeral stem (the exchange group) and 29 had retention of a convertible-platform humeral component (the retention group). Patient demographics, operative time, blood management, range of motion, complications, and patient-reported outcomes were compared between the 2 groups. Patients with retention had significantly shorter operative time (mean and standard deviation, 130 ± 48 versus 195 ± 58 minutes; p < 0.001) and lower estimated blood loss (292 ± 118 versus 492 ± 334 mL; p = 0.034). The rate of intraoperative complications was lower in the retention group (0% versus 15%; p = 0.027). Patients with retention had slightly better postoperative range of motion (active external rotation, 26° ± 23° versus 11° ± 23° [p = 0.006]; active forward elevation, 112° ± 37° versus 96° ± 33° [p = 0.055]). Shoulder arthroplasty systems that utilize a convertible-platform humeral stem offer an advantage for rTSA conversion in that a well-fixed, well-positioned humeral stem can be retained. There were significantly fewer complications as well as significantly decreased blood loss and operative time when a convertible-platform stem was utilized (p < 0.050). Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Towards computer-assisted surgery in shoulder joint replacement

NASA Astrophysics Data System (ADS)

Valstar, Edward R.; Botha, Charl P.; van der Glas, Marjolein; Rozing, Piet M.; van der Helm, Frans C. T.; Post, Frits H.; Vossepoel, Albert M.

A research programme that aims to improve the state of the art in shoulder joint replacement surgery has been initiated at the Delft University of Technology. Development of improved endoprostheses for the upper extremities (DIPEX), as this effort is called, is a clinically driven multidisciplinary programme consisting of many contributory aspects. A part of this research programme focuses on the pre-operative planning and per-operative guidance issues. The ultimate goal of this part of the DIPEX project is to create a surgical support infrastructure that can be used to predict the optimal surgical protocol and can assist with the selection of the most suitable endoprosthesis for a particular patient. In the pre-operative planning phase, advanced biomechanical models of the endoprosthesis fixation and the musculo-skeletal system of the shoulder will be incorporated, which are adjusted to the individual's morphology. Subsequently, the support infrastructure must assist the surgeon during the operation in executing his surgical plan. In the per-operative phase, the chosen optimal position of the endoprosthesis can be realised using camera-assisted tools or mechanical guidance tools. In this article, the pathway towards the desired surgical support infrastructure is described. Furthermore, we discuss the pre-operative planning phase and the per-operative guidance phase, the initial work performed, and finally, possible approaches for improving prosthesis placement.

Epidemiologic aspects of shoulder dystocia-related neurological birth injuries.

PubMed

Iffy, Leslie; Varadi, Valeria; Papp, Zoltan

2015-04-01

The first part of the study involved data collection for the detection of geographic variations and chronologic fluctuations in the rates of shoulder dystocia. The second part of the research evaluated head-to-body delivery times in cases of arrest of the shoulders at birth that had resulted in fetal damage during the last four decades in the USA. The study of geographic and chronologic changes in the rates of shoulder dystocia rested on reported statistics coming from the USA and 11 other countries. These data were obtained by computer search. Evaluation of head-to-body delivery times rested on 104 well-documented cases that resulted in permanent neonatal damage. Literary reports of shoulder dystocia indicate that the incidence of shoulder dystocia has increased in the USA about fourfold since the middle of the twentieth century. No comparable trend has been reported from most other countries. Study of head-to-body delivery times revealed that more than two-thirds of all injured fetuses had been extracted from the birth canal within 2 minutes. Incidents of shoulder dystocia began to escalate in the USA during the 1980s, shortly after the introduction of "active management" of the birthing process. This new technique replaced a conservative philosophy which had recommended abstinence from intervention on the part of the accoucheur. The authors consider the interventionist approach largely responsible for the exponential increase in the rates of shoulder dystocia in the USA. They recommend adherence to the traditional method of delivery on the part of obstetricians in Europe and elsewhere.

[Nuclear magnetic resonance tomography diagnosis of changes in the glenoid process in patients with unstable shoulder joints].

PubMed

Jerosch, J; Castro, W H; Assheuer, J

1992-09-01

In 4 fresh specimens and in 14 healthy volunteers we studied normal anatomy of the glenoid labrum by MRI. In a total of 124 patients we examined the shoulder joints by MRI. 69 patients had any kind of subacromial pathology. 55 patients showed a glenohumeral instability. All MRI findings were compared with the surgical findings during arthroscopy and during open surgery. 44 patients showed a recurrent anterior instability, 7 patients showed a multidirectional instability, 2 patients showed a posterior instability, and 2 patients presented acute anterior dislocation. We found significant variability in the labral shape as well as significant variability of anterior capsular attachment. The pathologic changes of the glenoid labrum were classified in four different types. In 78% we found a concomitant Hill-Sachs lesion of various diameter. 5 patients suffered from an additional complete rotator cuff tear. Compared to the intraoperative findings MRI had a sensitivity of 95%, a specificity of 94%, an accuracy of 94%, a positive predictive value of 91%, and a negative predictive value of 96% in detecting labral pathology. Presenting a high diagnostic value for detecting Bankart lesions, MRI may replace other diagnostic modalities like CT-arthrography.

Allograft reconstruction after resection of malignant tumors of the scapula.

PubMed

Mnaymneh, Walid A; Temple, H Thomas; Malinin, Theodore I

2002-12-01

The oncologic and functional outcomes of six patients who had scapular allograft reconstruction after scapulectomy for malignant tumors were reviewed. Five patients had Stage IIB and one patient had Stage IB tumors. Total scapulectomy was done in five patients, and partial scapulectomy (glenoid and neck) was done in one patient. Frozen glycerolized scapular allografts were implanted and fixed with plates and screws. The scapular muscles were reattached to the allograft. Tendon reconstruction to replace the excised muscles was done in two patients. The patients were followed up for an average of 3.8 years (range, 2-6 years). Cosmesis, elbow, and hand function were good in all patients. There were no infections, nonunions, or shoulder dislocations. One patient fractured the body of the allograft after a fall. One patient had local recurrence and had scapulectomy 5 years postoperatively. Two patients died 3 and 5 years postoperatively with lung metastases but with functioning grafts. The mean functional result using the Musculoskeletal Tumor Society functional score was 82 (range, 77-87). In this series, scapular allograft reconstruction restored cosmesis, shoulder stability, and function. Preservation or reconstruction of rotator cuff muscles is recommended.

Deficits in glenohumeral passive range of motion increase risk of elbow 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

2014-09-01

Injuries to the elbow joint in baseball pitchers appear common. There appears to be a correlation between shoulder range of motion and elbow injuries. To prospectively determine whether decreased ROM of the throwing shoulder is correlated with the onset of elbow injuries in professional baseball pitchers. Cohort study; Level of evidence, 2. For 8 consecutive years (2005-2012), passive range of motion of both the throwing and nonthrowing shoulders of all major and minor league pitchers within a single professional baseball organization were measured by using a bubble goniometer during spring training. In total, 505 examinations were conducted on 296 pitchers. Glenohumeral external rotation and internal rotation were assessed in the supine position with the arm at 90° of abduction and in the plane of the scapula. The scapula was stabilized per methods previously established. Total rotation was defined as the sum of external rotation and internal rotation. Passive shoulder flexion was assessed with the subject supine and the scapula stabilized per methods previously established. Elbow injuries and days missed because of elbow injuries were assessed and recorded by the medical staff of the team. Throwing and nonthrowing shoulder measurements were compared by using Student t tests; 1-tailed Fisher exact tests were performed to identify significant associations between shoulder motion and elbow injury. Nominal logistic regression was performed to determine the odds of elbow injury. Significant differences were noted during side-to-side comparisons within subjects. There were 49 elbow injuries and 8 surgeries in 38 players, accounting for a total of 2551 days missed. Neither glenohumeral internal rotation deficit nor external rotation insufficiency was correlated with elbow injuries. Pitchers with deficits of >5° in total rotation in their throwing shoulders had a 2.6 times greater risk for injury. Pitchers with deficit of ≥5° in flexion of the throwing shoulder had a 2.8 times greater risk for injury. Bilateral differences in shoulder total rotation and flexion had a significant effect on the risk for elbow injuries in pitchers. Clinicians need to be aware of these findings and plan preventive programs that address these issues in hopes of reducing elbow injuries. © 2014 The Author(s).

Comparing the Immediate Effects of a Total Motion Release Warm-up and a Dynamic Warm-up Protocol on the Dominant Shoulder in Baseball Athletes.

PubMed

Gamma, Stephen C; Baker, Russell; May, James; Seegmiller, Jeff G; Nasypany, Alan; Iorio, Steven M

2018-04-10

Gamma, SC, Baker, R, May, J, Seegmiller, JG, Nasypany, A, and Iorio, SM. Comparing the immediate effects of a total motion release warm-up and a dynamic warm-up protocol on the dominant shoulder in baseball athletes. J Strength Cond Res XX(X): 000-000, 2017-A decrease in total range of motion (ROM) of the dominant shoulder may predispose baseball athletes to increased shoulder injury risk; the most effective technique for improving ROM is unknown. The purpose of this study was to compare the immediate effects of Total Motion Release (TMR) to a generic dynamic warm-up program in baseball athletes. Baseball athletes (n = 20) were randomly assigned to an intervention group: TMR group (TMRG; n = 10) or traditional warm-up group (TWG; n = 10). Shoulder ROM measurements were recorded for internal rotation (IR) and external rotation (ER), the intervention was applied, and postmeasurements were recorded. Each group then received the other intervention and postmeasurements were again recorded. The time main effect (p ≤ 0.001) and the time × group interaction effect were significant (p ≤ 0.001) for IR and ER. Post hoc analysis revealed that TMR produced significant increases in mean IR (p ≤ 0.005, d = 1.52) and ER (p ≤ 0.018, d = 1.22) of the dominant shoulder initially. When groups crossed-over, the TMRG experienced a decrease in mean IR and ER after the dynamic warm-up, whereas the TWG experienced a significant increase in mean IR (p ≤ 0.001, d = 3.08) and ER (p ≤ 0.001, d = 2.56) after TMR intervention. Total Motion Release increased IR and ER of the dominant shoulder more than a dynamic warm-up. Dynamic warm-up after TMR also resulted in decreased IR and ER; however, TMR after dynamic warm-up significantly improved IR and ER. Based on these results, TMR is more effective than a generic dynamic warm-up for improving dominant shoulder ROM in baseball players.

Failed Reverse Total Shoulder Arthroplasty Caused by Recurrent Candida glabrata Infection with Prior Serratia marcescens Coinfection

PubMed Central

Skedros, John G.; Keenan, Kendra E.; Updike, Wanda S.; Oliver, Marquam R.

2014-01-01

This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected with Candida glabrata and Serratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, the C. glabrata infection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement). His surgical and pharmacologic treatment concluded with (1) placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained), and (2) chronic use of daily oral fluconazole. We located only three reported cases of Candida species causing infection in shoulder arthroplasties (two C. albicans, one C. parapsilosis). To our knowledge, a total shoulder arthroplasty infected with C. glabrata has not been reported, nor has a case of a C. glabrata and S. marcescens periprosthetic coinfection in any joint. In addition, it is well known that S. marcescens infections are uncommon in periprosthetic joint infections. PMID:25431708

Shoulder and elbow pain in elementary school baseball players: The results from a nation-wide survey in Japan.

PubMed

Takagishi, Kenji; Matsuura, Tetsuya; Masatomi, Takashi; Chosa, Etsuo; Tajika, Tsuyoshi; Watanabe, Mikihiko; Iwama, Tetsu; Otani, Toshiro; Inagaki, Katsunori; Ikegami, Hiroyasu; Aoki, Mitsuhiro; Kato, Ko; Okuwaki, Toru; Sairyo, Koichi; Kameyama, Yasushi; Maeda, Akira; Beppu, Moroe

2017-07-01

Despite recommendations on how to prevent baseball injuries in youths by the Japanese Society of Clinical Sports Medicine, shoulder and elbow pain still frequently occurs in young baseball players. We conducted a questionnaire survey among baseball players at elementary schools across the country to understand the practice conditions of players, examining the risk factors of shoulder and elbow pain in baseball players. The questionnaire survey was conducted among elementary school baseball players as members of the Baseball Federation of Japan in September 2015. A total of 8354 players belonging to 412 teams (average age: 8.9) responded to the survey. Among 7894 players who did not have any shoulder and/or elbow pain in September 2014, elbow pain was experienced in 12.3% of them, shoulder pain in 8.0% and shoulder and/or elbow pain in 17.4% during the previous one year. A total of 2835 (39.9% of the total) practiced four days or more per week and 97.6% practiced 3 h or more per day on Saturdays and Sundays. The risk factors associated shoulder and elbow pain included a male sex, older age, pitchers and catchers, and players throwing more than 50 balls per day. It has been revealed that Japanese elementary school baseball players train too much. Coaches should pay attention to older players, male players, pitchers and catchers in order to prevent shoulder and elbow pain. Furthermore, elementary school baseball players should not be allowed to throw more than 50 balls per day. Retrospective cohort study. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

[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.

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.

Correlations of magnetic resonance imaging findings with clinical symptom severity and prognosis of frozen shoulder.

PubMed

Yoon, Jong Pil; Chung, Seok Won; Lee, Byung Joo; Kim, Hyung Sup; Yi, Jae Hyuck; Lee, Hyun-Joo; Jeong, Won-Ju; Moon, Sung Gyu; Oh, Kyung-Soo; Yoon, Seok Tae

2017-10-01

To evaluate the correlation between indirect magnetic resonance (MR) arthrographic imaging findings and the clinical symptoms and prognosis of patients with frozen shoulder. Indirect MR arthrography was performed for 52 patients with primary frozen shoulder (mean age 55.1 ± 9.0 years) and 52 individuals without frozen shoulder (mean age 53.1 ± 10.7 years); capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were evaluated. Clinical symptom severity was assessed using the Visual Analogue Scale for Pain (VAS Pain), simple shoulder test (SST), Constant score, American Shoulder and Elbow Surgeons (ASES) score, and range of motion (ROM). At 6-month follow-up, we evaluated whether MR arthrography findings correlated with the clinical symptoms and prognosis. Capsular thickening and enhancement of the axillary recess as well as soft tissue thickening of the rotator interval were significantly greater in the patient group than in the controls (p < 0.001). Capsular thickening of the axillary recess did not correlate with clinical symptoms or ROM (n.s.); however, capsular enhancement correlated with clinical symptom severity according to VAS Pain (p = 0.005), SST (p = 0.046), and ASES scores (p = 0.009). Soft tissue thickening of the rotator interval did not correlate with clinical symptom severity, but was associated with external rotation limitation (p = 0.002). However, none of the parameters correlated with clinical symptoms at 6-month follow-up. Indirect MR arthrography provided ancillary findings, especially with capsular enhancement, for evaluating clinical symptom severity of frozen shoulder, but did not reflect the prognosis. MR findings in frozen shoulder should not replace clinical judgments regarding further prognosis and treatment decisions. IV.

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly.

PubMed

Grubhofer, Florian; Wieser, Karl; Meyer, Dominik C; Catanzaro, Sabrina; Beeler, Silvan; Riede, Ulf; Gerber, Christian

2016-10-01

Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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.

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.

General and disease-specific use of outcomes scores for the shoulder: a survey of AOSSM, AANA, and ISAKOS members.

PubMed

Provencher, Matthew T; Frank, Rachel M; Scuderi, Matthew G; Solomon, Daniel J; Ghodadra, Neil S; Bach, Bernard R; McCarty, Eric; Romeo, Anthony A

2014-09-01

To report on the knowledge and use of both general and disease-specific shoulder outcomes scores among orthopedic surgeons. A 22-question Internet survey was administered to members of the American Orthopaedic Society for Sports Medicine, the Arthroscopy Association of North American, and the International Society of Arthroscopy, Knee Surgery, and Orthopedic Sports Medicine via voluntary e-mail participation. Questions targeted demographic information, preferred surgical management of shoulder conditions, and the preferred use of shoulder outcomes instruments in clinical practice. Excluding defunct and duplicate e-mails among membership societies, a total of 3892 unique e-mails were sent, from which 1129 surveys were returned and were fully completed (29%). The largest number of respondents were in private practice (52%); 21% were in academia; and 26% were in a mix of settings. As for location, 74% practiced in the United States, 10% in Europe, 8% in Mexico/South America, and 6% in Asia. A total of 31% total respondents used scores all or most of the time, and 30% used scores at least some of the time. Respondents felt that the 3 most commonly utilized shoulder scores were the American Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) score, and the Constant score. The majority of respondents (76%) performed all-arthroscopic instability repairs. The ASES and Western Ontario Shoulder Instability Index (WOSI) scores were the most preferred measures to monitor instability patients, whether or not the scores were actually implemented in their practice. Most perform between 10 and 25 superior labrum anterior-posterior repairs per year and preferred the ASES, UCLA, and Constant scores for these repairs; rotator cuff repair preferred outcomes instruments were similar. When asked to choose 1 score for all shoulder conditions, the ASES was the clear favorite. This study reports the knowledge and utilization of shoulder scores for both general and disease-specific conditions. Most respondents preferred the ASES score for most shoulder conditions; however, other scores, such as the WOSI, the Constant, and the Short-Form (SF)-36/12, were popular. This information offers insight into the current and future use of shoulder outcomes both for general and disease-specific use.

Psychometric Properties of the Persian Version of the Simple Shoulder Test (SST) Questionnaire.

PubMed

Ebrahimzadeh, Mohammad H; Vahedi, Ehsan; Baradaran, Aslan; Birjandinejad, Ali; Seyyed-Hoseinian, Seyyed-Hadi; Bagheri, Farshid; Kachooei, Amir Reza

2016-10-01

To validate the Persian version of the simple shoulder test in patients with shoulder joint problems. Following Beaton`s guideline, translation and back translation was conducted. We reached to a consensus on the Persian version of SST. To test the face validity in a pilot study, the Persian SST was administered to 20 individuals with shoulder joint conditions. We enrolled 148 consecutive patients with shoulder problem to fill the Persian SST, shoulder specific measure including Oxford shoulder score (OSS) and two general measures including DASH and SF-36. To measure the test-retest reliability, 42 patients were randomly asked to fill the Persian-SST for the second time after one week. Cronbach's alpha coefficient was used to demonstrate internal consistency over the 12 items of Persian-SST. ICC for the total questionnaire was 0.61 showing good and acceptable test-retest reliability. ICC for individual items ranged from 0.32 to 0.79. The total Cronbach's alpha was 0.84 showing good internal consistency over the 12 items of the Persian-SST. Validity testing showed strong correlation between SST and OSS and DASH. The correlation with OSS was positive while with DASH scores was negative. The correlation was also good to strong with all physical and most mental subscales of the SF-36. Correlation coefficient was higher with DASH and OSS in compare to SF-36. Persian version of SST found to be valid and reliable instrument for shoulder joint pain and function assessment in Iranian population.

[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.

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.

Pain and Opioid Use After Total Shoulder Arthroplasty With Injectable Liposomal Bupivacaine Versus Interscalene Block.

PubMed

Angerame, Marc R; Ruder, John A; Odum, Susan M; Hamid, Nady

2017-09-01

Postoperative pain control is a significant concern after total shoulder arthroplasty. Injectable periarticular liposomal bupivacaine, which has been found to decrease opioid use after orthopedic procedures, has been proposed as a viable alternative to regional anesthesia. This study compared the efficacy of liposomal bupivacaine vs interscalene block among patients undergoing total shoulder arthroplasty. A retrospective review was conducted of 79 patients who underwent anatomic total shoulder arthroplasty performed by a single surgeon between January 2013 and April 2015. Patient demographics, in-hospital Numeric Pain Rating Scale (NPRS) score obtained at 12-hour intervals, length of stay, and total in-hospital morphine equivalents in both the bupivacaine (n=25) and block (n=44) groups were recorded. Differences in length of stay, morphine equivalents, and age were assessed with Wilcoxon tests. Sex differences were assessed with the chi-square test. Repeated measures analysis with least square means was used to assess longitudinal changes in NPRS scores. No significant differences were found between groups for sex (P=.89), age (P=.81), American Society of Anesthesiologists classification (P=.50), preoperative opioid use (P=.41), length of stay (P=.32), or morphine equivalents (P=.71). The average NPRS score in the first 12 hours was 3.01 for the bupivacaine group and 4.41 for the interscalene block group (P=.25). By 48 hours postoperatively, average NPRS scores were similar (P=.93) for the 2 groups, 4.90 for the bupivacaine group and 4.19 for the interscalene block group. The findings for this cohort of patients undergoing anatomic total shoulder arthroplasty showed no significant difference for pain scores, postoperative narcotic use, or length of stay with injectable liposomal bupivacaine vs interscalene block. [Orthopedics. 2017; 40(5):e806-e811.]. Copyright 2017, SLACK Incorporated.

Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.

PubMed

Wilk, Kevin E; Macrina, Leonard C; Fleisig, Glenn S; Porterfield, Ronald; Simpson, Charles D; Harker, Paul; Paparesta, Nick; Andrews, James R

2011-02-01

Glenohumeral internal rotation deficit (GIRD) indicates a 20° or greater loss of internal rotation of the throwing shoulder compared with the nondominant shoulder. To determine whether GIRD and a deficit in total rotational motion (external rotation + internal rotation) compared with the nonthrowing shoulder correlate with shoulder injuries in professional baseball pitchers. Case series; Level of evidence, 4. Over 3 competitive seasons (2005 to 2007), passive range of motion measurements were evaluated on the dominant and nondominant shoulders for 170 pitcher-seasons. This included 122 professional pitchers during the 3 seasons of data collection, in which some pitchers were measured during multiple seasons. Ranges of motion were measured with a bubble goniometer during the preseason, by the same examiner each year. External and internal rotation of the glenohumeral joint was assessed with the participant supine and the arm abducted 90° in the plane of the scapula, with the scapula stabilized anteriorly at the coracoid process. The reproducibility of the test methods had an intraclass correlation coefficient of .81. Days in which the player was unable to participate because of injury or surgery were recorded during the season by the medical staff of the team and defined as an injury. Pitchers with GIRD (n = 40) were nearly twice as likely to be injured as those without but without statistical significance (P = .17). Pitchers with total rotational motion deficit greater than 5° had a higher rate of injury. Minor league pitchers were more likely than major league pitchers to be injured. However, when players were injured, major league pitchers missed a significantly greater number of games than minor league pitchers. Compared with pitchers without GIRD, pitchers with GIRD appear to be at a higher risk for injury and shoulder surgery.

Scapulohumeral rhythm in shoulders with reverse shoulder arthroplasty.

PubMed

Walker, David; Matsuki, Keisuke; Struk, Aimee M; Wright, Thomas W; Banks, Scott A

2015-07-01

Little is known about kinematic function of reverse total shoulder arthroplasty (RTSA). Scapulohumeral rhythm (SHR) is a common metric for assessing muscle function and shoulder joint motion. The purpose of this study was to compare SHR in shoulders with RTSA to normal shoulders. Twenty-eight subjects, more than 12 months after unilateral RTSA, were recruited for an Institutional Review Board-approved study. Subjects performed arm abduction in the coronal plane with and without a 1.4-kg hand-held weight. Three-dimensional model-image registration techniques were used to measure orientation and position for the humerus and scapula from fluoroscopic images. Analysis of variance and Tukey tests were used to assess groupwise and pairwise differences. SHR in RTSA shoulders (1.3:1) was significantly lower than in normal shoulders (3:1). Below 30° abduction, RTSA and normal shoulders show a wide range of SHR (1.3:1 to 17:1). Above 30° abduction, SHR in RTSA shoulders was 1.3:1 for unweighted abduction and 1.3:1 for weighted abduction. Maximum RTSA shoulder abduction in weighted trials was lower than in unweighted trials. SHR variability in RTSA shoulders decreased with increasing arm elevation. RTSA shoulders show kinematics that are significantly different from normal shoulders. SHR in RTSA shoulders was significantly lower than in normal shoulders, indicating that RTSA shoulders use more scapulothoracic motion and less glenohumeral motion to elevate the arm. With these observations, it may be possible to improve rehabilitation protocols, with particular attention to the periscapular muscles, and implant design or placement to optimize functional outcomes in shoulders with RTSA. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

Code of Federal Regulations, 2011 CFR

2011-04-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3660... device are: (1) FDA's: (i) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical... 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, 2011 CFR

2011-04-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3650... are: (1) FDA's: (i) “Use of International Standard ISO 10993 ‘Biological Evaluation of Medical Devices... metal/polymer non-constrained cemented prosthesis is a device intended to be implanted to replace a...

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders.

PubMed

Negahban, Hossein; Behtash, Zeinab; Sohani, Soheil Mansour; Salehi, Reza

2015-01-01

To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges = 0.77-0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma = -0.51 to -0.58) were found between the changes in SPADI/DASH and changes in global rating scale. The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis. The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings. The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

Short, Medium and Long Term Complications After Total Anatomical Shoulder Arthroplasty

PubMed Central

Gregory, T.M.; Boukebous, B.; Gregory, J.; Pierrart, J.; Masemjean, E.

2017-01-01

Total shoulder arthroplasty (TSA) is an effective approach for the treatment of a variety of clinical conditions affecting the shoulder, including osteoarthritis, inflammatory arthritis and osteonecrosis, and the number of TSA implanted has grown exponentially over the past decade. This review gives an update of the major complications, mainly infections, instability and loosening, encountered after TSA, based on a corpus of recent publications and a dynamic approach: The review focuses on the causes of glenoid loosening, which account for 80% of the complication, and underlines the importance of glenoid positioning in the recovery of early shouder function and in the long term survival rate of TSA. PMID:29152008

Preseason Strength Assessment of the Rotator Muscles and Shoulder Injury in Handball Players.

PubMed

Forthomme, Bénédicte; Croisier, Jean-Louis; Delvaux, François; Kaux, Jean-François; Crielaard, Jean-Michel; Gleizes-Cervera, Sophie

2018-02-01

  Few researchers have identified intrinsic risk factors for shoulder injury in team handball players by analyzing measurements of maximal isokinetic rotator muscle strength.   To identify possible intrinsic risk factors for shoulder injury by analyzing measurements of maximal isokinetic rotator muscle strength.   Cross-sectional study.   Male team handball senior divisions (the highest level) in France and Belgium.   A total of 108 male high-level handball players (age = 24 ± 4 years, height = 189 ± 6 cm, mass = 87 ± 11 kg) were enrolled.   All players completed a preseason questionnaire and performed a bilateral isokinetic assessment of the shoulder rotator muscles. On a monthly questionnaire, players reported any shoulder injury that they sustained during the season.   On the preseason questionnaire, 51 of 108 (47%) participants reported a history of dominant-shoulder injury. A total of 106 participants completed the in-season questionnaire, with 22% (n = 23) reporting a shoulder injury on their dominant side during the subsequent season. Fourteen percent (n = 15) sustained microtraumatic injuries, and 8% (n = 8) described a traumatic injury. Backcourt players had a 3.5-times increased risk of injury during the new season compared with players in other positions. Among the isokinetic results, no risk factor for further injury was identified in handball players with microtraumatic injuries. For traumatic injuries, the concentric maximal strength developed by the internal rotators at high speed (240°/s) in the dominant shoulder was a protective factor against the risk of further injury.   These results can potentially identify intrinsic risk factors for shoulder injury and may be used to determine potential interventions for reducing this risk in handball players.

Acute effects of scapular Kinesio Taping® on shoulder rotator strength, ROM and acromiohumeral distance in asymptomatic overhead athletes.

PubMed

Harput, Gulcan; Guney, Hande; Toprak, Ugur; Colakoglu, Filiz; Baltaci, Gul

2017-11-01

There is limited information in the literature that shows whether scapular taping has an effect on the acromiohumeral distance (AHD) and shoulder functions. The aim of this study was to investigate the acute effects of scapular Kinesio Taping® on shoulder internal rotation (IR) and external rotation (ER) strength, IR and ER range of motion (ROM) and AHD in asymptomatic overhead athletes. Forty-one volleyball athletes (24 men, 17 women; mean age: 16.1±1.5 years, body mass: 66.5±9.6 kg, body height: 179.6±8.4 cm, Body Mass Index: 20.5±2.3 kg/m2, time participating in overhead sports activity: 6.2±1.4 h/week, experience in sport: 4.1±2.4 years) were included in this study. Shoulder IR and ER ROM, total rotation ROM, AHD, shoulder isometric IR and ER strength and ER:IR strength ratio of the dominant side were tested before and after taping. Scapular taping increased the shoulder IR (P<0.001) and total ROM (P<0.001), AHD (P<0.001), shoulder IR (P=0.002) and ER (P=0.006) strength. ER ROM and ER:IR ratio did not change after taping (P=0.26, P=0.98, respectively). The results of this study suggest that scapular taping could be an effective method for enhancing the acromiohumeral distance, shoulder rotator strength and range of motion. Therefore, scapular taping could be recommended for not only in the asymptomatic athletes' shoulder exercise training but also in the prevention of subacromial impingement syndrome.

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.

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.

Glenohumeral Rotational Range of Motion in Collegiate Overhead-Throwing Athletes During an Athletic Season

PubMed Central

Dwelly, Priscilla M.; Tripp, Brady L.; Tripp, Patricia A.; Eberman, Lindsey E.; Gorin, Steven

2009-01-01

Abstract Context: Repetitive throwing at high velocities leads to altered range of motion (ROM) in the dominant shoulder compared with the nondominant shoulder in overhead-throwing athletes. Loss of glenohumeral internal rotation (IR), or glenohumeral internal-rotation deficit (GIRD), is associated with shoulder injuries. Therefore, GIRD should be evaluated during the clinical examination of the thrower's shoulder. Objective: To assess glenohumeral ROM in competitive baseball and softball athletes at 3 intervals over the course of an athletic season in order to (1) examine changes in ROM over time and (2) monitor the prevalence of GIRD. Design: Observational, repeated-measures study. Setting: Collegiate athletic training room. Patients or Other Participants: Forty-eight healthy National Collegiate Athletic Association (NCAA) Division I or Division II athletes (age  =  19 ± 1 years, height  =  174 ± 14 cm, mass  =  77.8 ± 18.1 kg; 19 softball, 29 baseball players). Main Outcome Measure(s): We measured glenohumeral IR, external rotation (ER), total arc (ER + IR), and GIRD at 3 times: prefall, prespring, and postspring. We calculated GIRD in 2 ways: as the difference in IR between dominant and nondominant shoulders and as the percentage of the total arc. Results: In the dominant shoulder, ER increased during the season (F2,96  =  17.433, P < .001), but IR remained the same (F2,96  =  1.839, P  =  .17). The total arc in the dominant shoulder increased between time intervals (F2,96  =  14.030, P < .001); the mean difference between prefall and postspring measurements was 9.694° (P < .001), and the mean difference between prefall and postspring measurements was 10.990° (P < .001). In the nondominant shoulder, ER increased over the season (F2,96  =  23.395, P < .001), but IR did not change over the season (F2,96  =  0.087, P  =  .90). The total arc in the nondominant shoulder increased between prefall and prespring measurements and between prefall and postspring measurements (F2,96  =  18.552, P < .001). No changes were noted in GIRD over time. However, more athletes with GIRD were identified with the GIRD (IR difference) calculation in prefall (n  =  6) than in prespring (n  =  1) and postspring (n  =  4) (Cochran Q  =  5.2, P  =  .07). In addition, more athletes with GIRD were identified with the GIRD (% total arc) calculation in postspring (n  =  6) than in prefall (n  =  5) or prespring (n  =  4) (Cochran Q  =  2.6, P  =  .27). Conclusions: Healthy NCAA Division I and Division II athletes did not display changes in glenohumeral IR over an athletic season. However, they gained in ER and total arc during the season in both shoulders. Future researchers should investigate changes over multiple seasons. The 2 methods of calculating GIRD identified different athletes as having GIRD, indicating that additional investigation is warranted to determine the clinical benefits of each method. PMID:19911087

The cost effectiveness of vancomycin for preventing infections after shoulder arthroplasty: a break-even analysis.

PubMed

Hatch, M Daniel; Daniels, Stephen D; Glerum, Kimberly M; Higgins, Laurence D

2017-03-01

Increasing methicillin resistance and recognition of Propionibacterium acnes as a cause of infection in shoulder arthroplasty has led to the adoption of local vancomycin powder application as a more effective method to prevent expensive periprosthetic infections. However, no study has analyzed the cost effectiveness of vancomycin powder for preventing infection after shoulder replacement. Cost data for infection-related care of 16 patients treated for deep periprosthetic shoulder infection was collected from our institution for the break-even analysis. An equation was developed and applied to the data to determine how effective vancomycin powder would need to be at reducing a baseline infection rate to make prophylactic use cost effective. The efficacy of vancomycin (absolute risk reduction [ARR]) was evaluated at different unit costs, baseline infection rates, and average costs of treating infection. We determined vancomycin to be cost effective if the initial infection rate decreased by 0.04% (ARR). Using the current costs of vancomycin reported in the literature (range: $2.50/1000 mg to $44/1000 mg), we determined vancomycin to be cost effective with an ARR range of 0.01% at a cost of $2.50/1000 mg to 0.19% at $44/1000 mg. Baseline infection rate does not influence the ARR obtained at any specific cost of vancomycin or the cost of treating infection. We have derived and used a break-even equation to assess efficacy of prophylactic antibiotics during shoulder surgery. We further demonstrated the prophylactic administration of local vancomycin powder during shoulder arthroplasty to be a highly cost-effective practice. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

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

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.

Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation.

PubMed

Denard, Patrick J; Raiss, Patric; Gobezie, Reuben; Edwards, T Bradley; Lederman, Evan

2018-06-01

Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings. The purpose of this report is to review the current literature on press-fit fixation of the humeral component during total shoulder arthroplasty and propose minimum requirements for radiographic descriptions of stress shielding. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reverse total shoulder arthroplasty

PubMed Central

Familiari, Filippo; Rojas, Jorge; Nedim Doral, Mahmut; Huri, Gazi; McFarland, Edward G.

2018-01-01

Since the introduction of reverse total shoulder arthroplasty (RTSA) in 1987 (in Europe) and 2004 (in the United States), the number of RTSAs performed annually has increased. Although the main indication for RTSA has been rotator cuff tears, indications have expanded to include several shoulder conditions, many of which involve dysfunction of the rotator cuff. RTSA complications have been reported to affect 19% to 68% of patients and include acromial fracture, haematoma, infection, instability, mechanical baseplate failure, neurological injury, periprosthetic fracture and scapular notching. Current controversies in RTSA include optimal baseplate positioning, humeral neck-shaft angle (135° versus 155°), glenosphere placement (medial, lateral or bony increased offset RTSA) and subscapularis repair. Improvements in prosthesis design, surgeon experience and clinical results will need to occur to optimize this treatment for many shoulder conditions. Cite this article: EFORT Open Rev 2018;3:58–69 DOI: 10.1302/2058-5241.3.170044 PMID:29657846

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.

Thromboembolism Following Shoulder Arthroscopy

PubMed Central

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

2014-01-01

Background: Thromboembolism following shoulder arthroscopy is considered an uncommon complication, with fewer than 50 cases reported in the literature. Arthroscopy of the shoulder is one of the most commonly performed orthopaedic procedures, with low associated risks. Purpose: To identify potential risk factors for the development of venous thromboembolism (VTE) following shoulder arthroscopy and to determine the overall incidence of this complication. Study Design: Case-control study; Level of evidence, 3. Methods: A retrospective case-control review was performed of patients who developed symptomatic deep venous thrombosis (DVT) or pulmonary embolism (PE) following shoulder arthroscopy. Multiple surgeons from across North America were queried. For every case of DVT or PE identified, 2 control cases of shoulder arthroscopy were analyzed. The incidence of DVT/PE following shoulder arthroscopy was determined. A univariate analysis and a multivariate logistic regression model were conducted to identify any potential risk factors for the development of VTE following shoulder arthroscopy. Results: A total of 17 surgeons participated in this study and had performed a total of 15,033 cases of shoulder arthroscopy from September 2002 through August 2011. Eleven of the 17 participating surgeons had had a patient with a VTE complication during this time frame. The incidence of VTE in the 15,033 cases was 0.15%; 22 patients of the 15,033 patients had a DVT (n = 15) and/or PE (n = 8). Forty-four control cases were also analyzed. Univariate and multivariate analyses were performed. No significant risk factors were identified other than patient positioning. All cases and controls were positioned in the beach-chair position for surgery. Conclusion: The results of this study show that although rare, VTE occurs following shoulder arthroscopy at a rate of 0.15%. The variables analyzed in the cases of VTE compared with the control cases did not show any significant risk factors. All cases were positioned in the beach-chair position. Further analysis of future cases is warranted. PMID:26535285

Shoulder fusion after a self-inflicted gunshot wound: an injury pattern and treatment option.

PubMed

Zsoldos, C M; Basamania, C J; Bal, G K

2013-06-01

Gunshot injuries to the shoulder are rare and difficult to manage. We present a case series of seven patients who sustained a severe shoulder injury to the non-dominant side as a result of a self-inflicted gunshot wound. We describe the injury as 'suicide shoulder' caused by upward and outward movement of the gun barrel as the trigger is pulled. All patients were male, with a mean age of 32 years (21 to 48). All were treated at the time of injury with initial repeated debridement, and within four weeks either by hemiarthroplasty (four patients) or arthrodesis (three patients). The hemiarthroplasty failed in one patient after 20 years due to infection and an arthrodesis was attempted, which also failed due to infection. Overall follow-up was for a mean of 26 months (12 to 44). All four hemiarthroplasty implants were removed with no feasible reconstruction ultimately possible, resulting in a poor functional outcome and no return to work. In contrast, all three primary arthrodeses eventually united, with two patients requiring revision plating and grafting. These patients returned to work with a good functional outcome. We recommend arthrodesis rather than replacement as the treatment of choice for this challenging injury.

Patients recall worse preoperative pain after shoulder arthroplasty than originally reported: a study of recall accuracy using the American Shoulder and Elbow Surgeons score.

PubMed

Lowe, Jeremiah T; Li, Xinning; Fasulo, Sydney M; Testa, Edward J; Jawa, Andrew

2017-03-01

Patient-reported outcome measures (PROMs) are valuable tools for quantifying outcomes of orthopedic surgery. However, when baseline scores are not obtained, there is considerable controversy about whether PROMs can be administered retrospectively for patients to recall their preoperative state. We investigated the accuracy of patient recall after total shoulder arthroplasty (TSA) using the American Shoulder and Elbow Surgeons (ASES) assessment score. Recalled ASES scores were collected postoperatively at 6 weeks, 3 months, 6 months, and 12 months from 169 patients who previously completed baseline scores before TSA. The ASES total score was divided into its two subcomponents: functional ability and visual analog scale (VAS) for pain. We compared preoperative and recalled scores for each subcomponent and the total ASES score. Recalled ASES function scores were comparable to corresponding preoperative scores across all time points (analysis of variance, P = .21), but recalled VAS pain was significantly higher at all time points beyond 6 weeks after surgery (P = .0001 at 3 months; P = .005 at 6 months; and P = .001 at 12 months). As a result, the ASES total score was only comparable at 6 weeks after surgery (P = .39) and differed at all time points thereafter. Patients are able to recall preoperative function with considerable accuracy for up to 12 months after TSA. However, beyond 6 weeks postoperatively, patients recall having worse pain than they originally reported, and recalled ASES total scores are unreliable as a result. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Few geographic and socioeconomic variations exist in primary total shoulder arthroplasty: a multi-level study of Australian registry data.

PubMed

Brennan-Olsen, Sharon L; Page, Richard S; Lane, Stephen E; Lorimer, Michelle; Buchbinder, Rachelle; Osborne, Richard H; Pasco, Julie A; Wluka, Anita E; Sanders, Kerrie M; Ebeling, Peter R; Graves, Stephen E

2016-07-16

Associations between socioeconomic position (SEP) and the uptake of primary total shoulder arthroplasty (TSA) is not well understood in the Australian population, thus potentially limiting equitable allocation of healthcare resources. We used the Australian Orthopaedic Association National Joint Replacement Registry (AOA NJRR) to examine whether geographic or socioeconomic variations exist in TSA performed for a diagnosis of osteoarthritis 2007-11 for all Australians aged ≥40 years. Primary anatomical and reverse TSA data were extracted from the AOA NJRR which captures >99 % of all TSA nationally. Residential addresses were cross-referenced to Australian Bureau of Statistics 2011 Census data to identify SEP measured at the area-level (categorised into deciles), and geographic location defined as Australian State/Territory of residence. We used a Poisson distribution for the number of TSA over the study period, and modelled the effects of age, SEP and geographic location using multilevel modelling. During 2007-11, we observed 6,123 TSA (62.2 % female). For both sexes, TSA showed a proportional increase with advancing age. TSA did not vary by SEP or geographic location, with the exception of greater TSA among men in New South Wales. Using a national registry approach we provide the first reliable picture of TSA at a national level. The uptake of TSA was equitable across SEP; however, there was some variation between the States/Territories. With an aging population, it is imperative that monitoring of major surgical procedures continues, and be focused toward determining whether TSA uptake correlates with need across different social and area-based groups.

Induction of bone ingrowth with a micropore bioabsorbable suture anchor in rotator cuff tear: an experimental study in a rabbit model.

PubMed

Kang, Yun Gyeong; Kim, Jung-Han; Shin, Jung-Woog; Baik, Jong-Min; Choo, Hye-Jung

2013-11-01

The bioabsorbable suture anchor is probably one of the most commonly used tools in arthroscopic shoulder operations. However, there is controversy about whether the bioabsorbable anchor is replaced by bone. The object of this study is to evaluate bone ingrowth into the micropore bioabsorbable suture anchor and the differences in the biomechanical properties of a micropore anchor and a nonpore anchor. A total of 16 microsized holes (diameter, 250 ± 50 μm; depth, 0.2 mm) were made on the bioabsorbable anchors with a microdrill. Twelve adult New Zealand White rabbits were randomly divided into two groups: group A (n = 6), the nonpore bioabsorbable suture anchor group, and group pA (n = 6), the micropore bioabsorbable suture anchor group. Microcomputed tomography was used at 4 and 8 weeks postoperatively to evaluate ingrowth by bone volume fraction (BVF), which was measured by calculating the ratio of the total volume of bone ingrowth to that of the region of interest. For pullout strength testing, 3 additional rabbits (6 limbs) were used for mechanical testing. The mean BVF was higher in group pA (0.288 ± 0.054) than in group A (0.097 ± 0.006). The micropore anchor had a higher pullout strength (0.520 ± 0.294 N) than the nonpore anchor (0.275 ± 0.064 N). Micropore bioabsorbable suture anchors induced bone ingrowth and showed higher pullout strength, despite processing. Copyright © 2013 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Variability of medial and posterior offset in patients with fourth-generation stemmed shoulder arthroplasty.

PubMed

Irlenbusch, Ulrich; Berth, Alexander; Blatter, Georges; Zenz, Peter

2012-03-01

Most anthropometric data on the proximal humerus has been obtained from deceased healthy individuals with no deformities. Endoprostheses are implanted for primary and secondary osteoarthritis, rheumatoid arthritis,humeral-head necrosis, fracture sequelae and other humeral-head deformities. This indicates that pathologicoanatomical variability may be greater than previously assumed. We therefore investigated a group of patients with typical shoulder replacement diagnoses, including posttraumatic and rheumatic deformities. One hundred and twenty-two patients with a double eccentrically adjustable shaft endoprosthesis served as a specific dimension gauge to determine in vivo the individual humeral-head rotation centres from the position of the adjustable prosthesis taper and the eccentric head. All prosthesis heads were positioned eccentrically.The entire adjustment range of the prosthesis of 12 mm medial/lateral and 6 mm dorsal/ventral was required. Mean values for effective offset were 5.84 mm mediolaterally[standard deviation (SD) 1.95, minimum +2, maximum +11]and 1.71 mm anteroposteriorly (SD 1.71, minimum −3,maximum 3 mm), averaging 5.16 mm (SD 1.76, minimum +2,maximum + 10). The posterior offset averaged 1.85 mm(SD 1.85, minimum −1, maximum + 6 mm). In summary, variability of the combined medial and dorsal offset of the humeral-head rotational centre determined in patients with typical underlying diagnoses in shoulder replacement was not greater than that recorded in the literature for healthy deceased patients.The range of deviation is substantial and shows the need for an adjustable prosthetic system.

The incidence and demographics of shoulder repair in Wisconsin, 2002-2010.

PubMed

Ablove, Robert H; Aul, Allison; Baer, Geoffrey

2014-12-01

Recent evidence has demonstrated a profound increase in the incidence of shoulder surgery. Superior labral anterior and posterior (SLAP) repair is a common procedure that has been noted in other studies to be increasing. The purpose of this study is to report the incidence and demographics of a single shoulder surgery code in the state of Wisconsin in order to evaluate whether it is being performed in increasing numbers relative to population. In a retrospective review of the Wisconsin Hospital Association statewide database for the years 2002-2010, we queried one ICD-9 procedure code: 81.83, other repair of shoulder (not replacement or repair of recurrent dislocation). This code was selected because it would include SLAP repair and exclude most other common shoulder surgeries. The data retrieved includes ICD-9 diagnosis codes, county of surgery, patient age, and gender. The number of surgeries performed in Wisconsin over the course of the study increased by 91.4% between 2002 and 2010, starting at 5649 in 2002 and rising to 10,812 by 2010. The incidence of surgeries increased 83.1% over this time period: from 103.8 per 100,000 in 2002 to 190.1 per 100,000 in 2010. The ratio of male to female surgeries remained nearly constant at 3:2 throughout the length of the study. The mean patient age at time of surgery increased 2.6 years, from 48.3 in 2002 to 50.9 in 2010. The increase in number of shoulder surgeries is well beyond expectations based on population growth. The relatively high percentage of females does not correspond with reported gender ratios in other studies of similar shoulder procedures. The high mean age of patients and the large number of surgeries in older patients also is concerning. More educational effort needs to be given regarding the diagnosis and treatment of common shoulder conditions.

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.

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

Trends in Medicare Reimbursement for Orthopedic Procedures: 2000 to 2016.

PubMed

Eltorai, Adam E M; Durand, Wesley M; Haglin, Jack M; Rubin, Lee E; Weiss, Arnold-Peter C; Daniels, Alan H

2018-03-01

Understanding trends in reimbursement is critical to the financial sustainability of orthopedic practices. Little research has examined physician fee trends over time for orthopedic procedures. This study evaluated trends in Medicare reimbursements for orthopedic surgical procedures. The Medicare Physician Fee Schedule was examined for Current Procedural Terminology code values for the most common orthopedic and nonorthopedic procedures between 2000 and 2016. Prices were adjusted for inflation to 2016-dollar values. To assess mean growth rate for each procedure and subspecialty, compound annual growth rates were calculated. Year-to-year dollar amount changes were calculated for each procedure and subspecialty. Reimbursement trends for individual procedures and across subspecialties were compared. Between 2000 and 2016, annual reimbursements decreased for all orthopedic procedures examined except removal of orthopedic implant. The orthopedic procedures with the greatest mean annual decreases in reimbursement were shoulder arthroscopy/decompression, total knee replacement, and total hip replacement. The orthopedic procedures with the least annual reimbursement decreases were carpal tunnel release and repair of ankle fracture. Rate of Medicare procedure reimbursement change varied between subspecialties. Trauma had the smallest decrease in annual change compared with spine, sports, and hand. Annual reimbursement decreased at a significantly greater rate for adult reconstruction procedures than for any of the other subspecialties. These findings indicate that reimbursement for procedures has steadily decreased, with the most rapid decrease seen in adult reconstruction. [Orthopedics. 2018; 41(2):95-102.]. Copyright 2018, SLACK Incorporated.

How do deltoid muscle moment arms change after reverse total shoulder arthroplasty?

PubMed

Walker, David R; Struk, Aimee M; Matsuki, Keisuke; Wright, Thomas W; Banks, Scott A

2016-04-01

Although many advantages of reverse total shoulder arthroplasty (RTSA) have been demonstrated, a variety of complications indicate there is much to learn about how RTSA modifies normal shoulder function. This study used a subject-specific computational model driven by in vivo kinematic data to assess how RTSA affects deltoid muscle moment arms after surgery. A subject-specific 12 degree-of-freedom musculoskeletal model was used to analyze the shoulders of 26 individuals (14 RTSA and 12 normal). The model was modified from the work of Holzbaur to directly input 6 degree-of-freedom humeral and scapular kinematics obtained using fluoroscopy. The moment arms of the anterior, lateral, and posterior aspects of the deltoid were significantly different when RTSA and normal cohorts were compared at different abduction angles. Anterior and lateral deltoid moment arms were significantly larger in the RTSA group at the initial elevation of the arm. The posterior deltoid was significantly larger at maximum elevation. There was large intersubject variability within the RTSA group. Placement of implant components during RTSA can directly affect the geometric relationship between the humerus and scapula and the muscle moment arms in the RTSA shoulder. RTSA shoulders maintain the same anterior and posterior deltoid muscle moment-arm patterns as healthy shoulders but show much greater intersubject variation and larger moment-arm magnitudes. These observations provide a basis for determining optimal implant configuration and surgical placement to maximize RTSA function in a patient-specific manner. Published by Elsevier Inc.

Glenoid deformity in the coronal plane correlates with humeral head changes in osteoarthritis: a radiographic analysis.

PubMed

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

2017-02-01

A variety of measurements can be used to assess radiographic osteoarthritic changes of the shoulder. This study aimed to analyze the correlation between the radiographic humeral-sided Samilson and Prieto classification system and 3 different radiographic classifications describing the changes of the glenoid in the coronal plane. The study material included standardized radiographs of 50 patients with idiopathic osteoarthritis before anatomic shoulder replacement. On the basis of radiographic measurements, the cases were evaluated using the Samilson and Prieto grading system, angle β, inclination type, and critical shoulder angle by 2 independent observers. Classification measurements showed an excellent agreement between observers. Our results showed that the humeral-sided Samilson and Prieto grading system had a statistically significant good correlation with angle β (observer 1, r = 0.74; observer 2, r = 0.77; P < .05) and a statistically significant excellent correlation with the inclination type of the glenoid (observer 1, r  = 0.86; observer 2, r = 0.8; P < .05). A poor correlation to the critical shoulder angle was observed (r = -0.14, r = 0.03; P > .05). The grade of humeral-sided osteoarthritis according to Samilson and Prieto correlates with the glenoid-sided osteoarthritic changes of the glenoid in the coronal plane described by the angle β and by the inclination type of the glenoid. Higher glenoid-sided inclination is associated with higher grade of osteoarthritis in primary shoulder osteoarthritis. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The Family and Friends Plan: Grateful to Be Engaged, Parents, Grandparents, and Friends Happily Give

ERIC Educational Resources Information Center

Lum, Lydia

2011-01-01

Growing numbers of colleges and universities, as well as independent schools, are targeting parents, grandparents, and other nonalumni friends for gifts to meet institutional needs and, at many public institutions, replace appropriations lost to Draconian state cuts. Such efforts have taken root despite parents shouldering ever-climbing college…

The effects of Clinical Pilates exercises on patients with shoulder pain: A randomised clinical trial.

PubMed

Atılgan, Esra; Aytar, Aydan; Çağlar, Aslıcan; Tığlı, Ayça Aytar; Arın, Gamze; Yapalı, Gökmen; Kısacık, Pınar; Berberoğlu, Utku; Şener, Hülya Özlem; Ünal, Edibe

2017-10-01

The purpose of this study was to determine the effect of Clinical Pilates exercises on patients with shoulder pain. Thirty-three patients, experiencing shoulder pain continuously for at least four weeks were selected as study subjects. The patients were randomly divided into two groups, namely Clinical Pilates exercise (n = 17) group and conventional exercise (n = 16) group. The patients were treated for five days a week, the total treatment being carried out for 10 days. The assessment of pain and disability amongst the patients were done at the baseline and at the end of the treatment sessions, using Visual Analogue Scale (VAS) and Shoulder Pain and Disability Index (SPADI). The clinical Pilates exercise group showed a significant improvement in all scores used for assessment (p < 0.05), while the conventional exercise group demonstrated a significant improvement only in the SPADI total score (p < 0.05). A comparison of scores for the VAS, SPADI-Pain and SPADI-Total between the two groups, revealed a significant improvement in the Clinical Pilates exercise group (p < 0.05). It was demonstrated by the study that Clinical Pilates exercise is an efficient technique for patients experiencing shoulder pain, as it helps reduce pain and disability among them. Copyright © 2017 Elsevier Ltd. All rights reserved.

Effects of pea chips on pig performance, carcass quality and composition, and palatability of pork.

PubMed

Newman, D J; Harris, E K; Lepper, A N; Berg, E P; Stein, H H

2011-10-01

Pea chips are produced as a by-product when field peas are processed to produce split peas for human consumption. The objective of this experiment was to test the hypothesis that inclusion of pea chips in diets fed to finishing pigs does not negatively influence pig growth performance, carcass composition, and the palatability of pork. A total of 24 barrows (initial BW: 58.0 ± 6.6 kg) were allotted to 1 of 4 treatments and fed early finishing diets for 35 d and late finishing diets for 35 d. A corn-soybean meal (SBM) control diet and 3 diets containing pea chips were formulated for each phase. Pea chips replaced 33.3, 66.6, or 100% of the SBM in the control diet. Pigs were housed individually, and all pigs were slaughtered at the conclusion of the experiment. Overall, there were no differences (P > 0.11) in final BW, ADFI, and G:F of pigs among treatments, but there was a quadratic response in ADG (P = 0.04), with the smallest value observed in pigs fed the control diet. Dressing percentage linearly decreased (P = 0.04) as pea chips replaced SBM in diets, but there were no differences (P > 0.20) among treatments in HCW, LM area, 10th-rib backfat, lean meat percentage, and marbling. Likewise, pH in loin and ham, drip loss, and purge loss were not influenced (P > 0.13) by treatment. However, there was a quadratic response (P = 0.08) in 24-h pH in the shoulder, with the smallest value present in pigs fed the diet, in which 66.6% of the SBM was replaced by pea chips. Subjective LM color and Japanese color score standard were reduced (quadratic, P = 0.03 and 0.05, respectively) and LM b* values and hue angle were increased (quadratic, P = 0.09 and 0.10, respectively) when pea chips replaced SBM in the diets. Ham L* (quadratic, P = 0.04), a* (linear, P = 0.02), b* (quadratic, P = 0.07), color saturation (linear, P = 0.02), and hue angle (quadratic, P = 0.05) were increased when pea chips replaced SBM. However, there were no differences (P > 0.16) in shoulder and fat color. Moreover, cook loss percentage, shear force, juiciness, and pork flavor of pork chops were not different (P > 0.10) among treatments, but tenderness of pork chops linearly decreased (P = 0.04) as SBM replaced pea chips. It is concluded that all the SBM in diets fed to growing-finishing pigs may be replaced by pea chips without negatively influencing growth performance or carcass composition. However, pigs fed pea chips will have pork chops and hams that are lighter, and chops may be less tender if pigs are fed pea chips rather than corn and SBM.

Impact of movement training on upper limb motor strategies in persons with shoulder impingement syndrome

PubMed Central

Roy, Jean-Sébastien; Moffet, Hélène; McFadyen, Bradford J; Lirette, Richard

2009-01-01

Background Movement deficits, such as changes in the magnitude of scapulohumeral and scapulathoracic muscle activations or perturbations in the kinematics of the glenohumeral, sternoclavicular and scapulothoracic joints, have been observed in people with shoulder impingement syndrome. Movement training has been suggested as a mean to contribute to the improvement of the motor performance in persons with musculoskeletal impairments. However, the impact of movement training on the movement deficits of persons with shoulder impingement syndrome is still unknown. The aim of this study was to evaluate the short-term effects of supervised movement training with feedback on the motor strategies of persons with shoulder impingement syndrome. Methods Thirty-three subjects with shoulder impingement were recruited. They were involved in two visits, one day apart. During the first visit, supervised movement training with feedback was performed. The upper limb motor strategies were evaluated before, during, immediately after and 24 hours after movement training. They were characterized during reaching movements in the frontal plane by EMG activity of seven shoulder muscles and total excursion and final position of the wrist, elbow, shoulder, clavicle and trunk. Movement training consisted of reaching movements performed under the supervision of a physiotherapist who gave feedback aimed at restoring shoulder movements. One-way repeated measures ANOVAs were run to analyze the effect of movement training. Results During, immediately after and 24 hours after movement training with feedback, the EMG activity was significantly decreased compared to the baseline level. For the kinematics, total joint excursion of the trunk and final joint position of the trunk, shoulder and clavicle were significantly improved during and immediately after training compared to baseline. Twenty-four hours after supervised movement training, the kinematics of trunk, shoulder and clavicle were back to the baseline level. Conclusion Movement training with feedback brought changes in motor strategies and improved temporarily some aspects of the kinematics. However, one training session was not enough to bring permanent improvement in the kinematic patterns. These results demonstrate the potential of movement training in the rehabilitation of movement deficits associated with shoulder impingement syndrome. PMID:19445724

Locomotion in simulated microgravity: gravity replacement loads

NASA Technical Reports Server (NTRS)

McCrory, Jean L.; Baron, Heidi A.; Balkin, Sandy; Cavanagh, Peter R.

2002-01-01

BACKGROUND: When an astronaut walks or runs on a treadmill in microgravity, a subject load device (SLD) is used to return him or her back to the treadmill belt. The gravity replacement load (GRL) in the SLD is transferred, via a harness, to the pelvis and/or the shoulders. This research compared comfort and ground reaction forces during treadmill running in a microgravity locomotion simulator at GRLs of 60%, 80%, and 100% of body weight (BW). Two harness designs (shoulder springs only (SSO) and waist and shoulder springs (WSS)) were used. HYPOTHESES: 1) The 100% BW gravity replacement load conditions would be comfortably tolerated and would result in larger ground reaction forces and loading rates than the lower load conditions, and 2) the WSS harness would be more comfortable than the SSO harness. METHODS: Using the Penn State Zero Gravity Locomotion Simulator (ZLS), 8 subjects ran at 2.0 m x s(-1) (4.5 mph) for 3 min at each GRL setting in each harness. Subjective ratings of harness comfort, ground reaction forces, and GRL data were collected during the final minute of exercise. RESULTS: The 100% BW loading conditions were comfortably tolerated (2.3 on a scale of 0-10), although discomfort increased as the GRL increased. There were no overall differences in perceived comfort between the two harnesses. The loading rates (27.1, 33.8, 39.1 BW x s(-1)) and the magnitudes of the first (1.0, 1.4, 1.6 BW) and second (1.3, 1.7, 1.9 BW) peaks of the ground reaction force increased with increasing levels (60, 80, 100% BW respectively) of GRL. CONCLUSIONS: Subjects were able to tolerate a GRL of 100% BW well. The magnitude of the ground reaction force peaks and the loading rate is directly related to the magnitude of the GRL.

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

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

Effects of the humeral tray component positioning for onlay reverse shoulder arthroplasty design: a biomechanical analysis.

PubMed

Berhouet, Julien; Kontaxis, Andreas; Gulotta, Lawrence V; Craig, Edward; Warren, Russel; Dines, Joshua; Dines, David

2015-04-01

Recent shoulder prostheses have introduced a concept of a universal humeral stem component platform that has an onlay humeral tray for the reverse total shoulder arthroplasty (RTSA). No studies have reported how humeral tray positioning can affect the biomechanics of RTSA. The Newcastle Shoulder Model was used to investigate the biomechanical effect of humeral tray positioning in the Biomet Comprehensive Total Shoulder System (Biomet, Warsaw, IN, USA) RTSA. Five humeral tray configuration positions were tested: no offset, and 5 mm offset in the anterior, posterior, medial, and lateral positions. Superior and inferior impingement were evaluated for abduction, scapular plane elevation, forward flexion, and external/internal rotation with the elbow at the side (adduction) and at 90° of shoulder abduction. Muscle lengths and moment arms (elevating and rotational) were calculated for the deltoid, the infraspinatus, the teres minor, and the subscapularis. Inferior impingement was not affected by the humeral tray position. There was less superior impingement during abduction, scapular plane elevation, and rotation with the shoulder when the tray was placed laterally or posteriorly. The subscapularis rotational moment arm was increased with a posterior offset, whereas infraspinatus and teres minor rotational moment arms were increased with an anterior offset. Very little change was observed for the deltoid elevating moment arm or for its muscle length. Positioning the humeral tray with posterior offset offers a biomechanical advantage for patients needing RTSA by decreasing superior impingement and increasing the internal rotational moment arm of the subscapularis, without creating inferior impingement. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The Shoulder Instability-Return to Sport after Injury (SIRSI): a valid and reproducible scale to quantify psychological readiness to return to sport after traumatic shoulder instability.

