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Clinical Biomechanics (Bristol, Avon) Jul 2023Compromised abduction ability after reverse shoulder arthroplasty is primarily linked to limited glenohumeral range of motion while scapulothoracic mobility can...
BACKGROUND
Compromised abduction ability after reverse shoulder arthroplasty is primarily linked to limited glenohumeral range of motion while scapulothoracic mobility can typically be maintained. Glenohumeral joint forces strongly depend on the resulting scapulohumeral rhythm, however, an association between the acting muscle and joint forces and the subject-specific scapulohumeral rhythm after reverse shoulder arthroplasty has not been established.
METHODS
Eleven reverse shoulder arthroplasty patients were divided into groups of poor and excellent abduction ability. Subject-specific models were developed and scaled for each patient using existing motion capture data in AnyBody™. Shoulder muscle and joint forces were obtained using inverse dynamics calculations during shoulder abduction to 100° in the scapula plane. The scapulohumeral rhythm, the resting abduction angle and internal body forces between the outcome groups were compared using a Mann Whitney U test.
FINDINGS
The mean glenohumeral and scapulothoracic contribution to overall shoulder abduction for the excellent group was on average 9.7% higher and 21.4% lower, respectively, compared to the mean of the poor group. For shoulder abduction angles between 30° and 60°, the excellent group demonstrated on average 25% higher muscle forces in the anterior deltoid which was significantly higher compared to the poor outcome patients. Scapulothoracic muscle activity did not differ significantly between the two functional groups.
INTERPRETATION
Accordingly, rehabilitation strategies focusing on strengthening the anterior part of the deltoid in particular may improve clinical outcomes.
Topics: Humans; Shoulder; Arthroplasty, Replacement, Shoulder; Biomechanical Phenomena; Shoulder Joint; Scapula; Muscle, Skeletal; Range of Motion, Articular
PubMed: 37413811
DOI: 10.1016/j.clinbiomech.2023.106030 -
Journal of Neurophysiology Apr 2023Muscle stiffness is altered following postmastectomy breast reconstruction and breast cancer treatment. The exact mechanisms underlying these alterations are unknown;...
Muscle stiffness is altered following postmastectomy breast reconstruction and breast cancer treatment. The exact mechanisms underlying these alterations are unknown; however, muscle stretch reflexes may play a role. This work examined short- (SLR) and long-latency (LLR) shoulder muscle stretch reflexes in breast cancer survivors. Forty-nine patients who had undergone postmastectomy breast reconstruction, 17 who had undergone chemoradiation, and 18 healthy, age-matched controls were enrolled. Muscle activity was recorded from the clavicular and sternocostal regions of the pectoralis major and anterior, middle, and posterior deltoids during vertical ab/adduction or horizontal flex/extension perturbations while participants maintained minimal torques. SLR and LLR were quantified for each muscle. Our major finding was that following postmastectomy breast reconstruction, SLR and LLR are impaired in the clavicular region of the pectoralis major. Individuals who had chemoradiation had impaired stretch reflexes in the clavicular and sternocostal region of the pectoralis major, anterior, middle, and posterior deltoid. These findings indicate that breast cancer treatments alter the regulation of shoulder muscle stretch reflexes and may be associated with surgical or nonsurgical damage to the pectoral fascia, muscle spindles, and/or sensory Ia afferents. Shoulder muscle stretch reflexes may be impacted following postmastectomy breast reconstruction and chemoradiation. Here, we examined short- and long-latency shoulder muscle stretch reflexes in two experiments following common breast reconstruction procedures and chemoradiation. We show impairments in pectoralis major stretch reflexes following postmastectomy breast reconstruction and pectoralis major and deltoid muscle stretch reflexes following chemoradiation. These findings indicate that breast cancer treatments alter the regulation of shoulder muscle stretch reflexes.
Topics: Humans; Female; Shoulder; Breast Neoplasms; Mastectomy; Muscle, Skeletal; Reflex, Stretch; Mammaplasty
PubMed: 36947887
DOI: 10.1152/jn.00081.2022 -
Pain Physician Mar 2022Chronic postsurgical pain remains a major hurdle in postoperative management, especially in patients undergoing shoulder surgery, for whom persistent pain rates are...
BACKGROUND
Chronic postsurgical pain remains a major hurdle in postoperative management, especially in patients undergoing shoulder surgery, for whom persistent pain rates are higher than for any other surgical site. Little is known about pain beliefs and attitudes as preoperative predictors of postoperative pain following nonarthroplasty shoulder surgery.
