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Annals of Physical and Rehabilitation... Jan 2021Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a... (Review)
Review
BACKGROUND
Several studies reported the importance of glenohumeral and scapular muscle activity and scapular kinematics in multidirectional shoulder instability (MDI), yet a systematic overview is currently lacking.
OBJECTIVE
This systematic review evaluates and summarizes the evidence regarding muscle activity and shoulder kinematics in individuals with MDI compared to healthy controls.
METHOD
The electronic databases PubMed and Web of Science were searched in September 2020 with key words regarding MDI (population), muscle activity, and glenohumeral and scapular movement patterns (outcomes). All studies that compared muscle activity or scapular kinematics between shoulders with MDI and healthy shoulders were eligible for this review, except for case reports and case series. All articles were screened on the title and abstract, and remaining eligible articles were screened on full text. The risk of bias of included articles was assessed by a checklist for case-control data, as advised by the Cochrane collaboration.
RESULTS
After full text screening, 12 articles remained for inclusion and one study was obtained by hand search. According to the guidelines of the Dutch Institute for Healthcare Improvement, most studies were of moderate methodological quality. We found moderate evidence that MDI individuals show increased or prolonged activity of several rotator cuff muscles that control and centre the humeral head. Furthermore, we found evidence of decreased and/or shortened activity of muscles that move or accelerate the arm and shoulder girdle as well as increased and/or lengthened activity of muscles that decelerate the arm and shoulder girdle. The most consistent kinematic finding was that MDI individuals show significantly less upward rotation and more internal rotation of the scapula during elevation of the arm in the scapular plane as compared with controls. Finally, several studies also suggest that the humeral head demonstrates increased translations relative to the glenoid surface.
CONCLUSION
There is moderate evidence for altered muscle activity and altered humeral and scapular kinematics in MDI individuals as compared with controls.
Topics: Biomechanical Phenomena; Humans; Joint Instability; Muscle, Skeletal; Range of Motion, Articular; Scapula; Shoulder; Shoulder Joint
PubMed: 33221471
DOI: 10.1016/j.rehab.2020.10.008 -
Brazilian Journal of Physical Therapy 2019The serratus anterior (SA) is capable of a wide range of actions across the scapulothoracic joint. Furthermore, the lack of control, strength, or activation of this... (Review)
Review
BACKGROUND
The serratus anterior (SA) is capable of a wide range of actions across the scapulothoracic joint. Furthermore, the lack of control, strength, or activation of this important muscle is believed to be associated with several painful conditions involving the shoulder complex. Studies and clinical intuition have therefore identified several exercises that selectively target the activation of the SA.
METHODS
This paper reviews the anatomy, innervation, testing, and complex actions of the SA. In addition, this paper describes the classic signs and symptoms of weakness or reduced activation of the SA. Several exercises are described and illustrated that purportedly target the activation of the SA, with the intention of optimizing muscular control and encouraging pain free shoulder motion.
CONCLUSIONS
This review provides the theoretical background and literature-based evidence that can help explain the SA's complex pathokinesiology, as well as guide the clinician to further develop exercises that likely challenge the muscle. This paper is written along with a companion paper entitled: Kinesiologic considerations for targeting activation of scapulothoracic muscles: part 2: trapezius. Both papers prepare the reader to expand their pallet of exercises that target and challenge these two dominant muscles, with a goal of improving function of the shoulder for several painful conditions caused by their reduced or altered activation pattern.
Topics: Exercise; Humans; Muscle, Skeletal; Shoulder; Superficial Back Muscles
PubMed: 30737019
DOI: 10.1016/j.bjpt.2019.01.008 -
Journal of Shoulder and Elbow Surgery Jan 2020Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this...
BACKGROUND
Pathologic activation pattern of muscles can cause shoulder instability. We propose to call this pathology functional shoulder instability (FSI). The purpose of this prospective study was to provide an in-detail description of the characteristics of FSI.