PubMed

Gerometta, Antoine; Klouche, Shahnaz; Herman, Serge; Lefevre, Nicolas; Bohu, Yoann

2018-01-01

The main goal of this study was to propose and validate a tool to quantify the psychological readiness of athletes to return to sport following traumatic shoulder instability and conservative or surgical management. «Knee» was replaced by the term «shoulder» in the Anterior Cruciate Ligament-Return to Sport after Injury scale. This pilot test of the Shoulder Instability-Return to Sport after Injury scale (SIRSI) was performed in a group of athletes who underwent surgery for post-traumatic chronic anterior shoulder instability. The final version was then validated according to the international COSMIN methodology. A retrospective study was performed including all rugby players who had reported an episode of instability between 2012 and 2013. The WOSI and the Walch-Duplay scales were used as reference questionnaires. Sixty-two patients were included, mean age 26 ± 5.2 years old, 5 women/57 men. Patients were professional or competitive athletes (70.9%) and followed-up for 4.6 ± 1.6 years after the first episode of shoulder instability. Shoulder surgery was performed in 30/62 (48.4%) patients, a mean 1.6 ± 1.2 years after the first episode of instability. The SIRSI was strongly correlated with the reference questionnaires (r = 0.80, p < 10 -5 ). The mean SIRSI score was significantly higher in patients who returned to play rugby (60.9 ± 26.6% vs 38.1 ± 25.6%, p = 0.001). The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.93, 95% CI [0.89-0.96], p < 10 -5 ). No ceiling/floor effects were found. The SIRSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after an episode of shoulder instability, whether they undergo surgery or not. III.

Carcass characteristics of lambs fed spineless cactus as a replacement for sugarcane.

PubMed

de Oliveira, Juliana Paula Felipe; de Andrade Ferreira, Marcelo; Alves, Adryanne Marjorie Souza Vitor; de Melo, Ana Caroline Cerqueira; de Andrade, Ida Barbosa; Urbano, Stela Antas; Suassuna, Juraci Marcos Alves; de Barros, Leonardo José Assis; de Barros Melo, Tobias Tobit

2018-04-01

Fresh sugarcane has been a new roughage source for ruminant's in semiarid regions, a function of the decline of sugar and alcohol industry in recent years. However, there is little data published regarding lambs fed sugarcane associated with spineless cactus. This study evaluated the effect of sugarcane replacement with spineless cactus (0%, 33%, 66%, and 100%) in the diet of Santa Inês lambs on carcass characteristics. Thirty-six non-castrated Santa Ines lambs at four months of age and an initial body weight of 22±2.3 kg were assigned in a randomized block design and slaughtered after 70 days of confinement. The effects of spineless cactus as a replacement for sugarcane in the diet of the lambs on the carcass characteristics, commercial cut weight and yield, leg tissue composition, and carcass measurements were studied. The study revealed quadratic behavior in slaughter body weight, and hot and cold carcass weight, with maximum values of 38.60, 18.60, and 18.11 kg and replacement levels of 40.18%, 44.42%, and 43.14%, respectively. The cold carcass yield presented an increasing linear behavior. The compactness index of carcass and leg presented a quadratic effect, with estimated maximal values of 0.28 and 0.57 kg/cm and replacement levels of 43.37% and 45.5%, respectively. The weights of commercial cuts of leg, loin, shoulder, and breast showed quadratic behavior, with maximum values of 2.79, 0.852, 1.46, and 1.30 kg and replacement levels of 49.5, 45.32, 39.0, and 40.7, respectively. For tissue composition, quadratic behavior was verified for leg weight, subcutaneous fat, and total fat. The replacement of sugarcane by spineless cactus at level 44% is recommended for finishing lambs considering that this level improved most of the carcass characteristics, weights, and yields of commercial cuts and leg tissue composition.

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.

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.

How sensitive is the deltoid moment arm to humeral offset changes with reverse total shoulder arthroplasty?

PubMed

Walker, David R; Kinney, Allison L; Wright, Thomas W; Banks, Scott A

2016-06-01

Reverse total shoulder arthroplasty commonly treats cuff-deficient or osteoarthritic shoulders not amenable to rotator cuff repair. This study investigates deltoid moment arm sensitivity to variations in the joint center and humeral offset of 3 representative reverse total shoulder arthroplasty subjects. We hypothesized that a superior joint implant placement may exist, indicated by muscle moment arms, compared with the current actual surgical implant configuration. Moment arms for the anterior, lateral, and posterior aspects of the deltoid muscle were determined for 1521 perturbations of the humeral offset location away from the surgical placement in a subject-specific musculoskeletal model with motion defined by subject-specific in vivo abduction kinematics. The humeral offset was varied from its surgical position ±4 mm in the anterior/posterior direction, ±12 mm in the medial/lateral direction, and -10 to 14 mm in the superior/inferior direction. The anterior deltoid moment arm varied in humeral offset and center of rotation up to 20 mm, primarily in the medial/lateral and superior/inferior directions. The lateral deltoid moment arm varied in humeral offset up to 20 mm, primarily in the medial/lateral and anterior/posterior directions. The posterior deltoid moment arm varied up to 15 mm, primarily in early abduction, and was most sensitive to humeral offset changes in the superior/inferior direction. High variations in muscle moment arms were found for all 3 deltoid components, presenting an opportunity to dramatically change the deltoid moment arms through surgical placement of the reverse shoulder components and by varying the overall offset of the humerus. Basic Science Study; Computer Modeling. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Association between neck and shoulder pain, back pain, low back pain and body composition parameters among the Japanese general population.

PubMed

Iizuka, Yoichi; Iizuka, Haku; Mieda, Tokue; Tajika, Tsuyoshi; Yamamoto, Atsushi; Ohsawa, Takashi; Sasaki, Tsuyoshi; Takagishi, Kenji

2015-11-04

Neck and shoulder pain, back pain and low back pain are common symptoms in Japanese subjects, and it is important to elucidate the pathology and associated factors of these pains due to their frequency and impact on the quality of life (QOL) and activities of daily living (ADL). The purpose of the present study was to investigate whether body composition is associated with these pains. We collected the data of 273 Japanese subjects regarding the presence and the visual analogue scale (VAS) of neck and shoulder pain, back pain, low back pain and body composition parameters calculated using bioelectrical impedance analysis (BIA) technology. Furthermore, we investigated the association between these pains and the body composition using statistical methods. According to a multivariate analysis adjusted for age and gender, lower total body water ratio was significantly associated with the presence of neck and shoulder pain at present (P < 0.05); additionally, total body muscle mass (standardized β = -0.26, 95 % CI, -0.17 - -0.008, P < 0.05), total body water (standardized β = -0.27, 95 % CI, -0.23 - -0.04, P < 0.01), appendicular muscle mass (standardized β = -0.29, 95 % CI, -0.36 - -0.04, P < 0.05), and the appendicular muscle mass index (AMI) (standardized β = -0.24, 95 % CI, -1.18 - -0.20, P <0.01) were negatively correlated with the VAS of neck and shoulder pain, whereas no body composition parameters were significantly associated with back pain, low back pain at present and any type of chronic pain. The present study demonstrated that some body composition parameters regarding body water and body muscle were associated or correlated with the presence or intensity of neck and shoulder pain.

Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections.

PubMed

King, Joseph J; Nystrom, Lukas M; Reimer, Nickolas B; Gibbs, C Parker; Scarborough, Mark T; Wright, Thomas W

2016-01-01

Proximal humerus reconstructions after resection of tumors are challenging. Early success of the reverse shoulder arthroplasty for reconstructions has recently been reported. The reverse allograft-prosthetic composite offers the advantage of improved glenohumeral stability compared with hemiarthroplasty for proximal humeral reconstructions as it uses the deltoid for stability. This article describes the technique for treating proximal humeral tumors, including preoperative planning, biopsy principles, resection pearls, soft tissue tensioning, and specifics about reconstruction using the reverse allograft-prosthetic composite. Two cases are presented along with the functional outcomes with use of this technique. Biomechanical considerations during reconstruction are reviewed, including techniques to improve the deltoid compression force. Reported instability rates are less with reverse shoulder arthroplasty reconstruction as opposed to hemiarthroplasty or total shoulder arthroplasty reconstructions of tumor resections. Reported functional outcomes are promising for the reverse allograft-prosthetic composite reconstructions, although complications are reported. Reverse allograft-prosthetic composites are a promising option for proximal humeral reconstructions, although nonunion of the allograft-host bone junction continues to be a challenge for this technique. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Condition Survey and Paver Implementation Davis-Monthan Air Force Base, Arizona

DTIC Science & Technology

1991-02-01

questiotns that the program asks, and then analysis results are produced based on those responses. The analysis reports can only be generated using the...09/01/89 PCI- 36 RATING- POOR CONDITION- RIDING- SAFETY - DRAINAGE- SHOULDERS- OVERALL- TOTAL NUMBER OF SAMPLES IN SECTION- 4 NUMBER OF SAMPLES...CONDITION- RIDING- SAFETY - DRAINAGE- SHOULDERS- OVERALL- TOTAL NUMBER OF SAMPLES IN SECTION- 17 NUMBER OF SAMPLES SURVEYED- 5 RECOMMENDED SAMPLES TO BE

Utility of polymer cerclage cables in revision shoulder arthroplasty.

PubMed

Edwards, T Bradley; Stuart, Kyle D; Trappey, George J; O'Connor, Daniel P; Sarin, Vineet K

2011-04-11

Revision shoulder arthroplasty often requires humeral osteotomy for stem extraction or is complicated by periprosthetic fracture. In these situations, various modes of fixation are used, including cerclage wires, cable plates, and allograft strut augmentation. The use of metal wires and cables, however, has been associated with soft tissue irritation, sharps injuries, and accelerated wear of joint arthroplasty bearing surfaces. As an alternative to traditional metal cables, the SuperCable (Kinamed Inc, Camarillo, California) contains braided ultra-high molecular-weight polyethylene fibers surrounding a nylon core. To date, no studies have examined the use of nonmetallic cerclage cables in shoulder arthroplasty.A retrospective review was performed of 11 patients who underwent shoulder arthroplasty for which nonmetallic cerclage cables were used. Clinical and radiographic data were examined regarding patient age, procedure performed, indication for cerclage cabling, time to healing of osteotomy or fracture, and any complications associated with the use of these cerclage cables. Minimum follow-up was 1 year. Ten patients underwent reverse total shoulder arthroplasty, and 1 patient underwent revision unconstrained total shoulder arthroplasty. Mean follow-up was 20.5 months. Ten patients required humeral osteotomy for stem or cement removal. Allograft augmentation was performed in 7 patients. Mean time to healing was 3.2 months. No patients experienced loosening or migration of hardware or allograft, and no complications directly related to the use of nonmetallic cerclage cables were identified. Copyright 2011, SLACK Incorporated.

Failure after reverse total shoulder arthroplasty: what is the success of component revision?

PubMed

Black, Eric M; Roberts, Susanne M; Siegel, Elana; Yannopoulos, Paul; Higgins, Laurence D; Warner, Jon J P

2015-12-01

Complication rates remain high after reverse total shoulder arthroplasty (RTSA). Salvage options after implant failure have not been well defined. This study examines the role of reimplantation and revision RTSA after failed RTSA, reporting outcomes and complications of this salvage technique. Sixteen patients underwent component revision and reimplantation after a prior failed RTSA from 2004 to 2011. Indications included baseplate failure (7 patients, 43.8%), instability (6 patients, 37.5%), infection (2 patients, 12.5%), and humeral loosening (1 patient, 6.3%). The average age of the patient during revision surgery was 68.6 years. Outcomes information at follow-up was recorded, including visual analog scale score for pain, subjective shoulder value, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test score, and these were compared with pre-revision values. Repeated surgeries and complications were noted. Average time to follow-up from revision was 58.9 months (minimum, 2 years; range, 24-103 months). The average postoperative visual analog scale score for pain was 1.7/10 (7.5/10 preoperatively; P < .0001), and the subjective shoulder value was 62% (17% preoperatively; P < .0001). The average postoperative American Shoulder and Elbow Surgeons score was 66.7, and the Simple Shoulder Test score was 52.6. Fourteen patients (88%) noted that they felt "better" postoperatively than before their original RTSA and would go through the procedure again if given the option. Nine patients suffered major complications (56%), and 6 of these ultimately underwent further procedures (38% of cohort). Salvage options after failure of RTSA remain limited. Component revision and reimplantation can effectively relieve pain and improve function compared with baseline values, and patient satisfaction levels are moderately high. However, complication rates and reoperation rates are significant. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Medical comorbidities and perioperative allogeneic red blood cell transfusion are risk factors for surgical site infection after shoulder arthroplasty.

PubMed

Everhart, Joshua S; Bishop, Julie Y; Barlow, Jonathan D

2017-11-01

Multiple perioperative factors have been implicated in infection risk after shoulder arthroplasty. The purpose of this study was to determine surgical site infection (SSI) risk due to medical comorbidities or blood transfusion after primary or revision shoulder arthroplasty. Comprehensive data on medical comorbidities, surgical indication, perioperative transfusion, and SSI were obtained for 707 patients who underwent primary or revision hemiarthroplasty or total shoulder arthroplasty in a single hospital system. Multivariate Poisson regression was used to determine the independent association between allogeneic red blood cell transfusion, medical comorbidities, and SSI after controlling for procedure. The SSI rate was 1.9% for primary hemiarthroplasties and 1.3% for primary total shoulder arthroplasties. Among patients without prior shoulder infection, revision arthroplasty or prior open reduction and internal fixation had higher SSI risk than primary arthroplasties (incidence risk ratio [IRR], 11.4; 95% confidence interval [CI], 3.84-34.0; P < .001); among primary arthroplasties, SSI risk factors included male gender (IRR, 60.0; CI, 4.39-819; P = .002), rheumatoid arthritis (IRR, 8.63; CI, 1.84-40.4; P = .006), and long-term corticosteroid use (IRR, 37.4; CI, 5.79-242; P < .001). Perioperative allogeneic red blood cell transfusion significantly increased SSI risk and was dose dependent (IRR, 1.68 per unit packed red blood cell; CI, 1.21-2.35; P = .002). Gender, rheumatoid arthritis, and long-term (>1 year) corticosteroid use affect SSI risk after shoulder arthroplasty. Revision surgery, particularly in the setting of prior infection, increased risk of future infection. Finally, allogeneic red blood cell transfusion increases SSI risk after shoulder arthroplasty in a dose-dependent manner. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Periprosthetic shoulder infection in the United States: incidence and economic burden.

PubMed

Padegimas, Eric M; Maltenfort, Mitchell; Ramsey, Matthew L; Williams, Gerald R; Parvizi, Javad; Namdari, Surena

2015-05-01

Periprosthetic joint infection (PJI) is a major cause of morbidity after shoulder arthroplasty. PJI epidemiology has not been well studied. We aimed to analyze the historical incidence, predisposing factors, and economic burden of PJI after shoulder arthroplasty in the United States. Primary shoulder arthroplasty patients were identified by the International Classification of Diseases, Ninth Revision, Clinical Modification codes 81.80 (total shoulder arthroplasty), 81.81 (hemiarthroplasty), and 81.88 (reverse arthroplasty) in the Nationwide Inpatient Sample from 2002 to 2011. PJI was identified by codes 80.01 (arthrotomy for device removal) and 996.66 (prosthetic infection). Multivariate logistic regression analysis was used to identify predisposing factors for PJI. PJI rate was 0.98% from 2002 to 2011 and did not vary significantly. Comorbidities associated with PJI were weight loss/nutritional deficiency (odds ratio [OR], 2.62; 95% confidence interval [CI], 1.53-4.51; P = .00047), drug abuse (OR, 2.38; 95% CI, 1.41-4.02; P = .0011), and anemia from blood loss (OR, 2.43; 95% CI, 1.50-3.93; P = .00031) or iron deficiency (OR, 2.05; 95% CI, 1.69-2.49; P < .0001). Demographic factors associated with PJI were younger age (OR, 1.020; 95% CI, 1.017-1.024; P < .0001) and male gender (OR, 1.961; 95% CI, 1.816-2.117; P < .0001). In 2011, median hospitalization costs for PJI were $17,163.57 compared with $16,132.68, $13,955.83, and $20,007.87 for total shoulder arthroplasty, hemiarthroplasty, and reverse arthroplasty, respectively. Increasing incidence of shoulder arthroplasty and a constant infection rate will result in greater overall PJI burden. Whereas hospitalization costs for PJI are comparable to those of primary arthroplasty, they are incurred after the original cost of shoulder arthroplasty. Certain identifiable patient variables correlate with higher PJI rates. Risk factor modification may decrease PJI incidence and help contain costs. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Physical examination findings in young athletes correlate with history of shoulder instability.

PubMed

Owens, Brett D; Duffey, Michele L; Deberardino, Thomas M; Cameron, Kenneth L

2011-06-01

The goal of this study was to evaluate physical examination findings in a healthy cohort and determine potential correlations with a history of shoulder instability. A cross-sectional analysis was performed using the baseline data for an ongoing prospective cohort study to examine the risk factors for shoulder instability. A complete history of shoulder instability events was obtained, and a blinded physical examination was performed. The cohort comprised 711 patients (627 men, 84 women) with a mean age of 18.8 years. A total of 100 patients had a history of shoulder instability. Patients with a history of instability were more likely to have increased posterior translation (P=.010), positive apprehension sign (P=.003), positive relocation sign (P=.007), and sulcus sign (P=.017). Copyright 2011, SLACK Incorporated.

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.

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.

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.

Handheld magnetic sensor for measurement of tension

NASA Astrophysics Data System (ADS)

Singal, K.; Rajamani, R.

2012-04-01

This letter develops an analytical formulation for measurement of tension in a string using a handheld sensor. By gently pushing the sensor against the string, the tension in the string can be obtained. An experimental sensor prototype is constructed to verify the analytical formulation. The centimeter-sized prototype utilizes three moving pistons and magnetic field based measurements of their positions. Experimental data show that the sensor can accurately measure tension on a bench top rig. The developed sensor could be useful in a variety of orthopedic surgical procedures, including knee replacement, hip replacement, ligament repair, shoulder stabilization, and tendon repair.

Medical service use and usual care of common shoulder disorders in Korea: a cross-sectional study using the Health Insurance Review and Assessment Service National Patient Sample

PubMed Central

Joo, Hwansoo; Lee, Yoon Jae; Shin, Joon-Shik; Lee, Jinho; Kim, Me-riong; Koh, Wonil; Park, Yeoncheol; Song, Yun Kyung; Cho, Jae-Heung

2017-01-01

Objectives This study examined National Health Insurance claims data to investigate the epidemiology of shoulder disorders in Korea. Detailed information on medical services and related costs was assessed by major shoulder disorder category. Design and setting The 2014 National Patient Sample dataset provided by the Health Insurance Review and Assessment Service was analysed. Among shoulder-related diagnosis codes, adhesive capsulitis of the shoulder (ACS), rotator cuff syndrome (RCS) and shoulder impingement syndrome (SIS) categories were of highest prevalence. Sociodemographic characteristics and medical service use, frequency and medical costs regarding common shoulder disorders were evaluated. Results The majority of patients with shoulder disorder received ambulatory care (97%). Total and per-patient expenses were highest in patients with RCS. The number of inpatients with RCS was more than twice that of the other two groups, and patients with RCS were more likely to receive surgical management compared with patients with ACS and SIS. Prevalence of shoulder disorders was highest among subjects in their 50s for all three groups. Primary care physicians treated 75.80% of patients with ACS, 56.99% of patients with RCS and 48.06% of patients with SIS, respectively, outlining the difference in medical institution usage patterns. In all three groups, the highest proportion of patients visited orthopaedic surgeons out of medical departments. In the ACS and SIS groups, cost of visits (consultations) took up the largest part of total expenses at 32.30% and 18.88%, respectively, while cost of procedure/surgery constituted the largest portion in patients with RCS (37.77%). The usage proportion of subcutaneous or intramuscular and intra-articular injections ranged between 20% and 30% for outpatients in all three groups. Conclusions Medical service use, frequency and cost distributions relating to major shoulder disorders in Korea were assessed using nationwide claims data. These findings are expected to aid policy-makers as well as researchers and practitioners as basic healthcare data. PMID:28706100

The impact of solid organ transplant history on inpatient complications, mortality, length of stay, and cost for primary total shoulder arthroplasty admissions in the United States.

PubMed

Malcolm, Tennison L; Chatha, Kiran; Breceda, Adam P; Guo, Eric; Friedman, Darren J; Sabesan, Vani J; Barsoum, Wael K

2018-05-04

There is a growing population of patients with history of solid organ transplant (SOT) surgery among total joint patients. Patients with history of SOT have been found to have longer lengths of stay and higher inpatient hospital costs and complications rates after hip and knee arthroplasty. The purpose of this study was to determine whether this is true for shoulder arthroplasty in SOT patients. The Nationwide Inpatient Sample was queried to describe relative demographic, hospital, and clinical characteristics, perioperative complications, length of stay, and total costs for patients with a history of SOT (International Classification of Diseases-9th Edition-Clinical Modificiation V42.0, V42.1, V42.7, V42.83) undergoing shoulder arthroplasty (81.80, 81.88) from 2004 to 2014. A weighted total of 843 patients (unweighted frequency = 171) and 382,773 patients (unweighted frequency = 77,534) with and without history of SOT, respectively, underwent shoulder arthroplasty. SOT patients were more often younger and more likely to be male, have Medicare, and undergo surgery in a large teaching institution in the Midwest or Northeast (P < .001). SOT patients had higher or similar comorbid disease prevalence for 27 of 29 Elixhauser comorbidities. The risk of any complication was significantly higher among SOT patients (15.5% vs. 9.3%, P = .007). SOT patients experienced inpatient admissions an average 0.27 days longer (P < .001) and $1103 more costly (P = .06) than non-SOT patients. Patients with history of SOT undergoing shoulder arthroplasty appear to remain a unique population due to their specific vulnerability to minor complications and inherently increased inpatient resource utilization. Copyright © 2018. Published by Elsevier Inc.

Effects of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: Finite element modeling of cadaver specimens.

PubMed

Lewis, Gregory S; Conaway, William K; Wee, Hwabok; Kim, H Mike

2017-02-28

A novel technique of "anterior offsetting" of the humeral head component to address posterior instability in total shoulder arthroplasty has been proposed, and its biomechanical benefits have been previously demonstrated experimentally. The present study sought to characterize the changes in joint mechanics associated with anterior offsetting with various amounts of glenoid retroversion using cadaver specimen-specific 3-dimensional finite element models. Specimen-specific computational finite element models were developed through importing digitized locations of six musculotendinous units of the rotator cuff and deltoid muscles based off three cadaveric shoulder specimens implanted with total shoulder arthroplasty in either anatomic or anterior humeral head offset. Additional glenoid retroversion angles (0°, 10°, 20°, and 30°) other than each specimen׳s actual retroversion were modeled. Contact area, contact force, peak pressure, center of pressure, and humeral head displacement were calculated at each offset and retroversion for statistical analysis. Anterior offsetting was associated with significant anterior shift of center of pressure and humeral head displacement upon muscle loading (p<0.05). Although statistically insignificant, anterior offsetting was associated with increased contact area and decreased peak pressure (p > 0.05). All study variables showed significant differences when compared between the 4 different glenoid retroversion angles (p < 0.05) except for total force (p < 0.05). The study finding suggests that the anterior offsetting technique may contribute to joint stability in posteriorly unstable shoulder arthroplasty and may reduce eccentric loading on glenoid components although the long term clinical results are yet to be investigated in future. Copyright © 2017 Elsevier Ltd. All rights reserved.

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.

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.

Mechanical load on the low back and shoulders during pushing and pulling of two-wheeled waste containers compared with lifting and carrying of bags and bins.

PubMed

Schibye, B; Søgaard, K; Martinsen, D; Klausen, K

2001-08-01

Compare the mechanical load on the low back and shoulders during pushing and pulling a two-wheeled container with the load during lifting and carrying the same amount of waste. Only little is known about risk factors and mechanical loads during push/pull operations. A complete 2(3) factor push/pull experiment. A two-wheeled container with 25 or 50 kg was pushed in front of and pulled behind the body by seven waste collectors. Further, the same subjects lifted and carried a paper bag and a dustbin both loaded with 7 and 25 kg. All operations were video recorded and the push/pull force was measured by means of a three-dimensional force transducer. Peak Motus and Watbak software were used for digitising and calculation of torque at L4/L5 and the shoulder joints and compression and shear forces at L4/L5. During pushing and pulling the compression at L4/L5 is from 605 to 1445 N. The extension torque at L4/L5 produced by the push/pull force is counteracted by the forward leaning of the upper body. The shear force is below 202 N in all situations. The torque at the shoulders is between 1 and 38 Nm. In the present experiments the torques at the low back and the shoulders are low during pushing and pulling. No relation exists between the size of the external force and the torque at the low back and the shoulder. Pushing and pulling are common in many workplaces and have often replaced lifting and carrying situations. This has emphasised the need for more knowledge of the internal mechanical load on the body during these activities.

Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears.

PubMed

El-Azab, Hossam Mahmoud; Rott, Olaf; Irlenbusch, Ulrich

2015-03-18

Irreparable posterosuperior rotator cuff tears are treated in several ways. Transfer of the latissimus dorsi is an alternative with acceptable mid-term results, but long-term results have rarely been published. The cases of 108 consecutive patients with 115 shoulders treated with latissimus dorsi transfer between 2000 and 2005 were reviewed clinically and radiographically. Ninety-three shoulders in eighty-six patients were included in the follow-up analysis. The mean duration of follow-up was 9.3 years (range, 6.6 to 11.7 years), and the mean age at the operation was fifty-six years (range, forty to seventy-two years). Outcome measures included the Constant-Murley score (Constant score), American Shoulder and Elbow Surgeons (ASES) index, and visual analog scale (VAS) for pain. The progress of cuff tear arthropathy was determined with radiographic evaluation according to the system described by Hamada et al. The mean relative Constant score improved from 44% preoperatively to 71% at the time of follow-up (p < 0.0001, effect size = 0.6), excluding the clinical failures. Similarly, the mean ASES index improved from 30 to 70 (p < 0.0001, effect size = 0.7), and the mean VAS score decreased from 7.8 to 2.4 (p < 0.0001, effect size = 0.8). A pain-free outcome was reported in only eighteen shoulders (19%). Active shoulder movement improved significantly (p < 0.05). The mean Hamada radiographic grade of cuff tear arthropathy increased from 1.7 (range, 0 to 2) preoperatively to 2.2 (range, 1 to 5) (p < 0.0001, effect size = 0.2). The rate of clinical failure of latissimus dorsi transfer was 10%, and the rate of shoulder prosthetic replacement after latissimus dorsi transfer was 4%. Pain relief and improvement of shoulder function were maintained a mean of 9.3 years after latissimus dorsi transfer for irreparable posterosuperior cuff defects. The younger the patient, the better the outcome. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

BEHAVIOR AND PREY OF NESTING RED-SHOULDERED HAWKS IN SOUTHWESTERN OHIO

EPA Science Inventory

We used direct observations to quantify prey types, prey delivery rate, and adult and nestling behavior at nests of Red-shouldered Hawks (Buteo lineatus) in suburban southwestern Ohio. Twenty-one nests were observed for a total of 256 hr in 1997-2001. Small mammals made up the ...

Comparison of ultrasonographic findings of the rotator cuff between diabetic and nondiabetic patients with chronic shoulder pain: a retrospective study.

PubMed

Kang, Jiunn-Horng; Tseng, Sung-Hui; Jaw, Fu-Shan; Lai, Chien-Hung; Chen, Hung-Chou; Chen, Shih-Ching

2010-11-01

It is still unclear whether diabetic mellitus (DM) is associated with rotator cuff lesions. The object of this retrospective study was to compare the ultrasonographic (US) findings of rotator cuffs in diabetic patients with those of nondiabetic patients with chronic shoulder pain. In total, 419 patients (80 diabetic, 339 nondiabetic) who had chronic shoulder pain and had been referred to receive US examination between January 2005 and January 2008 in a medical center were included in this study. The US findings of rotator cuff lesions were classified into two main categories: rotator cuff tears (RCTs) and calcifying tendinopathy (CT). In total, 114 (25.2%) shoulders with CT of the rotator cuff and 160 (35.3%), 15 (3.3%) and 5 (1.1%) shoulders with supraspinatus, infraspinatus and subscapularis tears, respectively, were noted. No difference in the ratio of tears of RCTs was found on US examinations between two groups. The crude odds ratio (OR) for CT of diabetic patients was 1.85 (p = 0.014); however, the adjusted OR for CT in diabetic patients became insignificant after controlling for the other variables (OR = 1.59, p = 0.08). To our knowledge, this is the first study to explore US findings among diabetic and nondiabetic patients with chronic shoulder pain. Further study is advised to confirm our findings. Copyright © 2010 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

Speed of recovery after shoulder arthroplasty: a comparison of reverse and anatomic total shoulder arthroplasty.

PubMed

Levy, Jonathan C; Everding, Nathan G; Gil, Carlos C; Stephens, Scott; Giveans, M Russell

2014-12-01

Whereas patient expectations after anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA) relate to sustained improvements in pain, function, and motion, the time necessary to reach these goals is unclear. Our purpose was to investigate the speed of recovery and to compare the effectiveness of primary TSA and RSA. We analyzed (preoperative, 3 month, 6 month, 1-year, and 2-year scores) pain scores, functional scores, and motion for 122 patients treated with primary RSA and 166 patients treated with primary TSA with a minimum of 1 year of follow-up. Comparisons were made to determine the effectiveness of treatment, time required to reach a plateau in improvement, and percentage of overall improvement at 3 and 6 months. Significant improvements were observed for both TSA and RSA at all intervals (P < .001), except with internal rotation for RSA. Pain relief was rapid after both TSA and RSA. TSA patients reached a consistent plateau for pain and function by 6 months and for shoulder elevation by 1 year. RSA patients demonstrated variability with multiple false plateau points. By 6 months, TSA patients had achieved 90% to 100% of functional improvement, whereas RSA patients reached 72% to 91%. The effectiveness of TSA was greater than that of RSA for all measures with the exception of elevation and abduction. Whereas patients treated with primary TSA and RSA can expect rapid improvements in pain, those treated with TSA can anticipate a more consistent and effective recovery of pain, function, and shoulder rotation. Patients receiving RSA can expect a variable length of recovery with greater improvements in forward elevation and abduction. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Scapular resting position, shoulder pain and function in disabled athletes.

PubMed

Aytar, Aydan; Zeybek, Aslican; Pekyavas, Nihan Ozunlu; Tigli, Ayca Aytar; Ergun, Nevin

2015-10-01

Despite the fact that the number of disabled individuals participating in sports is increasing, there are only sparse reports in the literature concerning overuse injuries. The purpose of this study was to compare scapular resting position, shoulder pain, and function in wheelchair basketball, amputee soccer, and disabled table tennis players. Descriptive study. A total of 63 disabled players from amputee soccer, wheelchair basketball, and disabled table tennis participated in our study. Scapular resting position was taken as primary outcome; pain and function were taken as secondary outcome measurements. Scapular resting position was evaluated with Lateral Scapular Slide Test. Visual Analog Scale was used for evaluating shoulder pain intensity. Quick disabilities of the arm, shoulder, and hand questionnaire were used to assess upper extremity function. There was a significant difference in shoulder pain, function, and scapular resting position in all groups (p < 0.05). Paired comparisons between amputee soccer and wheelchair basketball players and also amputee soccer and disabled table tennis showed difference for all measurement parameters (p < 0.05). When the results are evaluated, it may be stated that amputee soccer players have better scapular resting position than other sports. Crutch usage may not negatively affect scapular resting position and perceived function as much as wheelchair usage. Exercise techniques for shoulder and resting position could be included in training programs of disabled athletes. Wheelchair/crutch usage is a risk, and special exercise techniques for shoulder and dyskinesis could be included in training programs to prevent injury. However, it may not just be important for wheelchair athletes, it may also be important for amputee soccer players. In particular, total upper extremity evaluations and exercises could be added within exercise programs. © The International Society for Prosthetics and Orthotics 2014.

Effect of deltoid tension and humeral version in reverse total shoulder arthroplasty: a biomechanical study.

PubMed

Henninger, Heath B; Barg, Alexej; Anderson, Andrew E; Bachus, Kent N; Tashjian, Robert Z; Burks, Robert T

2012-04-01

No clear recommendations exist regarding optimal humeral component version and deltoid tension in reverse total shoulder arthroplasty (TSA). A biomechanical shoulder simulator tested humeral versions (0°, 10°, 20° retroversion) and implant thicknesses (-3, 0, +3 mm from baseline) after reverse TSA in human cadavers. Abduction and external rotation ranges of motion as well as abduction and dislocation forces were quantified for native arms and arms implanted with 9 combinations of humeral version and implant thickness. Resting abduction angles increased significantly (up to 30°) after reverse TSA compared with native shoulders. With constant posterior cuff loads, native arms externally rotated 20°, whereas no external rotation occurred in implanted arms (20° net internal rotation). Humeral version did not affect rotational range of motion but did alter resting abduction. Abduction forces decreased 30% vs native shoulders but did not change when version or implant thickness was altered. Humeral center of rotation was shifted 17 mm medially and 12 mm inferiorly after implantation. The force required for lateral dislocation was 60% less than anterior and was not affected by implant thickness or version. Reverse TSA reduced abduction forces compared with native shoulders and resulted in limited external rotation and abduction ranges of motion. Because abduction force was reduced for all implants, the choice of humeral version and implant thickness should focus on range of motion. Lateral dislocation forces were less than anterior forces; thus, levering and inferior/posterior impingement may be a more probable basis for dislocation (laterally) than anteriorly directed forces. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Revision of failed shoulder hemiarthroplasty to reverse total arthroplasty: analysis of 157 revision implants.

PubMed

Merolla, Giovanni; Wagner, Eric; Sperling, John W; Paladini, Paolo; Fabbri, Elisabetta; Porcellini, Giuseppe

2018-01-01

There remains a paucity of studies examining the conversion of failed hemiarthroplasty (HA) to reverse total shoulder arthroplasty (RTSA). Therefore, the purpose of this study was to examine a large series of revision HA to RTSA. A population of 157 patients who underwent conversion of a failed HA to a revision RTSA from 2006 through 2014 were included. The mean follow-up was 49 months (range, 24-121 months). The indications for revision surgery included instability with rotator cuff insufficiency (n = 127) and glenoid wear (n = 30); instability and glenoid wear were associated in 38 cases. Eight patients with infection underwent 2-stage reimplantation. Patients experienced significant improvements in their preoperative to postoperative pain and shoulder range of motion (P < .0001), with median American Shoulder and Elbow Surgeons and Simple Shoulder Test scores of 60 and 6 points, respectively. There were 11 (7%) repeated revision surgeries, secondary to glenoid component loosening (n = 3), instability (n = 3), humeral component disassembly (n = 2), humeral stem loosening (n = 1), and infection (n = 2). Implant survivorship was 95.5% at 2 years and 93.3% at 5 years. There were 4 reoperations including axillary nerve neurolysis (n = 2), heterotopic ossification removal (n = 1), and hardware removal for rupture of the metal cerclage for an acromial fracture (n = 1). At final follow-up, there were 5 "at-risk" glenoid components. Patients experience satisfactory pain relief and recovery of reasonable shoulder function after revision RTSA from a failed HA. There was a relatively low revision rate, with glenoid loosening and instability being the most common causes. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Worldsid Assessment of Far Side Impact Countermeasures

PubMed Central

Pintar, Frank A.; Yoganandan, Narayan; Stemper, Brian D.; Bostrom, Ola; Rouhana, Stephen W.; Smith, Stuart; Sparke, Laurie; Fildes, Brian N.; Digges, Kennerly H.

2006-01-01

Far side impact trauma has been demonstrated as a significant portion of the total trauma in side impacts. The objective of the study was to assess the potential usefulness of countermeasures and assess the trade-offs associated with generic countermeasure design. Because the WorldSID dummy has demonstrated promise as a potential far side impact dummy, it was chosen to assess countermeasures in this mode. A unique far side impact buck was designed for a sled test system that included, as a standard configuration, a center console and outboard three-point belt system. This configuration assumed a left side driver with a right side impact. The buck allowed for additional options of generic restraints including shoulder or thorax plates or an inboard shoulder belt. The entire buck could be mounted on the sled in either a 90-degree (3-o’clock PDOF) or a 60-degree (2-o’clock PDOF) orientation. A total of 19 WorldSID tests were completed. The inboard shoulder belt configuration produced high shear forces in the lower neck (2430 N) when the belt position was placed over the mid portion of the neck. Shear forces were reduced and of opposite sign when the inboard belt position was horizontal and over the shoulder; forces were similar to the standard outboard belt configuration (830 – 1100 N). A shoulder or thorax restraint was effective in limiting the head excursion, but each caused significant displacement at the corresponding region on the dummy. A shoulder restraint resulted in shoulder displacements of 30 – 43 mm. A thorax restraint caused thorax deflections of 39 – 64 mm. Inboard restraints for far side impacts can be effective in reducing head excursion but the specific design and placement of these restraints determine their overall injury mitigating characteristics. PMID:16968638

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.

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.

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.

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.

Risk factors for overuse shoulder injuries in a mixed-sex cohort of 329 elite handball players: previous findings could not be confirmed.

PubMed

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

2017-08-07

Shoulder injuries are common among handball players and predominantly characterised by overuse characteristics. Reduced total glenohumeral rotation, external rotation weakness and scapular dyskinesis have been identified as risk factors among elite male handball players. To assess whether previously identified risk factors are associated with overuse shoulder injuries in a large cohort of elite male and female handball players. 329 players (168 male, 161 female) from the two upper divisions in Norway were included and tested prior to the 2014-2015 season. Measures included glenohumeral internal and external rotation range of motion, isometric internal and external rotation strength, and assessment of scapular dyskinesis. Players were followed prospectively for one competitive season, with prevalence and severity of shoulder problems registered monthly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A severity score based on players' questionnaire responses was used as the outcome measure in multivariable logistic regression to investigate associations between candidate risk factors and overuse shoulder injury. No significant associations were found between total rotation (OR 1.05 per 5° change, 95% CI 0.98 to 1.13), external rotation strength (OR 1.05 per 10 N change, 95% CI 0.92 to 1.20) or obvious scapular dyskinesis (OR 1.23, 95% CI 0.25 to 5.99) and overuse shoulder injury. A significant positive association was found between greater internal rotation (OR 1.16 per 5° change, 95% CI 1.00 to 1.34) and overuse shoulder injury. None of the previously identified risk factors were associated with overuse shoulder injuries in a mixed-sex cohort of elite handball players. © 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.

Revision shoulder arthroplasty from resurfacing to non-cemented short-stem reverse prosthesis.

PubMed

Natera, L; Bruguera, J; Atoun, E; Levy, O

2016-01-01

To assess the surgical parameters and the clinical and radiological outcomes of revisions of resurfacing shoulder arthroplasty to non-cemented short-stem reverse total shoulder arthroplasty. A total of 23 revisions from resurfacing shoulder arthroplasty to reverse total shoulder arthroplasty were performed. The mean age was 70.3±11.95 years. The patients included 82.6% (19/23) revised for cuff failure; 13.04% (3/23) cuff failure and aseptic loosening, and 4.35% (1/23) peri-prosthetic fracture. The need for humeral osteotomy or structural allograft, operation length, blood loss, blood transfusions and intraoperative fractures were recorded. Minimum follow-up 25 months. No humeral osteotomy or humeral structural allograft was required, and 2/23 (8.69%) required allograft for glenoid reconstruction. The mean operation time was 113.35±21.30minutes. Intra-operative blood loss was 374±245.09 mls. Blood transfusion was required in one case. Intra-operative fracture occurred in 1 case. The Constant score improved from 17.32 to 59.78 (age/sex adjusted, 84). Overall satisfaction improved from 1.37 to 8.04. The range of motion increased 79.57° in forward elevation; 72.88° in abduction; 38.06° in internal rotation; and 13.57° in external rotation. There was no evidence of radiolucency, subsidence, or bone resorption. Revisions of resurfacing implants to non-cemented short-stem reverse prosthesis show good clinical and radiological outcomes, with minimal intra-operative complexities. IV, case series. Copyright © 2016 SECOT. Published by Elsevier Espana. 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.

Arthroscopic procedures for the treatment of anterior shoulder instability: local experiences.

PubMed

Choi, S T; Tse, P Y T

2005-04-01

To review the outcomes of arthroscopic stabilisation procedures for the treatment of recurrent anterior shoulder dislocation. Retrospective study. Regional hospital, Hong Kong. Patients receiving arthroscopic stabilisation procedures for recurrent anterior shoulder dislocation between 1999 and 2003. Functional outcomes including pain, range of motion, and activity level were assessed using the Constant score. Intra-operative findings were also discussed. A total of 18 arthroscopic stabilisation procedures were performed for the treatment of recurrent shoulder instability. Two cases converted to open procedures were excluded from this review. The overall outcomes were good and seven patients reported a full recovery. Fourteen out of 16 patients reported minimal or no pain, and the mean Constant score was 80. There were no cases of re-dislocation and no major complication was noted. All the reviewed patients had a satisfactory functional recovery. Therefore, we believe that the use of arthroscopic stabilisation procedure can produce a favourable outcome for appropriate shoulder pathologies.

Understanding the Importance of the Teres Minor for Shoulder Function: Functional Anatomy and Pathology.

PubMed

Williams, Matthew D; Edwards, Thomas Bradley; Walch, Gilles

2018-03-01

Although the teres minor is often overlooked in a normal shoulder, it becomes a key component in maintaining shoulder function when other rotator cuff tendons fail. The teres minor maintains a balanced glenohumeral joint and changes from an insignificant to the most significant external rotator in the presence of major rotator cuff pathology. The presence or absence of the teres minor provides prognostic information on the outcomes of reverse total shoulder arthroplasty and tendon transfers. Clinical tests include the Patte test, the Neer dropping sign, the external rotation lag sign, and the Hertel drop sign. Advanced imaging of the teres minor can be used for classification using the Walch system. Understanding the function and pathology surrounding the teres minor is paramount in comprehensive management of the patient with shoulder pathology. Appropriate clinical examination and imaging of the teres minor are important for preoperative stratification and postoperative expectations.

SHOULDER ARTHROPLASTY RECORDS

PubMed Central

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

2015-01-01

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

Treatment Strategy for Irreparable Rotator Cuff Tears

PubMed Central

Oh, Joo Han; Rhee, Sung Min

2018-01-01

Recently, patients with shoulder pain have increased rapidly. Of all shoulder disorders, rotator cuff tears (RCTs) are most prevalent in the middle-aged and older adults, which is the primary reason for shoulder surgery in the population. Some authors have reported that up to 30% of total RCTs can be classified as irreparable due to the massive tear size and severe muscle atrophy. In this review article, we provide an overview of treatment methods for irreparable massive RCTs and discuss proper surgical strategies for RCTs that require operative management. PMID:29854334

Glenohumeral internal rotation deficit in throwing athletes: current perspectives

PubMed Central

Rose, Michael B; Noonan, Thomas

2018-01-01

Glenohumeral internal rotation deficit (GIRD) is an adaptive process in which the throwing shoulder experiences a loss of internal rotation (IR). GIRD has most commonly been defined by a loss of >20° of IR compared to the contralateral shoulder. Total rotational motion of the shoulder is the sum of internal and external rotation and may be more important than the absolute value of IR loss. Pathologic GIRD has been defined as a loss of IR combined with a loss of total rotational motion. The leading pathologic process in GIRD is posterior capsular and rotator-cuff tightness, due to the repetitive cocking that occurs with the overhead throwing motion. GIRD has been associated with numerous pathologic conditions, including posterior superior labral tears, partial articular-sided rotator-cuff tears, and superior labral anterior-to-posterior tears. The mainstay of treatment for patients with GIRD is posterior capsular stretching and strengthening to improve scapular mechanics. In patients who fail nonoperative therapy, shoulder arthroscopy can be performed. Arthroscopic surgery in the high-level throwing athlete should be to restore them to their functional baseline with the minimum amount of intervention possible. PMID:29593438

Comparison of range of motion and function of subjects with reverse anatomy Bayley-Walker shoulder replacement with those of normal subjects.

PubMed

Masjedi, Milad; Lovell, Cara; Johnson, Garth R

2011-12-01

Patients with rotator cuff tear and degenerative shoulder joint disease commonly experience severe pain and reduced performance during activities of daily living. A popular way to treat these patients is by means of reverse anatomy shoulder prosthesis. Studying the kinematics of subjects with reverse anatomy implant would be useful in order to gain knowledge about functionality of different designs. It is hypothesized that the kinematics of these subjects, in the absence of rotator cuff muscles, differs from that of normal subjects. In this study the upper limb kinematics of 12 subjects with a Bayley-Walker reverse anatomy shoulder prosthesis while performing tasks common in everyday activities and those that represent the range of motion was analyzed and compared to that of 12 normal subjects. Each patient also completed an Oxford Shoulder Score. Substantial reduction in the Bayley-Walker subjects' ranges of motion was observed compared to normal subjects. The mean abduction angle decreased from 109° (±20) for normal subjects to 64° (±25). A similar trend was observed during flexion and axial rotation tasks. Furthermore, the normal group showed less variable ranges of motion performing the standard tasks, whereas for the prosthetic group this varied greatly, which is likely to be dependent on muscle strength. Although the decreased range of motion was prominent, subjects were able to complete most of the tasks by compensating with their elbow and trunk. The most challenging task for Bayley-Walker subjects was lifting an object to head height. Copyright © 2010 Elsevier B.V. All rights reserved.

Tool for Two Types of Friction Stir Welding

NASA Technical Reports Server (NTRS)

Carter, Robert

2006-01-01

A tool that would be useable in both conventional and self-reacting friction stir welding (FSW) has been proposed. The tool would embody both a prior tooling concept for self-reacting FSW and an auto-adjustable pin-tool (APT) capability developed previously as an augmentation for conventional FSW. Some definitions of terms are prerequisite to a meaningful description of the proposed tool. In conventional FSW, depicted in Figure 1, one uses a tool that includes (1) a rotating shoulder on top (or front) of the workpiece and (2) a rotating pin that protrudes from the shoulder into the depth of the workpiece. The main axial force exerted by the tool on the workpiece is reacted through a ridged backing anvil under (behind) the workpiece. When conventional FSW is augmented with an APT capability, the depth of penetration of the pin into the workpiece is varied in real time by a position- or force-control 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 (SR-FSW), there are two rotating 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. The main axial force exerted on the workpiece by the tool and front shoulder is reacted through the back shoulder and the threaded shaft, back into the FSW 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. A tool for SRFSW embodying this concept was reported in "Mechanism for Self-Reacted Friction Stir Welding" (MFS-31914), NASA Tech Briefs, Vol. 28, No. 10 (October 2004), page 53. In its outward appearance, the proposed tool (see Figure 2) would fit the above description of an SR-FSW tool. In this case, the FSW machine would have an APT capability and the pin would be modified to accept a bottom shoulder. The APT capability could be used to vary the distance between the front and back shoulders in real time to accommodate process and workpiece-thickness variations. The tool could readily be converted to a conventional FSW tool, with or without APT capability, by simply replacing the modified pin with a conventional FSW pin.

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.

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.

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.

Indications for reverse total shoulder arthroplasty in rotator cuff disease.

PubMed

Drake, Gregory N; O'Connor, Daniel P; Edwards, T Bradley

2010-06-01

Reverse total shoulder arthroplasty (RTSA) was introduced to treat rotator cuff tear arthropathy but is now used to treat a variety of problems. Although its use has expanded substantially since the FDA's approval in 2004, the appropriateness in patients with rotator cuff disease is unclear. We review the use of RTSA in patients with rotator cuff disease to (1) describe classification of rotator cuff tear reparability and the concept of a balanced shoulder; (2) explore the theory behind RTSA design relative to rotator cuff arthropathy; (3) discuss the indications and contraindications for RTSA; and (4) review published outcomes of RTSA for rotator cuff arthropathy. We performed a selective review of the literature on the use of RTSA in the treatment of rotator cuff disease. Modern RTSA designs restore deltoid tension and a functional fulcrum to the rotator cuff deficient shoulder, which allows recovery of active shoulder elevation and effectively restores function in short- and medium-term followup studies. In short-term followup the RTSA relieves symptoms and restores function for patients with cuff tear arthropathy and irreparable rotator cuff tears with pseudoparalysis (preserved deltoid contraction but loss of active elevation). Severely impaired deltoid function, an isolated supraspinatus tear, and the presence of full active shoulder elevation with a massive rotator cuff tear and arthritis are contraindications to RTSA. For properly selected patients who have symptomatic and disabling rotator cuff deficiency, RTSA can result in life-changing improvements in pain, motion, function, and patient satisfaction. Level V therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

The effect of electrical stimulation in combination with Bobath techniques in the prevention of shoulder subluxation in acute stroke patients.

PubMed

Fil, Ayla; Armutlu, Kadriye; Atay, Ahmet Ozgur; Kerimoglu, Ulku; Elibol, Bulent

2011-01-01

To examine the efficiency of electrical stimulation in combination with Bobath techniques in the prevention of inferior and anterior shoulder subluxation in acute stroke patients. A prospective randomized controlled trial. Intensive care unit and inpatient clinics of neurology in a university hospital. Forty-eight patients with acute stroke, divided equally into control and study groups. Subjects in both groups were treated in accordance with the Bobath concept during the early hospitalization period. In addition to Bobath techniques, electrical stimulation was also applied to the supraspinatus muscle, mid and posterior portions of the deltoid muscle of patients in the study group. Two radiological methods were used to measure the horizontal, vertical and total asymmetry and vertical distance values of the shoulder joint. Motor functions of the arm were evaluated with the Motor Assessment Scale. The hospitalization period was 12.62 ± 2.24 days for the control group and 11.66 ± 1.88 days for the study group. Shoulder subluxation occurred in 9 (37.5%) subjects in the control group, whereas it was not observed in the study group. All shoulder joint displacement values were higher in the control group than in the study group (horizontal asymmetry P = 0.0001, vertical asymmetry P = 0.0001, total asymmetry P = 0.0001, vertical range P = 0.002). Application of electrical stimulation combined with the Bobath approach proved to be efficient in preventing inferior and anterior shoulder subluxation in the acute stages of stroke.

Influence of shoulder diameter on Temperature and Z-parameter during friction stir welding of Al 6082 alloy

NASA Astrophysics Data System (ADS)

Kishore Mugada, Krishna; Adepu, Kumar

2018-03-01

In this research article, the effect of increasing shoulder diameter on temperature and Zener Holloman (Z)-parameter for friction stir butt welded AA6082-T6 was studied. The temperature at the Advancing side (AS) of weld was measured using the K-Type thermocouple at four different equidistant locations. The developed analytical model is utilized to predict the maximum temperature (Tpeak) during the welding. The strain, strain rate, Z- Parameter for all the shoulders at four distinct locations were evaluated. The temperature increases with increase in shoulder diameter and the maximum temperature was recorded for 24mm shoulder diameter. The computed log Z values are compared with the available process map and results shows that the values are in stable flow region and near to stir zone the values are in Dynamic recrystallization region (DRX). The axial load (Fz) and total tool torque (N-m) are found to be higher for shoulder diameter of 21 mm i.e., 6.3 kN and 56.5 N-m respectively.

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.

Analysis of a retrieved delta III total shoulder prosthesis.

PubMed

Nyffeler, R W; Werner, C M L; Simmen, B R; Gerber, C

2004-11-01

A reversed Delta III total shoulder prosthesis was retrieved post-mortem, eight months after implantation. A significant notch was evident at the inferior pole of the scapular neck which extended beyond the inferior fixation screw. This bone loss was associated with a corresponding, erosive defect of the polyethylene cup. Histological examination revealed a chronic foreign-body reaction in the joint capsule. There were, however, no histological signs of loosening of the glenoid base plate and the stability of the prosthetic articulation was only slightly reduced by the eroded rim of the cup.

A Critical Review on Prosthetic Features Available for Reversed Total Shoulder Arthroplasty

PubMed Central

De Wilde, Lieven

2016-01-01

Reversed total shoulder arthroplasty is a popular treatment in rotator cuff arthropathy and in displaced proximal humeral fractures in elderly. In 2016, 29 models of commercially available designs express this popularity. This study describes all the different design parameters available on the market. Prosthetic differences are found for the baseplate, glenosphere, polyethylene, and humeral component and these differences need to be weighed out carefully for each patient knowing that a gain in one mechanical parameter can balance the loss of another. Patient specific implants may help in the future. PMID:28105417

Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden.

PubMed

Virta, Lena; Joranger, Pål; Brox, Jens Ivar; Eriksson, Rikard

2012-02-10

Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden. The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model. 204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third. The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.

Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty.

PubMed

Denard, Patrick J; Noyes, Matthew P; Walker, J Brock; Shishani, Yousef; Gobezie, Reuben; Romeo, Anthony A; Lederman, Evan

2018-02-01

The purpose of this study was to compare the radiographic changes of the humerus in the short term after total shoulder arthroplasty with two different short-stem humeral components. The hypothesis was that there would be no difference in radiographic changes or functional outcome based on component type. A retrospective review was conducted of primary total shoulder arthroplasties performed with a short press-fit humeral component. Group A included a collarless humeral stem with an oval geometry and curved stem (Ascend or Ascend Flex; Wright Medical, Memphis, TN, USA). Group B included a humeral stem with a metaphyseal collar, rectangular geometry, and straight stem (Apex; Arthrex, Inc., Naples, FL, USA). Radiographic changes and functional outcome were evaluated at a minimum of 2 years postoperatively. There were 42 patients in group A and 35 patients in group B available for analysis. There was no difference in functional outcome between the groups. In group A, the mean total radiographic change score of the humerus was 3.9, with changes classified as low in 38% and high in 62%. In group B, the mean total radiographic change score of the humerus was 2.5, with changes classified as low in 77% and high in 23% (P < .001). Medial calcar osteolysis was present in 71% of group A compared with 28.5% of group B (P < .001). At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. However, bone adaptive changes and the rate of medial calcar osteolysis are significantly different. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Sensitivity of frozen section histology for identifying Propionibacterium acnes infections in revision shoulder arthroplasty.

PubMed

Grosso, Matthew J; Frangiamore, Salvatore J; Ricchetti, Eric T; Bauer, Thomas W; Iannotti, Joseph P

2014-03-19

Propionibacterium acnes is a clinically relevant pathogen with total shoulder arthroplasty. The purpose of this study was to determine the sensitivity of frozen section histology in identifying patients with Propionibacterium acnes infection during revision total shoulder arthroplasty and investigate various diagnostic thresholds of acute inflammation that may improve frozen section performance. We reviewed the results of forty-five patients who underwent revision total shoulder arthroplasty. Patients were divided into the non-infection group (n = 15), the Propionibacterium acnes infection group (n = 18), and the other infection group (n = 12). Routine preoperative testing was performed and intraoperative tissue culture and frozen section histology were collected for each patient. The histologic diagnosis was determined by one pathologist for each of the four different thresholds. The absolute maximum polymorphonuclear leukocyte concentration was used to construct a receiver operating characteristics curve to determine a new potential optimal threshold. Using the current thresholds for grading frozen section histology, the sensitivity was lower for the Propionibacterium acnes infection group (50%) compared with the other infection group (67%). The specificity of frozen section was 100%. Using a receiver operating characteristics curve, an optimized threshold was found at a total of ten polymorphonuclear leukocytes in five high-power fields (400×). Using this threshold, the sensitivity of frozen section for Propionibacterium acnes was increased to 72%, and the specificity remained at 100%. Using current histopathology grading systems, frozen sections were specific but showed low sensitivity with respect to the Propionibacterium acnes infection. A new threshold value of a total of ten or more polymorphonuclear leukocytes in five high-power fields may increase the sensitivity of frozen section, with minimal impact on specificity.

Use of a shoulder abduction brace after arthroscopic rotator cuff repair: A study on gait performance and falls.

PubMed

Sonoda, Yuma; Nishioka, Takashi; Nakajima, Ryo; Imai, Shinji; Vigers, Piers; Kawasaki, Taku

2018-04-01

Fall prevention is essential in patients after arthroscopic rotator cuff repair because of the high risk of re-rupture. However, there are no reports related to falls that occur during the early postoperative period, while the affected limb is immobilized. This study assessed gait performance and falls in patients using a shoulder abduction brace after arthroscopic rotator cuff repair. Prospective cohort and postoperative repeated measures. This study included 29 patients (mean age, 67.1 ± 7.4 years) who underwent arthroscopic rotator cuff repair followed by rehabilitation. The timed up and go test, Geriatric Depression Scale, and Falls Efficacy Scale were measured, and the numbers of falls were compared between those shoulder abduction brace users and patients who had undergone total hip or knee arthroplasty. In arthroscopic rotator cuff repair patients, there were significant improvements in timed up and go test and Geriatric Depression Scale, but no significant differences in Falls Efficacy Scale, between the second and fifth postoperative weeks ( p < 0.05). Additionally, arthroscopic rotator cuff repair patients fell more often than patients with total hip arthroplasty or total knee arthroplasty during the same period. The findings suggest that rehabilitation in arthroscopic rotator cuff repair patients is beneficial, but decreased gait performance due to the immobilizing shoulder abduction brace can lead to falls. Clinical relevance Although rehabilitation helps motor function and mental health after arthroscopic rotator cuff repair, shoulder abduction brace use is associated with impaired gait performance, high Falls Efficacy Scale scores, and risk of falls, so awareness of risk factors including medications and lower limb dysfunctions is especially important after arthroscopic rotator cuff repair.

Ultrasonic, needle, and carcass measurements for predicting chemical composition of lamb carcasses.

PubMed

Ramsey, C B; Kirton, A H; Hogg, B; Dobbie, J L

1991-09-01

Three groups (n = 147) of New Zealand mixed breed lambs averaging 170 d of age and 31.7 kg in weight were killed after a diet of pasture to determine whether the total depth of soft tissues over the 12th rib 11 cm from the dorsal midline (GR) could be measured in live lambs with sufficient accuracy to warrant its use as a selection tool for breeding flock replacements. Relationships among live and carcass measurements and carcass chemical composition also were determined. An ultrasonic measurement of GR in the live lambs was a more accurate predictor of carcass GR (r = .87) and percentage carcass fat (r = .80) than was a measurement of GR made with a needle (r = .80 and .67, respectively). Both measurements were sufficiently accurate to permit culling of over-fat lambs from breeding flock replacement prospects. The best single indicator of percentage carcass fat (r = .87) was a shoulder fat measurement, followed closely by carcass GR (r = .85). Both were superior to USDA yield grade for estimating carcass chemical composition in these young, lightweight lambs. These two measurements also were most highly related to percentage carcass protein (r = -.78 and r = -.77, respectively). These results indicate possibilities for improving the method of evaluating the composition of U. S. lamb carcasses.

Effectiveness of massage therapy on the range of motion of the shoulder: a systematic review and meta-analysis.

PubMed

Yeun, Young-Ran

2017-02-01

[Purpose] This study was conducted to identify and analyze the degree of effect of massage therapy on the range of motion of the shoulder. [Subjects and Methods] The database search was conducted using PubMed, CINAHL, Embase, PsycINFO, RISS, NDSL, NANET, DBpia, and KoreaMed. The meta-analysis was based on 7 studies, covered a total of 237 participants, and used a random-effects model. [Results] The effect size estimate showed that massage therapy significantly improved the shoulder range of motion, especially the flexion (SMD: 18.21, 95% CI 1.57-34.85) and abduction (SMD: 22.07, 95% CI 5.84-38.30). [Conclusion] The review findings suggest that massage therapy is effective in improving the shoulder flexion and abduction.

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.

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

PubMed

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

2016-06-01

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

Comparison of shoulder strength in males with and without myofascial trigger points in the upper trapezius.

PubMed

Kim, H A; Hwang, U J; Jung, S H; Ahn, S H; Kim, J H; Kwon, O Y

2017-11-01

This study was conducted in order to compare the strength of scapular elevator and shoulder abductor with and without restricted scapular elevation between male subjects with and without myofascial trigger points in the upper trapezius. In total, 15 male subjects with myofascial trigger points, and 15age- and weight-matched male subjects without myofascial trigger points in the upper trapezius. Each subject was measured in the strength of maximum isometric scapular elevation and shoulder abduction with and without restricted scapular elevation. Maximum isometric contractions were measured using the Smart KEMA strength measurement system. Independent t-tests were used to compare shoulder strength values between the myofascial trigger points and non- myofascial trigger points groups. The results showed that shoulder abductor strength in the group with myofascial trigger points (5.64kgf) was significantly lower than in the group without myofascial trigger points (11.96kgf) when scapular elevation was restricted (p<0.05). However, there was no significant difference in the strength of the scapular elevator or shoulder abductor between groups (p>0.05). These findings suggest that decreased strength in the shoulder abductor with restricted scapular elevation should be considered in evaluating and treating individuals with myofascial trigger points of the upper trapezius. Copyright © 2017 Elsevier Ltd. 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.

Maximizing shoulder function after accessory nerve injury and neck dissection surgery: A multicenter randomized controlled trial.