OBJECTIVES
We evaluated predictors of pain following nonarthroplasty shoulder surgery, hypothesizing that preoperative kinesiophobia, pain catastrophizing, and neuropathic pain scores are predictive of greater postoperative pain.
STUDY DESIGN
Case control study.
SETTING
Division of Sports Medicine at the University of Wisconsin School of Medicine and Public Health.
METHODS
Consecutive patients aged 18 and older undergoing a nonarthroplasty shoulder operation were selected. At the preoperative appointment and 3 months postoperative, patients completed the Short-Form McGill Pain Questionnaire-2 to assess severity and quality of pain, the painDetect Questionnaire to screen for neuropathic pain, the Tampa Scale of Kinesiophobia to assess fear of movement and fear-avoidance beliefs, and the Pain Catastrophizing Scale to gauge rumination, magnification, and pessimism. A univariable negative binomial regression model was used to identify associations between preoperative predictors and postoperative scores, reporting risk ratios and 95% confidence intervals.
RESULTS
Eighty-one patients completed the preoperative surveys and 43 patients completed at least one postoperative survey. The median pain score decreased from 3 out of 10 (interquartile range [IQR] = 2-5) in the preoperative group to one (IQR = 0-2) in the postoperative group (P < 0.001). Mean kinesiophobia scores decreased from 40.44 (standard deviation [SD] = 5.94) preoperatively to 35.40 (SD = 6.44) postoperatively (P < 0.001). Median pain catastrophizing scores decreased from 7 (IQR = 2-17]) preoperatively to 2 (IQR = 0-11]) postoperatively (P = 0.005). No significant changes in neuropathic pain scores were observed. Higher baseline kinesiophobia scores were associated with greater postoperative pain (risk ratio = 1.09, 95% confidence interval [CI] = 1.01 to 1.18), P = 0.03), as were higher pain catastrophizing scores (risk ratio = 1.05, 95% CI = 1.01 to 1.08), P = 0.01). No association between baseline neuropathic pain and degree of postoperative pain was identified.
LIMITATIONS
Limitations of the study include a single institution with multiple surgeons and types of surgery. The study drop-out rate was relatively high.
CONCLUSION
This study suggests that greater baseline kinesiophobia and pain catastrophizing are predictive of greater postoperative pain following nonarthroplasty shoulder surgery in an adult population.
Topics: Adult; Case-Control Studies; Catastrophization; Humans; Neuralgia; Pain, Postoperative; Shoulder; Shoulder Pain
PubMed: 35322983
DOI: No ID Found -
Journal of Orthopaedic Surgery (Hong... 2021This experimental study investigated the long head biceps tendon (LHBT) excursion that occurs at various positions of the upper limb during tendon stabilizing...
PURPOSE
This experimental study investigated the long head biceps tendon (LHBT) excursion that occurs at various positions of the upper limb during tendon stabilizing procedures. We hypothesized that shoulder abduction, elbow extension and forearm pronation would maximize the excursion of the LHBT and potential impacts on tendon stabilization.
MATERIALS & METHODS
Forequarter specimens from 12 fresh frozen cadavers were used in this study. The study was performed at 0° and 30° of shoulder abduction. Elbow position was either 90° of flexion or full extension with the forearm either in full pronation or supination. A total of 14 combinations of positions were studied. A load of 55 N was applied to the distal biceps. The excursion of the proximal part of LHBT was measured for each of the different positions.
RESULTS
At a shoulder position of 30° of flexion, shoulder abduction of 30° created significantly greater excursion than 0° of shoulder abduction ( < 0.001). Both full extension of the elbow and full pronation of the forearm also showed significant excursion of the tendon when compared to supination ( < 0.001).
CONCLUSIONS
The position of the shoulder, elbow and forearm has a significant effect on biceps excursion. Thirty degrees of shoulder abduction and 30° of forward flexion with the elbow in full extension and the forearm in full pronation maximizes excursion.
CLINICAL RELEVANCE
Information about the excursion of the LHBT affected by the position of the upper limb is useful for any biceps tendon stabilizing procedure. During an operation, the position of the upper limb should be monitored in order to maintain a proper anatomic length-tension relationship.
Topics: Cadaver; Elbow; Forearm; Humans; Shoulder; Tendons
PubMed: 34121510
DOI: 10.1177/23094990211022675 -
International Journal of Environmental... Nov 2022Current healthcare is centered on the perception of people's health. The purpose of this study was to investigate the relationship between self-perceived health...