METHODS
In the year 2017, a total of 36 consecutive cases of FSI presenting to our outpatient clinic were prospectively collected. Diagnostic investigation included a pathology-specific questionnaire, standardized clinical scores, clinical examination, psychological evaluation, video and dynamic fluoroscopy documentation of the instability mechanism, as well as magnetic resonance imaging (MRI). In a final reviewing process, the material from all collected cases was evaluated and, according to the observed pattern, different subtypes of FSI were determined and compared.
RESULTS
Based on the pathomechanism, positional FSI (78%) was distinguished from nonpositional FSI (22%). Controllable positional FSI was observed in 6% of all cases and noncontrollable positional FSI in 72%, whereas controllable and noncontrollable nonpositional FSI were each detected in 11% of the cases. The different subtypes of FSI showed significant differences in all clinical scores (Western Ontario Shoulder Instability Index: P = .002, Rowe Score: P = .001, Subjective Shoulder Value: P = .001) and regarding functional impairment (shoulder stability: P < .001, daily activities: P = .001, sports activities: P < .001). Seventy-eight percent had posterior, 17% anterior, and 6% multidirectional instability. Although several patients showed constitutional glenoid shape alterations or soft tissue hyperlaxity, only few patients with acquired minor structural defects were observed.
CONCLUSION
FSI can be classified into 4 subtypes based on pathomechanism and volitional control. Depending on the subtype, patients show different degrees of functional impairment. The majority of patients suffer from unidirectional posterior FSI.
Topics: Adolescent; Adult; Female; Fluoroscopy; Humans; Joint Instability; Magnetic Resonance Imaging; Male; Muscle, Skeletal; Posture; Prospective Studies; Shoulder; Shoulder Joint; Young Adult
PubMed: 31378683
DOI: 10.1016/j.jse.2019.05.025 -
The Journal of Hand Surgery Nov 2022Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically,...
Traumatic forequarter amputations are rare injuries in which the arm, clavicle, scapula, and proximal shoulder muscles are avulsed from the body. Historically, forequarter amputation has been treated with hemorrhage control, wound debridement, and soft tissue coverage. To our knowledge, successful forequarter replantation has not been previously reported. We present a rare case of forequarter amputation treated successfully with replantation. At the 4.5-year follow-up after replantation, the patient had antigravity elbow flexion, modest shoulder elevation, modest extrinsic finger function, and crude sensation. We discuss relevant technical considerations that indicate that, despite challenges, forequarter replantation can be achieved with success.
Topics: Humans; Replantation; Amputation, Traumatic; Amputation, Surgical; Shoulder; Upper Extremity
PubMed: 34561134
DOI: 10.1016/j.jhsa.2021.07.038 -
Physical Medicine and Rehabilitation... Nov 2021The shoulder is structurally and functionally complex. Shoulder pain may be refractory to conventional treatments, such as physical therapy, pharmacotherapy, and... (Review)
Review
The shoulder is structurally and functionally complex. Shoulder pain may be refractory to conventional treatments, such as physical therapy, pharmacotherapy, and corticosteroid injections. In such cases, radiofrequency ablation may serve as an alternative treatment plan. Current literature has demonstrated 4 target nerves for ablative therapy: the suprascapular nerve, axillary nerve, lateral pectoral nerve, and subscapular nerve. Special caution is needed when targeting these nerves in order to avoid motor denervation. This article summarizes the current evidence for radiofrequency ablation as a useful treatment option for chronic shoulder pain as well as the described techniques for performing this promising procedure.
Topics: Humans; Shoulder; Shoulder Pain
PubMed: 34593136
DOI: 10.1016/j.pmr.2021.07.002 -
The Journal of Bone and Joint Surgery.... Oct 2023
Topics: Humans; Shoulder; Elbow; Upper Extremity; Shoulder Joint
PubMed: 37616391
DOI: 10.2106/JBJS.23.00649 -
Orthopaedics & Traumatology, Surgery &... May 2022Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the...