PubMed

McGarvey, Aoife C; Hoffman, Gary R; Osmotherly, Peter G; Chiarelli, Pauline E

2015-07-01

Shoulder pain and dysfunction after neck dissection may result from injury to the accessory nerve. The effect of early physical therapy in the form of intensive scapular strengthening exercises is unknown. A total of 59 neck dissection participants were prospectively recruited for this study. Participants were randomly assigned to either the intervention group (n = 32), consisting of progressive scapular strengthening exercises for 12 weeks, or the control group (n = 29). Blinded assessment occurred at baseline, and at 3, 6, and 12 months. Three-month data were collected on 52 participants/53 shoulders. Per-protocol analysis demonstrated that the intervention group had statistically significantly higher active shoulder abduction at 3 months compared to the control group (+26.6°; 95% confidence interval [CI] 7.28-45.95; p = .007). The intervention is a favorable treatment for maximizing shoulder abduction in the short term. The effect of the intervention compared to usual care is uncertain in the longer term. © 2014 Wiley Periodicals, Inc.

Work postures and neck-shoulder pain among orchestra musicians.

PubMed

Nyman, Teresia; Wiktorin, Christina; Mulder, Marie; Johansson, Yvonne Liljeholm

2007-05-01

The purpose of the present study was to identify associations between a work posture with elevated arm position, duration of active playing time, and neck-shoulder pain among orchestra musicians. In this study, with a cross-sectional study design, a total of 235 subjects from 12 Swedish orchestras were categorized into four exposure groups according to arm position and duration of active playing time. Logistic regression analysis was used to calculate odds ratios (OR) for neck-shoulder pain in the four exposure groups. A higher prevalence of neck-shoulder pain were found in the groups "elevated arm position, <2 hr per workday" [OR 4.15 (1.30-13.22)], and "elevated arm position, >3 hr per workday" [OR 5.35 (1.96-14.62)] compared to the group "neutral arm position, <2 hr per workday". Musicians working in an elevated arm position (e.g., violinists, violists, flutists, and trumpet players) had a higher prevalence of neck-shoulder pain than those working in a more neutral position.

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.

Evaluation of fever in the immediate post-operative period following shoulder arthroplasty.

PubMed

Saltzman, B M; Mayo, B C; Bohl, D D; Frank, R M; Cole, B J; Verma, N N; Nicholson, G P; Romeo, A A

2017-11-01

To determine the incidence and timing of post-operative fevers following shoulder arthroplasty and the resulting investigations performed. A retrospective review was conducted of all patients undergoing shoulder arthroplasty over a nine-year period. The charts of all patients with a post-operative fever (≥ 38.6°C) were reviewed and the results of all investigations were analysed. A total of 2167 cases (in 1911 patients) were included of whom 92 (4.2%) had a documented fever. Obese cases had a significantly greater risk for fever (relative risk 1.53; 95% confidence interval 1.02 to 2.32; p = 0.041). Investigations were performed in 43/92 cases (46.7%), with a diagnosis being made in six cases (6.6% of the total, two of whom had their diagnosis made post-discharge). Around one in 25 cases develop a fever following shoulder arthroplasty; most have no infective aetiology. These patients may be being over-investigated; investigations should be performed in patients with persistent fever or on those with an identifiable source of infection on clinical examination. Cite this article: Bone Joint J 2017;99-B:1515-19. ©2017 The British Editorial Society of Bone & Joint Surgery.

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

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.

The comparison the effect of training by means of simulation and oral method on midwives’ skill in management of shoulder dystocia

PubMed Central

Kordi, Masoumeh; Erfanian, Fatemeh; Fakari, Farzaneh Rashidi; Dastfan, Fatemeh; Nejad, Keivan Shariati

2017-01-01

INTRODUCTION: Shoulder dystocia is one of the obstetric emergencies that are accompanied to serious risks for mother and fetus. It necessitates making the method of training of shoulder dystocia management more efficient, i.e., better management and giving services with higher quality. Thus, this study was carried out to compare the impact of training by simulation and oral technique on the skill of the employed midwives in obstetric clinics at Mashhad city (Iran) in shoulder dystocia management during 2012. METHODS: The current research is a double-group clinical trial that was conducted on 51 members of the employed midwives in the obstetric clinic at Mashhad city in 2012. The questionnaire of personal specification and awareness about shoulder dystocia and practical examination (objective-structured clinical examination) were employed as tools for data collection. The learners were divided into two groups by randomized allocation. Training was done by the presentation of lecture in the oral content group and a short movie was displayed at the end of it. The shoulder dystocia management technique was simulated in another group and through role-playing of instructor application of moulage (station) training was conducted. The period of the training course (4 h) and content of the educational workshop was identical for both groups. The practical examination was held for the learners before and immediately after training course. The given data were analyzed by means of statistical descriptive tests including Mann–Whitney U-test and Wilcoxon test via SPSS software (version 16). The significance level was considered as (P < 0.05) in all cases. RESULTS: The total mean score was significantly increased for the variable of shoulder dystocia management skill after intervention in both groups (P < 0.0001). Similarly, the results of Mann–Whitney U-test statistical tests indicated that total mean score for the variable of shoulder dystocia management skill after the intervention was significantly greater in simulation group than in an oral group (P = 0.040). CONCLUSION: Training in simulated delivery room by means of role-playing is an efficient method for training shoulder dystocia management skill, so it is recommended to use this program in the training of this skill. PMID:28616417

Effect of lateral offset center of rotation in reverse total shoulder arthroplasty: a biomechanical study.

PubMed

Henninger, Heath B; Barg, Alexej; Anderson, Andrew E; Bachus, Kent N; Burks, Robert T; Tashjian, Robert Z

2012-09-01

Lateral offset center of rotation (COR) reduces the incidence of scapular notching and potentially increases external rotation range of motion (ROM) after reverse total shoulder arthroplasty (rTSA). The purpose of this study was to determine the biomechanical effects of changing COR on abduction and external rotation ROM, deltoid abduction force, and joint stability. A biomechanical shoulder simulator tested cadaveric shoulders before and after rTSA. Spacers shifted the COR laterally from baseline rTSA by 5, 10, and 15 mm. Outcome measures of resting abduction and external rotation ROM, and abduction and dislocation (lateral and anterior) forces were recorded. Resting abduction increased 20° vs native shoulders and was unaffected by COR lateralization. External rotation decreased after rTSA and was unaffected by COR lateralization. The deltoid force required for abduction significantly decreased 25% from native to baseline rTSA. COR lateralization progressively eliminated this mechanical advantage. Lateral dislocation required significantly less force than anterior dislocation after rTSA, and both dislocation forces increased with lateralization of the COR. COR lateralization had no influence on ROM (adduction or external rotation) but significantly increased abduction and dislocation forces. This suggests the lower incidence of scapular notching may not be related to the amount of adduction deficit after lateral offset rTSA but may arise from limited impingement of the humeral component on the lateral scapula due to a change in joint geometry. Lateralization provides the benefit of increased joint stability, but at the cost of increasing deltoid abduction forces. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Preoperative doxycycline does not decolonize Propionibacterium acnes from the skin of the shoulder: a randomized controlled trial.

PubMed

Namdari, Surena; Nicholson, Thema; Parvizi, Javad; Ramsey, Matthew

2017-09-01

Propionibacterium acnes is frequently cultured in patients undergoing both primary and revision shoulder surgery. The purpose of this study was to evaluate the efficacy and safety of preoperative oral administration of doxycycline in decreasing the colonization of skin around the shoulder by P. acnes. This was a single-institution, prospective, randomized controlled trial of male patients undergoing shoulder arthroscopy. Patients were randomized to receive oral doxycycline (100 mg twice a day) for 7 days or to the standard of care (no drug). Before skin incision, 2 separate 3-mm punch biopsy specimens were obtained from the sites of the anterior and posterior arthroscopic portals and were sent for culture in anaerobic and aerobic medium held for 13 days. There were 22 of 37 (59.5%) patients in the no-drug group and 16 of 37 (43.2%) patients in the doxycycline group who had at least 1 dermal culture positive for P. acnes (P = .245). In the no-drug group, 10 patients (45.5%) had 1 positive culture and 12 (54.5%) had 2 positive cultures (34 total positive cultures [45.9%]). In the doxycycline group, 6 (37.5%) patients had 1 positive culture and 10 (62.5%) had 2 positive cultures (26 total positive cultures [35.1%]; P = .774). Administration of oral doxycycline for 7 days before surgery did not reduce colonization of P. acnes significantly. Given the potential risk for emergence of bacterial resistance and the adverse effects associated with administration of antibiotics, we do not recommend routine use of oral doxycycline for preoperative decolonization of the shoulder. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Reduced glenohumeral rotation, external rotation weakness and scapular dyskinesis are risk factors for shoulder injuries among elite male handball players: a prospective cohort study.

PubMed

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

2014-09-01

To determine whether rotator cuff strength, glenohumeral joint range of motion and scapular control are associated with shoulder injuries among elite male handball players. A total of 206 players in the Norwegian elite handball league for men were tested prior to the 2011-2012 season. Measures included: (1) glenohumeral internal and external rotation range of motion, (2) isometric internal rotation, external rotation and abduction strength and (3) assessment of scapular dyskinesis. Players were followed prospectively for the entire regular season (30 weeks), with shoulder problems registered bi-weekly using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A cumulative severity score was calculated for each player based on their questionnaire responses. This was used as the outcome measure in risk factor analyses. The average prevalence of shoulder problems throughout the season was 28% (95% CI 25% to 31%). The prevalence of substantial shoulder problems, defined as those leading to moderate or severe reductions in handball participation or performance, or to time loss, was 12% (95% CI 11% to 13%). Significant associations were found between obvious scapular dyskinesis (OR 8.41, 95% CI 1.47 to 48.1, p<0.05), total rotational motion (OR 0.77 per 5° change, 95% CI 0.56 to 0.995, p<0.05) and external rotation strength (OR 0.71 per 10 Nm change, 95% CI 0.44 to 0.99, p<0.05) and shoulder injury. Injury prevention programmes should incorporate interventions aimed at improving glenohumeral rotational range of motion, external rotation strength and scapular control. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Clinical Outcomes and Complications during the Learning Curve for Reverse Total Shoulder Arthroplasty: An Analysis of the First 40 Cases

PubMed Central

Song, Kwang-Soon; Koo, Tae-Won

2017-01-01

Background The purpose of this study was to investigate the results and complications during the learning curve of reverse total shoulder arthroplasty (RTSA) for rotator cuff deficiency. Methods We retrospectively reviewed the first 40 cases of RTSA performed by a single surgeon. The mean age of patients was 72.7 years (range, 63 to 81 years) and mean follow-up period was 26.7 months (range, 9 to 57 months). Clinical outcomes were evaluated using a visual analog scale (VAS) for pain, the University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, subjective shoulder value (SSV), and active range of motion (ROM). Intraoperative and postoperative complications were also evaluated. Results The average VAS pain score, UCLA score, ASES score, and SSV improved from 6.9%, 12.8%, 29.0%, and 29.0% before surgery to 1.6%, 27.0%, 73.3%, and 71.5% after surgery, respectively (p < 0.001). The mean forward flexion, abduction, and external rotation improved from 68.0°, 56.9°, and 28.0° before surgery to 131.0°, 112.3°, and 38.8° after surgery, respectively (p < 0.001, p < 0.001, and p = 0.021). However, the mean internal rotation did not improve after surgery (p = 0.889). Scapular notching was observed in 33 patients (51.5%). Eight shoulders (20%) had complications, including 2 major (1 deep infection and 1 glenoid fixation failure) and 6 minor complications (3 brachial plexus injuries, 2 acromial fractures, and 1 intraoperative periprosthetic fracture). Conclusions The first 40 cases of RTSA performed by a single surgeon during the learning curve period showed satisfactory short-term follow-up results with an acceptable complication rate. PMID:28567225

Usefulness of intra-articular botulinum toxin injections. A systematic review.

PubMed

Khenioui, Hichem; Houvenagel, Eric; Catanzariti, Jean François; Guyot, Marc Alexandre; Agnani, Olivier; Donze, Cécile

2016-03-01

Botulinum toxin is a proven and widely used treatment for numerous conditions characterized by excessive muscular contractions. Recent studies have assessed the analgesic effect of botulinum toxin in joint pain and started to unravel its mechanisms. We searched the international literature via the Medline database using the term "intraarticular botulinum toxin injection" combined with any of the following terms: "knee", "ankle", "shoulder", "osteoarthritis", "adhesive capsulitis of the shoulder". Of 16 selected articles about intraarticular botulinum toxin injections, 7 were randomized controlled trials done in patients with osteoarthritis, adhesive capsulitis of the shoulder, or chronic pain after joint replacement surgery. Proof of anti-nociceptive effects was obtained in some of these indications and the safety and tolerance profile was satisfactory. The studies are heterogeneous. The comparator was usually a glucocorticoid or a placebo; a single study used hyaluronic acid. Pain intensity was the primary outcome measure. The number of randomized trials and sample sizes are too small to provide a satisfactory level of scientific evidence or statistical power. Unanswered issues include the effective dosage and the optimal dilution and injection modalities of botulinum toxin. Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty: A systematic review and meta-analysis.

PubMed

Sun, Chuan-Xiu; Zhang, Lu; Mi, Li-Dong; Du, Guang-Yu; Sun, Xue-Gang; He, Sheng-Wei

2017-06-01

This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty. A systematic search was performed in Embase (1980-2017.04, embase.com), Medline (1966-2017.04, medline.com), PubMed (1966-2017.04, pubmed.com), ScienceDirect (1985-2017.04, sciencedirect.com), and Web of Science (1950-2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software. In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] -172.16, 95% confidence interval [CI] -35.46 to -308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI -0.12 to 0.22, P = .89, d = 0.19), length of stay (MD -0.06, 95% CI -0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53). Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required.

Efficiency and safety of tranexamic acid in reducing blood loss in total shoulder arthroplasty

PubMed Central

Sun, Chuan-Xiu; Zhang, Lu; Mi, Li-Dong; Du, Guang-Yu; Sun, Xue-Gang; He, Sheng-Wei

2017-01-01

Abstract Objective: This meta-analysis aimed to evaluate the efficiency and safety of tranexamic acid for reducing blood loss and transfusion requirements in patients undergoing total shoulder arthroplasty. Methods: A systematic search was performed in Embase (1980–2017.04, embase.com), Medline (1966–2017.04, medline.com), PubMed (1966–2017.04, pubmed.com), ScienceDirect (1985–2017.04, sciencedirect.com), and Web of Science (1950–2017.04, webofknowledge.com). Study which assessed the efficiency and safety of tranexamic acid in total shoulder arthroplasty was selected. Meta-analysis was performed using Stata 11.0 software. Results: In all, 484 patients from 2 randomized controlled trials (RCTs) and 2 non-RCTs were subjected to meta-analysis. The present meta-analysis demonstrated that there was less total blood loss (mean difference [MD] −172.16, 95% confidence interval [CI] −35.46 to −308.87, P = .01, d = 0.33) and transfusion rate (odds ratio 0.34, 95% CI 0.13 to 0.91, P = .03, d = 0.29) in tranexamic acid groups compared with the control groups. There were no significant differences in duration of surgery (MD 0.02, 95% CI −0.12 to 0.22, P = .89, d = 0.19), length of stay (MD −0.06, 95% CI −0.26 to 0.14, P = .56, d = 0.20), or incidence of adverse effects such as deep venous thrombosis (odds ratio 1.15, 95% CI 0.33 to 4.00, P = .83, d = 0.53). Conclusion: Clinical application of tranexamic acid seemed to result in significant reductions in total blood loss, hemoglobin decline and transfusion requirements following total shoulder arthroplasty. Moreover, no increased risk of the thrombotic events was identified. Due to the limited quality of the evidence currently available, higher quality RCTs are required. PMID:28562553

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes

PubMed Central

Ranalletta, Maximiliano; Rossi, Luciano A.; Sirio, Adrian; Dilernia, Fernando Diaz; Bertona, Agustin; Maignon, Gastón D.; Bongiovanni, Santiago L.

2017-01-01

Background: The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes. Purpose: To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors. Study Design: Case series; Level of evidence, 4. Methods: A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated. Results: The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery (P < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%. Conclusion: In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate. PMID:28932751

Return to Sports and Recurrences After Arthroscopic Anterior Shoulder Stabilization in Martial Arts Athletes.

PubMed

Ranalletta, Maximiliano; Rossi, Luciano A; Sirio, Adrian; Dilernia, Fernando Diaz; Bertona, Agustin; Maignon, Gastón D; Bongiovanni, Santiago L

2017-09-01

The high demands to the glenohumeral joint and the violent shoulder blows experienced during martial arts (MA) could compromise return to sports and increase the recurrence rate after arthroscopic stabilization for anterior shoulder instability in these athletes. To report the functional outcomes, return to sports, and recurrences in a series of MA athletes with anterior shoulder instability treated with arthroscopic stabilization with suture anchors. Case series; Level of evidence, 4. A total of 20 consecutive MA athletes were treated for anterior shoulder instability at a single institution between January 2008 and December 2013. Range of motion (ROM), the Rowe score, a visual analog scale (VAS), and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return-to-sport and recurrence rates were also evaluated. The mean age at the time of surgery was 25.4 years (range, 18-35 years), and the mean follow-up was 71 months (range, 36-96 months). No significant difference in preoperative and postoperative shoulder ROM was found. The Rowe, VAS, and ASOSS scores showed statistical improvement after surgery ( P < .001). In all, 19 athletes (95%) returned to sports. However, only 60% achieved ≥90% recovery after surgery. The recurrence rate was 20%. In this retrospective study of a consecutive cohort of MA athletes, arthroscopic anterior shoulder stabilization significantly improved functional scores. However, only 60% of the athletes achieved the same level of competition, and there was a 20% recurrence rate.

Poststroke Shoulder Pain in Turkish Stroke Patients: Relationship with Clinical Factors and Functional Outcomes

ERIC Educational Resources Information Center

Barlak, Aysegul; Unsal, Sibel; Kaya, Kurtulus; Sahin-Onat, Sule; Ozel, Sumru

2009-01-01

The objective of this study was to assess the possible causes of hemiplegic shoulder pain (HSP) in Turkish patients with stroke, to identify the correlation between HSP and clinical factors, and to review the effects of HSP on functional outcomes. A total of 187 consecutive patients with stroke were evaluated for the presence of HSP and for the…

A COMPARISON OF STATIC AND DYNAMIC OPTIMIZATION MUSCLE FORCE PREDICTIONS DURING WHEELCHAIR PROPULSION

PubMed Central

Morrow, Melissa M.; Rankin, Jeffery W.; Neptune, Richard R.; Kaufman, Kenton R.

2014-01-01

The primary purpose of this study was to compare static and dynamic optimization muscle force and work predictions during the push phase of wheelchair propulsion. A secondary purpose was to compare the differences in predicted shoulder and elbow kinetics and kinematics and handrim forces. The forward dynamics simulation minimized differences between simulated and experimental data (obtained from 10 manual wheelchair users) and muscle co-contraction. For direct comparison between models, the shoulder and elbow muscle moment arms and net joint moments from the dynamic optimization were used as inputs into the static optimization routine. RMS errors between model predictions were calculated to quantify model agreement. There was a wide range of individual muscle force agreement that spanned from poor (26.4 % Fmax error in the middle deltoid) to good (6.4 % Fmax error in the anterior deltoid) in the prime movers of the shoulder. The predicted muscle forces from the static optimization were sufficient to create the appropriate motion and joint moments at the shoulder for the push phase of wheelchair propulsion, but showed deviations in the elbow moment, pronation-supination motion and hand rim forces. These results suggest the static approach does not produce results similar enough to be a replacement for forward dynamics simulations, and care should be taken in choosing the appropriate method for a specific task and set of constraints. Dynamic optimization modeling approaches may be required for motions that are greatly influenced by muscle activation dynamics or that require significant co-contraction. PMID:25282075

Return to competition, re-injury, and impact on performance of preseason shoulder injuries in Major League Baseball pitchers.

PubMed

Makhni, Eric C; Lee, Randall W; Nwosu, Ekene O; Steinhaus, Michael E; Ahmad, Christopher S

2015-07-01

Major league baseball (MLB) pitchers are vulnerable to overuse injury of the upper extremity, especially in the shoulder. Injuries sustained in the preseason may have negative impact on performance following return. The goal of this study was to document the frequency of preseason shoulder injury in these athletes, as well as risk for re-injury and impact on performance following return from injury. A comprehensive search of MLB injury information from 2001 to 2010 of public databases yielded a cohort of MLB pitchers who sustained preseason shoulder injuries. These databases were utilized to obtain information regarding return to MLB competition, re-injury, and performance following return from injury. All performance metrics were compared to those of an age-matched control cohort. A total of 74 pitchers were identified who sustained a preseason shoulder injury. Only 39 (53%) returned that same season to pitch in the MLB competition. Of those that returned, nearly 50% of players were re-designated on the Disabled List during the return season. There was a decline in performance in earned run average and batting average against in the year of return. Compared to age-matched control pitchers, those with preseason shoulder injury had lower performance metrics across a number of outcomes. Preseason shoulder injury in MLB pitchers has the potential to result in high re-injury rates and decreased subsequent performance.

Nesting biology of Black-shouldered Kite (Elanus caeruleus) in oil palm landscape in Carey Island, Peninsular Malaysia.

PubMed

Ramli, Rosli; Fauzi, Aimi

2018-03-01

Black-shouldered Kite ( Elanus caeruleus ) is a well-known raptor that inhabits open areas such as oil palm plantation or paddy field. To determine preferable habitat and nesting site of Black-shouldered Kite in oil palm landscape, we conducted a study on Black-shouldered Kite's nesting biology in Carey Island, Selangor, Malaysia. We divided the island into six types of habitat and conducted road-side count of Black-shouldered Kite from April 2009 to February 2011. Whenever the Black-shouldered Kite was detected, we thoroughly searched the surrounding area for their nest. In total, we have recorded forty nests. The nests were built on 15 species of trees but most of the trees shared common physical characteristics. Some novice breeders also used oil palm tree as their nesting site. Structure and building materials of nests constructed on oil palm trees were different from nests built on other trees. Of all breeding attempts, only four nests which were located in residential area adjacent to young oil palm habitat were successful. Among important characteristics of successful nesting site include taller trees with strong branches and good leaf coverage. These trees not only protect nests from predator detection (except from other predatory birds) and physical environment but also facilitate Black-shouldered Kite's foraging activities by providing good vantage point.

[Interscalene block for total shoulder arthroplasty: comparative study (ultrasound vs. neurostimulation)].

PubMed

Mejía-Terrazas, Gabriel Enrique; Ruiz-Suárez, Michell; Gaspar-Carrillo, Sandra Patricia; Valero-González, Fernando; Unzueta-Navarro, David; Encalada-Díaz, Iván

2014-01-01

Modern anesthesiology has integrated the use of ultrasonography as a tool that has displaced neurostimulation as a technique for locating peripheral nerves. The aim of this study was to determine which procedure is more effective for guiding interscalene block for total shoulder arthroplasty. We carried out a comparative, prospective non-randomized study comprised of the group guided by neurostimulation interscalene block and the group guided by ultrasound. All patients in both groups were scheduled for total shoulder arthroplasty. Latency, degree of sensory and motor block, success rate, postoperative pain intensity at 6, 12, and 24 h, patient satisfaction and complications were measured. We included 110 patients, 55 per group. Patients were placed in beach chair position and the deltopectoral approach was used. There were no differences in demographic characteristics. Results for neurostimulation vs. ultrasound group: latency 19.11 ± 2.27 vs. 17.24 ± 1.42 min, p= 0.23. Block sensitivity in both groups was grade 0 motor block grade 0 in 76.4% and grade 1 in 23.6% vs. grade 0 to 100%. There was 100% success rate for both groups. Postoperative pain at 6 h was 0.13 ± 0.54 vs. 0.11 ± 0.13 p= 0.90, at 12 h 1.67 ± 1.15 vs. 1.65 ± 0.59 p= 0.89 and at 24 h 3.15 ± 1.66 vs. 2.99 ± 1.15 p= 0.78. Satisfaction 54.5% very satisfied and 45.5% satisfied 96.36% vs 3.6% very satisfied and satisfied. Complications 18.18% vs. 3.6% p= 0.023. Ultrasound-guided interscalene nerve block is the technique of choice in elective total shoulder arthroplasty.

Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study.

PubMed

Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W

2017-02-01

Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P < .05 were considered statistically significant. No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A randomized, controlled clinical trial of four anti-dandruff shampoos.

PubMed

Rapaport, M

1981-01-01

A total of 199 patients were selected for a comparison of the anti-dandruff efficacy of four shampoos. After a 2-week lead in (all patients used only Johnson's Baby Shampoo twice weekly) the patients were randomly assigned to Selsun Blue, Head & Shoulders, Flex, or Tegrin. The test preparation, which was unknown to the observer, was used twice weekly for 4 weeks. Loose and adherent dandruff were each rated on a scale of 0 to 20 (absent to severe) at the end of the lead-in (when a total score of 15 was required), and each week of study. The mean total pre-study score for all subjects was 19.5. At the end of the study the mean improvement scores were: 16.2 (Selsun Blue), 14.6 (head & Shoulders), 13.5 (Flex), and 13.1 (Tegrin). The improvement was significantly greater (p less than 0.05) on Selsun Blue than on any of the other shampoo. At the end of the study significantly (p less than 0.05) more patients had total scores of zero on Selsun Blue (15) than on Tegrin or Head & Shoulders. In addition, the rate of improvement was significantly (p less than 0.05) faster with Selsun Blue than with any of the other test preparations.

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

[Measurement of shoulder disability in the athlete: a systematic review].

PubMed

Fayad, F; Mace, Y; Lefevre-Colau, M M; Poiraudeau, S; Rannou, F; Revel, M

2004-08-01

To identify all available shoulder disability questionnaires and to examine those that could be used for athlete. We systematically reviewed the literature in Medline using the keywords shoulder, function, scale, index, score, questionnaire, disability, quality of life, assessment, and evaluation. We searched for scales used for athletes with the keywords scale name AND (sport OR athlete). Data were completed by using the "Guide des Outils de Mesure et d'Evaluation en Médecine Physique et de Réadaptation" textbook. Analysis took into account the clinimetric quality of the instruments and the number of items specifically related to sports. A total of 37 instruments have been developed to measure disease-, shoulder-specific or upper extremity specific outcome. Older instruments were developed before the advent of modern measurement methods. They usually combined objective and subjective measures. Recent instruments were designed with use of more advanced methods. Most are self-administered questionnaires. Fourteen scales included items assessing sport activity. Four of these scales have been used to assess shoulder disability in athlete. Six scales have been used to assess such disability but do not have specific items related to sports. There is no gold standard for assessing shoulder outcome in the general population and no validated outcome instruments specifically for athletes. We suggest the use of ASES, WOSI and WORC scales for evaluating shoulder function in the recreational athletes. The DASH scale should be evaluated in this population. The principal criterion in evaluating shoulder function in the high level athlete is a return to the same level of sport performance. Further studies are required to identify measurement tools for shoulder disability that have a high predictive value for return to sport.

Clinical Outcomes and Return to Sport After Arthroscopic Anterior, Posterior, and Combined Shoulder Stabilization

PubMed Central

Kraeutler, Matthew J.; Aberle, Nicholas S.; Brown, Colin C.; Ptasinski, Joseph J.; McCarty, Eric C.

2018-01-01

Background: Glenohumeral instability is a common abnormality, especially among athletes. Previous studies have evaluated outcomes after arthroscopic stabilization in patients with anterior or posterior shoulder instability but have not compared outcomes between groups. Purpose: To compare return-to-sport and other patient-reported outcomes in patients after primary arthroscopic anterior, posterior, and combined anterior and posterior shoulder stabilization. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary arthroscopic anterior, posterior, or combined anterior and posterior shoulder stabilization were contacted at a minimum 2-year follow-up. Patients completed a survey that consisted of return-to-sport outcomes as well as the Western Ontario Shoulder Instability Index (WOSI), Single Assessment Numeric Evaluation (SANE), American Shoulder and Elbow Sur’geons (ASES) score, and Shoulder Activity Scale. Results: A total of 151 patients were successfully contacted (anterior: n = 81; posterior: n = 22; combined: n = 48) at a mean follow-up of 3.6 years. No significant differences were found between the groups with regard to age at the time of surgery or time to follow-up. No significant differences were found between the groups in terms of WOSI (anterior: 76; posterior: 70; combined: 78; P = .28), SANE (anterior: 87; posterior: 85; combined: 87; P = .79), ASES (anterior: 88; posterior: 83; combined: 91; P = .083), or Shoulder Activity Scale (anterior: 12.0; posterior: 12.5; combined: 12.5; P = .74) scores. No significant difference was found between the groups in terms of the rate of return to sport (anterior: 73%; posterior: 68%; combined: 75%; P = .84). Conclusion: Athletes undergoing arthroscopic stabilization of anterior, posterior, or combined shoulder instability can be expected to share a similar prognosis. High patient-reported outcome scores and moderate to high rates of return to sport were achieved by all groups. PMID:29637085

MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER

PubMed Central

CELIK, HALUK; SECKIN, MUSTAFA FAIK; AKCAL, MEHMET AKIF; KARA, ADNAN; KILINC, BEKIR ERAY; AKMAN, SENOL

2017-01-01

ABSTRACT Objective: Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. Methods: A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Results: Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients’ values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Conclusion: Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series. PMID:29375258

MID-LONG TERM RESULTS OF MANIPULATION AND ARTHROSCOPIC RELEASE IN FROZEN SHOULDER.

PubMed

Celik, Haluk; Seckin, Mustafa Faik; Akcal, Mehmet Akif; Kara, Adnan; Kilinc, Bekir Eray; Akman, Senol

2017-01-01

Surgical treatment options should be discussed in cases of frozen shoulder, which is usually treated in a conservative manner. In this study, we evaluated the efficacy of manipulation and arthroscopic release in cases of frozen shoulder which resisted conservative treatment. A total of 32 patients who underwent manipulation and arthroscopic capsular release in 34 shoulders were included in the study. The average follow-up period was 49.5 months (range: 24-90 months). No reason for onset could be found in 8 (25%) patients, who were classified as primary frozen shoulder; twenty-four (75%) patients were classified as secondary frozen shoulder due to underlying pathologies. The average pre-operative complaint period was 11 months (range: 3-24 months). After arthroscopic examination, manipulation was performed first, followed by arthroscopic capsular release. The range of motion in both shoulders was compared before the procedure and in the last follow-up visit. Constant and Oxford classifications were used to assess functional results, and the results were assessed statistically. Patient values for passive elevation, abduction, adduction-external rotation, abduction-external rotation, and abduction-internal rotation increased in a statistically significant manner between the preoperative assessment and follow-up evaluation (p<0.01). The average change of 47.97±21.03 units observed in the patients' values obtained in the control measurements against the pre-op Constant scores was determined to be statistically significant (p<0.01). According to the Oxford classification, 29 shoulders were sufficient. Successful results can be obtained with arthroscopic release performed after manipulation in patients with frozen shoulder resistant to conservative treatment. Level of Evidence IV, Case Series.

East Europe Report, Economic and Industrial Affairs

DTIC Science & Technology

1984-08-30

an average fertility per 100 head of breeding stock of 86-90 calves, 111-120 lambs and 1,700-1,800 pigs." These high objectively determined targets...river harbors and factories processing imported raw materials, and fights for its survival on the oversalted soft shoulders of highways with heavy...old sooty coal heaters was replaced by traffic " ’ says Bela Donath, department head of the OKTH. ’ "Recently, together with the Ministry of

Customized dynamic splinting: orthoses that promote optimal function and recovery after radial nerve injury: a case report.

PubMed

McKee, Pat; Nguyen, Cecilia

2007-01-01

Radial nerve injury is a relatively common occurrence and recovery depends on the level of injury and extent of connective tissue damage. Orthoses (splints) are often provided to compensate for lost motor power. This article chronicles the recovery, over 27 months, of a 76-year-old woman who sustained a high radial nerve injury of her dominant arm during surgery for total shoulder replacement (Delta Reverse). Customized, low-profile dynamic splints, unlike any previously published design, were developed to address her goals for functional independence and the biological needs of the tissues. Dynamic power was provided to the wrist, fingers, and thumb by elastic cords and thin, flexible thermoplastic, without the need of an outrigger, thus avoiding the need for wire bending and cutting. At the outset, the splint was forearm-based and when wrist extension power was recovered, a hand-based splint was designed. Eventually, a circumferential hand-based thumb-stabilizing splint fulfilled most of the remaining orthotic requirements.

Physical fitness and job performance of firefighters.

PubMed

Rhea, Matthew R; Alvar, Brent A; Gray, Rayne

2004-05-01

Accurate correlations between a wide range of physical fitness measures and occupational demands are needed in order to identify specific fitness tests and training needs for firefighters. Twenty professional firefighters performed numerous fitness and job-related performance tests. Pearson product moment correlations were performed to identify the relationship between fitness components and job performance. Significant correlations (p <0.05) with job performance were identified for total fitness (r = -0.62), bench press strength (r = -0.66), hand grip strength (r = -0.71), bent-over row endurance (r = -0.61), bench press endurance (r = -0.73), shoulder press endurance (r = -0.71), bicep endurance (r = -0.69), squat endurance (r = -0.47), and 400-m sprint time (r = 0.79). It is apparent that firefighting taxes virtually all aspects of physical fitness. These data can help the exercise specialist choose appropriate tests and prescribe specific fitness programs for firefighters. Traditional firefighter exercise programs focusing mainly on cardiovascular fitness should be replaced with physical conditioning programs that address all components of fitness.

What Factors are Predictive of Patient-reported Outcomes? A Prospective Study of 337 Shoulder Arthroplasties.

PubMed

Matsen, Frederick A; Russ, Stacy M; Vu, Phuong T; Hsu, Jason E; Lucas, Robert M; Comstock, Bryan A

2016-11-01

Although shoulder arthroplasties generally are effective in improving patients' comfort and function, the results are variable for reasons that are not well understood. We posed two questions: (1) What factors are associated with better 2-year outcomes after shoulder arthroplasty? (2) What are the sensitivities, specificities, and positive and negative predictive values of a multivariate predictive model for better outcome? Three hundred thirty-nine patients having a shoulder arthroplasty (hemiarthroplasty, arthroplasty for cuff tear arthropathy, ream and run arthroplasty, total shoulder or reverse total shoulder arthroplasty) between August 24, 2010 and December 31, 2012 consented to participate in this prospective study. Two patients were excluded because they were missing baseline variables. Forty-three patients were missing 2-year data. Univariate and multivariate analyses determined the relationship of baseline patient, shoulder, and surgical characteristics to a "better" outcome, defined as an improvement of at least 30% of the maximal possible improvement in the Simple Shoulder Test. The results were used to develop a predictive model, the accuracy of which was tested using a 10-fold cross-validation. After controlling for potentially relevant confounding variables, the multivariate analysis showed that the factors significantly associated with better outcomes were American Society of Anesthesiologists Class I (odds ratio [OR], 1.94; 95% CI, 1.03-3.65; p = 0.041), shoulder problem not related to work (OR, 5.36; 95% CI, 2.15-13.37; p < 0.001), lower baseline Simple Shoulder Test score (OR, 1.32; 95% CI, 1.23-1.42; p < 0.001), no prior shoulder surgery (OR, 1.79; 95% CI, 1.18-2.70; p = 0.006), humeral head not superiorly displaced on the AP radiograph (OR, 2.14; 95% CI, 1.15-4.02; p = 0.017), and glenoid type other than A1 (OR, 4.47; 95% CI, 2.24-8.94; p < 0.001). Neither preoperative glenoid version nor posterior decentering of the humeral head on the glenoid were associated with the outcomes. The model predictive of a better result was driven mainly by the six factors listed above. The area under the receiver operating characteristic curve generated from the cross-validated enhanced predictive model was 0.79 (generally values of 0.7 to 0.8 are considered fair and values of 0.8 to 0.9 are considered good). The false-positive fraction and the true-positive fraction depended on the cutoff probability selected (ie, the selected probability above which the prediction would be classified as a better outcome). A cutoff probability of 0.68 yielded the best performance of the model with cross-validation predictions of better outcomes for 236 patients (80%) and worse outcomes for 58 patients (20%); sensitivity of 91% (95% CI, 88%-95%); specificity of 65% (95% CI, 53%-77%); positive predictive value of 92% (95% CI, 88%-95%); and negative predictive value of 64% (95% CI, 51%-76%). We found six easy-to-determine preoperative patient and shoulder factors that were significantly associated with better outcomes of shoulder arthroplasty. A model based on these characteristics had good predictive properties for identifying patients likely to have a better outcome from shoulder arthroplasty. Future research could refine this model with larger patient populations from multiple practices. Level II, therapeutic study.

The impact of body habitus on the surgical outcomes of transaxillary single-incision robotic thyroidectomy in papillary thyroid carcinoma patients.

PubMed

Lee, Sohee; Park, Seulkee; Lee, Cho Rok; Son, Haiyoung; Kim, Jungwoo; Kang, Sang-Wook; Jeong, Jong Ju; Nam, Kee-Hyun; Chung, Woong Youn; Park, Cheong Soo

2013-07-01

Robotic applications have achieved safe and precise thyroidectomy with notable cosmetic and functional benefits. This study was designed to document the influence of body habitus on robotic thyroidectomy in papillary thyroid carcinoma (PTC) patients. From July 2009 to February 2010, 352 patients underwent robotic thyroidectomy using a gasless, transaxillary single-incision approach at Yonsei University Health System. Body habitus was described using body mass index category (normal weight, overweight, obese), neck length, shoulder width, and shoulder width to neck length ratios. The impact of body habitus on surgical outcomes was analyzed with respect to operation time, number of retrieved central nodes, bleeding amount, and postoperative complications. Of the 352 patients, 217 underwent less than total thyroidectomy and 135 underwent total thyroidectomy. Operative variables (i.e. operation times, bleeding amounts, and numbers of retrieved central nodes) showed no significant differences between three BMI groups for less than total thyroidectomy. However, total operation and working space times were longer for obese patients during total thyroidectomy. In particular, shoulder width was positively correlated with total operation time, working space time, console time, and number of retrieved central nodes. On the other hand, postoperative complications were not significantly different in the three BMI groups and showed no significant correlation with the other indices of body habitus. Standardized robotic thyroidectomy can be performed safely and feasibly in patients with a large body habitus despite longer operation times.

[Therapy relevant imaging in modern surgical treatment of arthrosis of the shoulder: interesting facts for orthopedic surgeons].

PubMed

Krifter, R M; Zweiger, C; Lick-Schiffer, W; Mattiassich, G; Schüller-Weidekamm, C; Radl, R

2013-03-01

Imaging for shoulder surgery varies a lot nowadays. Advantages and disadvantages of possible imaging methods according to the pathology and treatment options are described. Digital projection radiography in 3 planes, ultrasonography, MRI, CT scanning and scintigrams. Special axial view to visualize the glenoid situation, as well as 3-D CT scanning for larger defects and classification. Imaging of the glenoid situation, the version and erosion in axial view x-ray is mandatory to plan and control glenoid replacement. Useful application of imaging methods for the daily routine of orthopedic surgeons. Digital 3 plane x-ray imaging in arthroplasty surgery is the minimum requirement. For rotator cuff lesions ultrasonography is good. In order to gain information on fatty infiltration of rotator muscles MRI is needed as well as for intra-articular lesions. For bony defects CT and reconstruction 3-D are recommended.

Arthroscopic suture bridge technique for intratendinous tear of rotator cuff in chronically painful calcific tendinitis of the shoulder.

PubMed

Ji, Jong-Hun; Shafi, Mohamed; Moon, Chang-Yun; Park, Sang-Eun; Kim, Yeon-Jun; Kim, Sung-Eun

2013-11-01

Arthroscopic removal, now the main treatment option, has almost replaced open surgery for treatment of resistant calcific tendinitis. In some cases of chronic calcific tendinitis of the shoulder, the calcific materials are hard and adherent to the tendon. Removal of these materials can cause significant intratendinous tears between the superficial and deep layers of the degenerated rotator cuff. Thus far, there are no established surgical techniques for removing the calcific materials while ensuring cuff integrity. Good clinical results for rotator cuff repair were achieved by using an arthroscopic suture bridge technique in patients with long-standing calcific tendinitis. Intact rotator cuff integrity and recovery of signal change on follow-up magnetic resonance imaging scans were confirmed. This is a technical note about a surgical technique and its clinical results with a review of relevant published reports. © 2013 Chinese Orthopaedic Association and Wiley Publishing Asia Pty Ltd.

Effectiveness of massage therapy for shoulder pain: a systematic review and meta-analysis.

PubMed

Yeun, Young-Ran

2017-05-01

[Purpose] This study performed an effect-size analysis of massage therapy for shoulder pain. [Subjects and Methods] The database search was conducted using PubMed, CINAHL, Embase, PsycINFO, RISS, NDSL, NANET, DBpia, and KoreaMed. The meta-analysis was based on 15 studies, covering a total of 635 participants, and used a random effects model. [Results] The effect size estimate showed that massage therapy had a significant effect on reducing shoulder pain for short-term efficacy (SMD: -1.08, 95% CI: -1.51 to -0.65) and for long-term efficacy (SMD: -0.47, 95% CI: -0.71 to -0.23). [Conclusion] The findings from this review suggest that massage therapy is effective at improving shoulder pain. However, further research is needed, especially a randomized controlled trial design or a large sample size, to provide evidence-based recommendations.

Scoping review of the literature on shoulder impairments and disability after neck dissection.

PubMed

Goldstein, David P; Ringash, Jolie; Bissada, Eric; Jaquet, Yves; Irish, Jonathan; Chepeha, Douglas; Davis, Aileen M

2014-02-01

The purpose of this article was to provide a review of the literature on shoulder disability after neck dissection. A literature review was performed using Ovid Medline and Embase databases. A total of 306 abstracts and 78 full-text articles were reviewed. Forty-two articles were eligible for inclusion. Patients undergoing nerve-sacrifice neck dissections have greater disability and lower quality of life scores than those undergoing neck dissections with the least manipulation (ie, selective neck dissections). Shoulder impairments can still occur in patients undergoing selective neck dissections. Disability typically improves over time in patients undergoing nerve-sparing neck dissections. There was significant variability in the literature in terms of the prevalence and recovery of shoulder morbidity after neck dissection. This variability may not just be related to surgical technique or rehabilitation, but also to study design, definitions, and the variability in disability questionnaires used. Copyright © 2013 Wiley Periodicals, Inc.

Complications in reverse shoulder arthroplasty

PubMed Central

Barco, Raul; Savvidou, Olga D.; Sperling, John W.; Sanchez-Sotelo, Joaquín; Cofield, Robert H.

2016-01-01

The reported rate of complications of reverse shoulder arthroplasty (RSA) seems to be higher than the complication rate of anatomical total shoulder arthroplasty. The reported overall complication rate of primary RSA is approximately 15%; when RSA is used in the revision setting, the complication rate may approach 40%. The most common complications of RSA include instability, infection, notching, loosening, nerve injury, acromial and scapular spine fractures, intra-operative fractures and component disengagement. Careful attention to implant design and surgical technique, including implantation of components in the correct version and height, selection of the best glenosphere-humeral bearing match, avoidance of impingement, and adequate management of the soft tissues will hopefully translate in a decreasing number of complications in the future. Cite this article: Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev 2016;1:72-80. DOI: 10.1302/2058-5241.1.160003. PMID:28461931

Complications in reverse shoulder arthroplasty.

PubMed

Barco, Raul; Savvidou, Olga D; Sperling, John W; Sanchez-Sotelo, Joaquín; Cofield, Robert H

2016-03-01

The reported rate of complications of reverse shoulder arthroplasty (RSA) seems to be higher than the complication rate of anatomical total shoulder arthroplasty.The reported overall complication rate of primary RSA is approximately 15%; when RSA is used in the revision setting, the complication rate may approach 40%.The most common complications of RSA include instability, infection, notching, loosening, nerve injury, acromial and scapular spine fractures, intra-operative fractures and component disengagement.Careful attention to implant design and surgical technique, including implantation of components in the correct version and height, selection of the best glenosphere-humeral bearing match, avoidance of impingement, and adequate management of the soft tissues will hopefully translate in a decreasing number of complications in the future. Cite this article: Barco R, Savvidou OD, Sperling JW, Sanchez-Sotelo J, Cofield RH. Complications in reverse shoulder arthroplasty. EFORT Open Rev 2016;1:72-80. DOI: 10.1302/2058-5241.1.160003.

The shoulder pain and disability index: the construct validity and responsiveness of a region-specific disability measure.

PubMed

Heald, S L; Riddle, D L; Lamb, R L

1997-10-01

The purposes of this study were (1) to assess the construct validity of the Shoulder Pain and Disability Index (SPADI) and (2) to determine whether the SPADI is more responsive than the Sickness Impact Profile (SIP), a generic health status measure. The sample consisted of 94 patients who were diagnosed with a shoulder problem and referred to six outpatient physical therapy clinics. Clinically meaningful change was determined by use of an ordinal rating scale designed to determine whether the patient's shoulder function was improved, the same, or worse following treatment. Spearman rho correlations were calculated for the initial visit SPADI and SIP scores. The standardized response mean (SRM) was used to measure responsiveness for the patients who were judged to be improved. One-tailed paired t tests (alpha = .01) were used to determine whether differences existed among SRM values. Correlations between the SPADI and SIP scores ranged from r = .01 to r = .57. The SRM value was higher for the SPADI total score (SRM = 1.38) than for the SIP total score (SRM = 0.79). Most correlations between SPADI and SIP scores provided support for the construct validity of the SPADI. The SPADI does not appear to strongly reflect occupational and recreational disability and is more responsive than the SIP.

Shoulder functional performance status of Minor League professional baseball pitchers.

PubMed

Fronek, Jan; Yang, Jingzhen Ginger; Osbahr, Daryl C; Pollack, Keshia M; ElAttrache, Neal S; Noonan, Thomas J; Conte, Stan A; Mandelbaum, Bert R; Yocum, Lewis A

2015-01-01

The Overhead Shoulder and Elbow Score (Kerlan-Jobe Orthopaedic Clinic [KJOC] score) among healthy or uninjured professional baseball pitchers is lacking. We hypothesized that shoulder function and performance status measured by the KJOC score among active Minor League professional baseball pitchers were high at pre-participation and that the pitchers who had not been previously treated for a shoulder injury and were playing without arm trouble had significantly higher KJOC scores than their counterparts. In this cross-sectional survey, data on pre-participation KJOC scores, along with other study measures, were collected from a cohort of Minor League professional baseball pitchers. Generalized estimating equations with a Poisson distribution were used for analysis. A total of 366 Minor League professional pitchers were included, with a mean KJOC score of 92.8 points (SD, 12.1 points), suggesting that participating pitchers' shoulder function and performance were high. Participating pitchers who had not received treatment for a shoulder injury had significantly higher KJOC scores than those who had received treatment, either surgical or nonsurgical (β = 0.0238, P = .0495). In addition, pitchers who were not currently injured, were playing without arm trouble, or had not missed games in the past 12 months because of a shoulder injury also had statistically significantly higher KJOC scores than their counterparts. This study provides an empirical profile of the KJOC score for a large sample of active Minor League professional baseball pitchers and identifies risk factors associated with decreased KJOC scores. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Point Cloud Oriented Shoulder Line Extraction in Loess Hilly Area

NASA Astrophysics Data System (ADS)

Min, Li; Xin, Yang; Liyang, Xiong

2016-06-01

Shoulder line is the significant line in hilly area of Loess Plateau in China, dividing the surface into positive and negative terrain (P-N terrains). Due to the point cloud vegetation removal methods of P-N terrains are different, there is an imperative need for shoulder line extraction. In this paper, we proposed an automatic shoulder line extraction method based on point cloud. The workflow is as below: (i) ground points were selected by using a grid filter in order to remove most of noisy points. (ii) Based on DEM interpolated by those ground points, slope was mapped and classified into two classes (P-N terrains), using Natural Break Classified method. (iii) The common boundary between two slopes is extracted as shoulder line candidate. (iv) Adjust the filter gird size and repeat step i-iii until the shoulder line candidate matches its real location. (v) Generate shoulder line of the whole area. Test area locates in Madigou, Jingbian County of Shaanxi Province, China. A total of 600 million points are acquired in the test area of 0.23km2, using Riegl VZ400 3D Laser Scanner in August 2014. Due to the limit Granted computing performance, the test area is divided into 60 blocks and 13 of them around the shoulder line were selected for filter grid size optimizing. The experiment result shows that the optimal filter grid size varies in diverse sample area, and a power function relation exists between filter grid size and point density. The optimal grid size was determined by above relation and shoulder lines of 60 blocks were then extracted. Comparing with the manual interpretation results, the accuracy of the whole result reaches 85%. This method can be applied to shoulder line extraction in hilly area, which is crucial for point cloud denoising and high accuracy DEM generation.

Glenoid subchondral bone density distribution in male total shoulder arthroplasty subjects with eccentric and concentric wear.

PubMed

Simon, Peter; Gupta, Anil; Pappou, Ioannis; Hussey, Michael M; Santoni, Brandon G; Inoue, Nozomu; Frankle, Mark A

2015-03-01

Glenoid component loosening in total shoulder arthroplasty may be prevented by component placement on a congruent and adequate bony surface. Glenoid subchondral bone density (SBD) variability may be correlated with this concept. This study analyzed the 3-dimensional distribution of glenoid SBD in total shoulder arthroplasty patients with osteoarthritis. Three-dimensional computed tomography osteoabsorptiometry (CT-OAM) was performed in 42 men (21 with eccentric and 21 with concentric wear patterns) with glenohumeral arthritis. Glenoid SBD was measured from the joint surface based on 5 clinically relevant topographic zones. The correlation of the wear pattern with the SBD distribution was investigated. The glenoid subarticular layers could be separated into distinct regions: calcified cartilage (≤ 1.5 mm), subchondral plate (2-4.5 mm) and cancellous bone (≥ 5 mm). There were significant differences in SBD among these layers within and between patients with concentric and eccentric wear patterns. In concentric glenoids, the SBD distribution was homogeneous, with greater mineralization in the central zone, 1,749.1 ± 162.3 Hounsfield units (HU) (at 2.5 mm), compared with the posterior, anterior, and superior zones (P < .001). In the eccentric group, the SBD distribution was inhomogeneous. Mineralization was greatest in the posterior zone, 1,739.0 ± 172.6 HU (at 2.5 mm), followed by the inferior zone, 1,722.1 ± 186.6 HU (at 3 mm). This study represents the first study using CT-OAM to evaluate the 3-dimensional SBD distribution of the glenoid vault for different arthritic wear patterns. The study findings indicate that the SBD distribution is dependent on (1) depth from the articular surface, (2) topographic zone, and (3) wear pattern. CT-OAM may be an effective tool to assist in preoperative planning for shoulder arthroplasty. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Influence of dominant- as compared with nondominant-side symptoms on Disabilities of the Arm, Shoulder and Hand and Western Ontario Rotator Cuff scores in patients with rotator cuff tendinopathy.

PubMed

Christiansen, David Høyrup; Michener, Lori; Roy, Jean-Sébastien

2018-02-13

The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Western Ontario Rotator Cuff (WORC) index are 2 widely used patient-reported questionnaires in individuals with rotator cuff (RC) tendinopathy. In contrast to the WORC index, for which the items are specific to the affected shoulder, the items of the DASH questionnaire assess the ability to perform activities regardless of the arm used. The objective of this study is to determine whether scores on the DASH questionnaire and WORC index are affected if the symptoms are on the dominant or nondominant side in individuals with RC tendinopathy. Given the number of items that can be influenced by dominance, the hypothesis is that DASH scores will be impacted by the side of the symptoms. Individuals with RC tendinopathy (N = 149) completed questions on symptomatology and hand dominance, the DASH questionnaire, and the WORC index. Differences in total scores (independent t test) and single items (Wilcoxon rank sum test) were compared between groups of participants with dominant-side symptoms and those without dominant-side symptoms. No significant differences were observed for WORC or DASH total scores when comparing participants with and without symptoms on their dominant side. Single-item comparison revealed more items being affected by symptom side on the DASH questionnaire (6 of 30 items) than on the WORC index (2 of 21 items). The side of the symptoms does not influence the DASH and WORC total scores, as there are no systematic differences between individuals with and without symptoms in their dominant shoulder. However, the presence of dominant symptoms does influence item scores more on the DASH questionnaire than on the WORC index. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Shoulder-specific outcomes 1 year after nontraumatic full-thickness rotator cuff repair: a systematic literature review and meta-analysis.

PubMed

Gurnani, Navin; van Deurzen, Derek F P; van den Bekerom, Michel P J

2017-10-01

Nontraumatic full-thickness rotator cuff tears are commonly initially treated conservatively. If conservative treatment fails, rotator cuff repair is a viable subsequent option. The objective of the present meta-analysis is to evaluate the shoulder-specific outcomes one year after arthroscopic or mini-open rotator cuff repair of nontraumatic rotator cuff tears. A literature search was conducted in PubMed and EMBASE within the period January 2000 to January 2017. All studies measuring the clinical outcome at 12 months after nontraumatic rotator cuff repair of full-thickness rotator cuff tears were listed. We included 16 randomized controlled trials that met our inclusion criteria with a total of 1.221 shoulders. At 12 months after rotator cuff repair, the mean Constant score had increased 29.5 points; the mean American Shoulder and Elbow Score score increased by 38.6 points; mean Simple Shoulder Test score was 5.6 points; mean University of California Los Angeles score improved by 13.0 points; and finally, mean Visual Analogue Scale score decreased by 4.1 points. Based on this meta-analysis, significant improvements in the shoulder-specific indices are observed 12 months after nontraumatic arthroscopic or mini-open rotator cuff repair.

The influence of psychiatric comorbidity on perioperative outcomes after shoulder arthroplasty.

PubMed

Bot, Arjan G J; Menendez, Mariano E; Neuhaus, Valentin; Ring, David

2014-04-01

Psychiatric comorbidity has been associated with increased health risks and poor long-term treatment outcomes in numerous medical disciplines, but its effect in short-term perioperative settings is incompletely understood. The purpose of this study was to evaluate the influence of a preoperative diagnosis of depressive disorder, anxiety disorder, schizophrenia, or dementia on in-hospital (1) adverse events, (2) blood transfusion, and (3) nonroutine discharge in patients undergoing shoulder arthroplasty. Using the National Hospital Discharge Survey (NHDS) database, we identified 348,824 discharges having undergone partial or total shoulder arthroplasty from 1990 to 2007. Multivariable regression analysis was performed for each of the outcome variables. The prevalence of diagnosed depressive disorder was 4.4%, anxiety disorder, 1.6%; schizophrenia, 0.6%; and dementia, 1.5%. Preoperative psychiatric disorders, with the exception of schizophrenia, were associated with higher rates of adverse events. Depression and schizophrenia were associated with higher perioperative rates of blood transfusion. Any preoperative psychiatric illness was associated with higher rates of nonroutine discharge. Patients with preoperative psychiatric illness undergoing shoulder arthroplasty are at increased risk for perioperative morbidity and posthospitalization care. Preoperative screening of psychiatric illness might help with planning of shoulder arthroplasty. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Reverse Shoulder Arthroplasty Prosthesis Design Classification System.

PubMed

Routman, Howard D; Flurin, Pierre-Henri; Wright, Thomas W; Zuckerman, Joseph D; Hamilton, Matthew A; Roche, Christopher P

2015-12-01

Multiple different reverse total shoulder arthroplasty (rTSA) prosthesis designs are available in the global marketplace for surgeons to perform this growing procedure. Subtle differences in rTSA prosthesis design parameters have been shown to have significant biomechanical impact and clinical consequences. We propose an rTSA prosthesis design classification system to objectively identify and categorize different designs based upon their specific glenoid and humeral prosthetic characteristics for the purpose of standardizing nomenclature that will help the orthopaedic surgeon determine which combination of design configurations best suit a given clinical scenario. The impact of each prosthesis classification type on shoulder muscle length and deltoid wrapping are also described to illustrate how each prosthesis classification type impacts these biomechanical parameters.

Reverse shoulder arthroplasty for massive irreparable rotator cuff tears and cuff tear arthropathy: a systematic review.

PubMed

Petrillo, S; Longo, U G; Papalia, R; Denaro, V

2017-08-01

To report the outcomes and complications of reverse shoulder arthroplasty (RSA) in massive irreparable rotator cuff tears (MIRCT) and cuff tear arthropathy (CTA). A systematic review of the literature contained in Medline, Cochrane, EMBASE, Google Scholar and Ovid databases was conducted on May 1, 2016, according to PRISMA guidelines. The key words "reverse total shoulder arthroplasty" or "reverse total shoulder prostheses" with "rotator cuff tears"; "failed rotator cuff surgery"; "massive rotator cuff tears"; "irreparable rotator cuff tears"; "cuff tear arthropathy"; "outcomes"; "complications" were matched. All articles reporting outcomes and complications of RSA for the management of MIRCT or CTA were included. The comparison between preoperative and postoperative clinical scores, as well as range of motion (ROM), was performed using the Wilcoxon-Mann-Whitney test. P values lower than 0.05 were considered statistically significant. Seven articles were included in our qualitative synthesis. A statistically significant improvement in all clinical scores and ROM was found comparing the preoperative value with the postoperative value. The degrees of retroversion of the humeral stem of the RSA do not influence the functional outcomes in a statistically significant fashion. There were 17.4% of complications. The most frequent was heterotopic ossification, occurring in 6.6% of patients. Revision surgery was necessary in 7.3% of patients. RSA restores pain-free ROM and improves function of the shoulder in patients with MIRCT or CTA. However, complications occur in a high percentage of patients. The lack of level I studies limits the real understanding of the potentials and limitations of RSA for the management of MIRCT and CTA.

Living with a pacemaker: patient-reported outcome of a pacemaker system.

PubMed

Magnusson, Peter; Liv, Per

2018-06-04

The aim of this study was to assess among pacemaker patients their overall satisfaction with the pacemaker system, pain, soreness/discomfort, cosmetic results, restrictions due to impaired movement of the shoulder/arm/chest, related sleep disturbances, and concern about possible device malfunction. The seven-item questionnaire was mailed to patients from a single center who had a pacemaker implant or replacement between 2006 and 2016. A higher score indicated worse outcome on a visual analog scale (VAS) of 0-100 mm. The response rate was 75.5% and 342 questionniares were analyzed. Median age of respondents was 77.6 years and 57.0% were males. In total, 65 complications requiring surgery (10 pocket corrections (2.9%), 5 in females) occurred during a median follow-up of 5.6 years.The distribution of the primary outcome had a median score of 5 while the 75th percentile was 13. Cosmetic appearance was significantly associated with reoperation (but not other variables). Overall scores for men and women were 5 vs. 6, respectively, which achieved significance (p = 0.042). Median ratings of pain, soreness/discomfort, cosmetic appearance, range of motion, sleep, and concern about device malfunction were all ≤5. Females reported worse outcomes for all questions, except for cosmetic results and concern about malfunction. The vast majority of patients report excellent overall satisfaction with the pacemaker system, and are not affected by pain, soreness/discomfort, or concern about device malfunction. They also reported favourable outcomes with respect to cosmetic results, shoulder movement, and sleep. However, some patients underwent a surgical correction of the pacemaker pocket.

Revision to Reverse Total Shoulder Arthroplasty Restores Stability for Patients With Unstable Shoulder Prostheses.

PubMed

Hernandez, Nicholas M; Chalmers, Brian P; Wagner, Eric R; Sperling, John W; Cofield, Robert H; Sanchez-Sotelo, Joaquin

2017-11-01

Instability after shoulder arthroplasty remains a complication with limited salvage options. Reoperation for instability with anatomic designs has led to high rates of persistent instability, therefore we aimed to evaluate the use of RSA for treatment of prosthetic instability. (1) After revision shoulder arthroplasty to a reverse prosthesis (RSA), what is the survivorship free from dislocations at 2 and 5 years? (2) What factors are associated with dislocations? (3) What is the survivorship free from revision after revision to RSA? (4) From preoperation to postrevision to RSA, what are the clinical outcomes-the proportion of patients with moderate to severe pain, shoulder elevation and external rotation ROM, American Shoulder and Elbow Surgeons scores, and Simple Shoulder Test scores? All shoulder arthroplasties revised for prosthetic instability using RSA components between January 2004 and July 2014 were retrospectively studied. During the period in question, we performed 82 revisions for instability of an anatomic total shoulder arthroplasty (TSA) (n = 62), hemiarthroplasty (n = 13), or reverse TSA (n = 7). We typically used a reverse TSA to treat this problem, but we identified 12 treated in other ways, including revision of a TSA to hemiarthroplasty (n = 3), revision of a reverse TSA to hemiarthroplasty (n = 2), revision of hemiarthroplasty to a hemiarthroplasty (n = 1), and revision of an anatomic TSA to another anatomic TSA (n = 6). This left 70 patients for evaluation; of those, 65 (93%) were available for analysis at a mean of 3 years (range, 2-10 years). A total of seven patients died. Eight of the 65 shoulders were not evaluated during the last 5 years, including three in patients who died earlier. The mean age of the patients at the time of revision RSA was 65 years (range, 40-89 years). Data were obtained from a longitudinally maintained institutional joint registry. Instability was defined as severe subluxation confirmed on clinical and radiographic examinations. We evaluated pain and ROM, and Kaplan-Meier curves were used to estimate survivorship. The survivorship free from dislocation at 2 and 5 years was 87% (95% CI, 80%-94%) and 79% (95% CI, 67%-91%) respectively, with 10 of 65 (15%) patients having an episode of dislocation after revision surgery. Persistent instability was more common in those with a BMI greater than 35 kg/m 2 (hazard ratio [HR], 5; 95% CI, 2-16; p = 0.008) and prior hemiarthroplasty (HR, 5; 95% CI, 2-16; p = 0.005), whereas patients who had undergone a previous TSA were less likely to have persistent instability (HR, 0.08; 95% CI, 0.0-0.30; p < 0.001) The survival free from rerevision for any indication at 2 and 5 years was 85% (95% CI, 76%-94%) and 78% (95% CI, 66%-90%) respectively; with the numbers available, we were not able to find associated factors. Fewer patients had moderate or severe pain after revision to RSA (preoperative: 48 of 65 [74%]; postoperative: nine of 65 [14%]; p < 0.001). After surgery, patients showed improvement in shoulder elevation (preoperative: 42° [± 30°], postoperative: 112° [42°]; mean difference, 70° [95% CI, - 83 o to 57°]; p < 0.001) and external rotation (preoperative: 20° [± 22°], postoperative: 42° [± 23°]; mean difference, 22° [95% CI, - 30° to - 14°]; p < 0.001). American Shoulder and Elbow Surgeons scores improved (preoperative: 21 [± 10], postoperative: 68 [± 14], mean difference, 46 [95% CI, - 58 to - 35]; p < 0.001); where a higher score is better. Simple Shoulder Test scores also improved (preoperative: 2/12 [± 2], postoperative: 7/12 [± 3]; mean difference, 5 [95% CI, - 7 to - 2.17]; p < 0.001); where a higher score is better. Revision RSA for prosthetic instability after shoulder arthroplasty is associated with reasonable implant survival and few complications. Approximately one in seven patients will have a recurrent dislocation. In patients with persistent instability or with risk factors for instability, consideration should be given for use of larger glenospheres and increasing the lateral offset at the time of RSA. Level IV, therapeutic study.