Current healthcare is centered on the perception of people's health. The purpose of this study was to investigate the relationship between self-perceived health (physical, psychological, social, and environmental dimensions) and two main clinical symptoms (shoulder pain and restricted shoulder motion) in patients with frozen shoulders. A total of 49 patients diagnosed with frozen shoulders were recruited and divided into high- and low-disability groups according to the severity of their frozen shoulders. Participants were measured for shoulder passive range of motion, pain intensity, and self-perceived health, using a brief version of the World Health Organization Quality of Life questionnaire. The results showed that the high-disability group had poorer self-perceived health (lower quality of life scores) than the low-disability group ( < 0.05). There was no significant correlation between the quality of life scores and the two clinical symptoms in either the high- or low-disability group. Our findings revealed that the multidimensional self-perceived health of frozen shoulder patients could not be inferred from the severity of shoulder pain and restricted shoulder motions. This study suggests that healthcare providers should pay more attention to patients' self-perceived health needs while addressing the clinical symptoms in patients with frozen shoulders.
Topics: Humans; Shoulder Pain; Quality of Life; Bursitis; Shoulder Joint; Shoulder; Range of Motion, Articular
PubMed: 36361275
DOI: 10.3390/ijerph192114396 -
Orthopaedics & Traumatology, Surgery &... Feb 2020Antegrade percutaneous intra-medullary nailing (IMN) has a poor reputation in the treatment of humerus fractures. The aim of the present study was to assess rotator cuff...
INTRODUCTION
Antegrade percutaneous intra-medullary nailing (IMN) has a poor reputation in the treatment of humerus fractures. The aim of the present study was to assess rotator cuff integrity and shoulder function after IMN in humerus fracture.
HYPOTHESIS
Third-generation humeral nails (straight, small diameter, with locked screws) conserve rotator cuff tendon integrity and avoid the shoulder stiffness and pain incurred by 1st generation (large diameter, without self-blocking screw) and 2nd generation nails (curved, penetrating the supraspinatus insertion on the greater tuberosity).
METHODS
Forty patients (26 female, 14 male; mean age, 60 years (range, 20-89 years)) with displaced humeral fracture (23 proximal humerus, 17 humeral shaft) underwent IMN using a 3rd generation nail (34 Aequalis™ (Tornier-Wright), 6 MultiLoc™ (Depuy-Synthes)). Mean clinical, radiologic and ultrasound follow-up was 8 months (range, 6-18 months); 22 patients agreed to postoperative CT scan.
RESULTS
There were no revision surgeries for rotator cuff repair or secondary bone displacement. Mean Adjusted Constant Score (ACS) was 93±22% and the Subjective Shoulder Value (SSV) 77±18%. Elevation was 140±36°, external rotation 48±22° and internal rotation was to L3. Ultrasound found: 5 supraspinatus tendon lesions (12.5%) (2 full and 3 deep partial tears) without functional impact (ACS) 91% without vs. 107% with tear; (p=0.12); 2 of the deep partial tears involved excessively lateral and high nail positioning. Eight patients (20%) had painful tendinopathy of the long head of the biceps (LHB) tendon associated with significantly impaired functional scores (ACS 65% vs. 100%; p<0.001); and 4 cases of technical error: 3 of anterior LHB screwing in the groove, and 1 of LHB irritation due to an excessively long posterior screw.
CONCLUSION
Supraspinatus tendon lesions following IMN with a 3-generation humeral nail were rare (12.5%) and asymptomatic; prevalence was not higher than in the general population in the literature (16%). LHB tendinopathy was frequent (20%) and symptomatic, and due to technical error in half of the cases.
LEVEL OF EVIDENCE
IV, retrospective study.
Topics: Adult; Aged; Aged, 80 and over; Bone Nails; Female; Fracture Fixation, Intramedullary; Humans; Humerus; Male; Middle Aged; Retrospective Studies; Rotator Cuff; Rotator Cuff Injuries; Shoulder; Treatment Outcome; Young Adult
PubMed: 31882328
DOI: 10.1016/j.otsr.2019.11.004 -
BMC Musculoskeletal Disorders Apr 2021Obtaining and maintaining final shoulder balance after the entire treatment course is essential for early-onset scoliosis (EOS) patients. The relatively small number of...
BACKGROUND
Obtaining and maintaining final shoulder balance after the entire treatment course is essential for early-onset scoliosis (EOS) patients. The relatively small number of growing-rod (GR) graduates who complete final fusion has resulted in an overall paucity of research on the GR treatment of EOS and a lack of research on the shoulder balance of EOS patients during GR treatment.