INTRODUCTION
Repeated transfers and wheelchair propulsion in patients with a neurological deficit of the lower limbs overloads the upper limbs mechanically, particularly the shoulders, which become weight-bearing. Under these conditions, arthroplasty implants are subjected to large stresses, even though this indication is controversial in such a context. We hypothesized that joint replacement in weight-bearing shoulders will relieve pain and improve range of motion, with a positive impact on function and autonomy, without increasing the complication rate relative to the able-bodied population.
MATERIALS AND METHODS
This retrospective study involved 13 implants in 11 patients (4 total shoulder arthroplasty, 4 hemi-arthroplasty and 3 reverse shoulder arthroplasty) who had a mean follow-up of 33.7 ± 27 months (12-85 months). The clinical assessment included active and passive range of motion, pain, Constant score, and the Wheelchair User's Shoulder Pain Index (WUSPI). Radiographs were evaluated to look for signs of loosening and scapular notching. The patients' autonomy was evaluated through the number of transfers, means of locomotion (manual or electric wheelchair) and the functional independence measure (FIM). Two subgroups were defined based on the initial pathology: neurological shoulder or functional shoulder.
RESULTS
The 11 patients had a mean age of 64±19 years (23-85 years) and were all long-term wheelchair users (electrical or mechanical). The pain level on VAS decreased from 8±3 preoperatively to 4±2 postoperatively (p=0.003). The mean Constant score increased 90% from 22±11 preoperatively to 42±23 postoperatively (p=0.008). The WUSPI score decreased by 73% from 80±30 to 21±15 (p=0.001). The range of motion improved in the subgroup of patients with functional shoulders but not in the subgroup of patients with neurological shoulders. The means of locomotion was altered in five patients (63%) by the acquisition of an electric wheelchair, but with no significant change in the number of daily transfers. There were no radiographic signs of implant loosening at the final assessment. Two implants had to be revised: one anatomical prosthesis was converted to a reverse configuration because of a secondary rotator cuff rupture; one case of early infection required a two-stage implant change.
DISCUSSION
Joint replacement in weight-bearing shoulders is an effective medium-term solution for cuff tear arthropathy and glenohumeral OA, mainly for addressing pain, with slight improvements in range of motion, depending on the initial pathology. This intervention requires lifestyle adaptations such as changes in daily transfer practices and means of locomotion.
LEVEL OF EVIDENCE
IV, retrospective study.
Topics: Aged; Aged, 80 and over; Arthroplasty, Replacement, Shoulder; Follow-Up Studies; Humans; Middle Aged; Range of Motion, Articular; Retrospective Studies; Rotator Cuff Injuries; Shoulder; Shoulder Joint; Shoulder Pain; Treatment Outcome; Weight-Bearing
PubMed: 34780996
DOI: 10.1016/j.otsr.2021.103145 -
Seminars in Roentgenology Jan 2021Acute injuries to the shoulder girdle are common and frequently encountered by the practicing radiologist. The type of injury is highly dependent on the age of the... (Review)
Review
Acute injuries to the shoulder girdle are common and frequently encountered by the practicing radiologist. The type of injury is highly dependent on the age of the patient and mechanism of trauma with injuries occurring at the site of greatest mechanical weakness. In this review, we discuss the main clinical features and key imaging findings for the most common shoulder injuries. For each injury, we also provide a section on the important features that the orthopedic surgeon needs to know in order to guide surgical versus nonsurgical management.
Topics: Acute Disease; Diagnostic Imaging; Humans; Shoulder; Shoulder Injuries
PubMed: 33422184
DOI: 10.1053/j.ro.2020.07.018 -
World Neurosurgery Oct 2023
Topics: Humans; Shoulder; Upper Extremity
PubMed: 37803688
DOI: 10.1016/j.wneu.2023.08.001 -
AORN Journal Oct 2021
Topics: Shoulder
PubMed: 34586669
DOI: 10.1002/aorn.13526