[Shoulder joint pain of rotator cuff injury treated with electroacupuncture and Mulligan's mobilization: a randomized controlled trial].

PubMed

Wang, Yanwu; Wang, Chongmin; Chen, Huade; Ye, Xinmiao

2018-01-12

To verify the clinical therapeutic effects on shoulder joint pain of rotator cuff injury treated with electroacupuncture (EA) and Mulligan's mobilization. A total of 120 patients of shoulder joint pain of rotator cuff injury were randomized into an EA group, a rehabilitation group and a combined therapy group, 40 cases in each one. In the EA group, EA was applied to Jianzhen (SI 9), Jianliao (TE 14), Jianyu (LI 15), Tianzong (SI 11), Jianqian (extra) and Binao (LI 14) in the affected side. Of these acupoints, Jianliao (TE 14) and Jianyu (LI 15), Jianzhen (SI 9) and Tianzong (SI 11) were stimulated with Han 's electric apparatus. In the rehabilitation group, Mulligan's mobilization was used, including scapular mobilization, static joint mobilization and dynamic joint mobilization. In the combined therapy group, EA was used in combination with Mulligan mobilization. The treatment was given once a day in each group, 5 sessions a week, totally for 6 weeks. The pain intensity of shoulder joint (VAS), the University of California at Los Angeles shoulder rating scale (UCLA) and the range of motion (ROM) of shoulder joint were evaluated before and 6 weeks after treatment separately. The adverse reactions were recorded in each group. VAS scores were all reduced, UCLA scores increased and ROM improved after treatment as compared with those before treatment in the patients of the three groups (all P <0.05). After treatment, VAS score, UCLA score and ROM in the combined therapy group were remarkably improved as compared with those in the EA group and the rehabilitation group (all P <0.05). Regarding the improvements of VAS and UCLA scores, the results in the EA group were better than those in the rehabilitation group (both P <0.05). Regarding ROM improvement, the results in the rehabilitation group were superior to those in the EA group (all P <0.05). There was no adverse reaction in the two groups. The combined therapy of EA and Mulligan's mobilization relieves shoulder joint pain of rotator cuff injury, better than the simple application of either EA or Mulligan's mobilization.

Peripheral nerve blocks in shoulder arthroplasty: how do they influence complications and length of stay?

PubMed

Stundner, Ottokar; Rasul, Rehana; Chiu, Ya-Lin; Sun, Xuming; Mazumdar, Madhu; Brummett, Chad M; Ortmaier, Reinhold; Memtsoudis, Stavros G

2014-05-01

Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery. Using a large national cohort, we asked: (1) How frequently are upper-extremity peripheral nerve blocks added to general anesthesia in patients undergoing total shoulder arthroplasty? (2) Are there differences in the incidence of and adjusted risk for major perioperative complications and mortality between patients receiving general anesthesia with and without nerve blocks? And (3) does resource utilization (blood product transfusion, intensive care unit admission, length of stay) differ between groups? We searched a nationwide discharge database for patients undergoing total shoulder arthroplasty under general anesthesia with or without addition of a nerve block. Groups were compared with regard to demographics, comorbidities, major perioperative complications, and length of stay. Multivariable logistic regressions were performed to measure complications and resource use. A negative binomial regression was fitted to measure length of stay. We identified 17,157 patients who underwent total shoulder arthroplasty between 2007 and 2011. Of those, approximately 21% received an upper-extremity peripheral nerve block in addition to general anesthesia. Patients receiving combined regional-general anesthesia had similar mean age (68.6 years [95% CI: 68.2-68.9 years] versus 69.1 years [95% CI: 68.9-69.3 years], p < 0.0043), a slightly lower mean Deyo (comorbidity) index (0.87 versus 0.93, p = 0.0052), and similar prevalence of individual comorbidities, compared to those patients receiving general anesthesia only. Addition of regional anesthesia was not associated with different odds ratios for complications, transfusion, and intensive care unit admission. Incident rates for length of stay were also similar between groups (incident rate ratio = 0.99; 95% CI: 0.97-1.02; p = 0.467) CONCLUSIONS: Addition of regional to general anesthesia was not associated with an increased complication profile or increased use of resources. In combination with improved pain control as known from previous research, regional anesthesia may represent a viable management option for shoulder arthroplasty. However, further research is necessary to better clarify the risk of neurologic complications. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

19F and 31P magic-angle spinning nuclear magnetic resonance of antimony(III)-doped fluorapatite phosphors: Dopant sites and spin diffusion

NASA Astrophysics Data System (ADS)

Moran, Liam B.; Berkowitz, Jeffery K.; Yesinowski, James P.

1992-03-01

Phosphors based on calcium fluorapatite [Ca5F(PO4)3] doped with small amounts of Sb3+ as an activator are used in most fluorescent lamps. We have used quantitative 19F and 31P magic-angle spinning nuclear magnetic resonance (MAS-NMR) to study seven samples of calcium fluorapatite containing 0.0-3.0 wt % Sb3+ in order to determine the site of antimony substitution. The 31P MAS-NMR spectra of fluorapatite containing 3.0, 2.1, and 1.3 wt % antimony contain a single sharp peak at 2.8 ppm indistinguishable from undoped fluorapatite, and show no additional peaks attributable to the influence of antimony. The 31P MAS-NMR spectra of the model compounds SbPO4, Sr1.03Ca8.97F2(PO4)6, Sr5F(PO4)3, and Ba5F(PO4)3 were also obtained. The 19F MAS-NMR spectra of the antimony-doped samples exhibit, in addition to the main peak at 64.0 ppm (downfield from C6F6) arising from unperturbed fluorapatite, a shoulder at 65.6 ppm, and a sharp peak at 68.6 ppm. The measured spin-lattice relaxation times T1 of these antimony-related peaks are equal in all cases to that of the main peak in a given sample, and vary from 129 to 378 sec, indicating that these peaks arise from apatitic fluoride ions perturbed by antimony. Quantitative studies reveal that the 68.6-ppm peak arises from two fluoride ions and the 65.6-ppm shoulder from one fluoride ion per Sb3+ ion incorporated into the lattice. The selective population anti-z and rate of transfer to adjacent nuclei (SPARTAN) pulse sequence used to measure spin diffusion by selectively inverting the 68.6-ppm peak reveals the presence of cross-relaxation to the main peak at 64.0 ppm, but not to the shoulder at 65.6 ppm. Each Sb3+ ion thus appears to be perturbing fluoride ions in at least two different chains. An additional peak at 73.1 ppm observed in some samples is assigned to a second type of antimony(III) substitution, with a single fluoride ion perturbed by each antimony ion. The results in total provide detailed support for a substitution model in which antimony(III) occupies a phosphate site in the apatite lattice, with a SbO3-3 group replacing a PO3-4 group. Two types of substitution at this site appear to occur, depending upon which oxygen atom is replaced by the antimony lone electron pair.

Simulation in shoulder surgery.

PubMed

Colaço, Henry B; Tennent, Duncan

2016-10-01

Simulation is a rapidly developing field in medical education. There is a growing need for trainee surgeons to acquire surgical skills in a cost-effective learning environment to improve patient safety and compensate for a reduction in training time and operative experience. Although simulation is not a replacement for traditional models of surgical training, and robust assessment metrics need to be validated before widespread use for accreditation, it is a useful adjunct that may ultimately lead to improving surgical outcomes for our patients.

[Therapy of traumatic anterior shoulder dislocation: current status of therapy in Germany. Are there scientifically verified therapy concepts?].

PubMed

Tingart, M; Bäthis, H; Bouillon, B; Tiling, T

2001-06-01

There are no generally accepted concepts for the treatment of traumatic anterior shoulder dislocation. The objective of this study was to ascertain the current treatment for traumatic shoulder dislocations in German hospitals and to compare this with the data reported in the literature. A total of 210 orthopedic surgery departments were asked for their treatment strategy in an anonymous country-wide survey; 103 questionnaires (49%) were returned for evaluation. Additional imaging (ultrasound, CT, MRI) beyond the routine X-rays is performed in 82% of clinics for primary shoulder dislocation (94% in recurrent dislocation). A young, athletic patient (< 30 years old) would be operated on for a primary traumatic shoulder dislocation in 73% of hospitals (98% in recurrent dislocation). In contrast, a patient of the same age, with a moderate level of sporting activity would be treated conservatively in 67% of cases (14% in recurrent dislocation). Similarly, for an active, middle-aged patient with a demanding job, 74% of responses favored conservative treatment after a primary dislocation and 6% after a recurrent dislocation. Older patients (> 65 years old) are usually treated conservatively after a primary or recurrent shoulder dislocation (99%, 69%). For a primary shoulder dislocation the most popular surgical reconstruction is a Bankart repair (75%). For recurrent shoulder dislocation several different operative techniques are seen (Bankart 29%, T-shift 26%, Putti-Platt 8%, Eden-Lange-Hybbinette 22%, Weber osteotomy 13%). Based on our literature review, we found: (1) The clinical examination of both shoulders is important to diagnose hyperlaxity; (2) Routine CT or MRI is not necessary for primary traumatic shoulder dislocations; (3) A young, athletic patient should undergo surgical reconstruction after a primary shoulder dislocation; (4) The operation of choice for primary and recurrent dislocation is the Bankart repair; (5) There is no sufficient evidence that an arthroscopic Bankart repair is as good as an open procedure; (6) There are limited indications for other operative techniques, as they are associated with a higher recurrence and arthrosis rate.

Joint range of motion after total shoulder arthroplasty with and without a continuous interscalene nerve block: a retrospective, case-control study.

PubMed

Ilfeld, Brian M; Wright, Thomas W; Enneking, F Kayser; Morey, Timothy E

2005-01-01

Although a continuous interscalene nerve block (CISB) has been shown to provide potent analgesia after major shoulder surgery, its potential effects on postoperative rehabilitation remain uninvestigated. Therefore, this retrospective case-control study was undertaken to determine the association between CISB and joint range-of-motion after total shoulder arthroplasty (TSA). The medical records for patients who underwent TSA at our institution in the previous 3 years were examined. Each patient with a CISB (cases) was matched with a patient without a CISB (controls) for the following variables: age, gender, and TSA type (primary v revision). Data collected included maximum shoulder elevation and external rotation (primary endpoints), along with pre- and postoperative pain scores. Of 134 charts reviewed, 25 cases were matched with an equal number of controls. On postoperative day 1, patients with or without a CISB achieved a median (5th-95th percentiles) of 85% (51-100) and 33% (11-56) of their surgeon-defined goal for elevation (P = .048), respectively, and attained 100% (33-100) and 17% (-81-68) for external rotation (P < .001), respectively. The median numeric rating pain score (NRS) during shoulder movement for patients with CISB was 2.0 (0.0-8.7) versus 8.5 (1.8-10.0) for patients without CISB (P < .001). Least, median, and highest resting NRS for the 24 hours after surgery were 0.0 (0.0-5.8), 1.0 (0.0-6.4), and 3.0 (0.0-9.0) for patients with CISB, respectively, versus 2.0 (0.0-7.7), 6.0 (0.3-9.6), and 8.0 (0.0-10.0) for patients without CISB (P = .030, P < .001, and P < .001 between groups, respectively). The day after TSA, a CISB is associated with increased shoulder range of motion, most likely resulting from the potent analgesia these nerve blocks provide.

Topographical anatomy of the suprascapular nerve and vessels at the suprascapular notch.

PubMed

Yang, Hee-Jun; Gil, Young-Chun; Jin, Jeong-Doo; Ahn, Song Vogue; Lee, Hye-Yeon

2012-04-01

Suprascapular nerve entrapment caused by the superior transverse scapular ligament (STSL) causes pain, and limitation of motion in the shoulder. To relieve these symptoms, suprascapular nerve decompression is performed through the resection of STSL. To describe and classify the topographic anatomy of the suprascapular notch, 103 cadaveric shoulders were dissected. The mean length and width of STSLs were 11.2 and 3.4 mm, respectively. The bony bridges replacing STSL in four shoulders were 8.2 mm long and 3.5 mm wide on average. The suprascapular nerve always ran through the notch under the STSL. All shoulders had a single suprascapular artery, while multiple suprascapular veins appeared in 21.3%. The arrangement of the suprascapular vessels was classified into three types: in Type I (59.4%), all suprascapular vessels ran over the STSL; in Type II (29.7%), the vessels ran over and under the STSL simultaneously; in Type III (10.9%), all vessels ran under the STSL. In 48.9% of cadavers, these types were bilaterally matched. The omohyoid muscle originated distantly from the STSL in 38.0%, was adjacent to it in 44.0%, and was partially over the STSL in 18.0%. The number of suprascapular vessels running under the STSL was positively correlated with the size of the STSL and the middle diameter of the suprascapular notch. Age was inversely correlated with the length of STSL. The STSL was wider in males than in females. This study provides details of the structural variations in the region of the suprascapular notch. Copyright © 2011 Wiley Periodicals, Inc.

Glenohumeral joint rotation range of motion in competitive swimmers.

PubMed

Riemann, Bryan L; Witt, Joe; Davies, George J

2011-08-01

Much research has examined shoulder range of motion adaptations in overhead-unilateral athletes. Based on the void examining overhead-bilateral athletes, especially competitive swimmers, we examined shoulder external rotation, isolated internal rotation, composite internal rotation, and total arc of motion range of motion of competitive swimmers. The range of motion of registered competitive swimmers (n = 144, age = 12-61 years) was compared by limb (dominant, non-dominant), sex, and age group (youth, high school, college, masters). Significantly (P < 0.05) greater dominant external rotation was observed for both men and women high school and college swimmers, youth women swimmers, and men masters swimmers compared with the non-dominant limb. The isolated internal rotation (glenohumeral rotation), composite internal rotation (glenohumeral rotation plus scapulothoracic protraction), and total arc of motion (external rotation plus composite internal rotation) of the non-dominant limb was significantly greater than that of the dominant limb by sex and age group. Youth and high school swimmers demonstrated significantly greater composite internal rotation than college and masters swimmers. Youth swimmers displayed significantly greater total arc of motion than all other age groups. These data will aid in the interpretation of shoulder range of motion values in competitive swimmers during preseason screenings, injury evaluations and post-rehabilitation programmes, with the results suggesting that differences exist in bilateral external rotation, isolated internal rotation, composite internal rotation, and total arc of motion range of motion.

Two-year follow-up of low-level laser therapy for elderly with painful adhesive capsulitis of the shoulder

PubMed Central

Ip, David; Fu, Nga-Yue

2015-01-01

Introduction This paper reports on the medium-term mean 2-year prospective follow-up of a patient cohort of 35 unselected elderly patients with mean age of 65 years who visited our tertiary referral pain center for painful adhesive capsulitis of the shoulder managed with low-level laser therapy (LLLT). Materials and methods All patients in this prospective cohort study had documentation of the diagnosis by contrast-enhanced magnetic resonance imaging before study entry and all had failed to respond to a combination of conventional physical therapy and nonsteroidal anti-inflammatory medications for not fewer than 4 weeks. LLLT, at a wavelength of 810 nm emitted from a GaAIAs semiconductor laser device with 5.4 J per point and a power density of 20 mW/cm2, was employed to irradiate six predetermined anatomic points and two acupuncture points. The treatment regimen consisted of three sessions of treatment per week for 8 consecutive weeks. Each treatment session lasted 180 seconds. Serial clinical assessment was undertaken using the Constant–Murley shoulder score. Results A total of 50 painful shoulder joints were treated, as a number of elderly presented with bilateral symptoms. All but four painful shoulders showed significant improvement in Constant–Murley shoulder score at the end of 8-weeks’ LLLT treatment and, surprisingly, the improvement was found maintained at follow-up assessments at 1 year and 2 years. Conclusion We conclude that LLLT is a viable option in the conservative treatment of shoulder pain arising from adhesive capsulitis of the shoulder in the elderly, with a positive clinical result of more than 90% and with clinical efficacy both in the short-term and the medium-term. PMID:26045677

Effects of a Short-Duration Stretching Drill After Pitching on Elbow and Shoulder Range of Motion in Professional Baseball Pitchers.

PubMed

Escamilla, Rafael F; Yamashiro, Kyle; Mikla, Tony; Collins, Jeff; Lieppman, Keith; Andrews, James R

2017-03-01

A glenohumeral internal rotation (IR) deficit or a total rotational motion (IR plus external rotation [ER]) deficit in the throwing shoulder compared with the nonthrowing shoulder has been shown to increase the risk of shoulder and elbow injuries. After a pitching session, both IR and total rotational motion deficits have been shown to occur naturally for an extended period of time in asymptomatic pitchers, but it is unclear how to best control these deficits between pitching sessions. Purpose/Hypothesis: The purpose of this study was to determine whether performing a short-duration stretching/calisthenics drill after pitching will result in an increase in IR, ER, total rotational motion, and elbow extension in professional baseball pitchers. It was hypothesized that these shoulder and elbow passive range of motion (PROM) measurements would all decrease after pitching but would subsequently return to prepitching values after the short-duration stretching/calisthenics drill. Controlled laboratory study. A convenience sample of 20 male professional baseball pitchers served as study participants. The following sequence of activities was performed for all participants: (1) a 5- to 10-minute dynamic warm-up consisting of running and light throwing, (2) elbow extension and IR and ER PROM measurements taken before pitching, (3) 40 full-effort pitches off the pitching mound, (4) 8 minutes of rest, (5) elbow extension and IR and ER PROM measurements taken after pitching, (6) a short-duration stretching/calisthenics drill (two-out drill), and (7) elbow extension and IR and ER PROM measurements taken after the two-out drill. A 1-way repeated-measures analysis of variance ( P < .05) was employed to assess differences in elbow extension, IR, ER, and total rotational motion in the 3 measurement conditions (prepitching, postpitching, and postdrill). To assess intrarater and interrater reliability, intraclass correlation coefficients (ICCs) were calculated, and the measurement error was calculated using the standard error of measurement (SEM). Significant differences were observed among the 3 conditions for ER ( P = .002), IR ( P = .027), and total rotational motion ( P < .001), but there was no significant difference in elbow extension ( P = .117). Bonferroni post hoc analyses revealed (1) significantly greater ER during prepitching and postdrill versus the postpitching condition (94° ± 7° [prepitching] and 94° ± 8° [postdrill] vs 88° ± 8°; P = .010 and .005, respectively), (2) significantly greater IR during prepitching and postdrill versus the postpitching condition (36° ± 10° [prepitching] and 35° ± 9° [postdrill] vs 30° ± 10°; P = .034 and .043, respectively), and (3) significantly greater total rotational motion during prepitching and postdrill versus the postpitching condition (129° ± 13° [prepitching] and 129° ± 13° [postdrill] vs 119° ± 13°; P = .034 and .004, respectively). There were no significant differences in ER, IR, or total rotational motion between the prepitching and postdrill conditions ( P > .999 for all). The intrarater reliability (ICC 3,1 ) was 0.91 for ER (SEM, 1.3°) and 0.90 for IR (SEM, 1.9°), and the interrater reliability (ICC 2,1 ) was 0.81 for ER (SEM, 3.3°) and 0.77 for IR (SEM, 4.3°). After a 40-pitch bullpen session, IR and ER PROM as well as total rotational motion were significantly lower than prepitching values; however, these deficits were restored back to their prepitching levels after the players performed the two-out drill, which may increase pitching performance and decrease the risk of shoulder and elbow injuries. More research is needed to test these hypotheses and assess the clinical efficacy of the two-out drill. The findings from the current study will assist clinicians better understand the positive effects of performing a short duration stretching/calisthenics drill on shoulder internal and external rotation range of motion between innings while pitching during a baseball game.

Effect of Adding Interferential Current in an Exercise and Manual Therapy Program for Patients With Unilateral Shoulder Impingement Syndrome: A Randomized Clinical Trial.

PubMed

Gomes, Cid André Fidelis de Paula; Dibai-Filho, Almir Vieira; Moreira, William Arruda; Rivas, Shirley Quispe; Silva, Emanuela Dos Santos; Garrido, Ana Claudia Bogik

The purpose of this study was to measure the additional effect of adding interferential current (IFC) to an exercise and manual therapy program for patients with unilateral shoulder impingement syndrome. Forty-five participants were randomly assigned to group 1 (exercise and manual therapy), group 2 (exercise and manual therapy + IFC), or group 3 (exercise and manual therapy + placebo ultrasound). Individuals participated in 16 treatment sessions, twice a week for 8 weeks. The primary outcome of the study was total score of the Shoulder Pain and Disability Index (SPADI). The secondary outcomes were the pain and disability subscales of SPADI, Numeric Rating Scale, and Pain-Related Self-Statement Scale. Adjusted between-group mean differences (MDs) and 95% confidence intervals (CIs) were calculated using linear mixed models. After 16 treatment sessions, statistically significant but not clinically important differences were identified in favor of the exercise and manual therapy program alone in the SPADI-total (group 1 vs group 2, MD 11.12 points, 95% CI 5.90-16.35; group 1 vs group 3, MD 13.43 points, 95% CI 8.21-18.65). Similar results were identified for secondary outcomes. The addition of IFC does not generate greater clinical effects in an exercise and manual therapy program for individuals with unilateral shoulder impingement syndrome. Copyright © 2018. Published by Elsevier Inc.

Shoulder injuries to quarterbacks in the national football league.

PubMed

Kelly, Bryan T; Barnes, Ronnie P; Powell, John W; Warren, Russell F

2004-03-01

Quarterbacks are at risk for shoulder injury secondary to both the throwing motion as well as from contact injury. To delineate the incidence and etiology of shoulder injuries to quarterbacks in the National Football League (NFL). Using the NFL Injury Surveillance System (NFLISS), all reported injuries to quarterbacks between 1980 and 2001 were identified. A total of 1534 quarterback injuries were identified with a mean of 18.8 and a median of 6.0 days of playing time lost. The majority of these injuries occurred during a game (83.8%). Passing plays were responsible for 77.4% of all quarterback-related injuries. Shoulder injuries were the second most common injury reported (233 or 15.2%), following closely behind head injuries (15.4%). Direct trauma was responsible for 82.3% of the injuries, with acromioclavicular joint sprains being the most common injury overall (40%). Overuse injuries were responsible for 14% of the injuries, the most common being rotator cuff tendinitis (6.1%) followed by biceps tendinitis (3.5%). In this review, the vast majority of shoulder injuries in quarterbacks occurred as a result of direct trauma (82.3%), and less than 15% were overuse injuries resulting from the actual throwing motion.

Female adolescent elite handball players are more susceptible to shoulder problems than their male counterparts.

PubMed

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

2018-02-10

Shoulder problems are frequent among senior elite handball players. The objective of this study was to assess the prevalence of shoulder problems among adolescent elite handball players and to investigate potential differences in gender, school grade, playing position and playing level. During the 2014 and 2015 pre-season periods, 471 players (age 15-18 years, 54% female) completed a comprehensive baseline questionnaire regarding history of any shoulder pain and shoulder problems experienced during the past season. The players were monitored weekly for one competition season (September-April) regarding shoulder problems and the amount of match and training. Generalised linear models with a binomial link function were used to calculate a prevalence ratio (PR) with 95% confidence interval (CI) to compare the subgroups of players. In total, 110 players (23%) reported having substantial shoulder problems (defined as moderate/severe reduction in training volume, or moderate/severe reduction in performance, or complete inability to participate) at some point during the follow-up season, of which almost half reported complete inability to participate. Of those players reporting substantial problems, 43% (95% CI 39-48) did so for at least 3 consecutive weeks during the season. The prevalence was significantly higher in female players (PR 1.46, 95% 1.04-2.06) and in backcourt players (PR 1.58, 95% CI 1.08-2.32), but no differences were found for school grade (PR 1.21 95% CI 0.88-1.67) or playing level (PR 1.09 95% CI 0.76-1.56). The prevalence of substantial shoulder problems in adolescent elite handball players is high, especially among females, and this warrants further studies on risk factors for shoulder injury and the development of prevention strategies in handball players already before the age of 15. These findings also highlight the importance of introducing a clinical monitoring programme on a routine basis and improving the medical support, taking gender-related aspects into consideration, at handball-profiled secondary schools. II.

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

PubMed

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

2014-01-01

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

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

PubMed Central

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

2014-01-01

Introduction: Internal fixation with hook plate has been used to treat acromioclavicular joint dislocation. This study aims to evaluate the effect of its use on shoulder function, to further analyze the contributing factors, and provide a basis for selection and design of improved internal fixation treatment of the acromioclavicular joint dislocation in the future. Methods: A retrospective analysis was performed on patients treated with a hook plate for acromioclavicular joint dislocation in our hospital from January 2010 to February 2013. There were 33 cases in total, including 25 males and 8 females, with mean age of 48.27 ± 8.7 years. There were 29 cases of Rockwood type III acromioclavicular dislocation, 4 cases of type V. The Constant-Murley shoulder function scoring system was used to evaluate the shoulder function recovery status after surgery. Anteroposterior shoulder X-ray was used to assess the position of the hook plate, status of acromioclavicular joint reduction and the occurrence of postoperative complications. Results: According to the Constant-Murley shoulder function scoring system, the average scores were 78 ± 6 points 8 to 12 months after the surgery and before the removal of the hook plate, the average scores were 89 ± 5 minutes two months after the removal of hook plate. Postoperative X-ray imaging showed osteolysis in 10 cases (30.3%), osteoarthritis in six cases (18.1%), osteolysis associated with osteoarthritis in four cases(12.1%), and steel hook broken in one case (3%). Conclusion: The use of hook plate on open reduction and internal fixation of the acromioclavicular joint dislocation had little adverse effect on shoulder function and is an effective method for the treatment of acromioclavicular joint dislocation. Osteoarthritis and osteolysis are the two common complications after hook plate use, which are associated with the impairment of shoulder function. Shoulder function will be improved after removal of the hook plate. PMID:25356110

Inter-rater Reliability of Sustained Aberrant Movement Patterns as a Clinical Assessment of Muscular Fatigue

PubMed Central

Aerts, Frank; Carrier, Kathy; Alwood, Becky

2016-01-01

Background: The assessment of clinical manifestation of muscle fatigue is an effective procedure in establishing therapeutic exercise dose. Few studies have evaluated physical therapist reliability in establishing muscle fatigue through detection of changes in quality of movement patterns in a live setting. Objective: The purpose of this study is to evaluate the inter-rater reliability of physical therapists’ ability to detect altered movement patterns due to muscle fatigue. Design: A reliability study in a live setting with multiple raters. Participants: Forty-four healthy individuals (ages 19-35) were evaluated by six physical therapists in a live setting. Methods: Participants were evaluated by physical therapists for altered movement patterns during resisted shoulder rotation. Each participant completed a total of four tests: right shoulder internal rotation, right shoulder external rotation, left shoulder internal rotation and left shoulder external rotation. Results: For all tests combined, the inter-rater reliability for a single rater scoring ICC (2,1) was .65 (95%, .60, .71) This corresponds to moderate inter-rater reliability between physical therapists. Limitations: The results of this study apply only to healthy participants and therefore cannot be generalized to a symptomatic population. Conclusion: Moderate inter-rater reliability was found between physical therapists in establishing muscle fatigue through the observation of sustained altered movement patterns during dynamic resistive shoulder internal and external rotation. PMID:27347241

Clinical and radiographic outcomes after total shoulder arthroplasty with an anatomic press-fit short stem.

PubMed

Szerlip, Benjamin W; Morris, Brent J; Laughlin, Mitzi S; Kilian, Christopher M; Edwards, T Bradley

2018-01-01

There is limited information assessing outcomes after total shoulder arthroplasty (TSA) with a press-fit short stem. The purpose of this study was to evaluate early clinical and radiographic outcomes and complications after TSA with an anatomic press-fit short stem. We identified 118 TSAs completed with press-fit short stem and minimum 2-year follow-up; 85 of these patients had a grit-blasted (GB) short stem placed, whereas 33 patients had short stems with proximal porous coating (PPC). Shoulder function scores, active mobility measurements, and radiographs were assessed. The average age at surgery was 66.7 years, with average follow-up of 3 years. Significant improvements were noted for all shoulder function scores and active mobility measurements from the preoperative state to final follow-up (P < .001). There was no stem loosening in any patients with minimum 2-year follow-up; however, 3 female patients with GB stems had gross loosening of their humeral components before 1 year, 2 requiring revision. Radiolucent lines around the humeral component were found in 5.9% without evidence of loosening. Osseous resorption at the medial cortex was noted in 9.3%. Of patients with PPC stems, no patients were observed to have radiolucent lines compared with 8.2% in the GB group (P = .09). TSAs with anatomic press-fit short stem showed significant clinical improvements from the preoperative state to final short-term follow-up, with few complications and minimal radiographic changes. Lack of PPC may contribute to early loosening in patients with poor bone quality. The authors now use a short stem with PPC. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Range of motion and isometric strength of shoulder joints of team handball athletes during the playing season, Part II: changes after midseason.

PubMed

Fieseler, Georg; Jungermann, Philipp; Koke, Alexander; Irlenbusch, Lars; Delank, Karl-Stefan; Schwesig, Rene

2015-03-01

Our objective was to investigate the influence of workload and consecutive changes on active range of motion and isometric strength of team handball athletes' throwing shoulders (TSs) because the available data are insufficient. In a longitudinal investigation, 31 professional male handball athletes underwent a clinical shoulder examination. Athletes were examined at the beginning (week 0), at the end (week 6) of the preseasonal training, and at the end of the half-season (week 22) on both shoulders to determine isometric rotational strength (hand held dynamometer) and active range of motion (goniometer). This analysis demonstrates the results subsequently from week 6 to week 22 and from week 0 to week 22. The glenohumeral internal rotation (IR) deficit (GIRD), external rotation (ER) gain, and ER at the TS increased significantly (P < .05, η(2) > 0.10, d > 0.30) in the first sequence (week 6 to week 22) but not significantly from week 0 to week 22. The total range of motion remained stable, and IR changed but not significantly. There was no influence on IR, ER, and total range of motion at the non-TS. The isometric strength of the TS and non-TS IR did not change. The isometric strength in ER significantly increased bilaterally during the investigation period. Our data verify changes and influences, such as an increasing GIRD, at the overhead TS joint in accordance with the workload during team handball season. ER gain did improve after the half-season period but did not fully compensate the GIRD at the TS. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Quantifying the competing relationship between adduction range of motion and baseplate micromotion with lateralization of reverse total shoulder arthroplasty.

PubMed

Elwell, Josie; Choi, Joseph; Willing, Ryan

2017-02-08

Lateralizing the center of rotation (COR) of reverse total shoulder arthroplasty (rTSA) could improve functional outcomes and mitigate scapular notching, a commonly occurring complication of the procedure. However, resulting increases in torque at the bone-implant interface may negatively affect initial fixation of the glenoid-side component, especially if only two fixation screws can be placed. Shoulder-specific finite element (FE) models of four fresh-frozen cadaveric shoulders were constructed. Scapular geometry and material property distributions were derived from CT data. Generic baseplates with two and four fixation screws were virtually implanted, after which superiorly-oriented shear loads, accompanied by a compressive load, were applied incrementally further from the glenoid surface to simulate lateralization of the COR. Relationships between lateralization, adduction range of motion (ROM), the number of fixation screws and micromotion of the baseplate (initial implant fixation) were characterized. Lateralization significantly increases micromotion (p=0.015) and adduction ROM (p=0.001). Using two, versus four, baseplate fixation screws significantly increases micromotion (p=0.008). The effect of lateralization and the number of screws on adduction ROM and baseplate fixation is variable on a shoulder-specific basis. Trade-offs exist between functional outcomes, namely adduction ROM, and initial implant fixation and the negative effect of lateralization on implant fixation is amplified when only two fixation screws are used. The possibility of lateralizing the COR in order to improve functional outcomes of the procedure should be considered on a patient-specific basis accounting for factors such as availability and quality of bone stock. Copyright © 2016 Elsevier Ltd. All rights reserved.

Ecology of a nesting red-shouldered hawk population

USGS Publications Warehouse

Stewart, R.E.

1949-01-01

An ecological study of a nesting Red-shouldered Hawk population was made over a 185 square mile area on the Coastal Plain of Maryland in 1947. The courting and nesting season extended from late February until late June.....During the nesting season a combination of fairly extensive flood-plain forest with adjacent clearings appears to meet the major ecological requirements of the Red-shouldered Hawk in this region. A total of 51 pairs was found in the study area, occupying about 42 square miles or 23% of the total area studied. The population density on the land that was suitable for this species was about 1 pair per .8 of a square mile, while the density for the entire study area would be only about 1 pair per 3.6 square miles.....Nests were spaced fairly evenly over most of the flood-plain forests, especially in areas where the width.of the flood plain was relatively constant. There was an inverse correlation between the width of the flood plain and the distances between nests in adjacent territories. The nests were all situated in fairly large trees and were from 28 feet to 77 feet above the ground, averaging 50. They were found in 14 different species of trees, all deciduous.....The Barred Owl and Red-shouldered Hawk were commonly associated together in the same lowland habitats. Other raptores were all largely restricted to upland habitats....The average number of young in 47 occupied nests following the hatching period was 2.7 with extremes of 1 and 4. Only 3 out of 52 nests (6%) were found deserted at this time....The food habits of nestling Red-shouldered Hawks are very diversified. They feed on many types of warm-blooded and cold-blooded vertebrates as well as invertebrates.

Effects of Prosthetic Mismatch and Subscapularis Tear on Glenohumeral Contact Patterns in Total Shoulder Arthroplasty: A Numerical Musculoskeletal Analysis.

PubMed

Sins, Lauranne; Tétreault, Patrice; Nuño, Natalia; Hagemeister, Nicola

2016-12-01

Prosthetic components' mismatch and subscapularis (SC) tear are determining factors for glenoid failure complication in nonconforming total shoulder arthroplasty (NC-TSA). Risk factors are linked to glenoid prosthetic loading. However, the mechanisms underlying the clinical observations remain unclear. This study assessed the combined impact of mismatch and subscapularis tear on glenoid loading. It was assumed that adequate glenoid loading was associated with minimal, but non-null, humeral head translations and contact pressure, as well as with maximal glenoid contact area, and that the center of pressure (COP) on the glenoid would have a centered displacement pattern. A numerical model was used to achieve two objectives. The first was to verify whether an optimum mismatch existed, for which failure risk would be minimal. The second was to explore the effect of subscapularis tear on the position of applied forces on the glenoid. A shoulder AnyBody musculoskeletal model was adapted to the arthroplasty context by introducing humeral head translations and contact between implants. Ten simulations were computed to compare combinations of varying mismatches (1.4 mm, 3.4 mm, 6.4 mm, 8.6 mm, and 9 mm) with two shoulder conditions (intact-muscle or subscapularis tear). Humeral head translations, center-of-pressure, contact area, contact pressure, and glenohumeral joint contact forces were numerically estimated. Mismatches between 3.4 mm and 6.4 mm were associated with the most minimal humeral translations and contact pressure, as well as with maximal contact area. Center of pressure displacement pattern differed according to shoulder condition, with an outward anterior tendency in presence of tear.

Latissimus dorsi transfer to restore external rotation with reverse shoulder arthroplasty: a biomechanical study.

PubMed

Favre, Philippe; Loeb, Michael D; Helmy, Naeder; Gerber, Christian

2008-01-01

In patients with pseudoparesis of the shoulder resulting from irreparable rotator cuff tears, reverse shoulder arthroplasty (RSA) can restore active elevation, but external rotation remains less predictable. Latissimus dorsi transfer (LDT) has been shown to be effective in restoring external rotation in patients with posterosuperior tears of the rotator cuff. The aim of this study is to determine the capacity of the LDT to restore external rotation in combination with RSA and to investigate the mechanical advantage produced by 3 different insertion sites. A biomechanical model was created using a reverse total shoulder prosthesis with 3 different transfer insertions. Moment arms were measured for 2 static positions and 1 motion of the humerus. The moment arm analysis showed that LDT can improve active external rotation in the setting of a reverse prosthesis. An insertion site on the posterior side of the greater tuberosity (adjacent to the teres minor insertion) produced a greater external rotation moment arm.

Liposomal bupivacaine versus interscalene nerve block for pain control after total shoulder arthroplasty: A systematic review and meta-analysis.

PubMed

Wang, Kun; Zhang, Hong-Xia

2017-10-01

To illustrate the efficacy liposomal bupivacaine versus interscalene nerve block for pain management after total shoulder arthroplasty. A systematic search was performed in Medline, PubMed, Embase, ScienceDirect and the Cochrane Library. Data on patients prepared for total shoulder arthroplasty in studies that compared liposomal bupivacaine versus interscalene nerve block were retrieved. The endpoints were the visual analogue scale (VAS) and opioid consumption. Fixed/random effect model was used according to the heterogeneity tested by I 2 statistic. Software of Stata 11.0 was used for pooling the final outcomes. Four randomized controlled trials (RCTs) including 510 patients met the inclusion criteria. The present meta-analysis indicated that there were no significant differences between groups in terms of VAS score at 12 h, 24 h, and 48 h (p > 0.05). No significant differences were found regarding to opioid consumption at postoperative 12 h, 24 h and 48 h (p > 0.05). Compared with interscalene nerve block, liposomal bupivacaine had comparative effectiveness on reducing both pain scores and opioid consumption. Higher quality RCTs are required for further research. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

Association of objectively measured arm inclination with shoulder pain: A 6-month follow-up prospective study of construction and health care workers.

PubMed

Koch, Markus; Lunde, Lars-Kristian; Veiersted, Kaj Bo; Knardahl, Stein

2017-01-01

The aim was to determine the association of occupational arm inclination with shoulder pain in construction and health care workers. Arm inclination relative to the vertical was measured with an accelerometer placed on the dominant upper arm for up to four full days at baseline in 62 construction workers and 63 health care workers. The pain intensity in the shoulder and mechanical and psychosocial work factors were measured by self-reports at baseline and prospectively after 6 months. The associations between exposures and shoulder pain were analyzed with multilevel mixed-effects linear regressions. For the total study population working with the dominant arm at inclinations > 30° and >120° was associated with lower levels of shoulder pain both cross-sectionally and after 6 months. Associations were attenuated when adjusting for individual and social factors, psychological state, and exposure during leisure time, especially for the high inclination levels. Analyses, only including subjects with no pain at baseline revealed no significant associations. While stratified analysis showed negative associations in the construction worker group, there were no significant association in health care workers. Compared to the number of hypotheses tested, the number of significant findings was low. Adjustment by Bonferroni-correction made almost all findings insignificant. All analyses reflected a negative association between arm inclination and shoulder pain, but few analyses showed these associations to be statistically significant. If there is a relationship between arm inclination and shoulder pain, these findings could indicate that pain-avoidance may modify how workers perform their tasks.

Propionibacterium acnes in primary shoulder arthroplasty: rates of colonization, patient risk factors, and efficacy of perioperative prophylaxis.

PubMed

Koh, Chuan Kong; Marsh, Jonathan P; Drinković, Dragana; Walker, Cameron G; Poon, Peter C

2016-05-01

Recent literature has shown that Propionibacterium acnes can be cultured from superficial and deep layers of the shoulder. Our aims were to assess the rate of P. acnes colonization in patients undergoing primary shoulder arthroplasty, to identify patient-related risk factors, and to evaluate the efficacy of our perioperative antisepsis protocol. Thirty consecutive patients undergoing primary shoulder arthroplasty were included in our study. Swabs were taken perioperatively (4 superficial and 2 deep wound swabs) and analyzed quantitatively for P. acnes. Cefazolin minimum inhibitory concentration was determined for P. acnes isolates from positive deep cultures. Twenty-two patients (73%) had positive cultures for P. acnes. Male gender (P = .024) and presence of hair (P = .005) had significantly higher rates of P. acnes superficial cultures. Subjects with positive superficial P. acnes cultures (P = .076) and presence of hair with a history of steroid injection (P = .092) were more likely to have deep P. acnes-positive cultures, but this was not statistically significant. Local topical antisepsis measures did not eradicate P. acnes (P = .12). Mean cefazolin minimum inhibitory concentration for P. acnes was 0.32 μg/mL. P. acnes is commonly isolated from the skin and deep surgical wounds of patients undergoing primary total shoulder arthroplasty who have not had previous shoulder surgery. Male gender and presence of hair were significant risk factors for P. acnes colonization. Perioperative local topical antisepsis and cefazolin administration were not effective in eliminating P. acnes colonization. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Association of objectively measured arm inclination with shoulder pain: A 6-month follow-up prospective study of construction and health care workers

PubMed Central

Koch, Markus; Lunde, Lars-Kristian; Veiersted, Kaj Bo; Knardahl, Stein

2017-01-01

Objectives The aim was to determine the association of occupational arm inclination with shoulder pain in construction and health care workers. Methods Arm inclination relative to the vertical was measured with an accelerometer placed on the dominant upper arm for up to four full days at baseline in 62 construction workers and 63 health care workers. The pain intensity in the shoulder and mechanical and psychosocial work factors were measured by self-reports at baseline and prospectively after 6 months. The associations between exposures and shoulder pain were analyzed with multilevel mixed-effects linear regressions. Results For the total study population working with the dominant arm at inclinations > 30° and >120° was associated with lower levels of shoulder pain both cross-sectionally and after 6 months. Associations were attenuated when adjusting for individual and social factors, psychological state, and exposure during leisure time, especially for the high inclination levels. Analyses, only including subjects with no pain at baseline revealed no significant associations. While stratified analysis showed negative associations in the construction worker group, there were no significant association in health care workers. Compared to the number of hypotheses tested, the number of significant findings was low. Adjustment by Bonferroni-correction made almost all findings insignificant. Conclusions All analyses reflected a negative association between arm inclination and shoulder pain, but few analyses showed these associations to be statistically significant. If there is a relationship between arm inclination and shoulder pain, these findings could indicate that pain-avoidance may modify how workers perform their tasks. PMID:29176761

Effectiveness of Kinesiotaping and Subacromial Corticosteroid Injection in Shoulder Impingement Syndrome.

PubMed

Şahin Onat, Şule; Biçer, Seda; Şahin, Zehra; Küçükali Türkyilmaz, Ayşegül; Kara, Murat; Özbudak Demir, Sibel

2016-08-01

The aim of this study was to investigate whether kinesiotaping or subacromial corticosteroid injection provides additional benefit when used with nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with shoulder impingement syndrome. Patients with shoulder impingement syndrome were divided into 3 groups as follows: NSAID group (n = 33), kinesiotaping group (kinesiotaping + NSAID) (n = 33), and injection group (subacromial corticosteroid injection + NSAID) (n = 33). Outcome measures including visual analog scale, shoulder ranges of motion, Shoulder Disability Questionnaire, and University of California-Los Angeles (UCLA) scale were evaluated before and after the treatment (fourth week). A total of 99 patients (21 male and 78 female patients) were enrolled in this study. Demographic and baseline clinical characteristics of the groups (except for body mass index and visual analog scale at night, both P = 0.05) were similar between the groups (all P > 0.05). Clinical parameters were found to have improved in the 3 groups (all P < 0.001). While the kinesiotaping and injection groups showed similar improvements (all P > 0.05), each group had better outcome than did the NSAID group as regards pain (activity visual analog scale), ranges of motion, and Shoulder Disability Questionnaire and UCLA scale scores (all P < 0.05). Addition of kinesiotaping or subacromial corticosteroid injection to NSAID treatment seems to have better/similar effectiveness in patients with shoulder impingement syndrome. Therefore, kinesiotaping might serve as an alternative treatment in case (injection of) corticosteroids are contraindicated. Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES:: Upon completion of this article, the reader should be able to: (1) Delineate appropriate treatment options for shoulder impingement syndrome; (2) Identify treatment benefits of kinesiotaping and corticosteroid injections in shoulder impingement syndrome; and (3) Incorporate kinesiotaping and corticosteroid injections into the treatment plan for patients with shoulder impingement syndrome. Advanced : The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for amaximumof 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Isolated glenohumeral range of motion, excluding side-to-side difference in humeral retroversion, in asymptomatic high-school baseball players.

PubMed

Mihata, Teruhisa; Takeda, Atsushi; Kawakami, Takeshi; Itami, Yasuo; Watanabe, Chisato; Doi, Munekazu; Neo, Masashi

2016-06-01

Glenohumeral range of motion is correlated with shoulder capsular condition and is thus considered to be predictive of shoulder pathology. However, in throwing athletes, a side-to-side difference in humeral retroversion makes it difficult to evaluate capsular condition on the basis of glenohumeral range of motion measured by using the conventional technique. The purpose of this study was to measure isolated glenohumeral rotation, excluding side-to-side differences in humeral retroversion, in asymptomatic high-school baseball players. A total of 195 high-school baseball players (52 pitchers and 143 position players; median age, 16 years) and 20 high-school non-throwing athletes (median age, 16 years) without any shoulder symptoms were enroled in this study. Glenohumeral external and internal rotations were measured by using both a conventional technique and our ultrasound-assisted technique. This technique, neutral rotation, was standardized on the basis of the ultrasonographically visualized location of the bicipital groove to exclude side-to-side differences in humeral retroversion from the calculated rotation angle. Intra- and inter-observer agreements of rotational measurements were evaluated by using intra-class correlation coefficients (ICCs). Isolated glenohumeral rotation measurements, excluding side-to-side differences in humeral retroversion, demonstrated excellent intra-observer (ICC > 0.89) and inter-observer (ICC > 0.78) agreements. Isolated glenohumeral internal rotation was significantly less in the dominant shoulder than in the non-dominant shoulder in asymptomatic baseball players (P < 0.001). Isolated glenohumeral external rotation in baseball players was significantly greater than in non-throwing athletes (P < 0.05). In the baseball players, humeral torsion in the dominant shoulder was significantly greater than that in the non-dominant shoulder (P < 0.001), indicating that the retroversion angle was greater in dominant shoulders than in non-dominant shoulders. Isolated glenohumeral external and internal rotations can be measured with high intra- and inter-observer reliability with the exclusion of side-to-side differences in humeral retroversion. Capsular and muscular changes in the throwing shoulder may be better evaluated by using our ultrasound-assisted technique. Cross-sectional study, Level III.

Posterior glenoid bone grafting in total shoulder arthroplasty for osteoarthritis with severe posterior glenoid wear.

PubMed

Nicholson, Gregory P; Cvetanovich, Gregory L; Rao, Allison J; O'Donnell, Patrick

2017-10-01

Total shoulder arthroplasty (TSA) in cases with posterior wear can be addressed by eccentric reaming of the anterior glenoid or by augmenting the posterior glenoid with bone grafting or augmented glenoid implants. We report the results of TSA with posterior glenoid bone grafting (PGBG) with humeral head autograft in patients with shoulder osteoarthritis and severe posterior glenoid wear. A retrospective review of cases from 2004 to 2014 revealed 34 patients. Preoperative and postoperative radiographs were evaluated for glenoid version and humeral head subluxation as well as component loosening. Patient-reported outcomes were compared preoperatively and postoperatively. Complications and reoperations were also evaluated. Of the 34 patients, 28 (82.4%) were available at a minimum of 2 years' follow-up. PGBG corrected glenoid retroversion from -28° ± 4° preoperatively to -4° ± 2° (P < .001). Humeral head subluxation also improved after PGBG with respect to the scapular axis and to the midglenoid face (P < .001). Radiographic analysis revealed all PGBGs had incorporated. Radiographically, 3 patients (10.7%) had a total of 5 broken or displaced screws. In addition, 3 patients (10.7%) had a broken metal marker in the center peg of the glenoid component. No patients required component revision surgery by final follow-up. Only 1 reoperation occurred for capsular release. Patients showed significant improvements in all patient-reported outcomes. Patients undergoing primary TSA with humeral head autograft PGBG showed significant improvements in glenoid version, humeral head subluxation, patient-reported outcomes, and range of motion at an average of 4 years' follow-up. There was a low revision rate and a high rate of graft incorporation. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Performance of PROMIS Instruments in Patients With Shoulder Instability.

PubMed

Anthony, Chris A; Glass, Natalie A; Hancock, Kyle; Bollier, Matt; Wolf, Brian R; Hettrich, Carolyn M

2017-02-01

Shoulder instability is a relatively common condition occurring in 2% of the population. PROMIS (Patient-Reported Outcome Measurement Information System) was developed by the National Institutes of Health in an effort to advance patient-reported outcome (PRO) instruments by developing question banks for major health domains. To compare PROMIS instruments to current PRO instruments in patients who would be undergoing operative intervention for recurrent shoulder instability. Cohort study (diagnosis); Level of evidence, 2. A total of 74 patients with a primary diagnosis of shoulder instability who would be undergoing surgery were asked to fill out the American Shoulder and Elbow Surgeons shoulder assessment form (ASES), Marx shoulder activity scale (Marx), Short Form-36 Health Survey Physical Function subscale (SF-36 PF), Western Ontario Shoulder Instability Index (WOSI), PROMIS physical function computer adaptive test (PF CAT), and PROMIS upper extremity item bank (UE). Correlation between PRO instruments was defined as excellent (>0.7), excellent-good (0.61-0.7), good (0.4-0.6), and poor (0.2-0.3). Utilization of the PROMIS UE demonstrated excellent correlation with the SF-36 PF ( r = 0.78, P < .01) and ASES ( r = 0.71, P < .01); there was excellent-good correlation with the EQ-5D ( r = 0.66, P < .01), WOSI ( r = 0.63, P < .01), and PROMIS PF CAT ( r = 0.63, P < .01). Utilization of the PROMIS PF CAT demonstrated excellent correlation with the SF-36 PF ( r = 0.72, P < .01); there was excellent-good correlation with the ASES ( r = 0.67, P < .01) and PROMIS UE ( r = 0.63, P < .01). When utilizing the PROMIS UE, ceiling effects were present in 28.6% of patients aged 18 to 21 years. Patients, on average, answered 4.6 ± 1.8 questions utilizing the PROMIS PF CAT. The PROMIS UE and PROMIS PF CAT demonstrated good to excellent correlation with common shoulder and upper extremity PRO instruments as well as the SF-36 PF in patients with shoulder instability. In patients aged ≤21 years, there were significant ceiling effects utilizing the PROMIS UE. While the PROMIS PF CAT appears appropriate for use in adults of any age, our findings demonstrate that the PROMIS UE has significant ceiling effects in patients with shoulder instability who are ≤21 years old, and we do not recommend use of the PROMIS UE in this population.

Allograft-Prosthetic Composite Reconstruction for Massive Proximal Humeral Bone Loss in Reverse Shoulder Arthroplasty.

PubMed

Sanchez-Sotelo, Joaquin; Wagner, Eric R; Sim, Franklin H; Houdek, Matthew T

2017-12-20

Reverse total shoulder arthroplasty (RTSA) performed in the setting of massive proximal humeral bone loss often requires special reconstructive techniques. Restoration of the proximal part of the humerus with an allograft provides a number of theoretical benefits, including implant support, restoration of humeral length, deltoid tensioning, and an opportunity to repair the posterior aspect of the cuff to improve strength in external rotation and repair of the subscapularis to improve stability. However, reverse allograft-prosthesis composites (APCs) are costly, are technically demanding to use, and can be compromised by progressive allograft resorption. Between 2005 and 2012, the lead author used an APC reconstruction in 8 primary and 18 revision RTSAs (26 patients; mean age, 62 years; mean body mass index, 27.9 kg/m). The indications for the primary RTSAs included severe proximal humeral bone loss after trauma (n = 5) and tumor resection (n = 3). The indications in the revision setting were failed hemiarthroplasty (n = 11), anatomic total shoulder arthroplasty (n = 4), and reverse arthroplasty (n = 3). The most common reason for revision was instability (n = 10). A compression plate was used for graft-to-host fixation in all shoulders. Shoulders were assessed for pain, motion, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, Neer score, revision or reoperation, radiographic evidence of graft union or resorption, and implant fixation. The mean duration of follow-up was 4 years (range, 2 to 10 years). RTSA using an APC construct resulted in substantial improvements in pain scores (p < 0.0001), elevation (p < 0.0001), and external rotation (p = 0.004). With the numbers available, there were no significant differences in clinical outcomes between primary and revision cases. No patients required revision surgery for nonunion at the host-allograft junction. The mean time to union was 7 months, with 1 patient requiring bone-grafting for delayed union. Other complications included dislocation, deep infection, graft fracture, and periprosthetic fracture distal to the previous APC construct in 1 patient each. The 2 and 5-year revision-free survival rate was 96%. Reconstruction of proximal humeral bone loss with an APC at the time of primary or revision RTSA is safe and effective, with acceptable functional outcomes and complication rates. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effects of low-level laser therapy in combination with physiotherapy in the management of rotator cuff tendinitis.

PubMed

Eslamian, Fariba; Shakouri, Seyyed Kazem; Ghojazadeh, Morteza; Nobari, Ozra Eslampanah; Eftekharsadat, Bina

2012-09-01

Rotator cuff tendinitis is one of the main causes of shoulder pain. The objective of this study was to evaluate the possible additive effects of low-power laser treatment in combination with conventional physiotherapy endeavors in these patients. A total of 50 patients who were referred to the Physical Medicine and Rehabilitation Clinic with shoulder pain and rotator cuff disorders were selected. Pain severity measured with visual analogue scale (VAS), abduction, and external rotation range of motion in shoulder joint was measured by goniometry, and evaluation of daily functional abilities of patients was measured by shoulder disability questionnaire. Twenty-five of the above patients were randomly assigned into the control group and received only routine physiotherapy. The other 25 patients were assigned into the experimental group and received conventional therapy plus low-level laser therapy (4 J/cm(2) at each point over a maximum of ten painful points of shoulder region for total 5 min duration). The above measurements were assessed at the end of the third week of therapy in each group and the results were analyzed statistically. In both groups, statistically significant improvement was detected in all outcome measures compared to baseline (p < 0.05). Comparison between two different groups revealed better results for control of pain (reduction in VAS average) and shoulder disability problems in the experimental group versus the control (3.1 ± 2.2 vs. 5 ± 2.6, p = 0.029 and 4.4 ± 3.1 vs. 8.5 ± 5.1, p = 0.031, respectively ) after intervention. Positive objective signs also had better results in the experimental group, but the mean range of active abduction (144.92 ± 31.6 vs. 132.80 ± 31.3) and external rotation (78.0 ± 19.5 vs. 76.3 ± 19.1) had no significant difference between the two groups (p = 0.20 and 0.77, respectively). As one of physical modalities, gallium-arsenide low-power laser combined with conventional physiotherapy has superiority over routine physiotherapy from the view of decreasing pain and improving the patient's function, but no additional advantages were detected in increasing shoulder joint range of motion in comparison to other physical agents.

Continuum theory for cluster morphologies of soft colloids.

PubMed

Kosmrlj, A; Pauschenwein, G J; Kahl, G; Ziherl, P

2011-06-09

We introduce a continuum description of the thermodynamics of colloids with a core-corona architecture. In the case of thick coronas, their overlap can be treated approximately by replacing the exact one-particle density distribution by a suitably shaped step profile, which provides a convenient way of modeling the spherical, columnar, lamellar, and inverted cluster morphologies predicted by numerical simulations and the more involved theories. We use the model to study monodisperse particles with the hard-core/square-shoulder pair interaction as the simplest representatives of the core-corona class. We derive approximate analytical expressions for the enthalpies of the cluster morphologies which offer a clear insight into the mechanisms at work, and we calculate the lattice spacing and the cluster size for all morphologies of the phase sequence as well as the phase-transition pressures. By comparing the results with the exact crystalline minimum-enthalpy configurations, we show that the accuracy of the theory increases with shoulder width. We discuss possible extensions of the theory that could account for the finite-temperature effects.

The use of synthetic ligaments in the design of an enhanced stability total knee joint replacement.

PubMed

Stokes, Michael D; Greene, Brendan C; Pietrykowski, Luke W; Gambon, Taylor M; Bales, Caroline E; DesJardins, John D

2018-03-01

Current total knee replacement designs work to address clinically desired knee stability and range of motion through a balance of retained anatomy and added implant geometry. However, simplified implant geometries such as bearing surfaces, posts, and cams are often used to replace complex ligamentous constraints that are sacrificed during most total knee replacement procedures. This article evaluates a novel total knee replacement design that incorporates synthetic ligaments to enhance the stability of the total knee replacement system. It was hypothesized that by incorporating artificial cruciate ligaments into a total knee replacement design at specific locations and lengths, the stability of the total knee replacement could be significantly altered while maintaining active ranges of motion. The ligament attachment mechanisms used in the design were evaluated using a tensile test, and determined to have a safety factor of three with respect to expected ligamentous loading in vivo. Following initial computational modeling of possible ligament orientations, a physical prototype was constructed to verify the function of the design by performing anterior/posterior drawer tests under physiologic load. Synthetic ligament configurations were found to increase total knee replacement stability up to 94% compared to the no-ligament case, while maintaining total knee replacement flexion range of motion between 0° and 120°, indicating that a total knee replacement that incorporates synthetic ligaments with calibrated location and lengths should be able to significantly enhance and control the kinematic performance of a total knee replacement system.

The use of dual-energy X-ray absorptiometry to estimate the dissected composition of lamb carcasses.

PubMed

Mercier, J; Pomar, C; Marcoux, M; Goulet, F; Thériault, M; Castonguay, F W

2006-06-01

A total of 140 male and female Dorset and Suffolk lambs were slaughtered according to four live weight classes (36-39kg, 41-44kg, 46-49kg and 51-54kg). Total tissue, fat and lean masses, and bone mineral content measured by dual-energy X-ray absorptiometry (DXA) were used to predict dissected tissue weights. The DXA total weights accurately predict half-carcasses and primal cuts weights (shoulder, leg, loin and flank) (R(2)>0.99, CVe<1.3%). The prediction of the half-carcass dissected fat percentage is weaker (R(2)=0.77, CVe=10.4%). Fatness prediction accuracy is equivalent for the shoulder, leg and loin (R(2) between 0.68 and 0.78, CVe between 10% and 13%). The R(2) obtained when predicting dissected lean content from DXA variables is 0.93 for the half-carcass and higher than 0.83 for all cuts other than flank (CVe are between 3.5% and 6.5%, except for the flank, which is 9.1%). The prediction of bone weight using the bone mineral content is not very accurate for the half-carcass, shoulder and leg (R(2): 0.48, 0.47 and 0.43; CVe: 10.2%, 12.0% and 11.6%, respectively). The situation improves, however, for the loin (R(2)=0.70, CVe=10.7%). In conclusion, DXA is an effective technology for predicting total weight and the amount of lean and fat in lamb carcasses and their primal cuts.

Testing of a novel pin array guide for accurate three-dimensional glenoid component positioning.