METHODS
Twenty-four consecutive patients who underwent GR treatment until final fusion were included. Radiographic shoulder balance parameters, including the radiographic shoulder height (RSH), clavicle angle (CA), and T1 tilt angle (T1T), before and after each step of the entire treatment were measured. Shoulder balance changes from GR implantation to the last follow-up after final fusion were depicted and analysed. Demographic data, surgical-related factors, and radiographic parameters were analysed to identify risk factors for final shoulder imbalance. The shoulder balance of patients at different time points was further analysed to explore the potential effect of the series of GR treatment steps on shoulder balance.
RESULTS
The RSH showed substantial improvement after GR implantation (P = 0.036), during the follow-up period after final fusion (P = 0.021) and throughout the entire treatment (P = 0.011). The trend of change in the CA was similar to that of the RSH, and the T1T improved immediately after GR implantation (P = 0.037). Further analysis indicated that patients with shoulder imbalance before final fusion showed significantly improved shoulder balance after fusion (P = 0.045), and their RSH values at early postfusion and the final follow-up did not show statistically significant differences from those in the prefusion shoulder balance group (P > 0.05). Early postfusion shoulder imbalance (odds ratio (OR): 19.500; 95% confidence interval (CI) = 1.777-213.949; P = 0.015) was identified as an independent risk factor for final shoulder imbalance.
CONCLUSIONS
Shoulder balance could be improved by GR implantation but often changes during the multistep lengthening process, and the final result is relatively unpredictable. Final fusion could further adjust the prefusion shoulder imbalance. Focusing on the prefusion shoulder balance of GR graduates and providing patients with early shoulder balance after fusion might be necessary.
Topics: Follow-Up Studies; Humans; Postural Balance; Retrospective Studies; Scoliosis; Shoulder; Spinal Fusion; Thoracic Vertebrae; Treatment Outcome
PubMed: 33853576
DOI: 10.1186/s12891-021-04221-9 -
Clinics in Orthopedic Surgery Mar 2020Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical... (Review)
Review
BACKGROUND
Synovial chondromatosis occurs rarely in the shoulder, and its details remain unclear. The purpose of this study was to clarify the clinical results of surgical resection and the histopathological findings of synovial chondromatosis in the shoulder.
METHODS
Ten shoulders with synovial chondromatosis that had been operatively resected were reviewed retrospectively. Osteochondral lesions were present in the glenohumeral joint in six shoulders and in the subacromial space in four shoulders. Two patients had a history of trauma with glenohumeral dislocation without recurrent instability, and the other seven patients (eight shoulders) did not have any traumatic episodes or past illness involving the ipsilateral shoulder girdle. The occurrences of osteochondral lesions, inferior humeral osteophytes, and acromial spurs were assessed on radiographs before resection, just after resection, and at final follow-up. The Constant scores were compared before resection and at final follow-up with Wilcoxon signed-rank tests. Resected lesions were histopathologically differentiated between primary and secondary synovial chondromatosis.
RESULTS
Inferior humeral osteophytes were found in five shoulders with synovial chondromatosis in the glenohumeral joint, and all four shoulders with synovial chondromatosis in the subacromial space had acromial spur formation. Osteochondral lesions appeared to have been successfully removed in all shoulders on postoperative radiographs. At the final follow-up, however, one shoulder with secondary synovial chondromatosis in the subacromial space showed recurrence of osteochondral lesions and acromial spur formation. The mean Constant score improved significantly from 53.0 points before resection to 76.0 points at a mean follow-up of 6.0 years ( = 0.002). On histopathological evaluation, one shoulder was diagnosed as having primary synovial chondromatosis, while nine shoulders had secondary synovial chondromatosis.
CONCLUSIONS
The present study showed that resection of shoulder osteochondral lesions successfully relieved the clinical symptoms and that primary synovial chondromatosis is less common than secondary synovial chondromatosis in the shoulder. Although most of the present osteochondral lesions were clinically determined to be primary chondromatosis, only one case was histopathologically categorized as primary synovial chondromatosis. These results suggest that histopathological identification is needed to differentiate between primary and secondary synovial chondromatosis.
Topics: Adolescent; Adult; Aged; Child; Chondromatosis, Synovial; Female; Humans; Male; Middle Aged; Pain Measurement; Range of Motion, Articular; Retrospective Studies; Shoulder; Young Adult
PubMed: 32117541
DOI: 10.4055/cios.2020.12.1.68 -
International Journal of Occupational... Jul 2019The objective of this study was to assess the postures that were commonly used in automobile chassis repair operations, and to evaluate shoulder girdle muscle fatigue...