PubMed

Lewis, Gregory S; Stevens, Nicole M; Armstrong, April D

2015-12-01

A substantial challenge in total shoulder replacement is accurate positioning and alignment of the glenoid component. This challenge arises from limited intraoperative exposure and complex arthritic-driven deformity. We describe a novel pin array guide and method for patient-specific guiding of the glenoid central drill hole. We also experimentally tested the hypothesis that this method would reduce errors in version and inclination compared with 2 traditional methods. Polymer models of glenoids were created from computed tomography scans from 9 arthritic patients. Each 3-dimensional (3D) printed scapula was shrouded to simulate the operative situation. Three different methods for central drill alignment were tested, all with the target orientation of 5° retroversion and 0° inclination: no assistance, assistance by preoperative 3D imaging, and assistance by the pin array guide. Version and inclination errors of the drill line were compared. Version errors using the pin array guide (3° ± 2°) were significantly lower than version errors associated with no assistance (9° ± 7°) and preoperative 3D imaging (8° ± 6°). Inclination errors were also significantly lower using the pin array guide compared with no assistance. The new pin array guide substantially reduced errors in orientation of the central drill line. The guide method is patient specific but does not require rapid prototyping and instead uses adjustments to an array of pins based on automated software calculations. This method may ultimately provide a cost-effective solution enabling surgeons to obtain accurate orientation of the glenoid. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Neck-Shoulder Pain and Work Status among Former Sewing Machine Operators: A 14-year Follow-up Study.

PubMed

Jakobsen, Emma Lise Thorlund; Biering, Karin; Kærgaard, Anette; Andersen, Johan Hviid

2018-03-01

Purpose A total of 243 Danish female sewing machine operators lost their jobs in 1996 because of outsourcing. The aim was to investigate the employment status during follow-up from 1996 to 2008, and to estimate to what extent former neck-shoulder pain had an impact on later work participation. Methods Assessment of neck-shoulder pain was based on questionnaires completed in 1994. The Danish Register-Based Evaluation of Marginalization (DREAM) register was used to describe employment status during the follow-up period. Register data were explored by sequence analyses and graphics, and the association between neck-shoulder pain and work participation was analyzed by logistic regression analysis. Results In all, 987 working years were lost during follow-up, and a sequence index plot revealed interrupted and heterogeneous courses of incomes. The odds ratio between neck and shoulder pain and a work participation score less than 75% was 1.49 (95% CI 0.84-2.67). Conclusions After outsourcing of the textile industry, the former sewing machine operators had decreased work participation and frequent transitions between different income types. Previous neck-shoulder pain tended to be associated with poor work participation. The results suggest that increased attention should be to given to dismissed workers from other industries that become outsourced, especially unskilled workers with similar work-related health limitations. Additionally, we concluded that time-to-event measures in research involving employment status are insufficient because of the many transitions that take place in working life.

Glenohumeral range of motion (ROM) and isometric strength of professional team handball athletes, part III: changes over the playing season.

PubMed

Fieseler, Georg; Jungermann, Philipp; Koke, Alexander; Irlenbusch, Lars; Delank, Karl-Stefan; Schwesig, René

2015-12-01

The aim of our study was to investigate the relation of workload on range of motion and isometric strength of team handball athletes' shoulders over a competitive season. 31 Professional male handball athletes underwent clinical shoulder examinations. Athletes were examined subsequently during the complete playing season (week 0, 6, 22 and 40) to determine bilateral isometric shoulder rotational strength and active range of motion (ROM). In addition, relative (intraclass correlation coefficients (ICC) and absolute (standard error of measurement) reliability were calculated. Intraobserver reliability was excellent (ICC 0.76-0.98) for isometric strength and flexibility measurements. Internal rotation (IR) and total arc ROM in the throwing shoulder (TS) decreased significantly (p < 0.05) in both sequences (week 22 to week 40, week 0 to week 40). External rotation (ER) ROM and isometric strength in IR and ER did not change significantly. Glenohumeral internal rotation deficit (GIRD) and external rotation gain (ERG) of the TS decreased significantly between week 22 and week 40, but both did not change overall (week 0 to week 40). There was significant influence on IR ROM (week 22 to week 40) and strength in ER (week 0 to week 40) in the non-throwing shoulder. Several characteristics of handball players' shoulders changed significantly from the beginning to the end of a season. More specifically, the repetitive forces accumulated during the competitive season resulted in altered GIRD, ERG and isometric strength of the dominant glenohumeral joint.

GLENOHUMERAL MOTION DEFICITS: FRIEND OR FOE?

PubMed Central

Wilk, Kevin E.; Davies, George; Ellenbecker, Todd; Reinold, Mike

2013-01-01

In most shoulder conditions a loss of glenohumeral motion results in shoulder performance impairments. However, in the overhead athlete loss of glenohumeral internal rotation, termed glenohumeral internal rotation deficiency (GIRD), is a normal phenomenon that should be expected. Without a loss of glenohumeral internal rotation the overhead athlete will not have the requisite glenohumeral external rotation needed to throw a baseball at nearly 100 miles per hour, or serve a tennis ball at velocities of 120 miles per hour or more. Not all GIRD is pathologic. The authors of this manuscript have defined two types of GIRD; one that is normal and one that is pathologic. Anatomical GIRD (aGIRD) is one that is normal in overhead athletes and is characterized by a loss of internal rotation of less than 18°‐20° with symmetrical total rotational motion (TROM) bilaterally. Pathologic GIRD (pGIRD) is when there is a loss of glenohumeral internal rotation greater than 18°‐20° with a corresponding loss of TROM greater than 5° when compared bilaterally. A more problematic motion restriction may be that of a loss of TROM in the glenohumeral joint. Recent evidence supports that a loss of TROM is predictive of future injury to the shoulder in professional athletes. Additionally, external rotation deficiency (ERD), the difference between external rotation (ER) of the throwing shoulder and the non‐throwing shoulder of less than 5°, may be another predictor of future shoulder injury and disability. Level of Evidence: 5 PMID:24175137

Neck and shoulder pain in 70- to 79-year-old men and women: findings from the Health, Aging and Body Composition Study.

PubMed

Vogt, Molly T; Simonsick, Eleanor M; Harris, Tamara B; Nevitt, Michael C; Kang, James D; Rubin, Susan M; Kritchevsky, Stephen B; Newman, Anne B

2003-01-01

Musculoskeletal pain in the cervicobrachial region is considered a major health problem among adults of working age, but little is known about the impact of this pain in the elderly. Determine the prevalence of neck and shoulder pain in a well-functioning cohort, identify factors associated with this pain, assess the pattern of coexisting joint pain and evaluate the impact of this pain on physical functioning. Cross-sectional study. Black and white men and women, aged 70 to 79 years, participating in the Health, Aging and Body Composition (Health ABC) study. Not applicable. Between April 1997 and June 1998, 3,075 men and women participating in Health ABC study completed the initial home interview and clinical examination. Information was collected on musculoskeletal pain, medical history, depressive symptomatology and physical function. Physical performance measures were obtained. A total of 11.9% of participants reported neck pain of one month or more in duration and 18.9% reported shoulder pain. White women had the highest prevalence of neck pain (15.4%) and black women the highest prevalence of shoulder pain (24.3%). The correlates of both neck and shoulder pain were female gender, no education beyond high school, poorer self-rated health, depressive symptomatology and a medical history of arthritis, heart attack, angina. Increasing severity of both neck and shoulder pain was associated with an increased prevalence of joint pain at other body sites and with poor functional capacity. Measures of physical performance involving the upper extremity were also decreased. Neck and shoulder pain, either alone or in conjunction with pain in other joints, has a substantial impact on the function and well-being of the older adults in this cohort.

Magnetic-Stimulation-Related Physiological Artifacts in Hemodynamic Near-Infrared Spectroscopy Signals

PubMed Central

Näsi, Tiina; Mäki, Hanna; Kotilahti, Kalle; Nissilä, Ilkka; Haapalahti, Petri; Ilmoniemi, Risto J.

2011-01-01

Hemodynamic responses evoked by transcranial magnetic stimulation (TMS) can be measured with near-infrared spectroscopy (NIRS). This study demonstrates that cerebral neuronal activity is not their sole contributor. We compared bilateral NIRS responses following brain stimulation to those from the shoulders evoked by shoulder stimulation and contrasted them with changes in circulatory parameters. The left primary motor cortex of ten subjects was stimulated with 8-s repetitive TMS trains at 0.5, 1, and 2 Hz at an intensity of 75% of the resting motor threshold. Hemoglobin concentration changes were measured with NIRS on the stimulated and contralateral hemispheres. The photoplethysmograph (PPG) amplitude and heart rate were recorded as well. The left shoulder of ten other subjects was stimulated with the same protocol while the hemoglobin concentration changes in both shoulders were measured. In addition to PPG amplitude and heart rate, the pulse transit time was recorded. The brain stimulation reduced the total hemoglobin concentration (HbT) on the stimulated and contralateral hemispheres. The shoulder stimulation reduced HbT on the stimulated shoulder but increased it contralaterally. The waveforms of the HbT responses on the stimulated hemisphere and shoulder correlated strongly with each other (r = 0.65–0.87). All circulatory parameters were also affected. The results suggest that the TMS-evoked NIRS signal includes components that do not result directly from cerebral neuronal activity. These components arise from local effects of TMS on the vasculature. Also global circulatory effects due to arousal may affect the responses. Thus, studies involving TMS-evoked NIRS responses should be carefully controlled for physiological artifacts and effective artifact removal methods are needed to draw inferences about TMS-evoked brain activity. PMID:21887362

Magnetic-stimulation-related physiological artifacts in hemodynamic near-infrared spectroscopy signals.

PubMed

Näsi, Tiina; Mäki, Hanna; Kotilahti, Kalle; Nissilä, Ilkka; Haapalahti, Petri; Ilmoniemi, Risto J

2011-01-01

Hemodynamic responses evoked by transcranial magnetic stimulation (TMS) can be measured with near-infrared spectroscopy (NIRS). This study demonstrates that cerebral neuronal activity is not their sole contributor. We compared bilateral NIRS responses following brain stimulation to those from the shoulders evoked by shoulder stimulation and contrasted them with changes in circulatory parameters. The left primary motor cortex of ten subjects was stimulated with 8-s repetitive TMS trains at 0.5, 1, and 2 Hz at an intensity of 75% of the resting motor threshold. Hemoglobin concentration changes were measured with NIRS on the stimulated and contralateral hemispheres. The photoplethysmograph (PPG) amplitude and heart rate were recorded as well. The left shoulder of ten other subjects was stimulated with the same protocol while the hemoglobin concentration changes in both shoulders were measured. In addition to PPG amplitude and heart rate, the pulse transit time was recorded. The brain stimulation reduced the total hemoglobin concentration (HbT) on the stimulated and contralateral hemispheres. The shoulder stimulation reduced HbT on the stimulated shoulder but increased it contralaterally. The waveforms of the HbT responses on the stimulated hemisphere and shoulder correlated strongly with each other (r = 0.65-0.87). All circulatory parameters were also affected. The results suggest that the TMS-evoked NIRS signal includes components that do not result directly from cerebral neuronal activity. These components arise from local effects of TMS on the vasculature. Also global circulatory effects due to arousal may affect the responses. Thus, studies involving TMS-evoked NIRS responses should be carefully controlled for physiological artifacts and effective artifact removal methods are needed to draw inferences about TMS-evoked brain activity.

The Relationship Between Shoulder Stiffness and Rotator Cuff Healing: A Study of 1,533 Consecutive Arthroscopic Rotator Cuff Repairs.

PubMed

McNamara, William J; Lam, Patrick H; Murrell, George A C

2016-11-16

Retear and stiffness are not uncommon outcomes of rotator cuff repair. The purpose of this study was to evaluate the relationship between rotator cuff repair healing and shoulder stiffness. A total of 1,533 consecutive shoulders had an arthroscopic rotator cuff repair by a single surgeon. Patients assessed their shoulder stiffness using a Likert scale preoperatively and at 1, 6, 12, and 24 weeks (6 months) postoperatively, and examiners evaluated passive range of motion preoperatively and at 6, 12, and 24 weeks postoperatively. Repair integrity was determined by ultrasound evaluation at 6 months. After rotator cuff repair, there was an overall significant loss of patient-ranked and examiner-assessed shoulder motion at 6 weeks compared with preoperative measurements (p < 0.0001), a partial recovery at 12 weeks, and a full recovery at 24 weeks. Shoulders that were stiff before surgery were more likely to be stiff at 6, 12, and, to a lesser extent, 24 weeks after surgery (r = 0.10 to 0.31; p < 0.0001). A stiffer shoulder at 6 and 12 weeks (but not 24 weeks) postoperatively correlated with better rotator cuff integrity at 6 months postoperatively (r = 0.11 to 0.18; p < 0.001). The retear rate of patients with ≤20° of external rotation at 6 weeks postoperatively was 7%, while the retear rate of patients with >20° of external rotation at 6 weeks was 15% (p < 0.001). In patients who developed stiffness after surgery, a rotator cuff repair was more likely to heal. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Serum C-reactive protein in patients undergoing elective shoulder arthroplasty. Prospective study.

PubMed

Torrens, Carlos; Santana, Fernando; Marí, Raquel; Puig, Lluis; Alier, Albert

2017-09-01

The objective of the study was to determine the normalization curve of the serum C-reactive protein (CRP) in elective shoulder arthroplasty. A prospective study including 58 consecutive patients who had undergone elective shoulder arthroplasty. Forty-one patients had received a Reverse Shoulder Arthroplasty, 13 a Total Shoulder Arthroplasty and 4 a Hemiarthroplasty. Based on a pilot study, blood samples to determine CRP values were obtained at baseline (1 h before surgery), on the 1st, 2nd, 6th, 8th and 14th postoperative days. All the patients included presented no postoperative complications during inpatient stay or any re-admission during the three months after surgery. Mean CRP values showed a rapid increase on the 1st postoperative day (7-fold higher than the baseline in cuff tear arthropathy, 11-fold higher in primary osteoarthritis, 1-fold higher in acute fracture) and reached a peak on the 2nd postoperative day (14-fold higher than the baseline in cuff tear arthropathy, 24-fold higher in primary osteoarthritis and 2-fold higher in acute fracture). After the 2nd postoperative day CRP values began to slowly decrease reaching the normal range in the 14th postoperative day. Serum CRP levels after elective shoulder arthroplasty rapidly increase to reach a maximum peak after the 2nd surgery day and then slowly decrease to return to normality on the 14th day. Knowing the normalization curve of CRP can be a helpful tool to help in the diagnosis of acute infections in elective shoulder arthroplasty. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Iatrogenic nerve injuries during shoulder surgery.

PubMed

Carofino, Bradley C; Brogan, David M; Kircher, Michelle F; Elhassan, Bassem T; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

2013-09-18

The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery. A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome. The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus. Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.

Shoulder biomechanics and the success of translational research.

PubMed

Cutti, Andrea Giovanni; Chadwick, Edward K

2014-03-01

In 2009, the International Shoulder Group (ISG) had the opportunity to propose to the readers of Medical and Biological Engineering and Computing a Special Issue on shoulder biomechanics. At that time, we pointed out that the field was evolving to include more applied research. After 4 years, we can confirm that impression: 10 out of 12 papers included in this second Special Issue deal with clinical related questions, through theoretical and experimental methodologies. This demonstrates that the translational research at the base of ISG foundation in 1989 is effective. We think that the papers of this issue will have an impact on clinics in general and on the treatment of work-related injuries and diseases in particular. Based on the statistics of the Italian Workers' Compensation Authority (INAIL), injuries at the shoulder are first in terms of average duration of "temporary total disability to work". Moreover, occupational diseases at the shoulder in the industrial and services sector represented 16 % of all occupational diseases in 2012, i.e., 46 % of those related to the upper limb. These data stress the need for specific interventions, with the contribution of both researchers and policy makers. Starting from the papers included here, we would encourage additional efforts on: (1) quantitative analysis of shoulder loading during tasks associated with musculoskeletal injuries, and ways to reduce that loading, (2) simple and effective tools to improve the diagnosis and outcome assessment of motion-related shoulder diseases, and (3) the development of rehabilitation treatments focused on occupational tasks, taking advantage of state-of-the-art biofeedback technologies, and exploiting the power of biomechanical models for muscle force prediction.

Prompt Referral in the Nonoperative Treatment of Obstetrical Brachial Plexus Injuries

PubMed Central

Aubin-Lemay, Camille; Kvann, Julie Chakriya; Retrouvey, Helene; Aldekhayel, Salah; Zadeh, Teanoosh

2017-01-01

Background: Prompt physical and occupational therapy is crucial in managing nonsurgical candidates with obstetrical brachial plexus injuries (OBPI). The objective of our study was to identify newborns suffering from nonoperative OBPI in need of a “fast-track” evaluation by a multidisciplinary team. Methods: This is a retrospective review of patients with OBPI from June 1995 to June 2015. All nonsurgical candidates (Narakas class 1) were included in the study. The Gilbert score and the Medical Research Council grading system were used to measure shoulder and elbow function, respectively. The relationship between shoulder and elbow functional outcomes and time delay to consultation was studied using analysis of variance and Welch’s tests. Various subgroups were studied based on OBPI risk factors: maternal diabetes, birth weight >4 kg, use of forceps, asphyxia, multiple comorbidities, and Apgar score at 1 and 5 minutes. Results: A total of 168 patients were included in this study. Mean follow-up time was 313.8 weeks (minimum: 52; maximum: 1072; SD: 228.1). A total of 19 patients had an Apgar scores <7 at 5 minutes. Time delay between birth and the first consult to our clinic had an impact on shoulder outcome in the subgroup of newborns with Apgar scores <7 at 5 minutes. Conclusions: The subgroup of newborns with an Apgar score <7 at 5 minutes shows improved long-term shoulder function when promptly examined by an OBPI clinic. We recommend a “fast-track” referral for this time-sensitive population. PMID:29632767

[Cuff tear arthropathy – long-term results of reverse total shoulder arthroplasty].

PubMed

Brunner, U; Rückl, K; Fruth, M

2013-07-01

The results after reverse total shoulder arthroplasty for cuff tear arthropathy are superior and the complications fewer than for other etiologies, such as rheumatoid arthritis, fracture, fracture sequelae or even revision. The improvements in function and pain are excellent whereas rotation may be unaffected. Revisions and complications can be encountered in the first 3 years and the survival curve of the prosthesis is still good after 10 years with 90%. Progressive functional and radiological deterioration is observed after 9 years in approximately 30% of the patients without apparent problems with the prosthesis. Notching is progressive with incidence and size over time, without a proven correlation to the functional results but remains a major concern. Modification of the implants, the operative techniques and experience could significantly improve the results and reduce the rate of complications. Lateralization of the center of rotation and smaller inclination angles have a positive effect on the rate of notching and the range of motion, especially for the rotation. New prosthetic designs and operative techniques attempt to implement a combination of the biomechanical improvements. Reverse shoulder arthroplasty remains a challenging operation with a high rate of complications. The results depend on the etiology and the function of the remaining muscles and therefore on the experience and the skill of the surgeon to implement the appropriate biomechanical factors. Because of the concerns regarding the longevity, reverse shoulder arthroplasty should be reserved for the elderly over 70 years of age.

Successful outcome of modified quad surgical procedure in preteen and teen patients with brachial plexus birth palsy.

PubMed

Nath, Rahul K; Somasundaram, Chandra

2012-01-01

To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5-9 years) with obstetric brachial plexus injury. We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1-17.9 years). The mean preoperative total Mallet score was 14.8 (range, 10-20), and active abduction was 84° (range, 20°-140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13-25, P < .0001), and the mean active abduction improved to 132° (range, 40°-180°, P < .0003). The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder.

More hypotension in patients taking antihypertensives preoperatively during shoulder surgery in the beach chair position.

PubMed

Trentman, Terrence L; Fassett, Sharon L; Thomas, Justin K; Noble, Brie N; Renfree, Kevin J; Hattrup, Steven J

2011-11-01

Hypotension is common in patients undergoing surgery in the sitting position under general anesthesia, and the risk may be exacerbated by the use of antihypertensive drugs taken preoperatively. The purpose of this study was to compare hypotensive episodes in patients taking antihypertensive medications with normotensive patients during shoulder surgery in the beach chair position. Medical records of all patients undergoing shoulder arthroscopy during a 44-month period were reviewed retrospectively. The primary endpoint was the number of moderate hypotensive episodes (systolic blood pressure ≤ 85 mmHg) during the intraoperative period. Secondary endpoints included the frequency of vasopressor administration, total dose of vasopressors, and fluid administered. Values are expressed as mean (standard deviation). Of 384 patients who underwent shoulder surgery, 185 patients were taking no antihypertensive medication, and 199 were on at least one antihypertensive drug. The antihypertensive medication group had more intraoperative hypotensive episodes [1.7 (2.2) vs 1.2 (1.8); P = 0.01] and vasopressor administrations. Total dose of vasopressors and volume of fluids administered were similar between groups. The timing of the administration of angiotensin-converting enzyme inhibitors and of angiotensin receptor antagonists (≤ 10 hr vs > 10 hr before surgery) had no impact on intraoperative hypotension. Preoperative use of antihypertensive medication was associated with an increased incidence of intraoperative hypotension. Compared with normotensive patients, patients taking antihypertensive drugs preoperatively are expected to require vasopressors more often to maintain normal blood pressure.

Anatomical glenohumeral internal rotation deficit and symmetric rotational strength in male and female young beach volleyball players.

PubMed

Saccol, Michele Forgiarini; Almeida, Gabriel Peixoto Leão; de Souza, Vivian Lima

2016-08-01

Beach volleyball is a sport with a high demand of shoulder structures that may lead to adaptations in range of motion (ROM) and strength like in other overhead sports. Despite of these possible alterations, no study evaluated the shoulder adaptations in young beach volleyball athletes. The aim of this study was to compare the bilateral ROM and rotation strength in the shoulders of young beach volleyball players. Goniometric passive shoulder ROM of motion and isometric rotational strength were evaluated in 19 male and 14 female asymptomatic athletes. External and internal ROM, total rotation motion, glenohumeral internal rotation deficit (GIRD), external rotation and internal rotation strength, bilateral deficits and external rotation to internal rotation ratio were measured. The statistical analysis included paired Student's t-test and analysis of variance with repeated measures. Significantly lower dominant GIRD was found in both groups (p<0.05), but only 6 athletes presented pathological GIRD. For strength variables, no significant differences for external or internal rotation were evident. Young beach volleyball athletes present symmetric rotational strength and shoulder ROM rotational adaptations that can be considered as anatomical. These results indicate that young practitioners of beach volleyball are subject to moderate adaptations compared to those reported for other overhead sports. Copyright © 2015 Elsevier Ltd. All rights reserved.

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial.

PubMed

Nejati, Parisa; Ghahremaninia, Armita; Naderi, Farrokh; Gharibzadeh, Safoora; Mazaherinezhad, Ali

2017-05-01

Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder. The evidence for the effectiveness of treatment options is inconclusive and limited. Therefore, there is a need for more evidence in this regard, particularly for long-term outcomes. Platelet-rich plasma (PRP) would be an effective method in treating subacromial impingement. Randomized controlled trial; Level of evidence, 1. This was a single-blinded randomized clinical trial with 1-, 3-, and 6-month follow-up. Sixty-two patients were randomly placed into 2 groups, receiving either PRP or exercise therapy. The outcome parameters were pain, shoulder range of motion (ROM), muscle force, functionality, and magnetic resonance imaging findings. Both treatment options significantly reduced pain and increased shoulder ROM compared with baseline measurements. Both treatments also significantly improved functionality. However, the treatment choices were not significantly effective in improving muscle force. Trend analysis revealed that in the first and third months, exercise therapy was superior to PRP in pain, shoulder flexion and abduction, and functionality. However, in the sixth month, only shoulder abduction and total Western Ontario Rotator Cuff score were significantly different between the 2 groups. Both PRP injection and exercise therapy were effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective.

Effects of Bobath-based therapy on depression, shoulder pain and health-related quality of life in patients after stroke.

PubMed

Hafsteinsdóttir, Thóra B; Kappelle, Jaap; Grypdonck, Maria H F; Algra, Ale

2007-10-01

To measure the effects of Bobath-based (BB) therapy on depression, shoulder pain and health-related quality of life (HRQoL) of patients during one year after stroke. In a prospective, non-randomized design, the use of BB therapy was compared with a more task-oriented therapy and no BB therapy. A total of 324 patients in 12 hospitals. Patients in the intervention group received BB therapy, whereas patients in the control group received no BB therapy and a more task-oriented therapy. HRQoL was measured using the SF-36; depression was measured with the Center of Epidemiological Studies Depression Scale and shoulder pain was measured with the Visual Analogue Scale at discharge, 6 and 12 months. Linear and logistic regression analyses were performed. No effects of BB therapy on HRQoL or shoulder pain were found. After one year fewer patients were depressed in the BB group (30%) than in the non-BB group (43%); the adjusted odds ratio was 0.6 (95% confidence interval 0.3-1.0). BB therapy did not have any effect on HRQoL or shoulder pain in stroke patients. Healthcare professionals should reconsider the use of BB therapy in the care of stroke patients.

Prevalence of Total Hip and Knee Replacement in the United States.

PubMed

Maradit Kremers, Hilal; Larson, Dirk R; Crowson, Cynthia S; Kremers, Walter K; Washington, Raynard E; Steiner, Claudia A; Jiranek, William A; Berry, Daniel J

2015-09-02

Descriptive epidemiology of total joint replacement procedures is limited to annual procedure volumes (incidence). The prevalence of the growing number of individuals living with a total hip or total knee replacement is currently unknown. Our objective was to estimate the prevalence of total hip and total knee replacement in the United States. Prevalence was estimated using the counting method by combining historical incidence data from the National Hospital Discharge Survey and the Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases from 1969 to 2010 with general population census and mortality counts. We accounted for relative differences in mortality rates between those who have had total hip or knee replacement and the general population. The 2010 prevalence of total hip and total knee replacement in the total U.S. population was 0.83% and 1.52%, respectively. Prevalence was higher among women than among men and increased with age, reaching 5.26% for total hip replacement and 10.38% for total knee replacement at eighty years. These estimates corresponded to 2.5 million individuals (1.4 million women and 1.1 million men) with total hip replacement and 4.7 million individuals (3.0 million women and 1.7 million men) with total knee replacement in 2010. Secular trends indicated a substantial rise in prevalence over time and a shift to younger ages. Around 7 million Americans are living with a hip or knee replacement, and consequently, in most cases, are mobile, despite advanced arthritis. These numbers underscore the substantial public health impact of total hip and knee arthroplasties. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.

The use of osteochondral allograft with bone marrow-derived mesenchymal cells and hinge joint distraction in the treatment of post-collapse stage of osteonecrosis of the femoral head.

PubMed

Gagala, J; Tarczynska, M; Gaweda, K; Matuszewski, L

2014-09-01

Osteonecrosis of the femoral head is an entity which occurs mainly in young and active patients aged between 20 and 50. The success of hip joint preserving treatments ranges from 15% to 50% depending on the stage and amount of osteonecrotic lesion. Total hip replacement is indicated in late post-collapse hips but it has unsatisfactory survival because of the wear and osteolysis in young and active patients. Osteochondral allografts have been reported in the treatment of large articular lesions with defects in underlying bone in knee, talus and shoulder. By combining osteoconductive properties of osteochondral allograft with osteogenic abilities of bone marrow-derived mesenchymal cells it has a potential to be an alternative to an autologous graft. The adjunct of hinged joint distraction should minimize stresses in subchondral bone to promote creeping substitution and prevent femoral head collapse. Unlike current treatment modalities, it would provide both structural support and allow bony and articular substitution. Copyright © 2014 Elsevier Ltd. All rights reserved.

Biologic resurfacing arthroplasty with acellular human dermal allograft and platelet-rich plasma (PRP) in young patients with glenohumeral arthritis-average of 60 months of at mid-term follow-up.

PubMed

Lo, Eddie Y; Flanagin, Brody A; Burkhead, Wayne Z

2016-07-01

The treatment of young patients with glenohumeral arthritis has been challenging. Alternative treatment options include activity modification, arthroscopic débridement, and arthroplasty. Addressing the glenoid during arthroplasty in this population of patients continues to be a significant challenge. In this study, we evaluated the midterm outcomes of hemiarthroplasty with biologic resurfacing of the glenoid with human dermal matrix allograft. Between 2004 and 2011, 55 patients underwent hemiarthroplasty and biologic resurfacing of the glenoid with human dermal matrix allograft. The average age was 50 ± 9 years. Subjective evaluation was performed with the Western Ontario Osteoarthritis of the Shoulder Index, American Shoulder and Elbow Surgeons score, visual analog scale, and Single Assessment Numeric Evaluation. Patients returned to the clinic for clinical examination and radiographic evaluation. The average follow-up was 60 months. The average postoperative American Shoulder and Elbow Surgeons score was 76 ± 22, and the Western Ontario Osteoarthritis of the Shoulder Index score was 76% ± 22%. The visual analog scale score was 2.4 ± 2.6. The average preoperative Single Assessment Numeric Evaluation score was 33% ± 22%, which significantly improved to 72% ± 22% postoperatively. Eighty-one percent of the patients were satisfied (10/47) or highly satisfied (28/47) with their result. With radiographic evaluation, the average joint space was 1 ± 1 mm preoperatively and 2 ± 1 mm postoperatively. A total of 5 cases (9.1%) were revised to anatomic total shoulder arthroplasty with implantation of a glenoid component. Hemiarthroplasty with biologic resurfacing of the glenoid using human dermal matrix allograft can lead to successful midterm outcomes with satisfactory complication and revision rates. Both patient satisfaction and clinical outcome remain high regardless of radiographic outcome. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial.

PubMed

Andersen, Christoffer H; Andersen, Lars L; Gram, Bibi; Pedersen, Mogens Theisen; Mortensen, Ole Steen; Zebis, Mette Kreutzfeldt; Sjøgaard, Gisela

2012-11-01

Specific strength training can reduce neck and shoulder pain in office workers, but the optimal combination of exercise frequency and duration remains unknown. This study investigates how one weekly hour of strength training for the neck and shoulder muscles is most effectively distributed. A total of 447 office workers with and without neck and/or shoulder pain were randomly allocated at the cluster-level to one of four groups; 1×60 (1WS), 3×20 (3WS) or 9×7 (9WS) min a week of supervised high-intensity strength training for 20 weeks, or to a reference group without training (REF). Primary outcome was self-reported neck and shoulder pain (scale 0-9) and secondary outcome work disability (Disability in Arms, Shoulders and Hands (DASH)). The intention-to-treat analysis showed reduced neck and right shoulder pain in the training groups after 20 weeks compared with REF. Among those with pain ≥3 at baseline (n=256), all three training groups achieved significant reduction in neck pain compared with REF (p<0.01). From a baseline pain rating of 3.2 (SD 2.3) in the neck among neck cases, 1WS experienced a reduction of 1.14 (95% CI 0.17 to 2.10), 3WS 1.88 (0.90 to 2.87) and 9WS 1.35 (0.24 to 2.46) which is considered clinically significant. DASH was reduced in 1WS and 3WS only. One hour of specific strength training effectively reduced neck and shoulder pain in office workers. Although the three contrasting training groups showed no statistical differences in neck pain reduction, only 1WS and 3WS reduced DASH. This study suggests some flexibility regarding time-wise distribution when implementing specific strength training at the workplace.

Transfer Technique Is Associated With Shoulder Pain and Pathology in People With Spinal Cord Injury: A Cross-Sectional Investigation.

PubMed

Hogaboom, Nathan S; Worobey, Lynn A; Boninger, Michael L

2016-10-01

To evaluate how transfer technique and subject characteristics relate to ultrasound measures of shoulder soft tissue pathology and self-reported shoulder pain during transfers in a sample of wheelchair users with spinal cord injury (SCI). Cross-sectional observational study. Research laboratory, national and local veterans' wheelchair sporting events. A convenience sample of wheelchair users (N=76) with nonprogressive SCI. Participants were aged >18 years, >1 year postinjury, and could complete repeated independent wheelchair transfers without the use of their leg muscles. Not applicable. Transfer pain items from the Wheelchair User's Shoulder Pain Index; transfer technique assessed using the Transfer Assessment Instrument (TAI); and shoulder pathology markers examined using the Ultrasound Shoulder Pathology Rating Scale (USPRS). Better transfer technique (higher TAI) correlated with less injury (lower USPRS) (partial η(2)=.062, P<.05) and less pain during transfers (partial η(2)=.049, P<.10). Greater age was the strongest predictor of greater pathology (USPRS total: partial η(2)=.225, supraspinatus grade: partial η(2)=.174, P<.01). An interaction between technique and weight was found (P<.10): participants with lower body weights showed a decrease in pathology markers with better transfer technique (low weight: R(2)=.422, P<.05; middle weight: R(2)=.200, P<.01), while those with higher weight showed little change with technique (R(2)=.018, P>.05). Participants with better transfer technique exhibited less shoulder pathology and reported less pain during transfers. The relationship between technique and pathology was strongest in lower-weight participants. While causation cannot be proven because of study design, it is possible that using a better transfer technique and optimizing body weight could reduce the incidence of shoulder pathology and pain. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Shoulder Injuries in Individuals Who Participate in CrossFit Training.

PubMed

Summitt, Ryan J; Cotton, Ryan A; Kays, Adam C; Slaven, Emily J

CrossFit, a sport and fitness program, has become increasingly popular both nationally and internationally. Researchers have recently identified significant improvements in health and wellness due to CrossFit. However, some individuals assert that CrossFit poses an inherent risk of injury, specifically to the shoulder, due to the intensity of training. Currently, there is limited evidence to support this assertion. Exercises performed during CrossFit do not place the shoulder at greater risk for injury. Injury rates are comparable to other sports of similar intensity. Descriptive survey study. Level 5. An electronic survey was developed and dispersed to approximately 980 individuals who trained in CrossFit gyms. The survey identified demographic data, training characteristics, and the prevalence of injury over a 6-month period in individuals who participated in CrossFit training. A total of 187 (19.1%) individuals completed the survey. Forty-four (23.5%) indicated that they had experienced a shoulder injury during CrossFit training over the previous 6 months. Of those who reported injury, 17 (38.6%) stated that this injury was an exacerbation of a previous injury sustained prior to starting CrossFit. There was no significant relationship between several demographic and training variables and shoulder injury. All shoulder injuries occurred at a rate of 1.94 per 1000 hours training, while "new" shoulder injuries occurred at a rate of 1.18 per 1000 hours training. The most commonly attributed causes of injury were improper form (33.3%) and exacerbation of a previous injury (33.3%). Twenty-five (64.1%) of those who experienced injury reported 1 month or less of training reduction due to the injury. Shoulder injury rates during CrossFit training are comparable to other methods of recreational exercise. Clinicians should be aware of training demands of exercises in CrossFit and modifications for these exercises to safely progress their patients back to participation.

Shoulder Injuries in Individuals Who Participate in CrossFit Training

PubMed Central

Summitt, Ryan J.; Cotton, Ryan A.; Kays, Adam C.; Slaven, Emily J.

2016-01-01

Background: CrossFit, a sport and fitness program, has become increasingly popular both nationally and internationally. Researchers have recently identified significant improvements in health and wellness due to CrossFit. However, some individuals assert that CrossFit poses an inherent risk of injury, specifically to the shoulder, due to the intensity of training. Currently, there is limited evidence to support this assertion. Hypothesis: Exercises performed during CrossFit do not place the shoulder at greater risk for injury. Injury rates are comparable to other sports of similar intensity. Study Design: Descriptive survey study. Level of Evidence: Level 5. Methods: An electronic survey was developed and dispersed to approximately 980 individuals who trained in CrossFit gyms. The survey identified demographic data, training characteristics, and the prevalence of injury over a 6-month period in individuals who participated in CrossFit training. Results: A total of 187 (19.1%) individuals completed the survey. Forty-four (23.5%) indicated that they had experienced a shoulder injury during CrossFit training over the previous 6 months. Of those who reported injury, 17 (38.6%) stated that this injury was an exacerbation of a previous injury sustained prior to starting CrossFit. There was no significant relationship between several demographic and training variables and shoulder injury. All shoulder injuries occurred at a rate of 1.94 per 1000 hours training, while “new” shoulder injuries occurred at a rate of 1.18 per 1000 hours training. The most commonly attributed causes of injury were improper form (33.3%) and exacerbation of a previous injury (33.3%). Twenty-five (64.1%) of those who experienced injury reported 1 month or less of training reduction due to the injury. Conclusion: Shoulder injury rates during CrossFit training are comparable to other methods of recreational exercise. Clinical Relevance: Clinicians should be aware of training demands of exercises in CrossFit and modifications for these exercises to safely progress their patients back to participation. PMID:27578854

Hip joint replacement

MedlinePlus

... Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... total hip replacement surgery in patients with hip osteoarthritis: a long-term follow-up of a randomised ...

Evaluation of shoulder integrity in space: first report of musculoskeletal US on the International Space Station.

PubMed

Fincke, E Michael; Padalka, Gennady; Lee, Doohi; van Holsbeeck, Marnix; Sargsyan, Ashot E; Hamilton, Douglas R; Martin, David; Melton, Shannon L; McFarlin, Kellie; Dulchavsky, Scott A

2005-02-01

Investigative procedures were approved by Henry Ford Human Investigation Committee and NASA Johnson Space Center Committee for Protection of Human Subjects. Informed consent was obtained. Authors evaluated ability of nonphysician crewmember to obtain diagnostic-quality musculoskeletal ultrasonographic (US) data of the shoulder by following a just-in-time training algorithm and using real-time remote guidance aboard the International Space Station (ISS). ISS Expedition-9 crewmembers attended a 2.5-hour didactic and hands-on US training session 4 months before launch. Aboard the ISS, they completed a 1-hour computer-based Onboard Proficiency Enhancement program 7 days before examination. Crewmembers did not receive specific training in shoulder anatomy or shoulder US techniques. Evaluation of astronaut shoulder integrity was done by using a Human Research Facility US system. Crew used special positioning techniques for subject and operator to facilitate US in microgravity environment. Common anatomic reference points aided initial probe placement. Real-time US video of shoulder was transmitted to remote experienced sonologists in Telescience Center at Johnson Space Center. Probe manipulation and equipment adjustments were guided with verbal commands from remote sonologists to astronaut operators to complete rotator cuff evaluation. Comprehensive US of crewmember's shoulder included transverse and longitudinal images of biceps and supraspinatus tendons and articular cartilage surface. Total examination time required to guide astronaut operator to acquire necessary images was approximately 15 minutes. Multiple arm and probe positions were used to acquire dynamic video images that were of excellent quality to allow evaluation of shoulder integrity. Postsession download and analysis of high-fidelity US images collected onboard demonstrated additional anatomic detail that could be used to exclude subtle injury. Musculoskeletal US can be performed in space by minimally trained operators by using remote guidance. This technique can be used to evaluate shoulder integrity in symptomatic crewmembers after strenuous extravehicular activities or to monitor microgravity-associated changes in musculoskeletal anatomy. Just-in-time training, combined with remote experienced physician guidance, may provide a useful approach to complex medical tasks performed by nonexperienced personnel in a variety of remote settings, including current and future space programs. (c) RSNA, 2004.

Evaluation of shoulder integrity in space: first report of musculoskeletal US on the International Space Station

NASA Technical Reports Server (NTRS)

Fincke, E. Michael; Padalka, Gennady; Lee, Doohi; van Holsbeeck, Marnix; Sargsyan, Ashot E.; Hamilton, Douglas R.; Martin, David; Melton, Shannon L.; McFarlin, Kellie; Dulchavsky, Scott A.

2005-01-01

Investigative procedures were approved by Henry Ford Human Investigation Committee and NASA Johnson Space Center Committee for Protection of Human Subjects. Informed consent was obtained. Authors evaluated ability of nonphysician crewmember to obtain diagnostic-quality musculoskeletal ultrasonographic (US) data of the shoulder by following a just-in-time training algorithm and using real-time remote guidance aboard the International Space Station (ISS). ISS Expedition-9 crewmembers attended a 2.5-hour didactic and hands-on US training session 4 months before launch. Aboard the ISS, they completed a 1-hour computer-based Onboard Proficiency Enhancement program 7 days before examination. Crewmembers did not receive specific training in shoulder anatomy or shoulder US techniques. Evaluation of astronaut shoulder integrity was done by using a Human Research Facility US system. Crew used special positioning techniques for subject and operator to facilitate US in microgravity environment. Common anatomic reference points aided initial probe placement. Real-time US video of shoulder was transmitted to remote experienced sonologists in Telescience Center at Johnson Space Center. Probe manipulation and equipment adjustments were guided with verbal commands from remote sonologists to astronaut operators to complete rotator cuff evaluation. Comprehensive US of crewmember's shoulder included transverse and longitudinal images of biceps and supraspinatus tendons and articular cartilage surface. Total examination time required to guide astronaut operator to acquire necessary images was approximately 15 minutes. Multiple arm and probe positions were used to acquire dynamic video images that were of excellent quality to allow evaluation of shoulder integrity. Postsession download and analysis of high-fidelity US images collected onboard demonstrated additional anatomic detail that could be used to exclude subtle injury. Musculoskeletal US can be performed in space by minimally trained operators by using remote guidance. This technique can be used to evaluate shoulder integrity in symptomatic crewmembers after strenuous extravehicular activities or to monitor microgravity-associated changes in musculoskeletal anatomy. Just-in-time training, combined with remote experienced physician guidance, may provide a useful approach to complex medical tasks performed by nonexperienced personnel in a variety of remote settings, including current and future space programs. (c) RSNA, 2004.

Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma.

PubMed

Kaushal, Seema; Sharma, Mehar Chand; Mathur, Sandeep R; Rastogi, Shishir; Bal, Chander Shekhar; Chumber, Sunil

2011-01-01

A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibility of anaplastic transformation should be kept in the differential diagnosis of rapidly enlarging painful mass in a known case of metastatic thyroid carcinoma to prevent misdiagnosis.

Relationship Between Deltoid and Rotator Cuff Muscles During Dynamic Shoulder Abduction: A Biomechanical Study of Rotator Cuff Tear Progression.

PubMed

Dyrna, Felix; Kumar, Neil S; Obopilwe, Elifho; Scheiderer, Bastian; Comer, Brendan; Nowak, Michael; Romeo, Anthony A; Mazzocca, Augustus D; Beitzel, Knut

2018-05-01

Previous biomechanical studies regarding deltoid function during glenohumeral abduction have primarily used static testing protocols. (1) Deltoid forces required for scapular plane abduction increase as simulated rotator cuff tears become larger, and (2) maximal abduction decreases despite increased deltoid forces. Controlled laboratory study. Twelve fresh-frozen cadaveric shoulders with a mean age of 67 years (range, 64-74 years) were used. The supraspinatus and anterior, middle, and posterior deltoid tendons were attached to individual shoulder simulator actuators. Deltoid forces and maximum abduction were recorded for the following tear patterns: intact, isolated subscapularis (SSC), isolated supraspinatus (SSP), anterosuperior (SSP + SSC), posterosuperior (infraspinatus [ISP] + SSP), and massive (SSC + SSP + ISP). Optical triads tracked 3-dimensional motion during dynamic testing. Fluoroscopy and computed tomography were used to measure critical shoulder angle, acromial index, and superior humeral head migration with massive tears. Mean values for maximum glenohumeral abduction and deltoid forces were determined. Linear mixed-effects regression examined changes in motion and forces over time. Pearson product-moment correlation coefficients ( r) among deltoid forces, critical shoulder angles, and acromial indices were calculated. Shoulders with an intact cuff required 193.8 N (95% CI, 125.5 to 262.1) total deltoid force to achieve 79.8° (95% CI, 66.4° to 93.2°) of maximum glenohumeral abduction. Compared with native shoulders, abduction decreased after simulated SSP (-27.2%; 95% CI, -43.3% to -11.1%, P = .04), anterosuperior (-51.5%; 95% CI, -70.2% to -32.8%, P < .01), and massive (-48.4%; 95% CI, -65.2% to -31.5%, P < .01) cuff tears. Increased total deltoid forces were required for simulated anterosuperior (+108.1%; 95% CI, 68.7% to 147.5%, P < .01) and massive (+57.2%; 95% CI, 19.6% to 94.7%, P = .05) cuff tears. Anterior deltoid forces were significantly greater in anterosuperior ( P < .01) and massive ( P = .03) tears. Middle deltoid forces were greater with anterosuperior tears ( P = .03). Posterior deltoid forces were greater with anterosuperior ( P = .02) and posterosuperior ( P = .04) tears. Anterior deltoid force was negatively correlated ( r = -0.89, P = .01) with critical shoulder angle (34.3°; 95% CI, 32.0° to 36.6°). Deltoid forces had no statistical correlation with acromial index (0.55; 95% CI, 0.48 to 0.61). Superior migration was 8.3 mm (95% CI, 5.5 to 11.1 mm) during testing of massive rotator cuff tears. Shoulders with rotator cuff tears require considerable compensatory deltoid function to prevent abduction motion loss. Anterosuperior tears resulted in the largest motion loss despite the greatest increase in deltoid force. Rotator cuff tears place more strain on the deltoid to prevent abduction motion loss. Fatigue or injury to the deltoid may result in a precipitous decline in abduction, regardless of tear size.

Risk Factors for Infection After Shoulder Arthroscopy in a Large Medicare Population.

PubMed

Cancienne, Jourdan M; Brockmeier, Stephen F; Carson, Eric W; Werner, Brian C

2018-03-01

Shoulder arthroscopy is well established as a highly effective and safe procedure for the treatment for several shoulder disorders and is associated with an exceedingly low risk of infectious complications. Few data exist regarding risk factors for infection after shoulder arthroscopy, as previous studies were not adequately powered to evaluate for infection. To determine patient-related risk factors for infection after shoulder arthroscopy by using a large insurance database. Case-control study; Level of evidence, 3. The PearlDiver patient records database was used to query the 100% Medicare Standard Analytic Files from 2005 to 2014 for patients undergoing shoulder arthroscopy. Patients undergoing shoulder arthroscopy for a diagnosis of infection or with a history of prior infection were excluded. Postoperative infection within 90 days postoperatively was then assessed with International Classification of Diseases, Ninth Revision codes for a diagnosis of postoperative infection or septic shoulder arthritis or a procedure for these indications. A multivariate binomial logistic regression analysis was then utilized to evaluate the use of an intraoperative steroid injection, as well as numerous patient-related risk factors for postoperative infection. Adjusted odds ratios (ORs) and 95% CIs were calculated for each risk factor, with P < .05 considered statistically significant. A total of 530,754 patients met all inclusion and exclusion criteria. There were 1409 infections within 90 days postoperatively (0.26%). Revision shoulder arthroscopy was the most significant risk factor for infection (OR, 3.25; 95% CI, 2.7-4.0; P < .0001). Intraoperative steroid injection was also an independent risk factor for postoperative infection (OR, 1.46; 95% CI, 1.2-1.9; P = .002). There were also numerous independent patient-related risk factors for infection, the most significant of which were chronic anemia (OR, 1.58; 95% CI, 1.4-1.8; P < .0001), malnutrition (OR, 1.42; 95% CI, 1.2-1.7; P = .001), male sex (OR, 2.71; 95% CI, 2.4-3.1; P < .0001), morbid obesity (OR, 1.41; 95% CI, 1.2-1.6; P < .0001), and depression (OR, 1.36; 95% CI, 1.2-1.5; P < .0001). Intraoperative steroid injection was a significant independent risk factor for postoperative infection after shoulder arthroscopy. There were also numerous significant patient-related risk factors for postoperative infection, including revision surgery, obesity, male sex, chronic anemia, malnutrition, depression, and alcohol use, among others.

Mapping the articular contact area of the long head of the biceps tendon on the humeral head.

PubMed

Morris, Brent J; Byram, Ian R; Lathrop, Ray A; Dunn, Warren R; Kuhn, John E

2014-01-01

The purpose of this investigation was to calculate the contact surface area of the long head of the biceps (LHB) in neutral position and abduction. We sought to determine whether the LHB articulates with the humeral head in a consistent pattern comparing articular contact area in neutral position and abduction. Eleven fresh frozen matched cadaveric shoulders were analyzed. The path of the biceps tendon on the articular surface of the humeral head and the total articular surface were digitized using a MicronTracker 2 H3-60 three-dimensional optical tracker. Contact surface area was significantly less in abduction than in neutral position (P = 0.002) with a median ratio of 41% (36%, 47.5%). Ratios of contact area in neutral position to full articular surface area were consistent between left and right shoulders (rho = 1, P = 0.017) as were ratios of abduction area to full articular surface area (rho = 0.97, P = 0.005). The articular contact surface area is significantly greater in neutral position than abduction. The ratios of articular contact surface areas to total humeral articular surface areas have a narrow range and are consistent between left and right shoulders of the same cadaver.

[Use of stimulation techniques in pain treatment].

PubMed

Rosted, Palle; Andersen, Claus

2006-05-15

Stimulation techniques (SB) include manipulation, acupuncture, acupressure, physiotherapy, transcutaneous electrical nerve stimulation, reflexotherapy, laser treatment and epidural stimulation technique. The purpose of this paper is to investigate the scientific evidence for these techniques. The Cochrane Library and Medline were searched for all techniques from 2000 to date. Only randomised controlled studies written in English were included. Search words were used, such as; acupuncture and neck pain, shoulder pain, etc. In total 587 papers were identified for the following diseases; headache, neck pain, shoulder pain, elbow pain, low back pain and knee pain. 415 papers were excluded, and the remaining 172 papers, a total of 20,431 patients, are the basis for this study. The effect of acupuncture and epidural stimulation technique is scientifically well-supported. For the remaining techniques, the scientific evidence is dubious.

Importance of latissimus dorsi muscle preservation for shoulder function after scapulectomy.

PubMed

Mimata, Yoshikuni; Nishida, Jun; Nagai, Taro; Tada, Hiroshi; Sato, Kotaro; Doita, Minoru

2018-03-01

Scapulectomy is an inevitable treatment for sarcomas of the scapula. This procedure is unavoidable because it reduces the local recurrence rate but can impair shoulder movements and affect the activities of daily living. This study investigated the factors influencing functional outcomes after scapulectomy. The clinical results of 8 patients (5 males, 3 females) who were diagnosed with primary or metastatic sarcomas of the scapula were retrospectively reviewed. The mean age was 49 years (range, 11-86 years). We examined the correlation between the type of excision of the scapula (total, subtotal, or partial) and postoperative functional outcomes according to the Musculoskeletal Tumor Society (MSTS) score. In partial excision, the glenohumeral joint was preserved; in subtotal excision, the glenoid was completely resected and some bony components were preserved; and in total excision, the entire bony component of the scapula was resected. The average follow-up period was 55 months (range, 9-142 months). The partial, subtotal, and total excision groups had mean functional scores of 96.7%, 76.7%, and 62.2%, respectively. Although the mean functional scores were lower in patients who underwent total and subtotal excisions, 3 patients in whom the latissimus dorsi muscle was preserved had better function (mean MSTS score, 76.7%) than the 2 patients in whom it was not preserved (mean MSTS score, 55.0%). These results suggest that the latissimus dorsi muscle, along with the deltoid and pectoralis major muscles, is one of the stabilizers of the proximal humerus after scapulectomy. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Work-related lesions of the supraspinatus tendon: a case-control study.

PubMed

Seidler, Andreas; Bolm-Audorff, Ulrich; Petereit-Haack, Gabriela; Ball, Elke; Klupp, Magdalena; Krauss, Noëlle; Elsner, Gine

2011-04-01

To examine the dose-response relationship between cumulative duration of work with highly elevated arms (work above shoulder level) as well as of manual material handling and ruptures of the supraspinatus tendon in a population-based case-control study. In 14 radiologic practices, we recruited 483 male patients aged 25-65 with radiographically confirmed partial (n = 385) or total (n = 98) supraspinatus tears associated with shoulder pain. A total of 300 male control subjects were recruited. Data were gathered in a structured personal interview. To calculate cumulative exposure, the self-reported duration of lifting/carrying of heavy loads (>20 kg) as well as the duration of work with highly elevated arms was added up over the entire working life. The results of our study support a dose-response relationship between cumulative duration of work with highly elevated arms and symptomatic supraspinatus tendon tears. For a cumulative duration of >3,195 h work above shoulder level, the risk of a supraspinatus tendon rupture is elevated to 2.0 (95% CI 1.1-3.5), adjusted for age, region, lifting/carrying of heavy loads, handheld vibration, apparatus gymnastics/shot put/javelin/hammer throwing/wrestling, and tennis. The cumulative duration of carrying/lifting of heavy loads also yields a positive dose-response relation with disease (independent from work above shoulder level and from handheld vibration), with an adjusted odds ratio of 1.8 (95% CI 1.0-3.2) in the highest exposure category (>77 h). We find an increased risk for subjects exposed to handheld vibration with an adjusted OR of 3.2 (95% CI 1.7-5.9) in the highest exposure category (16 years or more in the job with exposure), but a clear dose-response relationship is lacking. This study points to a potential etiologic role of long-term cumulative effects of work with highly elevated arms and heavy lifting/carrying on shoulder tendon disorders.

Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty.

PubMed

Dowdle, S Blake; Glass, Natalie; Anthony, Chris A; Hettrich, Carolyn M

2017-09-01

The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT). For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects. Cohort study (diagnosis); Level of evidence, 3. Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form-36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO. The PROMIS PF demonstrated excellent correlation with the SF-36 PF ( r = 0.81, P < .0001) and good correlation with the ASES ( r = 0.62, P < .0001), EQ-5D ( r = 0.64, P < .001), and WOOS index ( r = 0.51, P < .01). The PROMIS PF demonstrated low correlation with the Marx scale ( r = 0.29, P = .02). The PROMIS UE demonstrated good correlation with the ASES ( r = 0.55, P < .0001), SF-36 ( r = 0.53, P < .01), EQ-5D ( r = 0.48, P < .01), and WOOS ( r = 0.34, P <.01), and poor correlation with the Marx scale ( r = 0.06, P = .62). There were no ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4. These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased question burden with no ceiling effects.

Arthroscopic Shoulder Surgery in Female Professional Tennis Players: Ability and Timing to Return to Play.

PubMed

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

2017-07-01

To assess the outcome and time to return to previous level of competitive play after shoulder surgery in professional tennis players. Retrospective case series. Tertiary academic centre. The records of all female tennis players on the Women's Tennis Association (WTA) professional circuit between January 2008 and June 2010 were reviewed to identify players who underwent shoulder surgery on their dominant (serving) shoulder. Primary outcomes were the ability and time to return to professional play and if they were able to return to their previous level of function as determined by singles ranking. Preoperative and postoperative singles rankings were used to determine rate and completeness of return to preoperative function. During the study period, 8 professional women tennis players from the WTA tour underwent shoulder surgery on their dominant arm. Indications included rotator cuff debridement or repair, labral reconstruction for instability or superior labral anterior posterior lesion, and neurolysis of the suprascapular nerve. Seven players (88%) returned to professional play. The mean time to return to play was 7 months after surgery. However, only 25% (2 of 8) players achieved their preinjury singles rank or better by 18 months postoperatively. In total, 4 players returned to their preinjury singles ranking, with their peak singles ranking being attained at a mean of 2.4 years postoperatively. In professional female tennis players, a high return to play rate after arthroscopic shoulder surgery is associated with a prolonged and often incomplete return to previous level of performance. Thus, counseling the patient to this fact is important to manage expectations. Level IV-Case Series.

Prevalence rate of neck, shoulder and lower back pain in association with age, body mass index and gender among Malaysian office workers.

PubMed

Shariat, Ardalan; Cardoso, Jefferson Rosa; Cleland, Joshua A; Danaee, Mahmoud; Ansari, Noureddin Nakhostin; Kargarfard, Mehdi; Mohd Tamrin, Shamsul Bahri

2018-05-28

Malaysian office workers often experience Musculoskeletal Discomfort (MSD) which is typically related to the low back, shoulders, and neck. The objective of this study was to examine the occurrence of lower back, shoulder, and neck pain among Malaysian office workers. 752 subjects (478 women and 274 men) were randomly selected from the Malaysian office workers population of 10,000 individuals. The participants were aged between 20-50 years and had at least one year of work experience. All participants completed the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). Instructions to complete the questinnaire were given to the participants under the researchers supervision in the morning before they started a day of work. The participants were then classified into four categories based on body mas index (BMI) (BMI:≤18.4, 18.5-24.99, 25-29.99, ≥30) and age (Age: 20-29, 30-39, 40-49, ≥50). There was a significant association between pain severity in gender and right (p = 0.046) and left (p = 0.041) sides of the shoulders. There was also a significant association between BMI and severity of pain in the lower back area (p = 0.047). It was revealed that total pain score in the shoulders was significantly associated with age (p = 0.041). The results of this study demonstrated that a significant correlation existed between pain servity for gender in both right and left shoulder. These findings require further scientific investigation as do the identification of effective preventative stratgies.

A 12-week rehabilitation program improves body composition, pain sensation, and internal/external torques of baseball pitchers with shoulder impingement symptom.

PubMed

Cha, Jun-Youl; Kim, Jae-Hak; Hong, Ju; Choi, Young-Tae; Kim, Min-Ho; Cho, Ji-Hyun; Ko, Il-Gyu; Jee, Yong-Seok

2014-02-01

The aim of this study was to investigate the effects of a 12-week rehabilitation program on body composition, shoulder pain, and isokinetic internal/external torques of pitchers with impingement syndrome. A total of 30 pitchers were divided into 2 groups: experimental group (EG, n = 16) and control group (CG, n= 14). The rehabilitation program consisted of physical therapy, warm-up, work-out, and cool-down. As results, body weight and fat mass of EG were decreased whereas muscle mass of EG was significantly increased after the experiment. The pain degrees in resting, normal daily activity, and strenuous activity on the numeric pain rating scale were significantly decreased in the EG. The internal and external peak torques (PTs) of uninvolved and involved sides of EG were increased in EG after 12 weeks. Such results provide a deficit ratio of both sides in EG close to normal values. The ratios of internal/external PTs in EG were also close to the reference values. The internal and external total works of both sides in EG were similar to the values of PT. The fatigue indices of internal and external rotators of both sides in EG were decreased. As a conclusion, a 12-week rehabilitation program reduced the shoulder pain, improved the body composition and enhanced the isokinetic shoulder internal/external rotators in EG with impingement symptoms. Also the study suggested that the rehabilitation program evened out the ratio between internal and external rotators and lowered the fatigue level after the experiment.

A 12-week rehabilitation program improves body composition, pain sensation, and internal/external torques of baseball pitchers with shoulder impingement symptom

PubMed Central

Cha, Jun-Youl; Kim, Jae-Hak; Hong, Ju; Choi, Young-Tae; Kim, Min-Ho; Cho, Ji-Hyun; Ko, Il-Gyu; Jee, Yong-Seok

2014-01-01

The aim of this study was to investigate the effects of a 12-week rehabilitation program on body composition, shoulder pain, and isokinetic internal/external torques of pitchers with impingement syndrome. A total of 30 pitchers were divided into 2 groups: experimental group (EG, n = 16) and control group (CG, n= 14). The rehabilitation program consisted of physical therapy, warm-up, work-out, and cool-down. As results, body weight and fat mass of EG were decreased whereas muscle mass of EG was significantly increased after the experiment. The pain degrees in resting, normal daily activity, and strenuous activity on the numeric pain rating scale were significantly decreased in the EG. The internal and external peak torques (PTs) of uninvolved and involved sides of EG were increased in EG after 12 weeks. Such results provide a deficit ratio of both sides in EG close to normal values. The ratios of internal/external PTs in EG were also close to the reference values. The internal and external total works of both sides in EG were similar to the values of PT. The fatigue indices of internal and external rotators of both sides in EG were decreased. As a conclusion, a 12-week rehabilitation program reduced the shoulder pain, improved the body composition and enhanced the isokinetic shoulder internal/external rotators in EG with impingement symptoms. Also the study suggested that the rehabilitation program evened out the ratio between internal and external rotators and lowered the fatigue level after the experiment. PMID:24678503

Acupuncture at local and distal points for chronic shoulder pain: study protocol for a randomized controlled trial.

PubMed

Fu, Qing-Nan; Shi, Guang-Xia; Li, Qian-Qian; He, Tian; Liu, Bao-Zhen; Sun, San-Feng; Wang, Jun; Tan, Cheng; Yang, Bo-Feng; Liu, Cun-Zhi

2014-04-17

Chronic shoulder pain (CSP) is the third most common type of musculoskeletal pain. It has a major impact on health-related quality of life. In Chinese medicine, CSP is considered one of the conditions most amenable to treatment with acupuncture. The purpose of this study is to evaluate the efficacy of local acupoints in combination with distal acupoints in pain relief and shoulder function improvement in CSP patients. This is a multicenter, single blind, factorial randomized controlled clinical trial. A total of 164 participants will be randomly allocated to four different groups: Group A will receive acupuncture at local acupoints in combination with distal acupoint. Group B will receive acupuncture at local acupoints in combination with distal non-acupoint. Group C will receive acupuncture at local non-acupoints in combination with distal acupoint. Group D will receive acupuncture at local non-acupoints in combination with distal non-acupoint. Each group will receive 12 treatments of acupuncture one to three times per week for six weeks in total. The primary outcome is shoulder pain intensity, which is graded using a 100 -mm Visual Analogue Scale. The assessment is at baseline (before treatment initiation), 6 weeks after the first acupuncture, 10 weeks after the first acupuncture and 18 weeks after the first acupuncture. This trial will be helpful in identifying whether acupuncture at local acupoints in combination with distal acupoints may be more effective than needling points separately. International Standard Randomized Controlled Trial Number Register: ISRCTN61861069 (http://www.controlled-trials.com).

Successful Outcome of Modified Quad Surgical Procedure in Preteen and Teen Patients with Brachial Plexus Birth Palsy

PubMed Central

Nath, Rahul K.; Somasundaram, Chandra

2012-01-01

Objective: To evaluate the outcome of modified Quad procedure in preteen and teen patients with brachial plexus birth palsy. Background: We have previously demonstrated a significant improvement in shoulder abduction, resulting from the modified Quad procedure in children (mean age 2.5 years; range, 0.5–9 years) with obstetric brachial plexus injury. Methods: We describe in this report the outcome of 16 patients (6 girls and 10 boys; 7 preteen and 9 teen) who have undergone the modified Quad procedure for the correction of the shoulder function, specifically abduction. The patients underwent transfer of the latissimus dorsi and teres major muscles, release of contractures of subscapularis pectoralis major and minor, and axillary nerve decompression and neurolysis (the modified Quad procedure). Mean age of these patients at surgery was 13.5 years (range, 10.1–17.9 years). Results: The mean preoperative total Mallet score was 14.8 (range, 10–20), and active abduction was 84° (range, 20°–140°). At a mean follow-up of 1.5 years, the mean postoperative total Mallet score increased to 19.7 (range, 13–25, P < .0001), and the mean active abduction improved to 132° (range, 40°–180°, P < .0003). Conclusion: The modified Quad procedure greatly improves not only the active abduction but also other shoulder functions in preteen and teen patients, as this outcome is the combined result of decompression and neurolysis of the axillary nerve and the release of the contracted internal rotators of the shoulder. PMID:23308301

Outcomes After Shoulder and Elbow Injury in Baseball Players: Are We Reporting What Matters?

PubMed

Makhni, Eric C; Saltzman, Bryan M; Meyer, Maximilian A; Moutzouros, Vasilios; Cole, Brian J; Romeo, Anthony A; Verma, Nikhil N

2017-02-01

Return to play, as well as time to return to play, are the most important metrics considered by athletes when attempting to make treatment decisions after injury. However, the consistency of reporting of these metrics in the scientific literature is unknown. To investigate patterns of outcomes reporting in the medical literature of shoulder and elbow injuries in active baseball players. Systematic review. A systematic review of literature published within the past 10 years was performed to identify all recent clinical studies focusing on shoulder and elbow injuries in baseball players across all levels. Review articles, case reports, and laboratory/biomechanical studies were all excluded. A total of 49 studies were included for review. The majority of studies were either level 3 or level 4 evidence (96%). In total, 71% of studies reported on rates of return to preinjury level of play, whereas 31% of studies reported on time to return to preinjury level of play. Only 47% of studies reported on both rate and time of return to preinjury level of play. A minority of studies (8%) reported patient satisfaction rates. Finally, 27 different subjective and patient-reported outcomes were reported, and none of these appeared in more than 14% of all studies. Time to return to preinjury level of play is inadequately reported in studies of shoulder and elbow injury in baseball players. Similarly, satisfaction rates and scores are underreported. Finally, the significant variability of subjective and patient-reported outcomes utilized may undermine the ability of clinicians to accurately compare results from different studies.

Melanoma markers in marathon runners: increase with sun exposure and physical strain.

PubMed

Richtig, Erika; Ambros-Rudolph, Christina M; Trapp, Michael; Lackner, Helmut K; Hofmann-Wellenhof, Rainer; Kerl, Helmut; Schwaberger, Guenther

2008-01-01

Marathon runners seem to have an increased melanoma risk. To identify potential melanoma markers. 150 marathon runners volunteered to take part in the skin cancer screening campaign. After the runners completed a questionnaire about melanoma risk factors, types of sportswear and training programs, they received a total skin examination. The number of lentigines and nevi on the left shoulder and the left buttock were counted in each participant using templates in standardized positions. The potential association of training sportswear and training parameters with the number of lentigines and nevi on the left shoulder was evaluated. The mean number of lentigines on the left shoulder was 19.6 +/- 18.2 (SD), whereas no lentigines were found on the left buttock (p = 0.000). The number of nevi also differed significantly between the 2 localizations with higher numbers on the left shoulder (p = 0.000). While lifetime sunburn history and type of sportswear correlated with the number of lentigines, training parameters had an impact on the number of nevi. Independent of their mean weekly running time, runners with higher heart rates while training, higher training velocities and higher physical strain indexes showed more nevi on the shoulder than the other runners (p = 0.029, 0.046, 0.038, respectively). Sun exposure and high physical strain lead to an increase in melanoma markers such as lentigines and nevi in marathon runners. Copyright 2008 S. Karger AG, Basel.

Occupational neck and shoulder pain among automobile manufacturing workers in Iran.

PubMed

Alipour, Akbar; Ghaffari, Mostafa; Shariati, Batoul; Jensen, Irene; Vingard, Eva

2008-05-01

Work-related musculoskeletal disorders (MSDs) of the upper extremities are a major problem globally, though most relevant studies have been reported from high income countries. The prevalence of neck and shoulder pain and its association with work-related physical and psychosocial factors and life style was determined by a cross-sectional survey using the Nordic Musculoskeletal Questionnaire (NMQ) in the largest Iranian car manufacturing company, with more than 18,000 employees. A total of 14,384 (79.8%) of all employees completed the questionnaire. Depending on the questions used to measure neck and shoulder symptoms, the prevalence varied widely (from 20.5% to 3.9%). In the multiple logistic regression model, limited to employees with at least 1 year of work experience, risk indicators for disabling pain of the neck and/or shoulder that remained for male were: duration of employment, high visual demands, repetitive work, sitting position at work, awkward working position, no regular exercise, monotonous work, lack of encouraging organizational culture, and anxiety concerning change. For female repetitive work, sitting position at work and no support if there is trouble at work were the only remaining factors. The study confirms the effects of physical and psychosocial factors on neck and shoulder symptoms among automobile manufacturing workers in a low to middle income country in spite of the relative youth and job insecurity of the population. (c) 2008 Wiley-Liss, Inc.

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial

PubMed Central

Nejati, Parisa; Ghahremaninia, Armita; Naderi, Farrokh; Gharibzadeh, Safoora; Mazaherinezhad, Ali

2017-01-01

Background: Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder. The evidence for the effectiveness of treatment options is inconclusive and limited. Therefore, there is a need for more evidence in this regard, particularly for long-term outcomes. Hypothesis: Platelet-rich plasma (PRP) would be an effective method in treating subacromial impingement. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This was a single-blinded randomized clinical trial with 1-, 3-, and 6-month follow-up. Sixty-two patients were randomly placed into 2 groups, receiving either PRP or exercise therapy. The outcome parameters were pain, shoulder range of motion (ROM), muscle force, functionality, and magnetic resonance imaging findings. Results: Both treatment options significantly reduced pain and increased shoulder ROM compared with baseline measurements. Both treatments also significantly improved functionality. However, the treatment choices were not significantly effective in improving muscle force. Trend analysis revealed that in the first and third months, exercise therapy was superior to PRP in pain, shoulder flexion and abduction, and functionality. However, in the sixth month, only shoulder abduction and total Western Ontario Rotator Cuff score were significantly different between the 2 groups. Conclusion: Both PRP injection and exercise therapy were effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective. PMID:28567426

Rehabilitation following rotator cuff repair: A work of the Commission Rehabilitation of the German Society of Shoulder and Elbow Surgery e. V. (DVSE) in collaboration with the German Association for Physiotherapy (ZVK) e. V., the Association Physical Therapy, Association for Physical Professions (VPT) e. V. and the Section Rehabilitation-Physical Therapy of the German Society for Orthopaedics and Trauma e. V. (DGOU).

PubMed

Jung, Christian; Tepohl, Lena; Tholen, Reina; Beitzel, Knut; Buchmann, Stefan; Gottfried, Thomas; Grim, Casper; Mauch, Bettina; Krischak, Gert; Ortmann, Hans; Schoch, Christian; Mauch, Frieder

2018-01-01

Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e. V. (DVSE) shoulder experts. A literature search for the years 2004-2014 was conducted in relevant databases and bibliographies including the Guidelines International Network, National Guidelines, PubMed, Cochrane CentralRegister of Controlled Trials, Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database. In addition, 63 DVSE experts were contacted via online questionnaire. A total of 17 studies, four reviews and one guideline fulfilled the inclusion criteria. Based on these results and the obtained expert opinions, a four-phase rehabilitation protocol could be developed.

Bone mineralization changes of the glenoid in shoulders with symptomatic rotator cuff tear.

PubMed

Harada, Yohei; Yokoya, Shin; Akiyama, Yuji; Mochizuki, Yu; Ochi, Mitsuo; Adachi, Nobuo

2018-06-06

Computed tomography osteoabsorptiometry (CTO) is a method to analyze the stress distribution in joints by measuring the subchondral bone density. The purpose of this study was to evaluate the bone mineralization changes of the glenoid in shoulders with rotator cuff tears by CTO and to evaluate whether rotator cuff tears are associated with stress changes in the glenoid. In total, 32 patients, who were diagnosed with unilateral rotator cuff tears and underwent arthroscopic rotator cuff repair, were enrolled in this study. They underwent CT scanning of both shoulders pre-operatively and the glenoid was evaluated using CTO. Hounsfield units (HU) in seven areas of the glenoid were compared between the affected and unaffected sides. The central area of the glenoid on the affected side had significantly lower HU than on the unaffected side among all patients. Focusing on the rotator cuff tear size and the subscapularis tendon, only patients with larger cuff tears or with subscapularis tendon tears showed significantly lower HU in the central area of the affected side. This study showed a decrease in bone mineralization density in the central glenoid in shoulders with rotator cuff tear. This change was observed in the case of larger cuff tears and subscapularis tendon tears. Our results help clarify the changes in stress distribution in the shoulder joint caused by symptomatic rotator cuff tears.

[Treatment of proximal humeral fractures by reverse shoulder arthroplasty: mid-term evaluation of functional results and Notching].

PubMed

Hernández-Elena, J; de la Red-Gallego, M Á; Garcés-Zarzalejo, C; Pascual-Carra, M A; Pérez-Aguilar, M D; Rodríguez-López, T; Alfonso-Fernández, A; Pérez-Núñez, M I

2015-01-01

An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

[Evaluation of the extent of movement of the shoulder after breast cancer treatment].

PubMed

Silvia, Silvia H; Godoy, José M

2009-01-01

Treatment of breast cancer generally involves quadrantectomy and mastectomy followed by radiotherapy and chemotherapy depending on indication. The object of the present study was to verify the extent of movement of the shoulder after breast cancer treatment and the influence of the type of surgery (quadrantectomy and mastectomy). A total of 90 women submitted to surgery for breast cancer in the Region of Catanduva, Brazil and a control group of 20 women without surgical compromise were evaluated. The extents of bilateral flexion and abduction movements of the shoulders were assessed by goniometry. The non-matched student t-test and Fisher exact test were utilized for statistical analysis with an alpha error of up to 5% being considered acceptable. Differences of 20 degrees or more in the extent of movement of the shoulders of women submitted to surgery were seen in 47.7% of the cases for flexion and in 56.6% for abduction. The compromise to the movement of the shoulder in the control group was less than 20 degrees in 9 (45%) of the women. On comparing the incidence of alterations in the movements of the arms of women submitted to surgery with the control group, a significant difference was identified for both limbs (p-value < 0.01). The articular mobility of both arms of patients submitted to treatment for breast cancer can be affected.

Effectiveness of Manual Therapy and Stretching for Baseball Players With Shoulder Range of Motion Deficits.

PubMed

Bailey, Lane B; Thigpen, Charles A; Hawkins, Richard J; Beattie, Paul F; Shanley, Ellen

Baseball players displaying deficits in shoulder range of motion (ROM) are at increased risk of arm injury. Currently, there is a lack of consensus regarding the best available treatment options to restore shoulder ROM. Instrumented manual therapy with self-stretching will result in clinically significant deficit reductions when compared with self-stretching alone. Controlled laboratory study. Shoulder ROM and humeral torsion were assessed in 60 active baseball players (mean age, 19 ± 2 years) with ROM deficits (nondominant - dominant, ≥15°). Athletes were randomly assigned to receive a single treatment of instrumented manual therapy plus self-stretching (n = 30) or self-stretching only (n = 30). Deficits in internal rotation, horizontal adduction, and total arc of motion were compared between groups immediately before and after a single treatment session. Treatment effectiveness was determined by mean comparison data, and a number-needed-to-treat (NNT) analysis was used for assessing the presence of ROM risk factors. Prior to intervention, players displayed significant ( P < 0.001) dominant-sided deficits in internal rotation (-26°), total arc of motion (-18°), and horizontal adduction (-17°). After the intervention, both groups displayed significant improvements in ROM, with the instrumented manual therapy plus self-stretching group displaying greater increases in internal rotation (+5°, P = 0.010), total arc of motion (+6°, P = 0.010), and horizontal adduction (+7°, P = 0.004) compared with self-stretching alone. For horizontal adduction deficits, the added use of instrumented manual therapy with self-stretching decreased the NNT to 2.2 (95% CI, 2.1-2.4; P = 0.010). Instrumented manual therapy with self-stretching significantly reduces ROM risk factors in baseball players with motion deficits when compared with stretching alone. The added benefits of manual therapy may help to reduce ROM deficits in clinical scenarios where stretching alone is ineffective.

Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator.

PubMed

Tofte, Josef N; Westerlind, Brian O; Martin, Kevin D; Guetschow, Brian L; Uribe-Echevarria, Bastián; Rungprai, Chamnanni; Phisitkul, Phinit

2017-03-01

To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year. Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r; alpha = 0.05. 35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee: training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = -0.92, P = .004, 95% CI = -0.96, -0.84; and camera path length, r = -0.97, P = .0004, 95% CI = -0.98, -0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = -0.54, P = .002, 95% CI = -0.75, -0.22; and camera path length, r = -0.62, P = .0003, 95% CI = -0.8, -0.33. Shoulder: training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = -0.94, P = .001, 95% CI = -0.97, -0.89; and camera path length, r = -0.89, P = .007, 95% CI = -0.95, -0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = -0.62, P = .0002, 95% CI = -0.8, -0.33; and camera path length, r = -0.37, P = .044, 95% CI = -0.64, -0.01, by training year. FAST: training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = -0.86, P = .012, 95% CI = -0.93, -0.74; and camera path lengths, r = -0.85, P = .015, 95% CI = -0.92, -0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance. We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time. We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Postoperative implant-associated osteomyelitis of the shoulder: Hardware-retaining revision concept using temporary drainage].

PubMed

Schnetzke, M; Aytac, S; Herrmann, P; Wölfl, C; Grützner, P A; Heppert, V; Guehring, T

2015-06-01

Posttraumatic and postoperative osteomyelitis (PPO) is a subgroup of bone infections with increasing importance. However, to date no standardized reoperation concept exists particularly for patients with PPO of the shoulder region. Therefore the purpose of this study was to evaluate a revision concept including débridement, irrigation, and insertion of temporary drainage with hardware retention until healing. A total of 31 patients with PPO were included with a proximal humerus fracture (n = 14), clavicle fracture (n = 10), or AC-joint separation (n = 7). In all, 27 of these patients could be followed for > 1 year. Hardware retention until fracture or ligament healing could be achieved in > 83%. Six patients required follow-up débridement due to recurrent infections, but then were unremarkable. Clinical outcome showed excellent Constant scores (91.6 ± 2.8). A cost-efficient, simple, and successful revision concept for patients with PPO of the shoulder region is described.

Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study.

PubMed

Donmez, Turgut; Erdem, Vuslat Muslu; Uzman, Sinan; Yildirim, Dogan; Avaroglu, Huseyin; Ferahman, Sina; Sunamak, Oguzhan

2017-03-01

Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs . 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs . 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.

Technical note: Use of a digital and an optical Brix refractometer to estimate total solids in milk replacer solutions for calves.

PubMed

Floren, H K; Sischo, W M; Crudo, C; Moore, D A

2016-09-01

The Brix refractometer is used on dairy farms and calf ranches for colostrum quality (estimation of IgG concentration), estimation of serum IgG concentration in neonatal calves, and nonsalable milk evaluation of total solids for calf nutrition. Another potential use is to estimate the total solids concentrations of milk replacer mixes as an aid in monitoring feeding consistency. The purpose of this study was to evaluate the use of Brix refractometers to estimate total solids in milk replacer solutions and evaluate different replacer mixes for osmolality. Five different milk replacer powders (2 milk replacers with 28% crude protein and 25% fat and 3 with 22% crude protein and 20% fat) were mixed to achieve total solids concentrations from approximately 5.5 to 18%, for a total of 90 different solutions. Readings from both digital and optical Brix refractometers were compared with total solids. The 2 types of refractometers' readings correlated well with one another. The digital and optical Brix readings were highly correlated with the total solids percentage. A value of 1.08 to 1.47 would need to be added to the Brix reading to estimate the total solids in the milk replacer mixes with the optical and digital refractometers, respectively. Osmolality was correlated with total solids percentage of the mixes, but the relationship was different depending on the type of milk replacer. The Brix refractometer can be beneficial in estimating total solids concentration in milk replacer mixes to help monitor milk replacer feeding consistency. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

The Effect on Long-Term Survivorship of Surgeon Preference for Posterior-Stabilized or Minimally Stabilized Total Knee Replacement: An Analysis of 63,416 Prostheses from the Australian Orthopaedic Association National Joint Replacement Registry.

PubMed

Vertullo, Christopher J; Lewis, Peter L; Lorimer, Michelle; Graves, Stephen E

2017-07-05

Controversy still exists as to the optimum management of the posterior cruciate ligament (PCL) in total knee arthroplasty. Surgeons can choose to kinematically substitute the PCL with a posterior-stabilized total knee replacement or alternatively to utilize a cruciate-retaining, also known as minimally stabilized, total knee replacement. Proponents of posterior-stabilized total knee replacement propose that the reported lower survivorship in registries when directly compared with minimally stabilized total knee replacement is due to confounders such as selection bias because of the preferential usage of posterior-stabilized total knee replacement in more complex or severe cases. In this study, we aimed to eliminate these possible confounders by performing an instrumental variable analysis based on surgeon preference to choose either posterior-stabilized or minimally stabilized total knee replacement, rather than the actual prosthesis received. Cumulative percent revision, hazard ratio (HR), and revision diagnosis data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry from September 1, 1999, to December 31, 2014, for 2 cohorts of patients, those treated by high-volume surgeons who preferred minimally stabilized replacements and those treated by high-volume surgeons who preferred posterior-stabilized replacements. All patients had a diagnosis of osteoarthritis and underwent fixed-bearing total knee replacement with patellar resurfacing. At 13 years, the cumulative percent revision was 5.0% (95% confidence interval [CI], 4.0% to 6.2%) for the surgeons who preferred the minimally stabilized replacements compared with 6.0% (95% CI, 4.2% to 8.5%) for the surgeons who preferred the posterior-stabilized replacements. The revision risk for the surgeons who preferred posterior-stabilized replacements was significantly higher for all causes (HR = 1.45 [95% CI, 1.30 to 1.63]; p < 0.001), for loosening or lysis (HR = 1.93 [95% CI, 1.58 to 2.37]; p < 0.001), and for infection (HR = 1.51 [95% CI, 1.25 to 1.82]; p < 0.001). This finding was irrespective of patient age and was evident with cemented fixation and with both cross-linked polyethylene and non-cross-linked polyethylene. However, the higher revision risk was only evident in male patients. There was a 45% higher risk of revision for the patients of surgeons who preferred a posterior-stabilized total knee replacement compared with the patients of surgeons who preferred a minimally stabilized total knee replacement. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of Video Image Analysis (VIA) technology to predict meat yield of sheep carcasses on-line under UK abattoir conditions.

PubMed

Rius-Vilarrasa, E; Bünger, L; Maltin, C; Matthews, K R; Roehe, R

2009-05-01

The Meat and Livestock Commission's (MLC) EUROP classification based scheme and Video Image Analysis (VIA) system were compared in their ability to predict weights of primal carcass joints. A total of 443 commercial lamb carcasses under 12 months of age and mixed gender were selected by their cold carcass weight (CCW), conformation and fat scores. Lamb carcasses were classified for conformation and fatness, scanned by the VIA system and dissected into primal joints of leg, chump, loin, breast and shoulder. After adjustment for CCW, the estimation of primal joints using MLC EUROP scores showed high coefficients of determination (R(2)) in the range of 0.82-0.99. The use of VIA always resulted in equal or higher R(2). The precision measured as root mean square error (RMSE) was 27% (leg), 13% (chump), 1% (loin), 11% (breast), 5% (shoulders) and 13% (total primals) higher using VIA than MLC carcass information. Adjustment for slaughter day and gender effects indicated that estimations of primal joints using MLC EUROP scores were more sensitive to these factors than using VIA. This was consistent with an increase in stability of the prediction model of 28%, 11%, 2%, 12%, 6% and 14% for leg, chump, loin, breast and shoulder and total primals, respectively, using VIA compared to MLC EUROP scores. Consequently, VIA was capable of improving the prediction of primal meat yields compared to the current MLC EUROP carcass classification scheme used in the UK abattoirs.

Mineralisation and mechanical strength of the glenoid cavity subchondral bone plate.

PubMed

Kraljević, Marko; Zumstein, Valentin; Wirz, Dieter; Hügli, Rolf; Müller-Gerbl, Magdalena

2011-12-01

Failures in total shoulder replacements are often due to aseptic loosening of the glenoid component; the subchondral bone plate is an important factor governing primary fixation of implant materials. Therefore, we investigated characteristic mineralisation patterns of the subchondral bone plate, which demonstrate long-term stress on articular surfaces, age-related changes, postsurgical biomechanical situations and regions of fixation. Using computed tomography osteo-absorptiometry (CT-OAM), these distribution patterns can be demonstrated in vivo. The aim of this study was to investigate the relationship between subchondral bone-plate mineralisation measured with CT-OAM and the mechanical strength measured by indentation. A total of 32 cadaverous glenoid cavities were evaluated by CT-OAM and indentation testing. Linear regression was used to compare mineralisation and strength of the subchondral bone plate. Results showed two patterns of mineralisation distribution. Twenty-eight cavities were related to bicentric distribution pattern and four showed a single maximum. The correlation coefficient between CT-OAM density and subchondral bone-plate strength was determined to be between 0.62 and 0.96 (P < 0.02). Long-term stress affects not only the subchondral but also the underlying cancellous bone. It therefore can be assumed that mineralisation patterns of the subchondral bone plate continue in cancellous bone. Areas of high density could serve as anchoring locations for orthopaedic implants in resurfacing the glenoid cavity.

A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status.

PubMed

Harryman, Douglas T; Hettrich, Carolyn M; Smith, Kevin L; Campbell, Barry; Sidles, John A; Matsen, Frederick A

2003-04-01

Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons. Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function. As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function. Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.

A Profile of Glenohumeral Internal and External Rotation Motion in the Uninjured High School Baseball Pitcher, Part I: Motion

PubMed Central

Hurd, Wendy J.; Kaplan, Kevin M.; ElAttrache, Neal S.; Jobe, Frank W.; Morrey, Bernard F.; Kaufman, Kenton R.

2011-01-01

Context: The magnitude of motion that is normal for the throwing shoulder in uninjured baseball pitchers has not been established. Chronologic factors contributing to adaptations in motion present in the thrower's shoulder also have not been established. Objectives: To develop a normative profile of glenohumeral rotation motion in uninjured high school baseball pitchers and to evaluate the effect of chronologic characteristics on the development of adaptations in shoulder rotation motion. Design: Cohort study. Setting: Baseball playing field. Patients or Other Participants: A total of 210 uninjured male high school baseball pitchers (age = 16±1.1 years, height = 1.8 + 0.1 m, mass = 77.5±11.2 kg, pitching experience = 6±2.3 years). Intervention(s): Using standard goniometric techniques, we measured passive rotational glenohumeral range of motion bilaterally with participants in the supine position. Main Outcome Measure(s): Paired t tests were performed to identify differences in motion between limbs for the group. Analysis of variance and post hoc Tukey tests were conducted to identify differences in motion by age. Linear regressions were performed to determine the influence of chronologic factors on limb motion. Results: Rotation motion characteristics for the population were established. We found no difference between sides for external rotation (ER) at 0° of abduction (t209 = 0.658, P = .51), but we found side-to-side differences in ER (t209 = −13.012, P<.001) and internal rotation (t209 = 15.304, P<.001) at 90° of abduction. Age at the time of testing was a significant negative predictor of ER motion for the dominant shoulder (R2 = 0.019, P = .049) because less ER motion occurred at the dominant shoulder with advancing age. We found no differences in rotation motion in the dominant shoulder across ages (F4,205 range, 0.451–1.730, P>.05). Conclusions: This range-of-motion profile might be used to assist with the interpretation of normal and atypical shoulder rotation motion in this population. Chronologic characteristics of athletes had no influence on range-of-motion adaptations in the thrower's shoulder. PMID:21669098

Proton Density Fat-Fraction of Rotator Cuff Muscles Is Associated With Isometric Strength 10 Years After Rotator Cuff Repair: A Quantitative Magnetic Resonance Imaging Study of the Shoulder.

PubMed

Karampinos, Dimitrios C; Holwein, Christian; Buchmann, Stefan; Baum, Thomas; Ruschke, Stefan; Gersing, Alexandra S; Sutter, Reto; Imhoff, Andreas B; Rummeny, Ernst J; Jungmann, Pia M

2017-07-01

Quantitative muscle fat-fraction magnetic resonance (MR) imaging techniques correlate with semiquantitative Goutallier scores with failure after rotator cuff (RC) repair. To investigate the relationship of proton density fat fraction (PDFF) of the RC muscles with semiquantitative MR scores, cartilage T2 relaxation times, and clinical isometric strength measurements in patients 10 years after unilateral RC repair. Cross-sectional study; Level of evidence, 3. Bilateral shoulder MR imaging was performed in 13 patients (11 male, 2 female; age, 72 ± 8 years) 10.9 ± 0.4 years after unilateral autologous periosteal flap augmented RC repair (total shoulders assessed, N = 26). Goutallier classification, muscle atrophy, RC tendon integrity, and cartilage defects were determined based on morphological MR sequences. A paracoronal 2D multi-slice multi-echo sequence was used for quantitative cartilage T2 mapping. A chemical shift-encoding-based water-fat separation technique (based on a 6-echo 3D spoiled gradient echo sequence) was used for quantification of the PDFF of RC muscles. Isometric shoulder abduction strength was measured clinically. Mean and SD, Pearson correlation, and partial Spearman correlation were calculated. There were 6 RC full-thickness retears in ipsilateral shoulders and 6 RC full-thickness tears in contralateral shoulders. Isometric shoulder abduction strength was not significantly different between ipsilateral and contralateral shoulders (50 ± 24 N vs 54 ± 24 N; P = .159). The mean PDFF of RC muscles was 11.7% ± 10.4% (ipsilateral, 14.2% ± 8.5%; contralateral, 9.2% ± 7.8%; P = .002). High supraspinatus PDFF correlated significantly with higher Goutallier scores ( R = 0.75, P < .001) and with lower isometric muscle strength ( R = -0.49, P = .011). This correlation remained significant after adjustment for muscle area measurements and tendon rupture ( R = -0.41, P = .048). More severe cartilage defects at the humerus were significantly associated with higher supraspinatus PDFF ( R = 0.44; P = .023). Cartilage T2 values did not correlate with muscle PDFF ( P > .05). MR imaging-derived RC muscle PDFF is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes. It therefore provides complementary, clinically relevant information in tracking RC muscle composition on a quantitative level.

The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football.

PubMed

Dickens, Jonathan F; Owens, Brett D; Cameron, Kenneth L; DeBerardino, Thomas M; Masini, Brendan D; Peck, Karen Y; Svoboda, Steven J

2017-07-01

There is no consensus on the optimal method of stabilization (arthroscopic or open) in collision athletes with anterior shoulder instability. To examine the effect of "subcritical" bone loss and football-specific exposure on the rate of recurrent shoulder instability after arthroscopic stabilization in an intercollegiate American football population. Case-control study; Level of evidence, 3. Fifty intercollegiate football players underwent primary arthroscopic stabilization for anterior shoulder instability and returned to football for at least a single season. Preoperatively, 32 patients experienced recurrent subluxations, and 18 patients experienced a single or recurrent dislocation. Shoulders with glenoid bone loss >20%, an engaging Hill-Sachs lesion, an off-track lesion, and concomitant rotator cuff repair were excluded from the study. The primary outcome of interest was the ability to return to football without subsequent instability. Patients were followed for time to a subsequent instability event after return to play using days of exposure to football and total follow-up time after arthroscopic stabilization. Fifty consecutive patients returned to American football for a mean 1.5 seasons (range, 1-3) after arthroscopic stabilization. Three of 50 (6%; 95% CI, 1.3%-16.5%) patients experienced recurrent instability. There were no subsequent instability events after a mean 3.2 years of military service. All shoulders with glenoid bone loss >13.5% (n = 3) that underwent arthroscopic stabilization experienced recurrent instability upon returning to sport, while none of the shoulders with <13.5% glenoid bone loss (n = 47) sustained a recurrent instability event during football ( X 2 = 15.80, P < .001). Shoulders with >13.5% glenoid bone loss had an incidence rate of 5.31 cases of recurrent instability per 1000 athlete-exposures of football. In 72,000 athlete-exposures to football with <13.5% glenoid bone loss, there was no recurrent instability. Significantly more anchors were used during the primary arthroscopic stabilization procedure in patients who experienced multiple preoperative instability events ( P = .005), and lesions spanned significantly more extensive portions along the circumference of the glenoid ( P = .001) compared with shoulders having a single preoperative instability event before surgical stabilization. Arthroscopic stabilization of anterior shoulder instability in American football players with <13.5% glenoid bone loss provides reliable outcomes and low recurrence rates.

A Qualitative Investigation of Return to Sport After Arthroscopic Bankart Repair: Beyond Stability.

PubMed

Tjong, Vehniah K; Devitt, Brian M; Murnaghan, M Lucas; Ogilvie-Harris, Darrell J; Theodoropoulos, John S

2015-08-01

Arthroscopic shoulder stabilization is known to have excellent functional results, but many patients do not return to their preinjury level of sport, with return to play rates reported between 48% and 100% despite good outcome scores. To understand specific subjective psychosocial factors influencing a patient's decision to return to sport after arthroscopic shoulder stabilization. Case series; Level of evidence, 4. Semistructured qualitative interviews were conducted with patients aged 18 to 40 years who had undergone primary arthroscopic shoulder stabilization and had a minimum 2-year follow-up. All patients participated in sport before surgery without any further revision operations or shoulder injuries. Qualitative data analysis was performed in accordance with the Strauss and Corbin theory to derive codes, categories, and themes. Preinjury and current sport participation was defined by type, level of competition, and the Brophy/Marx shoulder activity score. Patient-reported pain and shoulder function were also obtained. A total of 25 patients were interviewed, revealing that fear of reinjury, shifts in priority, mood, social support, and self-motivation were found to greatly influence the decision to return to sport both in patients who had and had not returned to their preinjury level of play. Patients also described fear of sporting incompetence, self-awareness issues, recommendations from physical therapists, and degree of confidence as less common considerations affecting their return to sport. In spite of excellent functional outcomes, extrinsic and intrinsic factors such as competing interests, kinesiophobia, age, and internal stressors and motivators can have a major effect on a patient's decision to return to sport after arthroscopic shoulder stabilization. The qualitative methods used in this study provide a unique patient-derived perspective into postoperative recovery and highlight the necessity to recognize and address subjective and psychosocial factors rather than objective functional outcome scores alone as contributing to a patient's decision to return to play. © 2015 The Author(s).

Distal Tibia Allograft Glenoid Reconstruction in Recurrent Anterior Shoulder Instability: Clinical and Radiographic Outcomes.

PubMed

Provencher, Matthew T; Frank, Rachel M; Golijanin, Petar; Gross, Daniel; Cole, Brian J; Verma, Nikhil N; Romeo, Anthony A

2017-05-01

To assess the clinical and radiographic outcomes of patients with recurrent anterior shoulder instability treated with fresh distal tibia allograft (DTA) glenoid reconstruction. Consecutive patients with a minimum 15% anterior glenoid bone loss associated with recurrent anterior instability who underwent stabilization with DTA glenoid reconstruction were retrospectively reviewed. Patients were evaluated with the American Shoulder and Elbow Society score, Western Ontario shoulder instability index, and single numerical assessment evaluation score at a minimum 2 years after surgery. All patients also underwent postoperative imaging evaluation with computed tomography where graft incorporation and allograft angle were measured. Statistical analysis was performed with paired t-tests, with P < .05 considered significant. A total of 27 patients (100% male) with an average age of 31 ± 5 years and an average follow-up of 45 months (range, 30-66) were included. There were significant improvements in preoperative to postoperative American Shoulder and Elbow Society score (63-91, P < .01), Western Ontario shoulder instability index (46% to 11% of normal, P < .01), and single numerical assessment evaluation score (50-90.5, P < .01) outcomes. Analysis of computed tomography data at an average 1.4 years postoperatively (available for 25 patients) showed an allograft healing rate of 89% (range, 80% to 100%), average allograft angle of 14.9° (range, 6.6° to 29.3°), and average allograft lysis of 3% (range, 0% to 25%). Grafts with lesser allograft angles (<15°) were better opposed to the anterior glenoid, showing superior healing and graft incorporation. There were no cases of recurrent instability. At an average follow-up of 45 months, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with excellent clinical outcomes and minimal graft resorption. Optimal allograft placement resulted in superior bony incorporation with the native glenoid. Level IV, therapeutic case series. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Evaluation of shoulder function in clavicular fracture patients after six surgical procedures based on a network meta-analysis.

PubMed

Huang, Shou-Guo; Chen, Bo; Lv, Dong; Zhang, Yong; Nie, Feng-Feng; Li, Wei; Lv, Yao; Zhao, Huan-Li; Liu, Hong-Mei

2017-01-01

Purpose Using a network meta-analysis approach, our study aims to develop a ranking of the six surgical procedures, that is, Plate, titanium elastic nail (TEN), tension band wire (TBW), hook plate (HP), reconstruction plate (RP) and Knowles pin, by comparing the post-surgery constant shoulder scores in patients with clavicular fracture (CF). Methods A comprehensive search of electronic scientific literature databases was performed to retrieve publications investigating surgical procedures in CF, with the stringent eligible criteria, and clinical experimental studies of high quality and relevance to our area of interest were selected for network meta-analysis. Statistical analyses were conducted using Stata 12.0. Results A total of 19 studies met our inclusion criteria were eventually enrolled into our network meta-analysis, representing 1164 patients who had undergone surgical procedures for CF (TEN group = 240; Plate group = 164; TBW group  =  180; RP group  =  168; HP group  =  245; Knowles pin group  =  167). The network meta-analysis results revealed that RP significantly improved constant shoulder score in patients with CF when compared with TEN, and the post-operative constant shoulder scores in patients with CF after Plate, TBW, HP, Knowles pin and TEN were similar with no statistically significant differences. The treatment relative ranking of predictive probabilities of constant shoulder scores in patients with CF after surgery revealed the surface under the cumulative ranking curves (SUCRA) value is the highest in RP. Conclusion The current network meta-analysis suggests that RP may be the optimum surgical treatment among six inventions for patients with CF, and it can improve the shoulder score of patients with CF. Implications for Rehabilitation RP improves shoulder joint function after surgical procedure. RP achieves stability with minimal complications after surgery. RP may be the optimum surgical treatment for rehabilitation of patients with CF.

The role of the bicipital groove in tendopathy of the long biceps tendon.

PubMed

Pfahler, M; Branner, S; Refior, H J

1999-01-01

Long biceps tendon disease is often underrated but plays an important role in anterior shoulder pain. We studied prospectively the anatomy of the bicipital groove and its relationship to clinical symptoms. Sixty-seven consecutive patients were investigated by mutual ultrasonography and radiographs of the intertubercular groove. All images were scrutinized for biceps tendon status (ultrasonography) and groove anatomy (radiography). Thirty-seven patients (21 male, 16 female, average age 48 years) had chronic anterior shoulder pain, and 30 patients (16 male, 14 female, average age 46 years) served as a control group. In 28 shoulders we found sonographic signs of tendovaginitis, and in 14 we found degenerative changes. The mean age of patients with pathologic conditions of the long biceps tendon was 40 years, significantly lower than that of the complete study group. The x-ray films revealed a great variation in the medial and total opening angle of the groove, whereas width, depth, and humeral head diameter showed sex-related differences. Radiologic signs of groove degeneration correlated in 43.6% with biceps tendon disease on the sonogram. Our study revealed statistically significant correlations between groove anatomy and long biceps tendon disease, which should be considered more while shoulder problems are evaluated.

Do work technique and musculoskeletal symptoms differ between men and women performing the same type of work tasks?

PubMed

Dahlberg, Raymond; Karlqvist, Lena; Bildt, Carina; Nykvist, Karin

2004-11-01

Musculoskeletal disorders are more common among women than among men. When comparing the difference between men and women in the prevalence of musculoskeletal disorders, methodological problems arise as men and women seldom perform the same type of activities, neither at work nor at home. The main objective of this cross-sectional case study was to compare work technique and self-reported musculoskeletal symptoms between men and women performing the same type of work tasks within a metal industry. Other factors, such as leisure activities, were also taken into consideration. Three data collection methods were used; questionnaire, interviews and systematic observations. The results from the observations revealed that women worked more frequently and during longer times with their hands above shoulder height than men. Working with hands above shoulder height is considered a risk factor for neck and shoulder disorders according to previous studies. Workplace design factors were probably a reason for differences in working technique between men and women. A higher proportion of women than men reported shoulder symptoms. Women spent more time on household activities than men, which indicates a higher total workload in paid and unpaid work.

Determinants and magnitudes of manual force strengths and joint moments during two-handed standing maximal horizontal pushing and pulling.

PubMed

Chow, Amy Y; Dickerson, Clark R

2016-04-01

Pushing and pulling are common occupational exertions that are increasingly associated with musculoskeletal complaints. This study focuses on the sensitivity of shoulder capacity to gender, handle height, exertion type (push or pull) and handle orientation for these tasks. All factors except for handle orientation influenced unilateral and total manual force strength (p < 0.01), with exertion type being the most influential. Interaction effects also existed between handle height and exertion type. Additionally, joint moments at the shoulders and low back were influenced by all factors studied (p < 0.01), with exertion type again being most influential. Knowledge of the relative influence of multiple factors on shoulder capacity can provide guidance regarding these factors when designing or evaluating occupational pushing and pulling tasks for a diverse population. Practitioner Summary: pushing and pulling comprise nearly half of all manual materials handling tasks. Practitioners often assess, design or modify these tasks while incorporating constraints, including manual force direction and handle interface. This study provides guidance to aid design of pushing and pulling tasks in the context of shoulder physical capacity.

Evaluation of measurement properties of self-administered PROMs aimed at patients with non-specific shoulder pain and "activity limitations": a systematic review.

PubMed

Thoomes-de Graaf, M; Scholten-Peeters, G G M; Schellingerhout, J M; Bourne, A M; Buchbinder, R; Koehorst, M; Terwee, C B; Verhagen, A P

2016-09-01

To critically appraise and compare the measurement properties of self-administered patient-reported outcome measures (PROMs) focussing on the shoulder, assessing "activity limitations." Systematic review. The study population had to consist of patients with shoulder pain. We excluded postoperative patients or patients with generic diseases. The methodological quality of the selected studies and the results of the measurement properties were critically appraised and rated using the COSMIN checklist. Out of a total of 3427 unique hits, 31 articles, evaluating 7 different questionnaires, were included. The SPADI is the most frequently evaluated PROM and its measurement properties seem adequate apart from a lack of information regarding its measurement error and content validity. For English, Norwegian and Turkish users, we recommend to use the SPADI. Dutch users could use either the SDQ or the SST. In German, we recommend the DASH. In Tamil, Slovene, Spanish and the Danish languages, the evaluated PROMs were not yet of acceptable validity. None of these PROMs showed strong positive evidence for all measurement properties. We propose to develop a new shoulder PROM focused on activity limitations, taking new knowledge and techniques into account.

Duocentric® reversed shoulder prosthesis and Personal Fit® templates: innovative strategies to optimize prosthesis positioning and prevent scapular notching.

PubMed

Trouilloud, P; Gonzalvez, M; Martz, P; Charles, H; Handelberg, F; Nyffeler, R W; Baulot, E

2014-05-01

We describe our experience with a new system of patient-specific template called Personal Fit(®), which is unique in shoulder surgery and used in combination with Duocentric(®) prosthesis. The reverse prosthesis's concept is the invention of Paul Grammont, developed with Grammont's team of Dijon University as from 1981, which led to the first reversed total shoulder prosthesis called Trumpet in 1985. The Duocentric(®) prosthesis developed in 2001 is the third-generation prosthesis, coming from the Trumpet and the second-generation prosthesis Delta(®) (DePuy). This prosthesis provides a novel solution to the notching problem with an inferior overhang integrated onto the glenoid baseplate. Personal Fit(®) system is based on reconstructing the shoulder joint bones in three dimensions using CT scan data, placing a landmark on the scapula and locating points on the glenoid and humerus. That will be used as a reference for the patient-specific templates. We study the glenoid position planned with Personal Fit(®) software relative to native glenoid position in 30 cases. On average, the difference between the planned retroversion (or anteversion in one case) and native retroversion was 8.6°.

Adaptive Alterations in Shoulder Range of Motion and Strength in Young Tennis Players

PubMed Central

Gillet, Benoit; Begon, Mickaël; Sevrez, Violaine; Berger-Vachon, Christian; Rogowski, Isabelle

2017-01-01

Context: Playing tennis requires unilateral and intensive movement of the upper limb, which may lead to functional adaptations of the shoulder and an increased injury risk. Identifying which athletes will be future elite tennis players starts at 5 to 6 years of age. Therefore, highly skilled players practice intensively in their childhood. However, whether these functional changes occur during the prepubertal years has not been established. Objectives: To assess changes in glenohumeral-joint–rotation range of motion and strength of the shoulder-complex muscles in prepubertal elite tennis players. Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Sixty-seven male tennis players (age range = 7–13 years) selected by a regional tennis center of excellence were divided into 3 biological age groups relative to their predicted age at peak height velocity: greater than 4 (n = 26; age = 8.7 ± 0.7 years, height = 132.4 ± 12.9 cm, mass = 27.8 ± 3.8 kg), 3 to 4 (n = 21; age = 10.3 ± 0.6 years, height = 144.9 ± 5.7 cm, mass = 34.7 ± 4.0 kg), and 2 (n = 20; age = 12.8 ± 1.4 years, height = 158.5 ± 8.7 cm, mass = 43.0 ± 8.2 kg) years before their age at peak height velocity. Main Outcome Measures(s): We measured the internal- and external-rotation ranges of motion of the glenohumeral joint using a goniometer and calculated the total arc of motion. Maximal isometric strength of 8 shoulder muscles was measured using a handheld dynamometer. Strength values were normalized to body weight and used to calculate 4 agonist-to-antagonist strength ratios. Results: The total arc of motion of the glenohumeral joint decreased gradually with biological age (P ≤ .01) due to the decrease in internal-rotation range of motion (P < .001). Absolute strength increased gradually with biological age (P < .001), but the relative strengths and ratios remained similar. Conclusions: Functional adaptations of the shoulder seen in adolescent and adult tennis players were observed in healthy prepubertal players. This knowledge could help clinicians and coaches more effectively monitor shoulder adaptations to tennis practice during the prepubertal years. PMID:28145740

[Investigation of influencing factors associated with neck-shoulder symptoms among middle school students in three cities in China].

PubMed

Xu, L; Wan, Y H; Liu, W; Zhang, S C; Ma, S S; Xu, S J; Zhai, L L; Zhang, H; Cao, X J; Tao, F B

2017-09-06

Objective: The aim of this study was to describe the distribution of neck-shoulder symptoms among middle school students, and to explore its influence factors. Methods: A cross-sectional survey was conducted on 24 middle schools in Shenyang, Zhengzhou and Shenzhen by purposive sampling method. In each middle school, 3 to 4 classes were selected from each grade all the students in the selected class would be recruited to the survey to investigate the demographic characteristics, neck-shoulder symptoms, physical exercise time, academic stress, screen behavior, sedentary behavior and other information by questionnaire. A total of 10 566 questionnaires were issued and 10 270 valid questionnaires were withdrawn. The prevalence of neck-shoulder symptoms among students were compared by different characteristics. Logistic regression models were applied to examine influencing factors associated with neck-shoulder symptoms. Results: The prevalence of neck-shoulder symptoms among middle school students was 19.2% (1 968/10 270), while it was 22.6% (1 137/5 039) among girls and 15.9% (831/5 231) among boys; the difference showed statistical significance ( P< 0.001). The prevalence of neck-shoulder symptoms was separately 13.3% (253/1 901) in seventh grade, 16.8% (326/1 942) in eighth grade, 18.5% (299/1 617) in ninth grade, 21.8% (417/1 915) in sophomore, 21.4% (345/1 611) in junior, 25.5% (328/1 284) in senior; the difference showed statistical significance ( P< 0.001). The multivariate logistic regression analysis showed that in the last 3 months, students who always playing mobile phone ≥40 min continuously ( OR= 4.66, 95 %CI: 3.95-5.49), watching TV ≥40 min continuously ( OR= 4.01, 95 %CI: 3.39-4.73), using computer ≥40 min continuously ( OR= 3.61, 95 %CI: 3.09-4.23), doing homework ≥60 min continuously ( OR= 3.25, 95 %CI: 2.79-3.79), the average daily sitting time ≥10 h ( OR= 4.95, 95 %CI: 4.25-5.77), and always sitting ≥90 min continuously ( OR= 5.18, 95 %CI: 4.42-6.06) were risk factors of neck-shoulder symptoms. Conclusion: The prevalence of neck-shoulder symptoms was high among middle school students in China, especially girls in senior grades. Long time, high frequency video behaviors and sedentary behaviors were related to the occurrence of neck-shoulder symptoms among middle school students.

[Composite prevention strategy for shoulder dystocia: meta-analysis].

PubMed

Wang, Shaowei; Zhao, Xiaodong; Chu, Defa; Li, Min; Liang, Lin; Zhang, Junrong

2015-01-01

To investigate the composite prevention strategy for shoulder dystocia. The published articles of randomized controlled trial (RCT) of comparison about the prevention of shoulder dystocia were searched in PubMed, EMBASE, EBSCO databases and Cochrane Library, and these studies were screened under inclusion and exclusion criteria. The quality of included studies were evaluated. And the Meta-analysis using statistic software RevMan 5.1 was completed. Totally 16 articles, all English published with no one Chinese article being searched out, were included in this analysis, published from 1993 to 2009. ( 1)To the gestational diabetes mellitus (GDM) patients, reviewed from 2 articles, it was found that the incidence of shoulder dystocia was reduced significantly by prenatal intervention versus usual care (OR = 0.40, 95% CI:0.21- 0.75, P = 0.004). (2)To the GDM patients with intensive prenatal intervention, reviewed form 5 articles, it was found that the incidence of shoulder dystocia was reduced significantly by intensive intervention(diet control combined with insulin if necessary)versus less intensive intervention (only diet control), OR = 0.29 (95%CI:0.11-0.73, P = 0.009). (3) To the non-GDM patients with suspected macrosomia, reviewed from 4 articles, it was found that the incidence of shoulder dystocia was not reduced by early artificial induction of parturition (OR = 0.85, 95%CI:0.41-1.75, P = 0.660). (4)To the GDM patients, reviewed form 2 articles, it was found that the incidence of shoulder dystocia was reduced marginal significantly by artificial induction of parturition in 38-39 gestational weeks compared with all spontaneous parturition patients (OR = 0.18, 95%CI:0.03-0.97, P = 0.050) and significantly reduced when compared with those spontaneous parturition patients after 40 gestational weeks (OR = 0.13, 95%CI: 0.02-0.75, P = 0.020). (5)To the GDM patients with suspected macrosomia, reviewed from only one article, it was found that the incidence of shoulder dystocia was reduced marginal significantly by early artificial induction of parturition (OR = 0.34, 95%CI:0.12-0.99, P = 0.050). (6)Reviewed from 2 articles, it was found that the incidence of shoulder dystocia was not significantly reduced by the intrapartum prophylactic maneuvers (OR = 0.44, 95% CI:0.16-1.18, P = 0.100). Some varieties of intervention for the high risk patients could reduced the occurrence of shoulder dystocia.

Role of Clavicle Chest Cage Angle Difference in Predicting Postoperative Shoulder Balance in Lenke 5C Adolescent Idiopathic Scoliosis Patients after Selective Posterior Fusion.

PubMed

Liu, Zhen; Hu, Zong-Shan; Qiu, Yong; Zhang, Zhen; Zhao, Zhi-Hui; Han, Xiao; Zhu, Ze-Zhang

2017-02-01

To evaluate the role of preoperative clavicle chest cage angle difference (CCAD) on postoperative radiographic shoulder imbalance, patient's satisfaction and surgeon's fulfillment in Lenke 5 adolescent idiopathic scoliosis (AIS). CCAD, as a novel radiographic parameter, has proven to be a reliable predictor for postoperative shoulder imbalance in Lenke 1 AIS patients. However, the value of CCAD in predicting shoulder balance has never been evaluated in Lenke 5 AIS patients. A total of 42 Lenke 5C AIS patients aged from 10 to 18 years old with a minimum 2-year follow-up were enrolled for evaluation. All patients underwent selective posterior spinal instrumentation and fusion using the all segmental pedicle screw technique by the same surgical team. The fusion levels were determined according to the Lenke criteria. Shoulder height difference (SHD) and CCAD were measured on anteroposterior (AP) standing radiographs. 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. The average preoperative Cobb angle of the main curve was 46.8° ± 4.8°, and the average immediate postoperative Cobb angle was 13.3° ± 2.6°, representing an average surgical correction rate of 75.6% ± 8.5%. The average follow-up time was 29.2 months. At the last follow-up, the value of preoperative CCAD was significantly higher in patients with unbalanced shoulders (SHD ≥ 10 mm). At the final follow-up, 66.7% (28/42) of the patients were satisfied with their appearance, while 33.3% (14/42) of the patients were not satisfied with their appearance. At the final follow-up, 61.9% (26/42) of the surgeons were fulfilled with their operation, while 38.1% (16/42) of the surgeons were not. For patients' satisfaction and surgeons' fulfillment, the preoperative CCAD was significantly greater in patients with unsatisfied outcomes. Clavicle chest cage angle difference could be a reliable predictor for evaluating postoperative shoulder imbalance in AIS patients undergoing selective posterior fusion for Lenke 5C curves. A greater preoperative CCAD was significantly correlated with a postoperative radiographic imbalance of shoulders and dissatisfaction, which will guide spine surgeons in their preoperative planning and in the surgical management of AIS to reduce postoperative shoulder imbalance. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis.

PubMed

van der Molen, Henk F; Foresti, Chiara; Daams, Joost G; Frings-Dresen, Monique H W; Kuijer, P Paul F M

2017-10-01

The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case-control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders. © 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.

Patient-specific targeting guides compared with traditional instrumentation for glenoid component placement in shoulder arthroplasty: a multi-surgeon study in 70 arthritic cadaver specimens.

PubMed

Throckmorton, Thomas W; Gulotta, Lawrence V; Bonnarens, Frank O; Wright, Stephen A; Hartzell, Jeffrey L; Rozzi, William B; Hurst, Jason M; Frostick, Simon P; Sperling, John W

2015-06-01

The purpose of this study was to compare the accuracy of patient-specific guides for total shoulder arthroplasty (TSA) with traditional instrumentation in arthritic cadaver shoulders. We hypothesized that the patient-specific guides would place components more accurately than standard instrumentation. Seventy cadaver shoulders with radiographically confirmed arthritis were randomized in equal groups to 5 surgeons of varying experience levels who were not involved in development of the patient-specific guidance system. Specimens were then randomized to patient-specific guides based off of computed tomography scanning, standard instrumentation, and anatomic TSA or reverse TSA. Variances in version or inclination of more than 10° and more than 4 mm in starting point were considered indications of significant component malposition. TSA glenoid components placed with patient-specific guides averaged 5° of deviation from the intended position in version and 3° in inclination; those with standard instrumentation averaged 8° of deviation in version and 7° in inclination. These differences were significant for version (P = .04) and inclination (P = .01). Multivariate analysis of variance to compare the overall accuracy for the entire cohort (TSA and reverse TSA) revealed patient-specific guides to be significantly more accurate (P = .01) for the combined vectors of version and inclination. Patient-specific guides also had fewer instances of significant component malposition than standard instrumentation did. Patient-specific targeting guides were more accurate than traditional instrumentation and had fewer instances of component malposition for glenoid component placement in this multi-surgeon cadaver study of arthritic shoulders. Long-term clinical studies are needed to determine if these improvements produce improved functional outcomes. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Pain Management After Outpatient Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials.

PubMed

Warrender, William J; Syed, Usman Ali M; Hammoud, Sommer; Emper, William; Ciccotti, Michael G; Abboud, Joseph A; Freedman, Kevin B

2017-06-01

Effective postoperative pain management after shoulder arthroscopy is a critical component to recovery, rehabilitation, and patient satisfaction. This systematic review provides a comprehensive overview of level 1 and level 2 evidence regarding postoperative pain management for outpatient arthroscopic shoulder surgery. Systematic review. We performed a systematic review of the various modalities reported in the literature for postoperative pain control after outpatient shoulder arthroscopy and analyzed their outcomes. Analgesic regimens reviewed include regional nerve blocks/infusions, subacromial/intra-articular injections or infusions, cryotherapy, and oral medications. Only randomized control trials with level 1 or level 2 evidence that compared 2 or more pain management modalities or placebo were included. We excluded studies without objective measures to quantify postoperative pain within the first postoperative month, subjective pain scale measurements, or narcotic consumption as outcome measures. A combined total of 40 randomized control trials met our inclusion criteria. Of the 40 included studies, 15 examined nerve blocks, 4 studied oral medication regimens, 12 studied subacromial infusion, 8 compared multiple modalities, and 1 evaluated cryotherapy. Interscalene nerve blocks (ISBs) were found to be the most effective method to control postoperative pain after shoulder arthroscopy. Increasing concentrations, continuous infusions, and patient-controlled methods can be effective for more aggressively controlling pain. Dexamethasone, clonidine, intrabursal oxycodone, and magnesium have all been shown to successfully improve the duration and adequacy of ISBs when used as adjuvants. Oral pregabalin and etoricoxib administered preoperatively have evidence supporting decreased postoperative pain and increased patient satisfaction. On the basis of the evidence in this review, we recommend the use of ISBs as the most effective analgesic for outpatient arthroscopic shoulder surgery.

Ultrasound dimensions of the rotator cuff in young healthy adults.

PubMed

Karthikeyan, Shanmugam; Rai, Santosh B; Parsons, Helen; Drew, Steve; Smith, Christopher D; Griffin, Damian R

2014-08-01

No studies have looked at the rotator cuff dimensions in the young healthy population using ultrasonography. Our aim is to define the ultrasound dimensions of the rotator cuff in the healthy young adult population and explore correlations with other patient characteristics. Thirty male and 30 female healthy volunteers (aged 18-40 years), with no shoulder problems, underwent ultrasound assessment of both shoulders by a musculoskeletal radiologist. The dimensions of the rotator cuff, deltoid, and biceps were measured in a standardized manner. A total of 120 shoulders were scanned. The mean maximum width of the supraspinatus footprint was 14.9 mm in men and 13.5 mm in women (P < .001). The mean thickness of the supraspinatus tendon was 4.9 mm in women and 5.6 mm in men. The mean thickness of the subscapularis was 4.4 in men and 3.8 mm in women and for the infraspinatus was 4.9 mm in men and 4.4 mm in women. There was no correlation between height, weight, biceps, or deltoid thickness with any tendon measurements. Apart from supraspinatus tendon thickness, the difference between dominant and nondominant shoulders in the same sex was not significant for any other tendon dimensions. This study has defined the dimensions of the rotator cuff in the young healthy adult, which has not been previously published. This is important for the documentation of normal ultrasound anatomy of the rotator cuff and also demonstrates that the asymptomatic contralateral shoulder can and should be used to estimate the expected dimensions. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Factors that Influence Functional Outcome after Total or Subtotal Scapulectomy: Japanese Musculoskeletal Oncology Group (JMOG) Study

PubMed Central

Hayashi, Katsuhiro; Iwata, Shintaro; Ogose, Akira; Kawai, Akira; Ueda, Takafumi; Otsuka, Takanobu; Tsuchiya, Hiroyuki

2014-01-01

Background Scapulectomy requires not only joint resection but also wide resection of the shoulder girdle muscles. Even the significance of reconstruction has not yet been determined because of the difficulties in comparing the different conditions. The purpose of this study was to investigate factors that influence functional outcomes after scapulectomy in a multicenter study. Methods This retrospective study comprised 48 patients who underwent total or subtotal scapulectomy and were followed for at least one year after surgery. Patients were registered at the Japanese Musculoskeletal Oncology Group affiliated hospitals. Soft tissue reconstruction for joint stabilization was performed when there was enough remaining tissue for reconstruction of the rotator cuff and tendons. In 23 cases, humeral suspension was performed. The average follow-up period was 61.9 months. Multivariate analysis was performed using the patient’s background to determine which factors influence the Enneking functional score or active range of motion. Results The average functional score was 21.1 out of 30. Active shoulder range of motion was 42.7 degree in flexion, 39.7 degree in abduction, 49.6 degree of internal rotation and 16.8 degree of external rotation. The amount of remaining bone influenced functional outcome, which means that preserving the glenoid or the acromion lead to better function compared to total scapulectomy (p<0.01). Factors that influenced each functional measure include the amount of remaining bone, soft tissue reconstruction, the length of the resected humerus and nerve resection (p<0.05). Conclusion Although shoulder function was almost eliminated following total or subtotal scapulectomy, minimal resection of bone, and soft tissue reconstruction should lead to better function. PMID:24937254

Long-term follow-up of shoulder hemiarthroplasty for glenohumeral osteoarthritis.

PubMed

Levine, William N; Fischer, Charla R; Nguyen, Duong; Flatow, Evan L; Ahmad, Christopher S; Bigliani, Louis U

2012-11-21

There is major controversy surrounding the use of hemiarthroplasty as compared with total shoulder arthroplasty for glenohumeral osteoarthritis, and long-term clinical outcomes of hemiarthroplasty are lacking. Of a cohort of thirty patients (thirty-one shoulders) who were treated with hemiarthroplasty for glenohumeral osteoarthritis and followed longitudinally at our institution, twenty-five were available for long-term follow-up; five died, and one refused to participate. Three of the five patients who died had revision arthroplasty before death, and the data from those three were therefore included in the final follow-up (final follow-up data therefore included twenty-seven patients and twenty-eight shoulders). Follow-up through phone conversations and postal mail surveys included the following: Short Form-36, American Shoulder and Elbow Surgeons (ASES) shoulder outcome score, EuroQol, Simple Shoulder Test, modified Neer Score, and a unique, validated self-administered range-of-motion questionnaire. Correlations between clinical outcome and age, type of glenoid wear, and cause of osteoarthritis were determined. The average follow-up was 17.2 years (range, thirteen to twenty-one years). There were eight revisions (three of fifteen shoulders with concentric glenoids, and five of sixteen shoulders with eccentric glenoids). For those shoulders not revised, the average ASES score was 70.54 (range, 36.67 to 91.67). Overall, active shoulder forward elevation and external rotation with the arm at 90° of abduction increased from 104° preoperatively to 141.8° (range, 45° to 180°) and 20.7° to 61.0° (range, 30° to 90°), respectively (p < 0.05), at the time of final follow-up. Of those who required revision arthroplasty, the average patient age at the time of the index procedure was 51.0 years (range, twenty-six to eighty-one years), while those not requiring revision averaged 57.1 years (range, twenty-seven to sixty-three years). The overall Neer satisfaction rating was 25%. The average Neer score and Neer rating for unrevised cases were significantly higher for concentric glenoid wear compared with eccentric glenoid wear (p = 0.015 and p = 0.001, respectively). Patients who had concentric glenoid wear had higher EuroQol scores (p = 0.020). The average Neer scores were 65.29 (range, forty-seven to seventy-eight) for primary osteoarthritis and 54.46 (range, forty to seventy-seven) for secondary osteoarthritis (p = 0.036). Only 25% of patients with glenohumeral osteoarthritis treated with shoulder hemiarthroplasty are satisfied with their outcome at an average of seventeen years after the operation. Patients with concentric glenoid wear and primary osteoarthritis have better outcomes than those with eccentric glenoid wear and secondary osteoarthritis do, but patients in both groups experienced deterioration of results over time. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

40 CFR 52.2054 - Control of asphalt paving material.

Code of Federal Regulations, 2010 CFR

2010-07-01

... work on roadways and shoulders; and (3) No more than 2,500,000 gallons total of emulsion Class E-4 and... additional hydrocarbon emissions from emulsions. (b) The Pennsylvania Department of Transportation is...

40 CFR 52.2054 - Control of asphalt paving material.

Code of Federal Regulations, 2013 CFR

2013-07-01

... work on roadways and shoulders; and (3) No more than 2,500,000 gallons total of emulsion Class E-4 and... additional hydrocarbon emissions from emulsions. (b) The Pennsylvania Department of Transportation is...