OBJECTIVES
The objective of this study was to assess the postures that were commonly used in automobile chassis repair operations, and to evaluate shoulder girdle muscle fatigue for different combinations of the weight of hand-tools.
MATERIAL AND METHODS
Two right muscles, including upper trapezius (UT) and middle deltoid (MD), were selected. Surface electromyography (SEMG) and a perceived level of discomfort (PLD) were used to assess the degree of shoulder girdle fatigue. Fifteen healthy young male subjects from the Northwestern Polytechnical University participated in the test. The test consisted of assuming 4 different postures and maintaining each of them for 60 s. The 4 postures varied in terms of dumbbell weights, standing for the hand-tools weight: W1 was 0.48 kg and W2 was 0.75 kg; the 4 shoulder postures were shoulder flexions of 150°, 120°, 90°, and 60°, combined with an included elbow angle of 180°, 150°, 120° and 90°, respectively. The experimental sequences were randomly selected. The signals of SEMG and the values of PLD in the shoulder girdle were recorded in 60 s. All subjects completed the whole test. The repeated measure analysis of variance (ANOVA) was performed to ascertain differences between dumbbell weight (0.48 kg and 0.75 kg) and shoulder postures (150°/180°, 120°/150°, 90°/120° and 60°/90°). The Friedman test was utilized to determine the significant differences for UT(PLD) and MD(PLD) on shoulder postures. Spearman’s correlation was used to analyze the relationship between the subjective and objective measurements.
RESULTS
Significant correlational relationships existed between the UT percentage of the maximal voluntary electrical activation (%MVE) and UT(PLD) (r = 0.459, p < 0.01), between MD(%MVE) and MD(PLD) (r = 0.821, p < 0.01). The results showed that SEMG and PLD of the 4 postures under analysis differed significantly (p < 0.05).
CONCLUSIONS
It was indicated that posture T4 (shoulder forward flexion 60° and included elbow angle 90°) resulted in the lowest fatigue, both in terms of the objective measure and the subjective perception, which meant that this posture was more ergonomic. Int J Occup Med Environ Health. 2019;32(4):537–52
Topics: Adult; Automobiles; Electromyography; Ergonomics; Humans; Male; Muscle Fatigue; Muscle, Skeletal; Posture; Shoulder; Workload
PubMed: 31309815
DOI: 10.13075/ijomeh.1896.01387 -
Journal of Sport Rehabilitation Sep 2020A recent report demonstrated moderate to strong relationships between seated single-arm shot-put (SSASP) test performance and isokinetic pushing forces at varying... (Comparative Study)
Comparative Study
CONTEXT
A recent report demonstrated moderate to strong relationships between seated single-arm shot-put (SSASP) test performance and isokinetic pushing forces at varying velocities, directly supporting the SSASP test as a reflection of multijoint upper-extremity strength. Yet, no previous work appears to have assessed whether the SSASP test is more reflective of shoulder flexion or elbow extension strength.
OBJECTIVE
To examine the relationship between isokinetic shoulder flexion and elbow extension strength and SSASP test performance and to compare limb symmetry indices (LSI) between the 2 tests.
DESIGN
Correlational design.
SETTING
Biomechanics laboratory. Patients (or Other Participants): A total of 30 healthy and physically active young adults.
INTERVENTION(S)
Participants completed the SSASP test and concentric isokinetic (60°/s and 180°/s) shoulder flexion and elbow extension using their dominant and nondominant arms.
MAIN OUTCOME MEASURES
SSASP test performance and isokinetic shoulder flexion and elbow extension peak torques as well as LSI between the 2 tests.
RESULTS
Strong relationships were observed between SSASP ranges and isokinetic peak torques at each velocity for both shoulder and elbow (r ≥ .804, P < .001). While the Bland-Altman results on the LSI only demonstrated a significant bias for the shoulder (60°/s, P = .009), limits of agreement results demonstrated extremely wide intervals (32.5%-52.1%).
CONCLUSIONS
The SSASP test is a multijoint upper-extremity functional performance test that is reflective of equal shoulder flexion and elbow extension contributions; however, there was large variability regarding the agreement between the SSASP LSI and isokinetic shoulder and elbow strength LSI.
Topics: Adult; Elbow; Exercise Test; Female; Humans; Male; Muscle Strength; Physical Functional Performance; Shoulder; Torque; Young Adult
PubMed: 32871550
DOI: 10.1123/jsr.2020-0069