40 CFR 52.2054 - Control of asphalt paving material.

Code of Federal Regulations, 2011 CFR

2011-07-01

... work on roadways and shoulders; and (3) No more than 2,500,000 gallons total of emulsion Class E-4 and... additional hydrocarbon emissions from emulsions. (b) The Pennsylvania Department of Transportation is...

40 CFR 52.2054 - Control of asphalt paving material.

Code of Federal Regulations, 2014 CFR

2014-07-01

... work on roadways and shoulders; and (3) No more than 2,500,000 gallons total of emulsion Class E-4 and... additional hydrocarbon emissions from emulsions. (b) The Pennsylvania Department of Transportation is...

40 CFR 52.2054 - Control of asphalt paving material.

Code of Federal Regulations, 2012 CFR

2012-07-01

... work on roadways and shoulders; and (3) No more than 2,500,000 gallons total of emulsion Class E-4 and... additional hydrocarbon emissions from emulsions. (b) The Pennsylvania Department of Transportation is...

Intra-articular laser treatment plus Platelet Rich Plasma (PRP) significantly reduces pain in many patients who had failed prior PRP treatment

NASA Astrophysics Data System (ADS)

Prodromos, Chadwick C.; Finkle, Susan; Dawes, Alexander; Dizon, Angelo

2018-02-01

INTRODUCTION: In our practice Platelet Rich Plasma (PRP) injections effectively reduce pain in most but not all arthritic patients. However, for patients who fail PRP treatment, no good alternative currently exists except total joint replacement surgery. Low level laser therapy (LLLT) on the surface of the skin has not been helpful for arthritis patients in our experience. However, we hypothesized that intra-articular laser treatment would be an effective augmentation to PRP injection and would increase its efficacy in patients who had failed prior PRP injection alone. METHODS: We offered Intra-articular Low Level Laser Therapy (IAL) treatment in conjunction with repeat PRP injection to patients who had received no benefit from PRP injection alone at our center. They were the treatment group. They were not charged for PRP or IAL. They also served as a historical control group since they had all had failed PRP treatment alone. 28 patients (30 joints) accepted treatment after informed consent. 22 knees, 4 hips, 2 shoulder glenohumeral joints and 1 first carpo-metacarpal (1st CMC) joint were treated RESULTS: All patients were followed up at 1 month and no adverse events were seen from the treatment. At 6 months post treatment 46% of patients had good outcomes, and at 1 year 17% still showed improvement after treatment. 11 patients failed treatment and went on to joint replacement. DISCUSSION: A single treatment of IAL with PRP salvaged 46% of patients who had failed PRP treatment alone, allowing avoidance of surgery and good pain control.

[Multicenter analysis of risk factors and clinical characteristics of shoulder dystocia].

PubMed

Wang, Xiaoyi; He, Yutian; Zhong, Mei; Wang, Zhijian; Fan, Shangrong; Liu, Zengyou; Fan, Shushu; Chen, Dunjin

2015-01-01

To explore the risk factors and clinical characteristics of shoulder dystocia. The data of 44 580 single pregnancy and full-term head delivery were colleceted in the Third Affiliated Hospital of Guangzhou Medical University, Nanfang Hospital, Shenzhen Nanshan Hospital, Peking University Shenzhen Hospital and Yue Bei People's Hospital from January 2008 to September 2013. Totally 116 cases of shoulder dystocia were defined as the shoulder dystocia group, and the others were in the control group. The clinical data of the two groups were analyzed retrospectively, including the maternal age, maternal height, pre-gestational body mass index, weight gain during pregnancy, gestational weeks, gravidity, parity, fundal height, fetal abdominal perimeter, shoulder dystocia medical history, macrosomia, gestational diabetes mellitus, pre-gestational diabetes mellitus, post-term pregnancy and the condition of labor stages. (1) The incidence of shoulder dystocia was 0.260% (116/44 580). The maternal age, pre-gestational body mass index and weight gain during pregnancy in the shoulder dystocia group were higher than those in the control group (all P < 0.01). While the maternal height, gestational weeks, gravidity, parity, fundal height, abdominal circumference in the two groups had no significant difference (all P > 0.05). (2) In the shoulder dystocia group, the incidence of shoulder dystocia medical history (11.21%, 13/116), macrosomia (13.79% , 16/116), pre-gestational diabetes mellitus (7.76% , 9/116), post-term pregnancy (10.34%, 12/116), prolongation of maximum acceleration phase (8.62%, 10/116) and prolongation of second labor stage (7.76%, 9/116) were different from those in the control group[1.43% ( 636/44 464), 1.48% (658/ 44 464), 0.57% ( 252/44 464), 1.15% (513/44 464),0.72% (322/44 464), 0.65% (289/44 464), respectively; all P < 0.05]. (3) Logistic regression analysis showed that the risk factors of shoulder dystocia were maternal age over thirty-five years (OR = 1.116, 95%CI: 1.022-2.445), pre-gestational body mass index more than 27 kg/m(2) (OR = 1.893, 95% CI: 1.358-2.228), weight gain more than 20 kg during pregnancy (OR = 2.031, 95% CI: 1.749-3.231), shoulder dystocia medical history (OR = 2.138, 95%CI:1.564-3.853), macrosomia (OR = 3.276, 95% CI:2.315- 4.638), pre-gestational diabetes mellitus (OR = 3.261, 95% CI:2.237- 4.943), post-term pregnancy (OR = 1.473, 95% CI:1.003-2.721), prolongation of the maximum acceleration phase (OR = 2.022, 95% CI:1.681- 3.732), prolongation of second labor stage(OR = 1.943, 95% CI:1.285- 3.215). Maternal age over thirty-five years old, pre-gestational body mass index more than 27 kg/m(2), weight gain more than 20 kg during pregnancy, shoulder dystocia medical history, macrosomia, pre-gestational diabetes mellitus, post-term pregnancy, prolongation of the maximum acceleration phase, and prolongation of second labor stage are risk factors and clinical characteristics of shoulder dystocia.

MRI Before Radiography for Patients With New Shoulder Conditions.

PubMed

Small, Kirstin M; Rybicki, Frank J; Miller, Lindsay R; Daniels, Stephen D; Higgins, Laurence D

2017-06-01

To assess the patterns of Appropriate Criteria application among orthopedic specialists and other fields of medicine for use of MRI and radiography and the subsequent necessity for surgical intervention. The hospital electronic medical record was used to identify all shoulder MRI studies at a single large urban teaching hospital between January 2, 2011, and June 30, 2011. For each study, variables collected included ordering department, patient age, patient gender, patient's self-reported race/ethnicity, whether the patient obtained surgery for an issue related to the MRI diagnosis, the type of MRI ordered, the date of pain onset, the date of x-ray (if any), and the date of the MRI. A total of 475 patients who underwent shoulder MRI were included in our study. We found significant associations between a patient having had a prior x-ray and ordering department (P < .0001), male gender (P = .0005), and subjects who had subsequent surgery (P = .0006). Neither age nor race and ethnicity had an influence on x-ray before MRI. Orthopedic specialists ordering MRIs had the highest percentage of patients undergo subsequent surgery (33.3%) compared with the second-most, primary care (18.4%), and all other ordering departments (P = .0009). Detailed analysis suggests that providers who do not have specific training in shoulder pathology should consider consultation with an orthopedic surgeon before ordering shoulder MRI for patients who may need additional imaging after radiography. Copyright © 2017 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Biomechanical effects of mobile computer location in a vehicle cab.

PubMed

Saginus, Kyle A; Marklin, Richard W; Seeley, Patricia; Simoneau, Guy G; Freier, Stephen

2011-10-01

The objective of this research is to determine the best location to place a conventional mobile computer supported by a commercially available mount in a light truck cab. U.S. and Canadian electric utility companies are in the process of integrating mobile computers into their fleet vehicle cabs. There are no publications on the effect of mobile computer location in a vehicle cab on biomechanical loading, performance, and subjective assessment. The authors tested four locations of mobile computers in a light truck cab in a laboratory study to determine how location affected muscle activity of the lower back and shoulders; joint angles of the shoulders, elbows, and wrist; user performance; and subjective assessment. A total of 22 participants were tested in this study. Placing the mobile computer closer to the steering wheel reduced low back and shoulder muscle activity. Joint angles of the shoulders, elbows, and wrists were also closer to neutral angle. Biomechanical modeling revealed substantially less spinal compression and trunk muscle force. In general, there were no practical differences in performance between the locations. Subjective assessment indicated that users preferred the mobile computer to be as close as possible to the steering wheel. Locating the mobile computer close to the steering wheel reduces risk of injuries, such as low back pain and shoulder tendonitis. Results from the study can guide electric utility companies in the installation of mobile computers into vehicle cabs. Results may also be generalized to other industries that use trucklike vehicles, such as construction.

Microbial growth, communities and sensory characteristics of vacuum and modified atmosphere packaged lamb shoulders.

PubMed

Kiermeier, Andreas; Tamplin, Mark; May, Damian; Holds, Geoff; Williams, Michelle; Dann, Alison

2013-12-01

Packaging fresh lamb in a vacuum (VAC) versus a 100% CO2 modified atmosphere (MAP) may influence product shelf-life and the bacterial communities. While VAC is a common packing method and 100% CO2 MAP is used in some countries, there is little information about how these different techniques affect the growth of spoilage bacteria and sensory attributes of lamb. The aim of this study was to assess changes in microbiological and organoleptic properties, and determine differences in microbial communities by terminal restriction fragment length polymorphism (TRFLP) and 454 pyrosequencing, in bone-in (BI) and bone-out (BO) MAP- and VAC-packed lamb shoulders stored at -0.3 °C over 12 wk. VAC and MAP lamb shoulders were acceptable in sensory test scores over 12 wk of storage at -0.3 °C, despite total viable count (TVC) and lactic acid bacteria (LAB) levels increasing to 8 log10 CFU/cm(2) for VAC lamb and 4-6 log10 CFU/cm(2) for MAP lamb. Similar to the sensory results, there were no significant differences in microbial communities between BI and BO product. However, types of bacteria were different between VAC and MAP packaging. Specifically, while VAC shoulder became dominated by Carnobacterium spp. in the middle of the storage period, the MAP shoulder microbial population remained similar from the start until later storage times. Copyright © 2013 Elsevier Ltd. All rights reserved.

Outcome in adolescence of brachial plexus birth palsy

PubMed Central

Hulleberg, Gunn; Elvrum, Ann-Kristin G; Brandal, Merethe; Vik, Torstein

2014-01-01

Background and purpose — The frequency and severity of a permanent lesion after brachial plexus birth palsy (BPBP) and its impact on activities of daily living are not well documented. We therefore investigated the outcome of BPBP in adolescents, regarding arm function and consequences for activity and participation. Participants and methods — Of 30,574 babies born at St. Olavs University Hospital in 1991–2000, 91 had BPBP (prevalence 3 per 1,000), and 69 of these individuals were examined at a median age of 14 (10–20) years. The examination included the modified Mallet classification, range of motion, shoulder rotation and grip strength, Assisting Hand Assessment, and Canadian Occupational Performance Measure. Of the 22 subjects who were not examined, 3 could not be traced and 19 reported having no problems in the affected arm. Results — At follow-up, 17 adolescents had a permanent lesion (i.e. individual Mallet subscore below 4) with a median Mallet total score of 15 (9–19), while 52 had good or normal shoulder function (median Mallet total score 25 (23–25)). All participants with a permanent lesion had reduced active shoulder rotation (≤ 15°), 16 had elbow extension deficit, and 10 had subnormal grip strength. External rotation was considerably weaker in the affected shoulder. In addition, they had ineffective use of the affected arm in bimanual activities. Even so, all except 1 were independent in activities of daily living, although 15 experienced minor difficulties. Interpretation — Every fourth to fifth child with BPBP had a permanent lesion as an adolescent. External rotation was the most impaired movement. Despite ineffective use of the affected arm in bimanual activities, all of the participants except one were independent in activities of daily living. PMID:25238434

Outcome in adolescence of brachial plexus birth palsy. 69 individuals re-examined after 10–20 years.

PubMed

Hulleberg, Gunn; Elvrum, Ann-Kristin G; Brandal, Merethe; Vik, Torstein

2014-12-01

The frequency and severity of a permanent lesion after brachial plexus birth palsy (BPBP) and its impact on activities of daily living are not well documented. We therefore investigated the outcome of BPBP in adolescents, regarding arm function and consequences for activity and participation. Of 30,574 babies born at St. Olavs University Hospital in 1991-2000, 91 had BPBP (prevalence 3 per 1,000), and 69 of these individuals were examined at a median age of 14 (10-20) years. The examination included the modified Mallet classification, range of motion, shoulder rotation and grip strength, Assisting Hand Assessment, and Canadian Occupational Performance Measure. Of the 22 subjects who were not examined, 3 could not be traced and 19 reported having no problems in the affected arm. At follow-up, 17 adolescents had a permanent lesion (i.e. individual Mallet subscore below 4) with a median Mallet total score of 15 (9-19), while 52 had good or normal shoulder function (median Mallet total score 25 (23-25)). All participants with a permanent lesion had reduced active shoulder rotation (≤15°), 16 had elbow extension deficit, and 10 had subnormal grip strength. External rotation was considerably weaker in the affected shoulder. In addition, they had ineffective use of the affected arm in bimanual activities. Even so, all except 1 were independent in activities of daily living, although 15 experienced minor difficulties. Every fourth to fifth child with BPBP had a permanent lesion as an adolescent. External rotation was the most impaired movement. Despite ineffective use of the affected arm in bimanual activities, all of the participants except one were independent in activities of daily living.

Can patients manage toileting after reverse total shoulder arthroplasty? A systematic review.

PubMed

Rojas, Jorge; Joseph, Jacob; Liu, Bingli; Srikumaran, Uma; McFarland, Edward G

2018-03-23

A major concern for patients undergoing reverse total shoulder arthroplasty (RTSA) is managing toileting after surgery. The goals of this systematic review of RTSA studies were to determine the following: (1) the percentage of patients who can manage toileting, (2) their degree of difficulty with toileting, and (3) the percentage of patients who can manage toileting after bilateral versus unilateral RTSA. Medline, EMBASE, Google Scholar, and the Cochrane Central Register of Controlled Trials were searched for studies reporting the ability to manage toileting after RTSA. Six studies with at least 12 months of follow-up were included, yielding 183 patients (105 unilateral RTSA, 78 bilateral RTSA). We pooled patient data and calculated the weighted mean proportion of patients able to manage toileting, those who reported difficulty, and those able to manage toileting after unilateral versus bilateral RTSA. Statistical significance was set at P < 0.05. Most patients (92%; 95% confidence interval, 87-95%) were able to manage toileting after RTSA. Some degree of difficulty with toileting was reported for 20% of all shoulders. Almost all patients with bilateral RTSA were able to manage toileting with at least one arm (weighted mean proportion 97%; 95% confidence interval, 88-99%). There was no significant difference in the proportion of patients able to manage toileting after unilateral versus bilateral RTSA (P = 0.08). Only 3% of all papers published on the clinical results of RTSA by June 2017 reported upon toileting after the procedure. With the available evidence, most patients were able to manage toileting after RTSA, although one-fifth reported some degree of difficulty. Ability to manage toileting was similar after unilateral versus bilateral RTSA. In the future, this variable should be a standard question after shoulder arthroplasty. IV.

Associations Among Hip and Shoulder Range of Motion and Shoulder Injury in Professional Baseball Players

PubMed Central

Scher, Steve; Anderson, Kyle; Weber, Nick; Bajorek, Jeff; Rand, Kevin; Bey, Michael J.

2010-01-01

Abstract Context: The overhead throwing motion is complex, and restrictions in range of motion (ROM) at the hip may place additional demands on the shoulder that lead to injury. However, the relationship between hip and shoulder ROM in athletes with and without a history of shoulder injury is unknown. Objective: To (1) determine if differences exist in hip and shoulder ROM between professional baseball players with a history of shoulder injury and those with no history of shoulder injury and (2) assess relationships between hip and shoulder ROM in these players. Design: Cross-sectional study. Patients or Other Participants: Fifty-seven professional baseball players. Main Outcome Measure(s): Outcome measures consisted of hip extension and internal rotation, shoulder internal and external rotation, glenohumeral internal-rotation deficit, and history of shoulder injury. Differences in shoulder and hip ROM were assessed with a 1-way analysis of variance. Associations between hip and shoulder ROM were assessed with linear regression. Results: Nonpitchers with a history of shoulder injury had more external rotation and less internal rotation of the shoulder than nonpitchers with no history of shoulder injury. Glenohumeral internal-rotation deficit was greater in both pitchers and nonpitchers with a history of shoulder injury. The relationship between dominant hip extension and shoulder external rotation was significant for pitchers with a history of shoulder injury and nonpitchers with a history of shoulder injury. Conclusions: Shoulder injury may be associated with specific measures of hip and shoulder ROM, and hip extension and shoulder external rotation may be related in baseball players with a history of shoulder injury. Additional research is necessary to understand the specific mechanisms of shoulder injury in the throwing athlete. PMID:20210623

Severe brachial plexopathy after an ultrasound-guided single-injection nerve block for total shoulder arthroplasty in a patient with multiple sclerosis.

PubMed

Koff, Matthew D; Cohen, Jeffrey A; McIntyre, John J; Carr, Charles F; Sites, Brian D

2008-02-01

DESPITE the known benefits of regional anesthesia for patients undergoing joint arthroplasty, the performance of peripheral nerve blocks in patients with multiple sclerosis (MS) remains controversial. MS has traditionally been described as an isolated disease of the central nervous system, without involvement of the peripheral nerves, and peripheral nerve blockade has been suggested to be safe. However, careful review of the literature suggests that MS may also be associated with involvement of the peripheral nervous system, challenging traditional teachings. There is a paucity of evidence with regard to safety in using peripheral nerve regional anesthesia in these patients. This makes it difficult to provide adequate "informed consent" to these patients. This case report describes a patient with MS who sustained a severe brachial plexopathy after a total shoulder arthroplasty during combined general anesthesia and interscalene nerve block.

Subjective health complaints of teachers from primary and secondary schools in Hong Kong.

PubMed

Chong, Elaine Y L; Chan, Alan H S

2010-01-01

This study aimed to investigate the subjective health complaints (SHC) in the teaching profession of Hong Kong. On the basis of the SHC inventory, a questionnaire was prepared for data collection through a mail survey. A total of 1710 usable questionnaires were returned by the primary or secondary school teachers. The results showed that 99.5% (n = 1702) of respondents suffered at least one type of the 39 single health problems on the total SHC scale during the preceding 30 days. The 10 most frequently reported health complaints among the teachers were tiredness, eyestrain, anxiety, sleep problems, voice disorder, shoulder pain, neck pain, headache, cold/flu, and lower-back pain. With the exception of the category of pseudoneurological complaints, primary school teachers showed a statistically higher prevalence in reporting problems in 6 of 7 subscales. The 5 most severe complaints were tiredness, eyestrain, sleep problems, shoulder pain, and voice disorder.

High Satisfaction and Return to Sports After Total Shoulder Arthroplasty in Patients Aged 55 Years and Younger.

PubMed

Garcia, Grant H; Liu, Joseph N; Sinatro, Alec; Wu, Hao-Hua; Dines, Joshua S; Warren, Russell F; Dines, David M; Gulotta, Lawrence V

2017-06-01

Young, active candidates for total shoulder arthroplasty (TSA) are a unique group of patients. Not only do they demand longevity and improved function, but they also desire a return to physical activities. To determine the rate of return to sports in patients aged ≤55 years undergoing TSA. Case series; Level of evidence, 4. This was a retrospective review of consecutive patients who underwent anatomic TSA at a single institution. Exclusion criteria included age at the time of surgery >55 years and <2 years of follow-up. All patients had end-stage osteoarthritis with significant glenohumeral joint space narrowing. The final follow-up consisted of a patient-reported sports questionnaire, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale (VAS) score. From 70 eligible patients, 59 patients (61 shoulders) were included with an average follow-up of 61.0 months (range, 25-103 months) and average age at the time of surgery of 48.9 years (range, 25-55 years). The average VAS score improved from 5.6 to 0.9 ( P < .001), and the average ASES score improved from 39.3 to 88.4 ( P < .001). Forty-nine procedures (80.3%) were performed for a primary diagnosis of osteoarthritis. Four shoulders returned to the operating room; none were for glenoid loosening. There was a 93.2% satisfaction rate, and 67.7% of patients (n = 40) stated that they underwent their surgery to return to sports. Moreover, patients in 96.4% of shoulders (55/57) restarted at least 1 sport at an average of 6.7 months. Direct rates of return were as follows: fitness sports (97.2%), golf (93.3%), singles tennis (87.5%), swimming (77.7%), basketball (75.0%), and flag football (66.7%). Patients in 47 shoulders (82.4%) returned to a similar or higher level of sports; 90.3% returned to high-demand sports, and 83.8% returned to high upper extremity sports. There was no significant difference in rates of return to sports by body mass index, sex, age, preoperative diagnosis, revision status, and dominant extremity. In patients aged ≤55 years undergoing TSA, there was a 96.4% rate of return to ≥1 previous sports at an average of 6.7 months. Furthermore, at an average follow-up of 61.0 months, no patients needed revision of their glenoid component, despite an 83.8% rate of return to high upper extremity sports. While caution should still be advised in young, active patients undergoing TSA, these results demonstrate a high satisfaction rate and improved ability to return to most sports after surgery.

Incidence and prognostic factors for postoperative frozen shoulder after shoulder surgery: a prospective cohort study.

PubMed

Koorevaar, Rinco C T; Van't Riet, Esther; Ipskamp, Marcel; Bulstra, Sjoerd K

2017-03-01

Frozen shoulder is a potential complication after shoulder surgery. It is a clinical condition that is often associated with marked disability and can have a profound effect on the patient's quality of life. The incidence, etiology, pathology and prognostic factors of postoperative frozen shoulder after shoulder surgery are not known. The purpose of this explorative study was to determine the incidence of postoperative frozen shoulder after various operative shoulder procedures. A second aim was to identify prognostic factors for postoperative frozen shoulder after shoulder surgery. 505 consecutive patients undergoing elective shoulder surgery were included in this prospective cohort study. Follow-up was 6 months after surgery. A prediction model was developed to identify prognostic factors for postoperative frozen shoulder after shoulder surgery using the TRIPOD guidelines. We nominated five potential predictors: gender, diabetes mellitus, type of physiotherapy, arthroscopic surgery and DASH score. Frozen shoulder was identified in 11% of the patients after shoulder surgery and was more common in females (15%) than in males (8%). Frozen shoulder was encountered after all types of operative procedures. A prediction model based on four variables (diabetes mellitus, specialized shoulder physiotherapy, arthroscopic surgery and DASH score) discriminated reasonably well with an AUC of 0.712. Postoperative frozen shoulder is a serious complication after shoulder surgery, with an incidence of 11%. Four prognostic factors were identified for postoperative frozen shoulder: diabetes mellitus, arthroscopic surgery, specialized shoulder physiotherapy and DASH score. The combination of these four variables provided a prediction rule for postoperative frozen shoulder with reasonable fit. Level II, prospective cohort study.

21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic 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 glenoid (hemi-shoulder) metallic... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket) component...

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

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium...

21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic 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 glenoid (hemi-shoulder) metallic... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket) component...

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

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium...

21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic 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 glenoid (hemi-shoulder) metallic... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket) component...

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

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint glenoid (hemi-shoulder) metallic... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket) component...

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

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium...

21 CFR 888.3680 - Shoulder joint glenoid (hemi-shoulder) metallic 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 glenoid (hemi-shoulder) metallic... Shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis. (a) Identification. A shoulder joint glenoid (hemi-shoulder) metallic cemented prosthesis is a device that has a glenoid (socket) component...

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

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium...

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

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis is a device made of alloys, such as cobalt-chromium...

Shoulder pain and disability index: cross cultural validation and evaluation of psychometric properties of the Spanish version.

PubMed

Membrilla-Mesa, Miguel David; Cuesta-Vargas, Antonio Ignacio; Pozuelo-Calvo, Rocio; Tejero-Fernández, Victor; Martín-Martín, Lydia; Arroyo-Morales, Manuel

2015-12-21

The Shoulder Pain Disability Index (SPADI) is a recently published but widely used outcome measure. This study included 136 patients with shoulder disorders. SPADI was first translated and back-translated and then subjected to psychometric validation. Participants completed the Spanish versions of the SPADI, general health (SF-12), the Simple Shoulder Test (SST), Disability of Arm, Shoulder, and Hand (DASH) questionnaires and a pain intensity visual analog scale (VAS). The factors explained 62.8 % of the variance, with an internal consistency of α = 0.916 and 0.860, respectively. The confirmatory factor analysis showed a Comparative Fit Index of 0.82 and a Normed Fit Index of 0.80. The Root Mean Square Error of Aproximation was 0.12. The x (2) test for the 2-factor model was significant (x (2) = 185.41, df = 62, p < 0.01). The test-retest reliability was high, with an item ranging of the interclass correlation coefficient (ICC) from 0.89 to 0.93. The ICC for the total score was 0.91 (95 % CI 0.88 to 0.94). Measurement error by minimal detectable change (MDC)95 was 12.2 %. In the construct validity analysis, strong positive correlations were observed between Spanish Version of the SPADI and DASH (pain: r = 0.80; p < 0.01; disability: r = 0.76; p < 0.01). Moderate positive correlations were observed between Spanish Version of the SPADI and VAS (pain: r = 0.67; p < 0.01; disability: r = 0.65; p < 0.01). Moderate negative correlations were obtained between Spanish Version of the SPADI and SST-Sp (pain: r = -0.71; p < 0.01; disability: r = -0.75; p < 0.01). However, pain total Spanish Version of the SPADI was only weakly correlated with physical and mental components of SF-12 (both r = 0.40; p < 0.01). This Spanish version of SPADI demonstrated satisfactory psychometric properties in a patient sample in the hospital setting.

Use of PROMIS for Patients Undergoing Primary Total Shoulder Arthroplasty

PubMed Central

Dowdle, S. Blake; Glass, Natalie; Anthony, Chris A.; Hettrich, Carolyn M.

2017-01-01

Background: The Patient-Reported Outcomes Measurement Information System (PROMIS) consists of question banks for health domains through computer adaptive testing (CAT). Hypothesis: For patients with glenohumeral arthritis, (1) there would be high correlation between traditional patient-reported outcome (PRO) measures and the PROMIS upper extremity item bank (PROMIS UE) and PROMIS physical function CAT (PROMIS PF CAT), and (2) PROMIS PF CAT would not demonstrate ceiling effects. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Sixty-one patients with glenohumeral osteoarthritis were included. Each patient completed the American Shoulder and Elbow Surgeons (ASES) assessment form, Marx Shoulder Activity Scale, Short Form–36 physical function scale (SF-36 PF), EuroQol 5 Dimensions (EQ-5D) questionnaire, Western Ontario Osteoarthritis Shoulder (WOOS) index, PROMIS PF CAT, and the PROMIS UE. Correlation was defined as high (>0.7), moderate (0.4-0.6), or weak (0.2-0.3). Significant floor and ceiling effects were present if more than 15% of individuals scored the lowest or highest possible total score on any PRO. Results: The PROMIS PF demonstrated excellent correlation with the SF-36 PF (r = 0.81, P < .0001) and good correlation with the ASES (r = 0.62, P < .0001), EQ-5D (r = 0.64, P < .001), and WOOS index (r = 0.51, P < .01). The PROMIS PF demonstrated low correlation with the Marx scale (r = 0.29, P = .02). The PROMIS UE demonstrated good correlation with the ASES (r = 0.55, P < .0001), SF-36 (r = 0.53, P < .01), EQ-5D (r = 0.48, P < .01), and WOOS (r = 0.34, P <.01), and poor correlation with the Marx scale (r = 0.06, P = .62). There were no ceiling or floor effects observed. The mean number of items administered by the PROMIS PRO was 4. Conclusion: These data suggest that for a patient population with operative shoulder osteoarthritis, PROMIS UE and PROMIS PF CAT may be valid alternative PROs. Additionally, PROMIS PF CAT offers a decreased question burden with no ceiling effects. PMID:28944248

Pain Management Strategies in Shoulder Arthroplasty.

PubMed

Codding, Jason L; Getz, Charles L

2018-01-01

Pain control in total shoulder arthroplasty demands a multidisciplinary approach with collaboration between patients, surgeon, and anesthetist. A multimodal approach with preemptive medication, regional blockade, local anesthetics, and a combination of acetaminophen, nonsteroidal antiinflammatory drugs, tramadol, and gabapentinoids postoperatively leads to pain control and patient satisfaction. Assessment of patients' expectations constitutes a vital aspect of the preoperative patient evaluation. Educating and psychologically preparing patients reduces postoperative pain. Patients with anxiety and depression, preoperative narcotic use, and medical comorbidities are at an increased risk for suboptimal pain control. Minimizing narcotic use decreases opioid-related adverse effects and facilitates productive rehabilitation efforts. Copyright © 2017 Elsevier Inc. All rights reserved.

A Force-Velocity Relationship and Coordination Patterns in Overarm Throwing

PubMed Central

van den Tillaar, Roland; Ettema, Gertjan

2004-01-01

A force-velocity relationship in overarm throwing was determined using ball weights varying from 0.2 to 0.8 kg. Seven experienced handball players were filmed at 240 frames per second. Velocity of joints of the upper extremity and ball together with the force on the ball were derived from the data. A statistically significant negative relationship between force and maximal ball velocity, as well as between ball weight and maximal ball velocity was observed. Also, with increase of ball weight the total throwing movement time increased. No significant change in relative timing of the different joints was demonstrated, suggesting that the subjects did not change their “global ”coordination pattern (kinematics) within the tested range of ball weights. A simple model revealed that 67% of ball velocity at ball release was explained by the summation of effects from the velocity of elbow extension and internal rotation of the shoulder. With regard to the upper extremity the internal rotation of the shoulder and elbow extension are two important contributors to the total ball velocity at release. Key Points An inverse relationship between load and velocity and a linear force-velocity exists in overarm throwing with ball weights varying from 0.2 to 0.8 kg. Qualitatively, no changes in coordination pattern (relative timing) occur with increasing ball weight within the tested range of ball weights. The absolute throwing movement time increased with ball weight. Quantitatively, with regard to the upper extremity, the internal rotation of the shoulder and elbow extension are two important contributors to the total ball velocity at release. PMID:24624005

Mortality rates at 10 years after metal-on-metal hip resurfacing compared with total hip replacement in England: retrospective cohort analysis of hospital episode statistics

PubMed Central

Kendal, Adrian R; Prieto-Alhambra, Daniel; Arden, Nigel K; Judge, Andrew

2013-01-01

Objectives To compare 10 year mortality rates among patients undergoing metal-on-metal hip resurfacing and total hip replacement in England. Design Retrospective cohort study. Setting English hospital episode statistics database linked to mortality records from the Office for National Statistics. Population All adults who underwent primary elective hip replacement for osteoarthritis from April 1999 to March 2012. The exposure of interest was prosthesis type: cemented total hip replacement, uncemented total hip replacement, and metal-on-metal hip resurfacing. Confounding variables included age, sex, Charlson comorbidity index, rurality, area deprivation, surgical volume, and year of operation. Main outcome measures All cause mortality. Propensity score matching was used to minimise confounding by indication. Kaplan-Meier plots estimated the probability of survival up to 10 years after surgery. Multilevel Cox regression modelling, stratified on matched sets, described the association between prosthesis type and time to death, accounting for variation across hospital trusts. Results 7437 patients undergoing metal-on-metal hip resurfacing were matched to 22 311 undergoing cemented total hip replacement; 8101 patients undergoing metal-on-metal hip resurfacing were matched to 24 303 undergoing uncemented total hip replacement. 10 year rates of cumulative mortality were 271 (3.6%) for metal-on-metal hip resurfacing versus 1363 (6.1%) for cemented total hip replacement, and 239 (3.0%) for metal-on-metal hip resurfacing versus 999 (4.1%) for uncemented total hip replacement. Patients undergoing metal-on-metal hip resurfacing had an increased survival probability (hazard ratio 0.51 (95% confidence interval 0.45 to 0.59) for cemented hip replacement; 0.55 (0.47 to 0.65) for uncemented hip replacement). There was no evidence for an interaction with age or sex. Conclusions Patients with hip osteoarthritis undergoing metal-on-metal hip resurfacing have reduced mortality in the long term compared with those undergoing cemented or uncemented total hip replacement. This difference persisted after extensive adjustment for confounding factors available in our data. The study results can be applied to matched populations, which exclude patients who are very old and have had complex total hip replacements. Although residual confounding is possible, the observed effect size is large. These findings require validation in external cohorts and randomised clinical trials. PMID:24284336

Kinematic and EMG Comparison of Gait in Normal and Microgravity

NASA Technical Reports Server (NTRS)

DeWitt, John K.; Edwards, W. Brent; Perusek, Gail P.; Lewandowski, Beth E.; Samorezov, Sergey

2009-01-01

Astronauts regularly perform treadmill locomotion as a part of their exercise prescription while onboard the International Space Station. Although locomotive exercise has been shown to be beneficial for bone, muscle, and cardiovascular health, astronauts return to Earth after long duration missions with net losses in all three areas [1]. These losses might be partially explained by fundamental differences in locomotive performance between normal gravity (NG) and microgravity (MG) environments. During locomotive exercise in MG, the subject must wear a waist and shoulder harness that is attached to elastomer bungees. The bungees are attached to the treadmill, and provide forces that are intended to replace gravity. However, unlike gravity, which provides a constant force upon all body parts, the bungees provide a spring force only to the harness. Therefore, subjects are subjected to two fundamental differences in MG: 1) forces returning the subject to the treadmill are not constant, and 2) forces are only applied to the axial skeleton at the waist and shoulders. The effectiveness of the exercise may also be affected by the magnitude of the gravity replacement load. Historically, astronauts have difficulty performing treadmill exercise with loads that approach body weight (BW) due to comfort and inherent stiffness in the bungee system. Although locomotion can be executed in MG, the unique requirements could result in performance differences as compared to NG. These differences may help to explain why long term training effects of treadmill exercise may differ from those found in NG. The purpose of this investigation was to compare locomotion in NG and MG to determine if kinematic or muscular activation pattern differences occur between gravitational environments.

Prevention and management of post-instability glenohumeral arthropathy

PubMed Central

Waterman, Brian R; Kilcoyne, Kelly G; Parada, Stephen A; Eichinger, Josef K

2017-01-01

Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability, both with and without surgical stabilization. Classically related to anterior shoulder instability, the incidence and rates of arthritic progression may vary widely. Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30% after Latarjet procedure, with increasing rates associated with recurrent dislocation history, prominent implant position, non-anatomic reconstruction, and/or lateralized bone graft placement. However, the presence radiographic arthrosis does not predict poor patient-reported function. After exhausting conservative measures, both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors. Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology. For more advanced secondary arthropathy, total shoulder arthroplasty remains the most reliable option, although the clinical outcomes, wear characteristics, and implant survivorship remains a concern among active, young patients. PMID:28361016

PubMed Central

Daneshmandi, H.; Ghaem, H.; Alhamd, M.; Fakherpour, A.

2017-01-01

Summary Introduction. Work-related Musculoskeletal Disorders (WMSDs) can impact on fatigue and productivity of office workers. This study aimed to investigate the effect of musculoskeletal problems on fatigue and productivity among office personnel. Methods. This study was performed on 101 Iranian office workers. Data were gathered through a demographic questionnaire, Nordic Musculoskeletal Questionnaire, Numeric Rating Scale, Persian version of Multidimensional Assessment of Fatigue Scale, and Persian version of Health and Work Questionnaire. Results. The results revealed that the highest prevalence rates of musculoskeletal symptoms in the past week were related to neck (41.6%), lower back (41.6%), and shoulders (40.6%). The mean score of discomfort/pain was 1.67, 1.55, and 1.31 in the neck, lower back, and shoulders, respectively. Additionally, the severity of discomfort/pain in neck, shoulders, lower back, and thighs was correlated to total fatigue. The severity of discomfort/pain in neck, lower back, buttock, and thighs was also correlated to the concentration/focus subscale of productivity. Conclusions. Improvement of working conditions is suggested to reduce musculoskeletal problems and fatigue and enhance productivity. PMID:29123372

Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder.

PubMed

Jeon, Hong Jin; Woo, Jong-Min; Kim, Hyo-Jin; Fava, Maurizio; Mischoulon, David; Cho, Seong Jin; Chang, Sung Man; Park, Doo-Heum; Kim, Jong Woo; Yoo, Ikki; Heo, Jung-Yoon; Hong, Jin Pyo

2016-11-01

Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.

Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations.

PubMed

Laver, Lior; Garrigues, Grant E

2014-10-01

Superior tilt of the baseplate component in reverse total shoulder arthroplasty leads to tensile baseplate forces and may be a contributor to early loosening. The risk factors for this implant malposition include inadequate exposure through a superior approach and superior glenoid bone deficiency that obscures the native glenoid tilt. Here we review our preoperative evaluation and surgical management strategies to avoid superior tilt. Adequate exposure with a superior approach can be achieved but requires not just proper surgical technique but also careful patient selection. We propose that the superior approach be considered only for acute proximal humerus fractures or in patients when the following criteria are met: no prior open surgery on the shoulder; more than 30° of passive external rotation at 0° of abduction; no medial humeral osteophytes; and any superior migration must be reducible with a sulcus test during examination under anesthesia. Avoiding superior tilt when there is significant superior glenoid erosion can be accomplished with humeral head autograft, most easily performed through a deltopectoral approach. Preoperative templating is critical to determine proper graft thickness, inclination, reaming depth, and harvest technique. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Patient self-report section of the ASES questionnaire: a Spanish validation study using classical test theory and the Rasch model.

PubMed

Vrotsou, Kalliopi; Cuéllar, Ricardo; Silió, Félix; Rodriguez, Miguel Ángel; Garay, Daniel; Busto, Gorka; Trancho, Ziortza; Escobar, Antonio

2016-10-18

The aim of the current study was to validate the self-report section of the American Shoulder and Elbow Surgeons questionnaire (ASES-p) into Spanish. Shoulder pathology patients were recruited and followed up to 6 months post treatment. The ASES-p, Constant, SF-36 and Barthel scales were filled-in pre and post treatment. Reliability was tested with Cronbach's alpha, convergent validity with Spearman's correlations coefficients. Confirmatory factor analysis (CFA) and the Rasch model were implemented for assessing structural validity and unidimensionality of the scale. Models with and without the pain item were considered. Responsiveness to change was explored via standardised effect sizes. Results were acceptable for both tested models. Cronbach's alpha was 0.91, total scale correlations with Constant and physical SF-36 dimensions were >0.50. Factor loadings for CFA were >0.40. The Rasch model confirmed unidimensionality of the scale, even though item 10 "do usual sport" was suggested as non-informative. Finally, patients with improved post treatment shoulder function and those receiving surgery had higher standardised effect sizes. The adapted Spanish ASES-p version is a valid and reliable tool for shoulder evaluation and its unidimensionality is supported by the data.

An Alternative Frictional Boundary Condition for Computational Fluid Dynamics Simulation of Friction Stir Welding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chen, Gaoqiang; Feng, Zhili; Zhu, Yucan

For better application of numerical simulation in optimization and design of friction stir welding (FSW), this paper presents a new frictional boundary condition at the tool/workpiece interface for computational fluid dynamics (CFD) modeling of FSW. The proposed boundary condition is based on an implementation of the Coulomb friction model. Using the new boundary condition, the CFD simulation yields non-uniform distribution of contact state over the tool/workpiece interface, as validated by the experimental weld macrostructure. It is found that interfacial sticking state is present over large area at the tool-workpiece interface, while significant interfacial sliding occurs at the shoulder periphery, themore » lower part of pin side, and the periphery of pin bottom. Due to the interfacial sticking, a rotating flow zone is found under the shoulder, in which fast circular motion occurs. The diameter of the rotating flow zone is smaller than the shoulder diameter, which is attributed to the presence of the interfacial sliding at the shoulder periphery. For the simulated welding condition, the heat generation due to friction and plastic deformation makes up 54.4 and 45.6% of the total heat generation rate, respectively. In conclusion, the simulated temperature field is validated by the good agreement to the experimental measurements.« less

Effects of Deployment on Musculoskeletal and Physiological Characteristics and Balance.

PubMed

Nagai, Takashi; Abt, John P; Sell, Timothy C; Keenan, Karen A; McGrail, Mark A; Smalley, Brian W; Lephart, Scott M

2016-09-01

Despite many nonbattle injuries reported during deployment, few studies have been conducted to evaluate the effects of deployment on musculoskeletal and physiological characteristics and balance. A total of 35 active duty U.S. Army Soldiers participated in laboratory testing before and after deployment to Afghanistan. The following measures were obtained for each Soldier: shoulder, trunk, hip, knee, and ankle strength and range of motion (ROM), balance, body composition, aerobic capacity, and anaerobic power/capacity. Additionally, Soldiers were asked about their physical activity and load carriage. Paired t tests or Wilcoxon tests with an α = 0.05 set a priori were used for statistical analyses. Shoulder external rotation ROM, torso rotation ROM, ankle dorsiflexion ROM, torso rotation strength, and anaerobic power significantly increased following deployment (p < 0.05). Shoulder extension ROM, shoulder external rotation strength, and eyes-closed balance (p < 0.05) were significantly worse following deployment. The majority of Soldiers (85%) engaged in physical activity. In addition, 58% of Soldiers reported regularly carrying a load (22 kg average). The deployment-related changes in musculoskeletal and physiological characteristics and balance as well as physical activity and load carriage during deployment may assist with proper preparation with the intent to optimize tactical readiness and mitigate injury risk. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

An Alternative Frictional Boundary Condition for Computational Fluid Dynamics Simulation of Friction Stir Welding

DOE PAGES

Chen, Gaoqiang; Feng, Zhili; Zhu, Yucan; ...

2016-07-11

For better application of numerical simulation in optimization and design of friction stir welding (FSW), this paper presents a new frictional boundary condition at the tool/workpiece interface for computational fluid dynamics (CFD) modeling of FSW. The proposed boundary condition is based on an implementation of the Coulomb friction model. Using the new boundary condition, the CFD simulation yields non-uniform distribution of contact state over the tool/workpiece interface, as validated by the experimental weld macrostructure. It is found that interfacial sticking state is present over large area at the tool-workpiece interface, while significant interfacial sliding occurs at the shoulder periphery, themore » lower part of pin side, and the periphery of pin bottom. Due to the interfacial sticking, a rotating flow zone is found under the shoulder, in which fast circular motion occurs. The diameter of the rotating flow zone is smaller than the shoulder diameter, which is attributed to the presence of the interfacial sliding at the shoulder periphery. For the simulated welding condition, the heat generation due to friction and plastic deformation makes up 54.4 and 45.6% of the total heat generation rate, respectively. In conclusion, the simulated temperature field is validated by the good agreement to the experimental measurements.« less

Novel Solution for Massive Glenoid Defects in Shoulder Arthroplasty: A Patient-Specific Glenoid Vault Reconstruction System.

PubMed

Dines, David M; Gulotta, Lawrence; Craig, Edward V; Dines, Joshua S

Complex glenoid deformities present the most difficult challenges in shoulder arthroplasty. These deformities may be caused by severe degenerative or congenital deformity, posttraumatic anatomy, tumor, or, in most cases, bone loss after glenoid failure in anatomical total shoulder arthroplasty. Methods of treating severe bone loss have included inlay and onlay bone-graft options with augmented fixation and, in severe cases, salvage hemiarthroplasty with limited goal expectations. Unfortunately, none of these methods has provided consistently satisfactory reproducible results. In fact, each has had high rates of failure and complications. Borrowing from hip and knee arthroplasty surgeons' experience in using CAD/CAM (computer-aided design/computer-aided manufacturing) patient-specific implants to fill significant bony defects, Dr. D. M. Dines developed a glenoid vault reconstruction system (VRS) in conjunction with the Comprehensive Shoulder Arthroplasty System (Zimmer Biomet) to treat severe glenoid bone deficiency. The VRS is patient-specific; each case involves making a preoperative plan based on 3-dimensional reconstruction of a 2-dimensional computed tomography scan. The patient-specific implant and instrumentation that are created are used to reconstruct the deformed glenoid in an anatomical position without the need for additional bone graft. In this article, we describe the implant and its indications, technical aspects of production, and surgical technique.

Incidence of acute postoperative infections requiring reoperation after arthroscopic shoulder surgery.

PubMed

Yeranosian, Michael G; Arshi, Armin; Terrell, Rodney D; Wang, Jeffrey C; McAllister, David R; Petrigliano, Frank A

2014-02-01

An acute infection after arthroscopic shoulder surgery is a rare but serious complication. Previous studies estimating the incidence of infections after arthroscopic surgery have been conducted, but the majority of these had either relatively small study groups or were not specific to shoulder arthroscopic surgery. To investigate the incidence of acute infections after arthroscopic shoulder surgery and compare infection rates by age group, sex, geographic region, and specific procedures. Case series; Level of evidence, 4. A retrospective review of a large insurance company database was performed for all shoulder arthroscopic surgeries performed in the United States between 2004 and 2009 that required additional surgery for infections within 30 days. The data were stratified by sex, age group, and region. Data were also stratified for specific procedures (capsulorrhaphy, treatment for superior labrum anterior-posterior tears, claviculectomy, decompression, and rotator cuff repair) and used to assess the variation in the incidence of infections across different arthroscopic shoulder procedures. Linear regression was used to determine the significance of differences in the data from year to year. χ(2) analysis was used to assess the statistical significance of variations among all groups. Poisson regression analysis with exposure was used to determine significant differences in a pairwise comparison between 2 groups. The total number of arthroscopic shoulder surgeries performed was 165,820, and the number of infections requiring additional surgery was 450, resulting in an overall infection rate of 0.27%. The incidence of infections varied significantly across age groups (P < .001); the infection rate was highest in the ≥60-year age group (0.36%) and lowest in the 10- to 39-year age group (0.18%). The incidence of infections also varied by region (P < .001); the incidence was highest in the South (0.37%) and lowest in the Midwest (0.11%). The incidence of infection treatments was also significantly different between different arthroscopic procedures (P < .01) and was highest for rotator cuff repair (0.29%) and lowest for capsulorrhaphy (0.16%). The incidence did not significantly vary by year or sex. The overall infection rate for all arthroscopic shoulder procedures was 0.27%. The incidence was highest in elderly patients, in the South, and for rotator cuff repair. The incidence was lowest in young patients, in the Midwest, and for capsulorrhaphy. In general, shoulder arthroscopic surgery in this study population had a low rate of reoperation in the acute period.

Progressive glenoid bone loss caused by erosion in humeral head resurfacing.

PubMed

Werner, B S; Stehle, J; Abdelkawi, A; Plumhoff, P; Hudek, R; Gohlke, F

2017-12-01

Cementless surface replacement of the shoulder represents an alternative to conventional stemmed anatomic prostheses. Glenoid erosion is a well-known complication in hemiarthroplasty. However, there is limited data concerning radiographic evaluation and prognostic factors for this phenomenon. The aim of our study was to determine the development of glenoid erosion following shoulder resurfacing using a new measurement technique and detect potential prognostic factors. We performed a retrospective analysis on 38 shoulders undergoing humeral head resurfacing with a mean follow-up of 65.4 ± 43 months. Clinical and radiographic evaluation followed a standardized protocol including pre- and postoperative Constant score, active range of motion, and X‑rays in true anteroposterior view. Three independent observers performed measurements of glenoid erosion. We found good interobserver reliability for glenoid erosion measurements (intraclass correlation coefficient [ICC] 0.74-0.78). Progressive glenoid erosion was present in all cases, averaging 5.5 ± 3.9 mm at more than 5 years' follow-up. Male patients demonstrated increased glenoid bone loss within the first 5 years (p < 0.04). The mean Constant score improved to 55.4 ± 23.6 points at the latest follow-up. Younger age was correlated to increased functional outcome. Revision rate due to painful glenoid erosion was 37%. Glenoid erosion can be routinely expected in patients undergoing humeral head resurfacing. Painful glenoid erosion leads to deterioration in functional outcome and necessitates revision surgery in a high percentage of cases.

Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement

PubMed Central

Jacobson, Jon A.; Benson, Carol B.; Bancroft, Laura W.; Bedi, Asheesh; McShane, John M.; Miller, Theodore T.; Parker, Laurence; Smith, Jay; Steinbach, Lynne S.; Teefey, Sharlene A.; Thiele, Ralf G.; Tuite, Michael J.; Wise, James N.; Yamaguchi, Ken

2013-01-01

The Society of Radiologists in Ultrasound convened a panel of specialists from a variety of medical disciplines to reach a consensus about the recommended imaging evaluation of painful shoulders with clinically suspected rotator cuff disease. The panel met in Chicago, Ill, on October 18 and 19, 2011, and created this consensus statement regarding the roles of radiography, ultrasonography (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography. The consensus panel consisted of two co-moderators, a facilitator, a statistician and health care economist, and 10 physicians who have specialty expertise in shoulder pain evaluation and/or treatment. Of the 13 physicians on the panel, nine were radiologists who were chosen to represent a broad range of skill sets in diagnostic imaging, different practice types (private and academic), and different geographical regions of the United States. Five of the radiologists routinely performed musculoskeletal US as part of their practice and four did not. There was also one representative from each of the following clinical specialties: rheumatology, physical medicine and rehabilitation, orthopedic surgery, and nonoperative sports medicine. The goal of this conference was to construct several algorithms with which to guide the imaging evaluation of suspected rotator cuff disease in patients with a native rotator cuff, patients with a repaired rotator cuff, and patients who have undergone shoulder replacement. The panel hopes that these recommendations will lead to greater uniformity in rotator cuff imaging and more cost-effective care for patients suspected of having rotator cuff abnormality. © RSNA, 2013 PMID:23401583

Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study

PubMed Central

Erdem, Vuslat Muslu; Uzman, Sinan; Yildirim, Dogan; Avaroglu, Huseyin; Ferahman, Sina; Sunamak, Oguzhan

2017-01-01

Purpose Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Methods Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Results Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group. Conclusion CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA. PMID:28289667

Arthrographic and clinical findings in patients with hemiplegic shoulder pain.

PubMed

Lo, Sui-Foon; Chen, Shu-Ya; Lin, Hsiu-Chen; Jim, Yick-Fung; Meng, Nai-Hsin; Kao, Mu-Jung

2003-12-01

To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. Case series. Medical center of a 1582-bed teaching institution in Taiwan. Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. Not applicable. Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.

The effect of patient age at intervention on risk of implant revision after total replacement of the hip or knee: a population-based cohort study.

PubMed

Bayliss, Lee E; Culliford, David; Monk, A Paul; Glyn-Jones, Sion; Prieto-Alhambra, Daniel; Judge, Andrew; Cooper, Cyrus; Carr, Andrew J; Arden, Nigel K; Beard, David J; Price, Andrew J

2017-04-08

Total joint replacements for end-stage osteoarthritis of the hip and knee are cost-effective and demonstrate significant clinical improvement. However, robust population based lifetime-risk data for implant revision are not available to aid patient decision making, which is a particular problem in young patient groups deciding on best-timing for surgery. We did implant survival analysis on all patients within the Clinical Practice Research Datalink who had undergone total hip replacement or total knee replacement. These data were adjusted for all-cause mortality with data from the Office for National Statistics and used to generate lifetime risks of revision surgery based on increasing age at the time of primary surgery. We identified 63 158 patients who had undergone total hip replacement and 54 276 who had total knee replacement between Jan 1, 1991, and Aug 10, 2011, and followed up these patients to a maximum of 20 years. For total hip replacement, 10-year implant survival rate was 95·6% (95% CI 95·3-95·9) and 20-year rate was 85·0% (83·2-86·6). For total knee replacement, 10-year implant survival rate was 96·1% (95·8-96·4), and 20-year implant survival rate was 89·7% (87·5-91·5). The lifetime risk of requiring revision surgery in patients who had total hip replacement or total knee replacement over the age of 70 years was about 5% with no difference between sexes. For those who had surgery younger than 70 years, however, the lifetime risk of revision increased for younger patients, up to 35% (95% CI 30·9-39·1) for men in their early 50s, with large differences seen between male and female patients (15% lower for women in same age group). The median time to revision for patients who had surgery younger than age 60 was 4·4 years. Our study used novel methodology to investigate and offer new insight into the importance of young age and risk of revision after total hip or knee replacement. Our evidence challenges the increasing trend for more total hip replacements and total knee replacements to be done in the younger patient group, and these data should be offered to patients as part of the shared decision making process. Oxford Musculoskeletal Biomedical Research Unit, National Institute for Health Research. Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

Relating crash frequency and severity: evaluating the effectiveness of shoulder rumble strips on reducing fatal and major injury crashes.

PubMed

Wu, Kun-Feng; Donnell, Eric T; Aguero-Valverde, Jonathan

2014-06-01

To approach the goal of "Toward Zero Deaths," there is a need to develop an analysis paradigm to better understand the effects of a countermeasure on reducing the number of severe crashes. One of the goals in traffic safety research is to search for an effective treatment to reduce fatal and major injury crashes, referred to as severe crashes. To achieve this goal, the selection of promising countermeasures is of utmost importance, and relies on the effectiveness of candidate countermeasures in reducing severe crashes. Although it is important to precisely evaluate the effectiveness of candidate countermeasures in reducing the number of severe crashes at a site, the current state-of-the-practice often leads to biased estimates. While there have been a few advanced statistical models developed to mitigate the problem in practice, these models are computationally difficult to estimate because severe crashes are dispersed spatially and temporally, and cannot be integrated into the Highway Safety Manual framework, which develops a series of safety performance functions and crash modification factors to predict the number of crashes. Crash severity outcomes are generally integrated into the Highway Safety Manual using deterministic distributions rather than statistical models. Accounting for the variability in crash severity as a function geometric design, traffic flow, and other roadway and roadside features is afforded by estimating statistical models. Therefore, there is a need to develop a new analysis paradigm to resolve the limitations in the current Highway Safety Manual methods. We propose an approach which decomposes the severe crash frequency into a function of the change in the total number of crashes and the probability of a crash becoming a severe crash before and after a countermeasure is implemented. We tested this approach by evaluating the effectiveness of shoulder rumble strips on reducing the number of severe crashes. A total of 310 segments that have had shoulder rumble strips installed during 2002-2009 are included in the analysis. It was found that shoulder rumble strips reduce the total number of crashes, but have no statistically significant effect on reducing the probability of a severe crash outcome. Copyright © 2014 Elsevier Ltd. All rights reserved.

Do Magnetic Resonance Imaging Characteristics of Full-Thickness Rotator Cuff Tears Correlate With Sleep Disturbance?

PubMed

Reyes, Bryan A; Hull, Brandon R; Kurth, Alexander B; Kukowski, Nathan R; Mulligan, Edward P; Khazzam, Michael S

2017-11-01

Many patients with rotator cuff tears suffer from nocturnal shoulder pain, resulting in sleep disturbance. To determine whether rotator cuff tear size correlated with sleep disturbance in patients with full-thickness rotator cuff tears. Cross-sectional study; Level of evidence, 3. Patients with a diagnosis of unilateral full-thickness rotator cuff tears (diagnosed via magnetic resonance imaging [MRI]) completed the Pittsburgh Sleep Quality Index (PSQI), a visual analog scale (VAS) quantifying their shoulder pain, and the American Shoulder and Elbow Surgeons (ASES) questionnaire. Shoulder MRI scans were analyzed for anterior-posterior tear size (mm), tendon retraction (mm), Goutallier grade (0-4), number of tendons involved (1-4), muscle atrophy (none, mild, moderate, or severe), and humeral head rise (present or absent). Bivariate correlations were calculated between the MRI characteristics and baseline survey results. A total of 209 patients with unilateral full-thickness rotator cuff tears were included in this study: 112 (54%) female and 97 (46%) male (mean age, 64.1 years). On average, shoulder pain had been present for 24 months. The mean PSQI score was 9.8, and the mean VAS score was 5.0. No significant correlations were found between any of the rotator cuff tear characteristics and sleep quality. Only tendon retraction had a significant correlation with pain. Although rotator cuff tears are frequently associated with nocturnal pain and sleep disruption, this study demonstrated that morphological characteristics of full-thickness rotator cuff tears, such as size and tendon retraction, do not correlate with sleep disturbance and have little to no correlation with pain levels.

Injuries in an Extreme Conditioning Program.

PubMed

Aune, Kyle T; Powers, Joseph M

2016-10-19

Extreme conditioning programs (ECPs) are fitness training regimens relying on aerobic, plyometric, and resistance training exercises, often with high levels of intensity for a short duration of time. These programs have grown rapidly in popularity in recent years, but science describing the safety profile of these programs is lacking. The rate of injury in the extreme conditioning program is greater than the injury rate of weightlifting and the majority of injuries occur to the shoulder and back. Cross-sectional study. Level 4. This is a retrospective survey of injuries reported by athletes participating in an ECP. An injury survey was sent to 1100 members of Iron Tribe Fitness, a gym franchise with 5 locations across Birmingham, Alabama, that employs exercises consistent with an ECP in this study. An injury was defined as a physical condition resulting from ECP participation that caused the athlete to either seek medical treatment, take time off from exercising, or make modifications to his or her technique to continue. A total of 247 athletes (22%) completed the survey. The majority (57%) of athletes were male (n = 139), and 94% of athletes were white (n = 227). The mean age of athletes was 38.9 years (±8.9 years). Athletes reported participation in the ECP for, on average, 3.6 hours per week (± 1.2 hours). Eighty-five athletes (34%) reported that they had sustained an injury while participating in the ECP. A total of 132 injuries were recorded, yielding an estimated incidence of 2.71 per 1000 hours. The shoulder or upper arm was the most commonly injured body site, accounting for 38 injuries (15% of athletes). Athletes with a previous shoulder injury were 8.1 times as likely to injure their shoulder in the ECP compared with athletes with healthy shoulders. The trunk, back, head, or neck (n = 29, 12%) and the leg or knee (n = 29, 12%) were the second most commonly injured sites. The injury incidence rate among athletes with < 6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs which appears to be similar to other weight-training programs. © 2016 The Author(s).

Injuries in an Extreme Conditioning Program

PubMed Central

Aune, Kyle T.; Powers, Joseph M.

2016-01-01

Background: Extreme conditioning programs (ECPs) are fitness training regimens relying on aerobic, plyometric, and resistance training exercises, often with high levels of intensity for a short duration of time. These programs have grown rapidly in popularity in recent years, but science describing the safety profile of these programs is lacking. Hypothesis: The rate of injury in the extreme conditioning program is greater than the injury rate of weightlifting and the majority of injuries occur to the shoulder and back. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: This is a retrospective survey of injuries reported by athletes participating in an ECP. An injury survey was sent to 1100 members of Iron Tribe Fitness, a gym franchise with 5 locations across Birmingham, Alabama, that employs exercises consistent with an ECP in this study. An injury was defined as a physical condition resulting from ECP participation that caused the athlete to either seek medical treatment, take time off from exercising, or make modifications to his or her technique to continue. Results: A total of 247 athletes (22%) completed the survey. The majority (57%) of athletes were male (n = 139), and 94% of athletes were white (n = 227). The mean age of athletes was 38.9 years (±8.9 years). Athletes reported participation in the ECP for, on average, 3.6 hours per week (± 1.2 hours). Eighty-five athletes (34%) reported that they had sustained an injury while participating in the ECP. A total of 132 injuries were recorded, yielding an estimated incidence of 2.71 per 1000 hours. The shoulder or upper arm was the most commonly injured body site, accounting for 38 injuries (15% of athletes). Athletes with a previous shoulder injury were 8.1 times as likely to injure their shoulder in the ECP compared with athletes with healthy shoulders. The trunk, back, head, or neck (n = 29, 12%) and the leg or knee (n = 29, 12%) were the second most commonly injured sites. The injury incidence rate among athletes with <6 months of experience in the ECP was 2.5 times greater than that of more experienced athletes (≥6 months of experience). Of the 132 injuries, 23 (17%) required surgical intervention. Squat cleans, ring dips, overhead squats, and push presses were more likely to cause injury. Athletes reported that 35% of injuries were due to overexertion and 20% were due to improper technique. Conclusion: The estimated injury rate among athletes participating in this ECP was similar to the rate of injury in weightlifting and most other recreational activities. The shoulder or upper arm was the most commonly injured area, and previous shoulder injury predisposed to new shoulder injury. New athletes are at considerable risk of injury compared with more experienced athletes. Clinical Relevance: Extreme conditioning programs are growing in popularity, and there is disagreement between science and anecdotal reports from athletes, coaches, and physicians about their relative safety. This study estimates the incidence of injury in extreme conditioning programs, which appears to be similar to other weight-training programs. PMID:27760844

Sternoclavicular joint palpation pain: the shoulder's Waddell sign?

PubMed

Ponce, Brent A; Archie, Adam T; Watson, Shawna L; Hudson, Parke W; Menendez, Mariano E; McGwin, Gerald; Brabston, Eugene W

2018-07-01

Pain is a complex and subjective reality and can be magnified by nonorganic or nonanatomic sources. Multiple studies have demonstrated a correlation between psychological factors and patients' perceptions of musculoskeletal pain and disability. In addition, nonorganic findings as part of the physical examination are well and long recognized. The purpose of this study was to analyze the relationship between a shoulder examination test, palpation of the sternoclavicular joint (SCJ), and psychosocial conditions including chronic pain, depression, and anxiety. From June until October 2016, all new patients of 2 sports/shoulder fellowship-trained surgeons at an academic practice were screened for study enrollment. After their consent was obtained, patients were given a set of 5 surveys (Pain Catastrophizing Scale; Patient-Health Questionnaire 2; Pain Self-Efficacy Questionnaire; shortened Disabilities of the Arm, Shoulder and Hand questionnaire; and Shoulder Pain and Disability Index) to complete. The physician then completed a comprehensive standardized physical examination, with the examining physician being blinded to the patient's survey responses. Palpation of the SCJ was done with the examiner's thumbs and was accompanied by the question "Does this hurt?" If a positive pain response was given, clarification as to the correct side of the pain was made. A total of 132 patients were enrolled and completed the surveys and physical examination. Of the patients, 26 (19.7%) reported SCJ pain with SCJ palpation. Patients with and without confirmed pain on SCJ palpation had significantly different (P < .001) mean scores for all 5 surveys. A review of the medical histories between the 2 groups identified a significantly increased prevalence of chronic pain and mental health disorders, such as anxiety and depression, in SCJ palpation-positive patients. Patients who confirmed pain on SCJ palpation had significantly higher scores on various psychological surveys than those who denied pain on palpation, indicating that a portion of their pain was stemming from a nonorganic source. Inclusion of SCJ palpation during a routine shoulder or upper extremity physical examination may improve selection of treatment options for patients. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Prevalence and Impact of Glenoid Augmentation in American Football Athletes Participating in the National Football League Scouting Combine.

PubMed

Knapik, Derrick M; Gillespie, Robert J; Salata, Michael J; Voos, James E

2017-08-01

Bony augmentation of the anterior glenoid is used in athletes with recurrent shoulder instability and bone loss; however, the prevalence and impact of repair in elite American football athletes are unknown. To evaluate the prevalence and impact of glenoid augmentation in athletes invited to the National Football League (NFL) Scouting Combine from 2012 to 2015. Case series; Level of evidence, 4. A total of 1311 athletes invited to the NFL Combine from 2012 to 2015 were evaluated for history of either Bristow or Latarjet surgery for recurrent anterior shoulder instability. Athlete demographics, surgical history, imaging, and physical examination results were recorded using the NFL Combine database. Prospective participation data with regard to draft status, games played, games started, and status after the athletes' first season in the NFL were gathered using publicly available databases. Surgical repair was performed on 10 shoulders in 10 athletes (0.76%), with the highest prevalence in defensive backs (30%; n = 3). Deficits in shoulder motion were exhibited in 70% (n = 7) of athletes, while 40% (n = 4) had evidence of mild glenohumeral arthritis and 80% demonstrated imaging findings consistent with a prior instability episode (8 labral tears, 2 Hill-Sachs lesions). Prospectively, 40% (n = 4) of athletes were drafted into the NFL. In the first season after the combine, athletes with a history of glenoid augmentation were not found to be at significant risk for diminished participation with regard to games played or started when compared with athletes with no history of glenoid augmentation or athletes undergoing isolated shoulder soft tissue repair. After the conclusion of the first NFL season, 60% (n = 6 athletes) were on an active NFL roster. Despite being drafted at a lower rate than their peers, there were no significant limitations in NFL participation for athletes with a history of glenoid augmentation when compared with athletes without a history of shoulder surgery or those with isolated soft tissue shoulder repair. Glenohumeral arthritis and advanced imaging findings of labral tearing and Hill-Sachs lesions in elite American football players with a history of glenoid augmentation did not significantly affect NFL participation 1 year after the combine.

Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up.

PubMed

Kesikburun, Serdar; Tan, Arif Kenan; Yilmaz, Bilge; Yaşar, Evren; Yazicioğlu, Kamil

2013-11-01

Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT. To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT. Randomized controlled trial; Level of evidence, 1. A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week standard exercise program. Outcome measures (Western Ontario Rotator Cuff Index [WORC], Shoulder Pain and Disability Index [SPADI], 100-mm visual analog scale [VAS] of shoulder pain with the Neer test, and shoulder range of motion) were assessed at baseline and at 3, 6, 12, and 24 weeks and 1 year after injection. Comparison of the patients revealed no significant difference between the groups in WORC, SPADI, and VAS scores at 1-year follow-up (P = .174, P = .314, and P = .904, respectively). Similar results were found at other assessment points. Within each group, the WORC, SPADI, and VAS scores showed significant improvements compared with baseline at all time points (P < .001). In the range of motion measures, there were no significant group × time interactions. At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.

Augmented Reality Visualization with Use of Image Overlay Technology for MR Imaging–guided Interventions: Assessment of Performance in Cadaveric Shoulder and Hip Arthrography at 1.5 T

PubMed Central

Fritz, Jan; U-Thainual, Paweena; Ungi, Tamas; Flammang, Aaron J.; Fichtinger, Gabor; Iordachita, Iulian I.

2012-01-01

Purpose: To prospectively assess overlay technology in providing accurate and efficient targeting for magnetic resonance (MR) imaging–guided shoulder and hip joint arthrography. Materials and Methods: A prototype augmented reality image overlay system was used in conjunction with a clinical 1.5-T MR imager. A total of 24 shoulder joint and 24 hip joint injections were planned in 12 human cadavers. Two operators (A and B) participated, each performing procedures on different cadavers using image overlay guidance. MR imaging was used to confirm needle positions, monitor injections, and perform MR arthrography. Accuracy was assessed according to the rate of needle adjustment, target error, and whether the injection was intraarticular. Efficiency was assessed according to arthrography procedural time. Operator differences were assessed with comparison of accuracy and procedure times between the operators. Mann-Whitney U test and Fisher exact test were used to assess group differences. Results: Forty-five arthrography procedures (23 shoulders, 22 hips) were performed. Three joints had prostheses and were excluded. Operator A performed 12 shoulder and 12 hip injections. Operator B performed 11 shoulder and 10 hip injections. Needle adjustment rate was 13% (six of 45; one for operator A and five for operator B). Target error was 3.1 mm ± 1.2 (standard deviation) (operator A, 2.9 mm ± 1.4; operator B, 3.5 mm ± 0.9). Intraarticular injection rate was 100% (45 of 45). The average arthrography time was 14 minutes (range, 6–27 minutes; 12 minutes [range, 6–25 minutes] for operator A and 16 minutes [range, 6–27 min] for operator B). Operator differences were not significant with regard to needle adjustment rate (P = .08), target error (P = .07), intraarticular injection rate (P > .99), and arthrography time (P = .22). Conclusion: Image overlay technology provides accurate and efficient MR guidance for successful shoulder and hip arthrography in human cadavers. © RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12112640/-/DC1 PMID:22843764

Full fusion of proximal thoracic curve helps to prevent postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder.

PubMed

Jiang, Jun; Qian, Bang-Ping; Qiu, Yong; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang

2017-08-23

To date, no study had reported the phenomenon of deteriorated postoperative cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients. The purpose of this study is to evaluate the cervical tilt in Lenke type 2 adolescent idiopathic scoliosis patients with right-elevated shoulder treated by either full fusion or partial/non fusion of the proximal thoracic curve. A total of 30 Lenke type 2 AIS patients with preoperative right-elevated shoulder underwent posterior spinal instrumentation from 2009 to 2011 were included in this study. All the subjects were divided into 2 groups according to the selection of upper instrumented vertebra. There were 14 cases proximally fused to T1 or T2 (Group A) and 16 cases proximally fused to T3 or below (Group B). Both standing anteroposterior and sagittal X-ray films of the spine obtained preoperatively, one week after the operation, and at a minimum of two-year follow-up were analyzed with respect to the following parameters: cervical tilt, T1 tilt, proximal thoracic Cobb angle, main thoracic Cobb angle, apical vertebral translation of proximal thoracic curve, apical vertebral translation of main thoracic curve, radiographic shoulder height, cervical lordosis, proximal thoracic kyphosis and main thoracic kyphosis. Most (83.3%) of the patients in these two groups gained satisfactory shoulder balance after surgery. However, the cervical tilt significantly improved in group A (p < 0.001) but deteriorated in group B (p < 0.001). In group A, the decrease of cervical tilt significantly positively correlated with that of T1 tilt (p < 0.001). In group B, the increase of cervical tilt significantly positively correlated with both the increase of T1 tilt (p < 0.001) and the increase of apical vertebral translation of proximal thoracic curve (p < 0.05). Lenke type 2 AIS patients with right-elevated shoulder gain improved shoulder but deteriorated cervical tilt after partial/non fusion of proximal thoracic curve. Full fusion of proximal thoracic curve helps to prevent the residual cervical tilt in these patients.

[The influence of the different polishing methods on the marginal sealing property of the computer aided design and computer aided manufacture zirconium dioxide full crown].

PubMed

Zhou, Jianying; Deng, Jiupeng; Li, Jinyuan; Wang, Jide; Shen, Baolian

2016-05-01

To evaluate the influence of different polishing methods on marginal microleakage of zirconium dioxide full crown. Thirty extracted premolars were selected and randomly divided into three groups, A, B and C, with 10 in each group. Group A was prepared with MANI TF-13 bur completely without the treatment of shoulder. The shoulder of group B was polished with MANI TR13-EF bur after the preparation using MANI TF-13. The shoulder of group C was polished with the dental pneumatic ultrasonic hand-piece of KaVo SONICflex after the preparation using MANI TF-13 bur. Five specimens after preparation were selected in each group. Fifteen CAD/CAM zirconium dioxide full crowns have been made. The crowns were bonded using PULPDENT resin cement, and the root canals were sealed using nail polish, and apical foramen were closed using flow resin. The test-pieces have been immersed in a 3% solution of methylene blue for 24 h. The condition of shoulder marginal microleakage was observed using light stereomicroscopy and evaluated in classification index. The remaining specimens in each group were used for roughness test and scanning electron microscope(SEM) experiment. The marginal microleakage situations of specimens in three groups was analyzed by SPSS 17.0. The enamel surface of different polishing methods was observed using SEM. The specimens in group C demonstrated the least marginal microleakage, and those in group B showed an intermediate level of marginal microleakage, and those in group A characterized the most serious marginal microleakage (total, χ2=44.610, P<0.01; among the different groups, P<0.05). The roughness experiment showed that specimens in group C achieve the smoothest results ([0.27±0.03] μm). Preparation shoulder polished using the dental pneumatic ultrasonic hand-piece demonstrated the best result under the SEM among the three groups. The anti-microleakage effectiveness of dental pneumatic ultrasonic hand-piece in shoulder refinement is better than ordinary shoulder treatment.

Arthroscopic Stabilization After a First-Time Dislocation: Collision Versus Contact Athletes

PubMed Central

Ranalletta, Maximiliano; Rossi, Luciano A.; Alonso Hidalgo, Ignacio; Sirio, Adrian; Puig Dubois, Julieta; Maignon, Gastón D.; Bongiovanni, Santiago L.

2017-01-01

Background: There is no universally accepted definition of “contact” or “collision” sports in the literature. The few available studies evaluating contact and collision sports consider them to be synonymous. However, athletes in collision sports purposely hit or collide with each other or with inanimate objects with greater force and frequency than in contact sports, which could jeopardize functional outcomes. Purpose: To compare the functional outcomes, return to sports, and recurrences in a series of contact and collision athletes with a first-time anterior shoulder dislocation treated using arthroscopic stabilization with suture anchors. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 56 athletes were enrolled in this study, including 22 contact athletes and 34 collision athletes. All athletes underwent arthroscopic shoulder stabilization using suture anchors. Range of motion, the Rowe score, a visual analog scale (VAS) for pain, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Return to sports and recurrences were also evaluated. Results: The mean age at the time of surgery was 22.2 years, and the mean follow-up was 62.4 months (range, 36-94 months). No significant difference in shoulder motion was found between preoperative and postoperative results or between the contact and collision groups. The Rowe, VAS, and ASOSS scores showed statistical improvement in both groups after surgery (P = .001). Patients in the contact group returned to sports significantly faster than those in the collision group (5.2 vs 6.9 months, respectively; P = .01). In all, 43 athletes (76.8%) returned to near-preinjury sports activity levels (≥90% recovery) after surgery: 86.4% of patients in the contact group and 70.6% in the collision group (P = .04). The total recurrence rate was 8.9%. There were 5 recurrences (14.7%) in the collision group and no recurrences in the contact group (P < .01). Conclusion: Arthroscopic stabilization for anterior instability of the shoulder is a reliable procedure with respect to shoulder function, range of motion, and postoperative return to sports in contact and collision athletes. Compared with the contact group (0%), the collision group yielded a higher failure rate (14.7%). Moreover, patients in the contact group returned significantly faster (5.2 vs 6.9 months, respectively) and to and more returned to preinjury or near-preinjury activity levels (86.4% vs 70.6% of patients, respectively) than patients in the collision group. PMID:28979919

The management of failed ankle replacement.

PubMed

Kotnis, R; Pasapula, C; Anwar, F; Cooke, P H; Sharp, R J

2006-08-01

Advances in the design of the components for total ankle replacement have led to a resurgence of interest in this procedure. Between January 1999 and December 2004, 16 patients with a failed total ankle replacement were referred to our unit. In the presence of infection, a two-stage salvage procedure was planned. The first involved the removal of the components and the insertion of a cement spacer. Definitive treatment options included hindfoot fusion with a circular frame or amputation. When there was no infection, a one-stage salvage procedure was planned. Options included hindfoot fusion with an intramedullary nail or revision total ankle replacement. When there was suspicion of infection, a percutaneous biopsy was performed. The patients were followed up for a minimum of 12 months. Of the 16 patients, 14 had aseptic loosening, five of whom underwent a revision total ankle replacement and nine a hindfoot fusion. Of the two with infection, one underwent fusion and the other a below-knee amputation. There were no cases of wound breakdown, nonunion or malunion. Management of the failed total ankle replacement should be performed by experienced surgeons and ideally in units where multidisciplinary support is available. Currently, a hindfoot fusion appears to be preferable to a revision total ankle replacement.

Effectiveness and cost-utility of a guided self-help exercise program for patients treated with total laryngectomy: protocol of a multi-center randomized controlled trial.

PubMed

Jansen, Femke; Cnossen, Ingrid C; Eerenstein, Simone E J; Coupé, Veerle M H; Witte, Birgit I; van Uden-Kraan, Cornelia F; Doornaert, Patricia; Braunius, Weibel W; De Bree, Remco; Hardillo, José A U; Honings, Jimmie; Halmos, György B; Leemans, C René; Verdonck-de Leeuw, Irma M

2016-08-02

Total laryngectomy with or without adjuvant (chemo)radiation often induces speech, swallowing and neck and shoulder problems. Speech, swallowing and shoulder exercises may prevent or diminish these problems. The aim of the present paper is to describe the study, which is designed to investigate the effectiveness and cost-utility of a guided self-help exercise program built into the application "In Tune without Cords" among patients treated with total laryngectomy. Patients, up to 5 years earlier treated with total laryngectomy with or without (chemo)radiation will be recruited for participation in this study. Patients willing to participate will be randomized to the intervention or control group (1:1). Patients in the intervention group will be provided access to a guided self-help exercise program and a self-care education program built into the application "In Tune without Cords". Patients in the control group will only be provided access to the self-care education program. The primary outcome is the difference in swallowing quality (SWAL-QOL) between the intervention and control group. Secondary outcome measures address speech problems (SHI), shoulder disability (SDQ), quality of life (EORTC QLQ-C30, QLQ-H&N35 and EQ-5D), direct and indirect costs (adjusted iMCQ and iPCQ measures) and self-management (PAM). Patients will be asked to complete these outcome measures at baseline, immediately after the intervention or control period (i.e. at 3 months follow-up) and at 6 months follow-up. This randomized controlled trial will provide knowledge on the effectiveness of a guided self-help exercise program for patients treated with total laryngectomy. In addition, information on the value for money of such an exercise program will be provided. If this guided self-help program is (cost)effective for patients treated with total laryngectomy, the next step will be to implement this exercise program in current clinical practice. NTR5255 Protocol version 4 date September 2015.

Ice hockey shoulder pad design and the effect on head response during shoulder-to-head impacts.

PubMed

Richards, Darrin; Ivarsson, B Johan; Scher, Irving; Hoover, Ryan; Rodowicz, Kathleen; Cripton, Peter

2016-11-01

Ice hockey body checks involving direct shoulder-to-head contact frequently result in head injury. In the current study, we examined the effect of shoulder pad style on the likelihood of head injury from a shoulder-to-head check. Shoulder-to-head body checks were simulated by swinging a modified Hybrid-III anthropomorphic test device (ATD) with and without shoulder pads into a stationary Hybrid-III ATD at 21 km/h. Tests were conducted with three different styles of shoulder pads (traditional, integrated and tethered) and without shoulder pads for the purpose of control. Head response kinematics for the stationary ATD were measured. Compared to the case of no shoulder pads, the three different pad styles significantly (p < 0.05) reduced peak resultant linear head accelerations of the stationary ATD by 35-56%. The integrated shoulder pads reduced linear head accelerations by an additional 18-21% beyond the other two styles of shoulder pads. The data presented here suggest that shoulder pads can be designed to help protect the head of the struck player in a shoulder-to-head check.

SEAL FOR HIGH SPEED CENTRIFUGE

DOEpatents

Skarstrom, C.W.

1957-12-17

A seal is described for a high speed centrifuge wherein the centrifugal force of rotation acts on the gasket to form a tight seal. The cylindrical rotating bowl of the centrifuge contains a closure member resting on a shoulder in the bowl wall having a lower surface containing bands of gasket material, parallel and adjacent to the cylinder wall. As the centrifuge speed increases, centrifugal force acts on the bands of gasket material forcing them in to a sealing contact against the cylinder wall. This arrangememt forms a simple and effective seal for high speed centrifuges, replacing more costly methods such as welding a closure in place.

View of STS-109 MS Grunsfeld during EVA 1

NASA Image and Video Library

2002-03-04

STS109-E-5448 (4 March 2002) --- Astronaut John M. Grunsfeld, payload commander, peers into the crew cabin of the Space Shuttle Columbia during the first STS-109 extravehicular activity (EVA-1) on March 4, 2002. Grunsfeld's helmet visor displays a mirrored image of the Earth's hemisphere. Astronauts Grunsfeld and Richard M. Linnehan replaced the starboard solar array on the Hubble Space Telescope (HST) on the first of five scheduled STS-109 space walks. The lower portion of the giant telescope can be seen over Grunsfeld's left shoulder. The image was recorded with a digital still camera by a crewmate on shuttle's aft flight deck.

Scapulothoracic muscle activity and recruitment timing in patients with shoulder impingement symptoms and glenohumeral instability.

PubMed

Struyf, Filip; Cagnie, Barbara; Cools, Ann; Baert, Isabel; Brempt, Jolien Van; Struyf, Pieter; Meeus, Mira

2014-04-01

Various studies have investigated scapulothoracic muscle activity and recruitment patterns in relation to shoulder complaints in different populations, but a consensus review is lacking. To systematically review the state of the art regarding scapulothoracic muscle activity and recruitment timing in subjects with shoulder pain compared to pain free controls. Systematic review. The search for relevant articles was performed in Pubmed and Web of Science, including Web of Knowledge, using key words related to shoulder pain, scapulothoracic muscle activity or recruitment timing. Articles were included till November 2012. Case-control studies concerning the scapulothoracic region and muscle recruitment using electromyography (EMG) were included. Articles regarding rotator cuff muscles or neck-shoulder pathologies or studies handling a treatment outcome, were excluded. The methodological quality of the articles was assessed using appropriate risk of bias criteria for case-control studies. A total of 12 articles were included in the systematic review, containing patients with Shoulder Impingement Syndrome (SIS) or glenohumeral instability. In patients with SIS 3 out of 6 articles showed increased upper trapezius muscle (UT) activity, 3 out of 5 studies showed decreased lower trapezius muscle (LT) activity and 3 out of 5 articles showed decreased serratus anterior muscle (SA) activity. Patients with glenohumeral instability showed contradictory results on scapulothoracic muscle activity patterns. In both SIS and glenohumeral instability patients, no consensus was found on muscle recruitment timing. Patients with SIS and glenohumeral instability display numerous variations in scapulothoracic muscle activity compared to healthy controls. In the SIS-group, the LT and SA muscle activity is decreased. In addition, the UT muscle activity is increased among the SIS patients, whereas no clear change is seen among patients with glenohumeral instability. Although the scapulothoracic muscle activity changed, no consensus could be made regarding muscle recruitment timing. Copyright © 2013 Elsevier Ltd. All rights reserved.

Mean Glenoid Defect Size and Location Associated With Anterior Shoulder Instability

PubMed Central

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

2017-01-01

Background: There is a strong correlation between glenoid defect size and recurrent anterior shoulder instability. A better understanding of glenoid defects could lead to improved treatments and outcomes. Purpose: To (1) determine the rate of reporting numeric measurements for glenoid defect size, (2) determine the consistency of glenoid defect size and location reported within the literature, (3) define the typical size and location of glenoid defects, and (4) determine whether a correlation exists between defect size and treatment outcome. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, Ovid, and Cochrane databases were searched for clinical studies measuring glenoid defect size or location. We excluded studies with defect size requirements or pathology other than anterior instability and studies that included patients with known prior surgery. Our search produced 83 studies; 38 studies provided numeric measurements for glenoid defect size and 2 for defect location. Results: From 1981 to 2000, a total of 5.6% (1 of 18) of the studies reported numeric measurements for glenoid defect size; from 2001 to 2014, the rate of reporting glenoid defects increased to 58.7% (37 of 63). Fourteen studies (n = 1363 shoulders) reported defect size ranges for percentage loss of glenoid width, and 9 studies (n = 570 shoulders) reported defect size ranges for percentage loss of glenoid surface area. According to 2 studies, the mean glenoid defect orientation was pointing toward the 3:01 and 3:20 positions on the glenoid clock face. Conclusion: Since 2001, the rate of reporting numeric measurements for glenoid defect size was only 58.7%. Among studies reporting the percentage loss of glenoid width, 23.6% of shoulders had a defect between 10% and 25%, and among studies reporting the percentage loss of glenoid surface area, 44.7% of shoulders had a defect between 5% and 20%. There is significant variability in the way glenoid bone loss is measured, calculated, and reported. PMID:28203591

Car Transfer and Wheelchair Loading Techniques in Independent Drivers with Paraplegia

PubMed Central

Haubert, Lisa Lighthall; Mulroy, Sara J.; Hatchett, Patricia E.; Eberly, Valerie J.; Maneekobkunwong, Somboon; Gronley, Joanne K.; Requejo, Philip S.

2015-01-01

Car transfers and wheelchair (WC) loading are crucial for independent community participation in persons with complete paraplegia from spinal cord injury, but are complex, physically demanding, and known to provoke shoulder pain. This study aimed to describe techniques and factors influencing car transfer and WC loading for individuals with paraplegia driving their own vehicles and using their personal WCs. Sedans were the most common vehicle driven (59%). Just over half (52%) of drivers place their right leg only into the vehicle prior to transfer. Overall, the leading hand was most frequently placed on the driver’s seat (66%) prior to transfer and the trailing hand was most often place on the WC seat (48%). Vehicle height influenced leading hand placement but not leg placement such that drivers of higher profile vehicles were more likely to place their hand on the driver’s seat than those who drove sedans. Body lift time was negatively correlated with level of injury and age and positively correlated with vehicle height and shoulder abduction strength. Drivers who transferred with their leading hand on the steering wheel had significantly higher levels of shoulder pain than those who placed their hand on the driver’s seat or overhead. The majority of participants used both hands (62%) to load their WC frame, and overall, most loaded their frame into the back (62%) vs. the front seat. Sedan drivers were more likely to load their frame into the front seat than drivers of higher profile vehicles (53 vs. 17%). Average time to load the WC frame (10.7 s) was 20% of the total WC loading time and was not related to shoulder strength, frame weight, or demographic characteristics. Those who loaded their WC frame into the back seat had significantly weaker right shoulder internal rotators. Understanding car transfers and WC loading in independent drivers is crucial to prevent shoulder pain and injury and preserve community participation. PMID:26442253

Manipulative therapy in addition to usual medical care accelerates recovery of shoulder complaints at higher costs: economic outcomes of a randomized trial.

PubMed

Bergman, Gert J D; Winter, Jan C; van Tulder, Maurits W; Meyboom-de Jong, Betty; Postema, Klaas; van der Heijden, Geert J M G

2010-09-06

Shoulder complaints are common in primary care and have unfavourable long term prognosis. Our objective was to evaluate the clinical effectiveness of manipulative therapy of the cervicothoracic spine and the adjacent ribs in addition to usual medical care (UMC) by the general practitioner in the treatment of shoulder complaints. This economic evaluation was conducted alongside a randomized trial in primary care. Included were 150 patients with shoulder complaints and a dysfunction of the cervicothoracic spine and adjacent ribs. Patients were treated with UMC (NSAID's, corticosteroid injection or referral to physical therapy) and were allocated at random (yes/no) to manipulative therapy (manipulation and mobilization). Patient perceived recovery, severity of main complaint, shoulder pain, disability and general health were outcome measures. Data about direct and indirect costs were collected by means of a cost diary. Manipulative therapy as add-on to UMC accelerated recovery on all outcome measures included. At 26 weeks after randomization, both groups reported similar recovery rates (41% vs. 38%), but the difference between groups in improvement of severity of the main complaint, shoulder pain and disability sustained. Compared to the UMC group the total costs were higher in the manipulative group (€1167 vs. €555). This is explained mainly by the costs of the manipulative therapy itself and the higher costs due sick leave from work. The cost effectiveness ratio showed that additional manipulative treatment is more costly but also more effective than UMC alone. The cost-effectiveness acceptability curve shows that a 50%-probability of recovery with AMT within 6 months after initiation of treatment is achieved at €2876. Manipulative therapy in addition to UMC accelerates recovery and is more effective than UMC alone on the long term, but is associated with higher costs. INTERNATIONAL STANDARD RANDOMIZED CONTROLLED TRIAL NUMBER REGISTER: ISRCTN11216.

An investigation of shoulder forces in active shoulder tackles in rugby union football.

PubMed

Usman, Juliana; McIntosh, Andrew S; Fréchède, Bertrand

2011-11-01

In rugby union football the tackle is the most frequently executed skill and one most associated with injury, including shoulder injury to the tackler. Despite the importance of the tackle, little is known about the magnitude of shoulder forces in the tackle and influencing factors. The objectives of the study were to measure the shoulder force in the tackle, as well as the effects of shoulder padding, skill level, side of body, player size, and experimental setting on shoulder force. Experiments were conducted in laboratory and field settings using a repeated measures design. Thirty-five participants were recruited to the laboratory and 98 to the field setting. All were male aged over 18 years with rugby experience. The maximum force applied to the shoulder in an active shoulder tackle was measured with a custom built forceplate incorporated into a 45 kg tackle bag. The overall average maximum shoulder force was 1660 N in the laboratory and 1997 N in the field. This difference was significant. The shoulder force for tackling without shoulder pads was 1684 N compared to 1635 N with shoulder pads. There was no difference between the shoulder forces on the dominant and non-dominant sides. Shoulder force reduced with tackle repetition. No relationship was observed between player skill level and size. A substantial force can be applied to the shoulder and to an opponent in the tackle. This force is within the shoulder's injury tolerance range and is unaffected by shoulder pads. Copyright © 2011 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Current and innovative pain management techniques in total knee arthroplasty.

PubMed

Dalury, David F; Lieberman, Jay R; Macdonald, Steven J

2012-01-01

Pain management is a major concern for patients contemplating total knee replacement surgery and is one of the leading causes of dissatisfaction after knee replacement. Substantial progress has been made over the past several years in improving pain control after total knee replacement using multimodal pain control, preemptive analgesia, and periarticular injections.

[Early Experience with the Vercise^TM DBS System in the Treatment of Dystonic Tremor].

PubMed

Miyagi, Yasushi

2017-03-01

Six cases of dystonic tremor were treated with the Vercise^TM deep brain stimulation(DBS)system, which has the multiple independent current control(MICC)technology. The mean preoperative score of Burke-Fahn-Marsden dystonia rating scale was 16.2±9.4, which was reduced to 6.1±4.6 at 5 months postoperatively. A 65-year-old male presented an intractable dystonic tremor of the jaw, neck, and shoulders due to tardive syndrome. He experienced the successful tremor relief after unipolar DBS in the globus pallidus internus(GPi)with Vercise^TM but complained of dysarthria. Steering the current ventrally induced nausea without alleviating dysarthria, while steering the current dorsally alleviated dysarthria but a further dorsal current induced mandibular dyskinesia. The current steering with MICC enabled the simulation field in GPi with successful balance, maximizing tremor suppression, and minimizing the adverse effects. In a second case, 61-year-old male in whom cervical dystonia with rotatory tremor had been successfully treated with interleaving stimulation of GPi-DBS had needed to repeat the replacement of a non-rechargeable pulse generator in only 15-month interval. After the substitution of Vercise^TM, the interleaving stimulation of 9.5mA in total was replaced by 8.5mA with the current steering of MICC, while the patient's symptomatic control was unchanged. The microlesion effects after lead implantation are unclear and therapeutic effects are often delayed in cases of dystonia;therefore, the submaximal stimulation intensities must be frequently applied in the early phase following the implantation of DBS. A fine current steering of Vercise^TM DBS is very useful in both, the early and late phases of GPi-DBS for dystonic syndrome.

The "July effect" in total shoulder arthroplasty.

PubMed

Rao, Allison J; Bohl, Daniel D; Frank, Rachel M; Cvetanovich, Gregory L; Nicholson, Gregory P; Romeo, Anthony A

2017-03-01

New medical doctors enter their residency fields in July, a time in the hospital in which patient morbidity and mortality rates are perceived to be higher. It remains controversial whether a "July effect" exists in different areas of medicine and surgery, including in orthopedic surgery. The purpose of this study is to test for the July effect in patients undergoing primary total shoulder arthroplasty (TSA). Patients who underwent primary TSA from 2005-2012 were identified using the American College of Surgeons National Surgical Quality Improvement Program database. Cases were categorized as involving residents or fellows and as occurring during the first academic quarter. Rates of composite and any adverse event outcomes were compared between patient groups using multivariate logistic regression. A total of 1591 patients met the inclusion criteria. Of these cases, 711 (44.7%) had resident or fellow involvement and 390 (24.5%) were performed in the first academic quarter. There were few demographic and comorbidity differences between cases with and without residents or fellows or between cases performed during the first quarter and during the rest of the year. Overall, the rate of serious adverse events was 1.6% and the rate of any adverse events was 6.5%. Using one of the largest cohorts of primary TSA patients, this study could not provide evidence for a July effect. In the context of the recent growth in the volume of TSA procedures, these findings provide important reassurance to patients that it is safe to schedule their elective procedures at training institutions during the first part of the academic year. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Knee and Ankle Arthroplasty in Hemophilia

PubMed Central

Solimeno, Luigi Piero; Pasta, Gianluigi

2017-01-01

Today, major surgical procedures can be safely performed in hemophilic patients with chronic arthropathy, using available factor concentrates. In this setting, total knee replacement is considered the “gold standard”, while the use of total ankle replacement is still debated. Indeed, the unsatisfactory results obtained with the previous available design of implants did not raise enthusiasm as knee or hip replacement. Recently, the introduction of new implant designs and better reported outcomes have renewed the interest in total ankle replacement in people with hemophilia. In this review, the role of replacement surgery in the treatment of chronic hemophilic arthropathy will be described. PMID:29165342

Shoulder pain and concomitant hand oedema among stroke patients with pronounced arm paresis

PubMed Central

2013-01-01

Background The aim of this prospective study was to identify clinical factors associated with the development of shoulder pain in stroke patients with pronounced arm paresis. Methods At stroke onset, 485 patients were initially assessed in 2007–2009. Sixty-three patients with pronounced arm paresis completed the study, and 21 of these developed shoulder pain. Clinical findings were recorded fortnightly by the attending physiotherapist during hospital stay. Results Hand oedema on the paretic side was more common in patients developing shoulder pain compared with those who did not develop shoulder pain. The onset of shoulder pain was associated with concomitant hand oedema. High NIHSS score was associated with developing shoulder pain. Patients with a history of shoulder pain developed pain earlier than those without previous shoulder pain. Patients with haemorrhagic stroke were significantly more prone to developing shoulder pain. Conclusions One-third of the stroke patients with pronounced arm paresis developed shoulder pain. Concomitant hand oedema seems to be an additional symptom of shoulder injury. Patients with low general status are more vulnerable to develop post-stroke shoulder pain. PMID:24765589

Survey of patient-oriented total hip replacement information on the World Wide Web.

PubMed

Mabrey, J D

2000-12-01

The author conducted an informal survey of materials relating to diseases of the hip and total hip replacement as they appeared on the World Wide Web. The results varied depending on the key words used: hip and replacement yielded 1,818 matches; total hip replacement yielded 1,740 matches; hip replacement yielded 4,565 sites; and hip surgery yielded 1,073 sites. The number of sites for total hip replacement was observed to increase with time, having found an additional 30 sites from an identical search performed only 6 weeks earlier. The nature and quality of these sites varied from well-organized and informative, to personal testaments, to obvious commercial endeavors. Overall, this survey found an abundance of material regarding the hip and hip replacements on the World Wide Web, but orthopaedic societies need to take a more active role in constructing, maintaining, and monitoring these sites to best serve the needs of their patients and their members.

Hip contact forces in asymptomatic total hip replacement patients differ from normal healthy individuals: Implications for preclinical testing.

PubMed

Li, Junyan; Redmond, Anthony C; Jin, Zhongmin; Fisher, John; Stone, Martin H; Stewart, Todd D

2014-08-01

Preclinical durability testing of hip replacement implants is standardised by ISO-14242-1 (2002) which is based on historical inverse dynamics analysis using data obtained from a small sample of normal healthy individuals. It has not been established whether loading cycles derived from normal healthy individuals are representative of loading cycles occurring in patients following total hip replacement. Hip joint kinematics and hip contact forces derived from multibody modelling of forces during normal walking were obtained for 15 asymptomatic total hip replacement patients and compared to 38 normal healthy individuals and to the ISO standard for pre-clinical testing. Hip kinematics in the total hip replacement patients were comparable to the ISO data and the hip contact force in the normal healthy group was also comparable to the ISO cycles. Hip contact forces derived from the asymptomatic total hip replacement patients were comparable for the first part of the stance period but exhibited 30% lower peak loads at toe-off. Although the ISO standard provides a representative kinematic cycle, the findings call into question whether the hip joint contact forces in the ISO standard are representative of those occurring in the joint following total hip replacement. Copyright © 2014. Published by Elsevier Ltd.

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

Youth Baseball Pitching Mechanics: A Systematic Review.

PubMed

Thompson, Samuel F; Guess, Trent M; Plackis, Andreas C; Sherman, Seth L; Gray, Aaron D

Pitching injuries in youth baseball are increasing in incidence. Poor pitching mechanics in young throwers have not been sufficiently evaluated due to the lack of a basic biomechanical understanding of the "normal" youth pitching motion. To provide a greater understanding of the kinetics and kinematics of the youth baseball pitching motion. PubMed, MEDLINE, and SPORTDiscus databases were searched from database inception through February 2017. A total of 10 biomechanical studies describing youth pitching mechanics were included. Systematic review. Level 3. Manual extraction and compilation of demographic, methodology, kinetic, and kinematic variables from the included studies were completed. In studies of healthy youth baseball pitchers, progressive external rotation of the shoulder occurs throughout the start of the pitching motion, reaching a maximum of 166° to 178.2°, before internally rotating throughout the remainder of the cycle, reaching a minimum of 13.2° to 17°. Elbow valgus torque reaches the highest level (18 ± 4 N·m) just prior to maximum shoulder external rotation and decreases throughout the remainder of the pitch cycle. Stride length is 66% to 85% of pitcher height. In comparison with a fastball, a curveball demonstrates less elbow varus torque (31.6 ± 15.3 vs 34.8 ± 15.4 N·m). Multiple studies show that maximum elbow valgus torque occurs just prior to maximum shoulder external rotation. Forces on the elbow and shoulder are greater for the fastball than the curveball.

Reverse total shoulder glenoid baseplate stability with superior glenoid bone loss.

PubMed

Martin, Elise J; Duquin, Thomas R; Ehrensberger, Mark T

2017-10-01

Superior wear of the glenoid bone is common in patients with rotator cuff arthropathy. This can become a treatment challenge for patients who require shoulder arthroplasty. In reverse shoulder arthroplasty (RSA), glenoid bone loss may affect the stability of baseplate fixation. The primary purpose of this biomechanical laboratory study was to assess the initial fixation stability of RSA glenosphere baseplates in the presence of variable amounts of superior glenoid bone loss. High-density solid rigid polyurethane foam (30 pounds/cubic foot) was machined to model the glenoid with variable superior defects that provided different levels of support (100%, 90%, 75%, and 50%) for the glenosphere baseplate. The samples were cyclically loaded (0-750 N at 1 Hz for 5000 cycles) at a 60° glenohumeral angle. The micromotion and migration of the baseplate were calculated from displacement data captured during the loading tests with an array of 3 linear variable differential transformers mounted around the baseplate. Micromotion was significantly greater in samples with 50% defects compared with those with smaller defects. Migration was significantly greater after testing for all defect sizes. Initial fixation of RSA glenosphere baseplates was significantly reduced in models with 50% bone loss on the superior edge compared with models with less bone loss in this high-density bone foam model. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

[Effectiveness of physiotherapy on painful shoulder impingement syndrome].

PubMed

Gomora-García, Mónica; Rojano-Mejía, David; Solis-Hernández, José Luis; Escamilla-Chávez, Carolina

2016-01-01

Painful shoulder impingement syndrome is one of the first reasons for care in rehabilitation centres. As the evidence regarding the effectiveness of physical measures as adjuvant treatment is limited, the aim of this study was to determine the effectiveness of physiotherapy on shoulder pain. A retrospective and analytical study was conducted using the medical records of patients with shoulder pain who attended in a rehabilitation centre from October 2010 to September 2011. The demographic and clinical data were collected, and the clinical improvement was determined as: complete, incomplete, or no improvement. Chi squared was used to determine whether there were differences between the different modalities of physiotherapy, as well as the level of improvement. The study included a total of 181 patients, with a mean age of 54.3 years, and a mean of 4.6 months of onset of pain. The physiotherapy treatments included: warm compresses plus interferential current (60.2%), and warm compresses plus ultrasound (17.1%). Just over half (53.6%) obtained a moderate recovery, 36.4% slight improvement, and 9.9% no improvement. No significant differences were found between the different forms of therapy. The supervised rehabilitation program consists of 9 sessions of physiotherapy. A functional improvement of 90% was obtained, without finding any statistical differences between the therapies used. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

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

Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

PubMed Central

2012-01-01

Background Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal femoral bone mineral density after patellofemoral joint replacement. It is unclear whether this is due to periprosthetic stress shielding. The main objective of the current study was to evaluate the stress shielding effect of prosthetic replacement with 2 different patellofemoral prosthetic designs and with a total knee prosthesis. Methods We developed a finite element model of an intact patellofemoral joint, and finite element models of patellofemoral joint replacement with a Journey PFJ prosthesis, a Richards II prosthesis, and a Genesis II total knee prosthesis. For each of these 4 finite element models, the average Von Mises stress in 2 clinically relevant regions of interest were evaluated during a simulated squatting movement until 120 degrees of flexion. Results During deep knee flexion, in the anterior region of interest, the average Von Mises stress with the Journey PFJ design was comparable to the physiological knee, while reduced by almost 25% for both the Richards II design and the Genesis II total knee joint replacement design. The average Von Mises stress in the supracondylar region of interest was similar for both patellofemoral prosthetic designs and the physiological model, with slightly lower stress for the Genesis II design. Conclusions Patellofemoral joint replacement results in periprosthetic stress-shielding, although to a smaller degree than in total knee replacement. Specific patellofemoral prosthetic design properties may result in differences in femoral stress shielding. PMID:22704638

Outcomes of Latarjet versus Distal Tibial Allograft for Anterior Shoulder Instability Repair: A Prospective Matched Cohort Analysis

PubMed Central

Frank, Rachel M.; Kim, Jae; O’Donnell, Patrick Joseph; O’Brien, Michael; Newgren, Jonathan; Verma, Nikhil N.; Nicholson, Gregory P.; Cole, Brian J.; Romeo, Anthony A.; Provencher, Matthew T.

2017-01-01

Objectives: Recently, the use of fresh distal tibia allograft (DTA) for glenoid reconstruction in anterior shoulder instability has been described, with encouraging short-term outcomes, however, there is little available comparative data to the Latarjet procedure, long considered the gold standard for bone loss treatment. Thus, the purpose of this study was to determine the clinical outcomes for patients undergoing DTA compared to a matched cohort of patients undergoing Latarjet. Methods: A review of prospectively collected data of patients with a minimum 15% anterior glenoid bone loss who underwent shoulder stabilization with either DTA or Latarjet with a minimum follow-up of 2 years was conducted. Consecutive patients undergoing DTA were matched by age, body mass index, and number of previous ipsilateral shoulder surgeries to patients undergoing Latarjet in a 1-to- 1 format. Patients were evaluated preoperatively and at a minimum 2 years post operatively with American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Western Ontario Shoulder Instability Index (WOSI) outcomes assessments. Complications, reoperations, and episodes of recurrent instability were also analyzed. Statistical analysis was performed with student T-tests, with P<0.05 considered significant. Results: A total of 60 patients (30 Latarjet, 30 DTA) with an average age of 26.5±7.8 years were analyzed at an average 46±17 months (range, 24-87) following surgery. Twenty-two patients (73%) in each group underwent prior ipsilateral shoulder surgery (range, 1 to 3 surgeries) prior to Latarjet or DTA. There were no statistical differences in age, BMI, or number of prior surgeries between the groups. There were no differences between the groups in regards to recurrent instability events, subluxation, or apprehension on final examination (P>0.8). Patients in both groups experienced significant improvements in all outcomes scores following surgery (P>0.05 for all). When comparing final outcomes of Latarjet versus DTA, no significant differences were found in postoperative ASES, WOSI or SANE scores between the groups (P>0.05 for all). In the Latarjet group, 1 patient underwent reoperation (3.3%) with arthroscopic debridement with subacromial decompression for persistent anterolateral shoulder pain. In the DTA group, 1 patient (3.3%) underwent reoperation with DTA revision for asymptomatic hardware failure. There were no cases of neurovascular injuries or other complications in either cohort. Conclusion: At an average follow-up of nearly 4 years, fresh DTA reconstruction for recurrent anterior shoulder instability results in a clinically stable joint with similar clinical outcomes and recurrence rates compared to Latarjet. Longer-term studies are needed to determine if these results are maintained over time.

Effect of Training Supervision on Effectiveness of Strength Training for Reducing Neck/Shoulder Pain and Headache in Office Workers: Cluster Randomized Controlled Trial

PubMed Central

Gram, Bibi; Andersen, Christoffer; Zebis, Mette K.; Bredahl, Thomas; Pedersen, Mogens T.; Mortensen, Ole S.; Jensen, Rigmor H.; Andersen, Lars L.; Sjøgaard, Gisela

2014-01-01

Objective. To investigate the effect of workplace neck/shoulder strength training with and without regular supervision on neck/shoulder pain and headache among office workers. Method. A 20-week cluster randomized controlled trial among 351 office workers was randomized into three groups: two training groups with the same total amount of planned exercises three times per week (1) with supervision (3WS) throughout the intervention period, (2) with minimal supervision (3MS) only initially, and (3) a reference group (REF). Main outcome is self-reported pain intensity in neck and shoulder (scale 0–9) and headache (scale 0–10). Results. Intention-to-treat analyses showed a significant decrease in neck pain intensity the last 7 days in 3MS compared with REF: −0.5 ± 0.2 (P < 0.02) and a tendency for 3WS versus REF: −0.4 ± 0.2 (P < 0.07). Intensity of headache the last month decreased in both training groups: 3WS versus REF: −1.1 ± 0.2 (P < 0.001) and 3MS versus REF: −1.1 ± 0.2 (P < 0.001). Additionally, days of headache decreased 1.0 ± 0.5 in 3WS and 1.3 ± 0.5 in 3MS versus REF. There were no differences between the two training groups for any of the variables. Conclusion. Neck/shoulder training at the workplace reduced neck pain and headache among office workers independently of the extent of supervision. This finding has important practical implications for future workplace interventions. PMID:24701581

Journal Club: Shoulder MRI utilization: relationship of physician MRI equipment ownership to negative study frequency.

PubMed

Amrhein, Timothy J; Lungren, Matthew P; Paxton, Ben E; Srinivasan, Ramesh; Jung, Sin-Ho; Yu, Miao; Eastwood, James D; Kilani, Ramsey K

2013-09-01

The purpose of this article is to determine whether ownership of MRI equipment by ordering physicians influences the frequency of negative shoulder MRI scans. A retrospective review was performed of 1140 consecutive shoulder MRI scans ordered by two separate referring physician groups serving the same geographic community. The first group (financially incentivized) owned the scanners used and received technical fees for their use. The second group (non-financially incentivized) did not own the scanners used and had no direct financial interest. All examinations were performed with identical protocols and were interpreted by a single radiologist group without financial interest in the imaging equipment used. The frequency of negative examinations and the number of abnormalities in each positive study was tabulated for each group. A total of 1140 shoulder MRI scans met inclusion criteria; 255 were negative (142 for the financially incentivized group and 113 for the non-financially incentivized group). There were 25.6% more negative scans in the financially incentivized group (p=0.047). There was no statistically significant difference in the average number of lesions per positive scan (1.67 for the financially incentivized group and 1.71 for the non-financially incentivized group; p=0.34). No statistically significant difference was found in the frequency of 19 of 20 examined lesions. Shoulder MRI examinations referred by physicians with a financial interest in the imaging equipment used were significantly more likely to be negative. Positive examinations exhibited no statistically significant difference in the number of lesions per scan or in the frequency of 19 of 20 lesion subtypes. This finding suggests a highly similar distribution and severity of disease among the two patient groups.

Bi-tangential hybrid IMRT for sparing the shoulder in whole breast irradiation.

PubMed

Farace, P; Deidda, M A; Iamundo de Cumis, I; Iamundo de Curtis, I; Deiana, E; Farigu, R; Lay, G; Porru, S

2013-11-01

A bi-tangential technique is proposed to reduce undesired doses to the shoulder produced by standard tangential irradiation. A total of 6 patients affected by shoulder pain and reduced functional capacity after whole-breast irradiation were retrospectively analysed. The standard tangential plan used for treatment was compared with (1) a single bi-tangential plan where, to spare the shoulder, the lateral open tangent was split into two half-beams at isocentre, with the superior portion rotated by 10-20° medially with respect to the standard lateral beam; (2) a double bi-tangential plan, where both the tangential open beams were split. The planning target volume (PTV) coverage and the dose to the portion of muscles and axilla included in the standard tangential beams were compared. PTV95 % of standard plan (91.9 ± 3.8) was not significantly different from single bi-tangential plan (91.8 ± 3.4); a small but significant (p < 0.01) decrease was observed with the double bi-tangential plan (90.1 ± 3.7). A marked dose reduction to the muscle was produced by the single bi-tangential plan around 30-40 Gy. The application of the double bi-tangential technique further reduced the volume receiving around 20 Gy, but did not markedly affect the higher doses. The dose to the axilla was reduced both in the single and the double bi-tangential plans. The single bi-tangential technique would have been able to reduce the dose to shoulder and axilla, without compromising target coverage. This simple technique is valuable for irradiation after axillary lymph node dissection or in patients without dissection due to negative or low-volume sentinel lymph node disease.

Quantitative assessment and characterization of glenoid bone loss in a spectrum of patients with glenohumeral osteoarthritis.

PubMed

Lombardo, D J; Khan, J; Prey, B; Zhang, L; Petersen-Fitts, G R; Sabesan, V J

2016-12-01

Eccentric posterior bone loss and associated glenoid retroversion represent challenges to glenoid placement during total shoulder arthroplasty. This bone loss can lead to poor stability and perforation of the glenoid during arthroplasty. The purpose of this study was to evaluate the morphology of glenoid bone loss for a spectrum of osteoarthritis patients using 3D computed tomography imaging and simulation software. This study included 29 patients with glenohumeral osteoarthritis treated with shoulder arthroplasty. Three-dimensional reconstruction of preoperative CT images was performed. Glenoid bone loss was measured at ten, vertically equidistant axial planes along the glenoid surface at four distinct anterior-posterior points on each plane. The images were fitted with modeled pegged glenoid implants to predict glenoid perforation. The 3D maps demonstrated greatest average bone loss posteriorly in the AP plane at the central axis of the glenoid in the SI plane. The average amount of bone loss was 3.85 mm. Walch A2 and B1 shoulders showed more central bone loss, while Walch B2 shoulders displayed more posterior and inferior bone loss. Patients with predicted peg perforation displayed significantly greater bone loss than those without predicted peg perforation (p = 0.037). Peg perforation was most common in Walch B2 shoulders occurring in the posterior direction involving the central and posterior-inferior peg. These data demonstrate an anatomic pattern of glenoid bone loss for different classes of glenohumeral arthritis. These findings can be used to develop various models of glenoid bone loss to guide surgeons, predict failures, and develop better glenoid implants. This study has been approved by the Cleveland Clinic IRB: Number 6235.

Grammont humeral design versus onlay curved-stem reverse shoulder arthroplasty: comparison of clinical and radiographic outcomes with minimum 2-year follow-up.

PubMed

Merolla, Giovanni; Walch, Gilles; Ascione, Francesco; Paladini, Paolo; Fabbri, Elisabetta; Padolino, Antonio; Porcellini, Giuseppe

2018-04-01

There are few investigations comparing lateralized and medialized reverse total shoulder arthroplasty (RTSA) in patients with cuff tear arthropathy. This study assessed the outcomes of 2 RTSA designs. Sixty-eight consecutive cuff tear arthropathy patients (74 shoulders) with a follow-up of at least 24 months received a Grammont or an onlay curved short-stem humeral component, with or without glenoid lateralization; a cementless humeral stem was implanted in >90%. Clinical outcome measures included active range of motion (anterior and lateral elevation, external and internal rotation), pain, and the Constant-Murley score. Radiologic outcomes included radiolucency, condensation lines, cortical thinning, spot weld, loosening and subsidence, and tuberosity resorption for the humeral component and radiolucency, scapular notching, formation of scapular bone spurs, ossifications, and loosening for the glenoid component. Both prostheses provided significant differences between preoperative and postoperative scores and showed a similar complication rate. Scapular fractures were found only in the patients who received the curved short-stem implant. Glenoid bone grafting did not significantly affect clinical scores. Both implants provided similar postoperative shoulder mobility, even though the lateralized curved stem was associated with higher delta scores for external rotation (P = .002) and lower rates of scapular notching (P = .0003), glenoid radiolucency (P = .016), and humeral bone remodeling (P = .004 and P = .030 for cortical thinning and spot weld, respectively). Medialized and short-stem lateralized RTSA implants provided similar midterm clinical outcomes and range of motion. The curved short stem was associated with higher delta scores for external rotation and a lower rate of radiographic risk factors. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

The role of psychological factors in the perpetuation of pain intensity and disability in people with chronic shoulder pain: a systematic review

PubMed Central

Martinez-Calderon, Javier; Meeus, Mira; Struyf, Filip; Miguel Morales-Asencio, Jose; Gijon-Nogueron, Gabriel; Luque-Suarez, Alejandro

2018-01-01

Introduction Chronic shoulder pain is a very complex syndrome, and the mechanisms involved in its perpetuation remain unclear. Psychological factors appear to play a role in the perpetuation of symptoms in people with shoulder chronicity. The purpose of this systematic review is to examine the role of psychological factors in the perpetuation of symptoms (pain intensity and disability) in people with chronic shoulder pain. Methods and analysis A systematic search was performed on PubMed, AMED, CINAHL, PubPsych and EMBASE from inception to July 2017. Longitudinal studies with quantitative designs analysing the role of psychological factors on pain intensity, disability or both were included. The methodological quality of the included studies was evaluated with an adapted version of the Newcastle Ottawa Scale. The level of evidence per outcome was examined using the Grading of Recommendations Assessment, Development and Evaluation approach. Results A total of 27 articles were included with a sample of 11 176 people with chronic shoulder pain. The risk of bias ranges from 7/21 to 13/21 across the studies. The quality of the evidence was very low. High levels of self-efficacy, resilience and expectations of recovery were significantly associated with low levels of pain intensity and disability. Inversely, high levels of emotional distress, depressive symptoms, anxiety, preoperative concerns, fear-avoidance beliefs, somatisation and pain catastrophising were significantly associated with high levels of pain intensity and disability. Discussion Our results suggest that psychological factors may influence the perpetuation of pain intensity and disability, with very low evidence. A meta-analysis was not carried out due to the heterogeneity of the included studies so results should be interpreted with caution. PROSPERO trial registration number CRD42016036366. PMID:29654040

Recurrent instability after revision anterior shoulder stabilization surgery.

PubMed

Friedman, Lisa Genevra Mandeville; Griesser, Michael J; Miniaci, Anthony A; Jones, Morgan H

2014-03-01

The purpose of this study was to perform a systematic review of the literature to compare outcomes of revision anterior stabilization surgeries based on technique. This study also sought to compare the impact of bone defects on outcomes. A systematic review of the electronic databases PubMed, Cochrane Central Register of Controlled Trials, and Scopus was performed in July 2012 and March 2013. Of 345 articles identified in the search, 17 studies with Level I to IV Evidence satisfied the inclusion criteria and were analyzed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Recurrent instability was defined as redislocation, resubluxation, or a positive apprehensive test after revision surgery. Procedures were categorized as arthroscopic Bankart repair, open Bankart repair, Bristow-Latarjet procedure, and other open procedures. In total, 388 shoulders were studied. Male patients comprised 74.1% of patients, 66.7% of cases involved the dominant shoulder, the mean age was 28.2 years, and the mean follow-up period was 44.2 months. The surgical procedures classified as "other open procedures" had the highest rate of recurrent instability (42.7%), followed by arthroscopic Bankart repair (14.7%), the Bristow-Latarjet procedure (14.3%), and open Bankart repair (5.5%). Inconsistent reporting of bone defects precluded drawing significant conclusions. A number of different procedures are used to address recurrent instability after a primary operation for anterior shoulder instability has failed. There is significant variability in the rate of recurrent instability after revision anterior shoulder stabilization surgery. Level IV, systematic review of Level I to IV studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

The effect of balneotherapy on chronic shoulder pain. A randomized, controlled, single-blind follow-up trial. A pilot study.

PubMed

Tefner, Ildikó Katalin; Kovács, Csaba; Gaál, Ramóna; Koroknai, András; Horváth, Remény; Badruddin, Rakib Mohammed; Borbély, Ildikó; Nagy, Katalin; Bender, Tamás

2015-06-01

The effects of balneotherapy on chronic shoulder pain were studied. In this single-blind, randomized, follow-up study involving 46 patients with chronic shoulder pain, one group of patients received physiotherapy--exercise and transcutaneous electrical nerve stimulation--and the other group received balneotherapy in addition to physiotherapy for 4 weeks on 15 occasions. The following parameters were recorded before treatment (at week 0) and after treatment (at weeks 4, 7, and 13): Shoulder Pain and Disability Index (SPADI), the Short Form (36) Health Survey (SF-36) and EuroQuol-5D (EQ-5D) quality of life questionnaires, pain at rest and on movement on the visual analog scale (VAS), and active and passive range of motion. The SPADI pain, function, and total scores and the VAS scores at rest and on movement significantly improved in both groups after treatments. A greater improvement was observed in the balneotherapy group compared to the control group; regarding some parameters (VAS score on movement and SPADI function score at visit 2; VAS score at rest at visits 3 and 4), the difference between the groups was significant. The improvement of SF-36 and EQ-5D quality of life scores and the active range of motion was more pronounced in the balneotherapy group, the difference between the groups was not significant, except for EQ-5D at visit 2. Improvement of passive range of motion was not significant. Balneotherapy may have a beneficial effect on the clinical parameters and quality of life of patients with chronic shoulder pain. The number of patients should be increased.

Arthroscopic management of suprascapular neuropathy of the shoulder improves pain and functional outcomes with minimal complication rates.

PubMed

Memon, M; Kay, J; Ginsberg, L; Simunovic, N; Bak, K; Lapner, P; Ayeni, O R

2018-01-01

The purpose of this study was to systematically assess the arthroscopic management of suprascapular neuropathy, including the aetiology, surgical decision-making, clinical outcomes, and complications associated with the procedure. Three databases [PubMed, Ovid (Medline), and Embase] were searched. Systematic literature screening and data abstraction was performed in duplicate to present a review of studies reporting on arthroscopic management of suprascapular neuropathy. The quality of the included studies was assessed using level of evidence and the MINORS (Methodological Index for Nonrandomized Studies) checklist. In total, 40 studies (17 case reports, 20 case series, 2 retrospective comparative studies, and 1 prospective comparative study) were identified, including 259 patients (261 shoulders) treated arthroscopically for suprascapular neuropathy. The most common aetiology of suprascapular neuropathy was suprascapular nerve compression by a cyst at the spinoglenoid notch (42%), and the decision to pursue arthroscopic surgery was most commonly based on the results of clinical findings and investigations (47%). Overall, 97% of patients reported significant improvement in or complete resolution of their pre-operative symptoms (including pain, strength, and subjective function of the shoulder) over a mean follow-up period of 23.7 months. Further, there was a low overall complication rate (4%) associated with the arthroscopic procedures. While most studies evaluating arthroscopic management of suprascapular neuropathy are uncontrolled studies with lower levels of evidence, results indicate that such management provides patients with significant improvements in pain, strength, and subjective function of the shoulder, and has a low incidence of complications. Patients managed arthroscopically for suprascapular neuropathy may expect significant improvements in pain, strength, and subjective function of the shoulder. Level IV, systematic review of level II to IV studies.

Cytokine mRNA expression in synovial fluid of affected and contralateral stifle joints and the left shoulder joint in dogs with unilateral disease of the stifle joint.

PubMed

de Bruin, Tanya; de Rooster, Hilde; van Bree, Henri; Duchateau, Luc; Cox, Eric

2007-09-01

To examine mRNA expression of cytokines in synovial fluid (SF) cells from dogs with cranial cruciate ligament (CrCL) rupture and medial patellar luxation (MPL) and determine mRNA expression for 3 joints (affected stifle, unaffected contralateral stifle, and left shoulder joints) in dogs with unilateral CrCL rupture. 29 stifle joints with CrCL rupture (29 dogs), 8 stifle joints with MPL (7 dogs), and 24 normal stifle joints (16 clinically normal dogs). Immediately before reconstructive surgery, SF was aspirated from the cruciate-deficient stifle joint or stifle joint with MPL. Fourteen of 29 dogs had unilateral CrCL rupture; SF was also aspirated from the unaffected contralateral stifle joint and left shoulder joint. Those 14 dogs were examined 6 and 12 months after reconstructive surgery. Total RNA was extracted from SF cells and reverse transcription-PCR assay was performed to obtain cDNA. Canine-specific cytokine mRNA expression was determined by use of a real-time PCR assay. Interleukin (IL)-8 and -10 and interferon-gamma expression differed significantly between dogs with arthropathies and dogs with normal stifle joints. For the 14 dogs with unilateral CrCL rupture, a significant difference was found for IL-8 expression. Before reconstructive surgery, IL-8 expression differed significantly between the affected stifle joint and left shoulder joint or contralateral stifle joint. Six months after surgery, IL-8 expression was significantly increased in the unaffected contralateral stifle joint, compared with the shoulder joint. No conclusions can be made regarding the role of the examined cytokines in initiation of CrCL disease.

Age-Related, Sport-Specific Adaptions of the Shoulder Girdle in Elite Adolescent Tennis Players

PubMed Central

Cools, Ann M.; Palmans, Tanneke; Johansson, Fredrik R.

2014-01-01

Context: Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. Objective: To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14–16, and >16 years). Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Fifty-nine adolescent Swedish elite tennis players (ages 10–20 years) selected based on their national ranking. Main Outcome Measure(s): We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Results: Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight–normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Conclusions: Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence. PMID:25098662

Age-related, sport-specific adaptions of the shoulder girdle in elite adolescent tennis players.

PubMed

Cools, Ann M; Palmans, Tanneke; Johansson, Fredrik R

2014-01-01

Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (<14, 14-16, and >16 years). Cross-sectional study. Tennis training sports facilities. Fifty-nine adolescent Swedish elite tennis players (ages 10-20 years) selected based on their national ranking. We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Players older than 16 years showed less scapular upward rotation on the dominant side at 90° and 180° (P < .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight-normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence.

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.