摘要:

&NA;The scapula is a pivotal element in normal scapulohumeral rhythm and glenohumeral stability. It helps to maintain normal glenohumeral angle and acts as a stable base for muscular origins. Scapular dyskinesis, or alterations in scapular position and motion in arm activity, is common in both traumatic and microtraumatic glenohumeral instability. The exact etiology of dyskinesis is not known, but the resulting biomechanical alterations increase glenohumeral angulation, increase tensile strain in the glenohumeral ligaments, and decrease rotator cuff activation. These two actions increase the dysfunction associated with instability and decrease the effectiveness of treatment. Evaluation of scapular motion should be an integral part of the evaluation of the unstable shoulder, and restoration of normal scapulohumeral kinematics should accompany treatment and rehabilitation of the underlying instability.Instability of the glenohumeral joint, either on a macrotraumatic or microtraumatic basis, presents many issues in diagnosis, treatment, and rehabilitation that must be addressed to return the shoulder to maximum function. Alteration in position and function of the scapula is such an issue because the alterations are common in association with instability and may play a large role in determining the extent of the dysfunction and the effectiveness of treatment and rehabilitation. This paper will present information about the roles of the scapula in glenohumeral stability and instability, discuss methods of evaluation of altered scapular position and motion, and provide examples of specific exercises and progressions to help in restoring normal coupled scapulohumeral rhythm.

ISSN:1523-9896    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The trapezius is one of the major scapular‐stabilizing muscles. It is composed of 3 functional components and contributes to coordinated scapulothoracic rhythm by elevating, rotating, and retracting the scapula. The muscle is primarily innervated by the spinal accessory nerve, or cranial nerve XI. The superficial course of the spinal accessory nerve in the posterior cervical triangle makes it susceptible to iatrogenic or penetrating trauma. Idiopathic and traction injuries are also seen.Paralysis and/or dysfunction of the trapezius may result in pain, stiffness, weakness, and altered mechanics of the shoulder girdle. The scapula translates laterally and rotates downward, resulting in pronounced drooping of the shoulder. Patients typically present with an asymmetric neckline, winging of the scapula, and weakness of forward elevation and abduction. A complete clinical, radiographic, and electrodiagnostic evaluation is critical to making an accurate diagnosis.When trapezius dysfunction is recognized within 1 year of a penetrating injury or iatrogenic insult, microsurgical reconstruction of the nerve may be considered. Dysfunction discovered after this time is less likely to improve with direct nerve repair or neurolysis. Active and healthy patients who fail a reasonable trial (9‐12 months) of nonoperative management are appropriate candidates for surgical reconstruction to stabilize the scapula. The modified Eden‐Lange procedure, which laterally transfers the insertions of the levator scapulae, rhomboideus minor, and rhomboideus major muscles, is the current treatment of choice for such patients. This procedure reliably relieves pain, corrects deformity, and improves function in patients with irreparable injury to the spinal accessory nerve.

ISSN:1523-9896    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;With the continuing success of total shoulder arthroplasty in the treatment of glenohumeral arthrosis, the longevity of implanted glenohumeral components has become a considerable concern. Since glenoid component loosening appears to be the primary long‐term mode of failure of shoulder arthroplasty, considerable interest has been focused on the development of alternative glenoid component designs. Interestingly, despite modern technology, glenoid component designs remain remarkably similar to the original Neer design. Various approaches have been taken including altering component geometry, component materials, and implant fixation. However, only time will tell whether the subtle nuances of glenoid component design will alter longterm outcome or whether other factors including diagnosis, soft tissue integrity, surgical technique, and rehabilitation will more profoundly affect the longevity of total shoulder arthroplasty.

ISSN:1523-9896    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;The shoulder is among the most difficult joints to image well using ultrasound, likely contributing to the wide range of reported success of ultrasound in diagnosing rotator cuff tears. Using well defined techniques and criteria, recent studies have demonstrated very favorable results in detecting rotator cuff pathology using ultrasound. Special attention must be given to the potential pitfalls due to tendon curvature and the complex anatomy of the rotator cuff, as well as to using appropriate equipment. Current literature demonstrates a sensitivity of 91 to 95% and approximately 90% specificity and accuracy in the assessment of both partial‐ and full‐thickness tears using ultrasound.Technical advances in ultrasound imaging are expected to further expand the role of ultrasound in the evaluation of rotator cuff pathology by offering improved image quality and reducing its inherent operator dependence. These include tissue harmonic imaging, extended field‐of‐view imaging, and 3‐dimensional imaging. The real‐time nature of ultrasound permits dynamic assessment of shoulder stability, tendon subluxations, as well as allowing accentuation of cuff tears. This review will covers the sonographic anatomy, scanning techniques, and pathology of the rotator cuff and long head of biceps tendons, emphasizing recent advances in ultrasound technology as these apply to the rotator cuff. Examples of the sonographic appearances following cuff repair and in the presence of a shoulder replacement will also be included.

ISSN:1523-9896    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Osteoarthritis and rheumatoid arthritis are very common conditions in our aging population. Patients with this condition usually complain of pain and decreased range of motion that affect their activities of daily living. This study is a retrospective review of a third‐generation shoulder arthroplasty performed for nontraumatic conditions such as osteoarthritis and rheumatoid arthritis. All surgeries were performed by the same surgeon, between 1997 and 2000, with an average postoperative follow‐up of 28 months. Thirty‐six patients, with 28 total shoulder arthroplasties and nine hemiarthroplasties were included in this study. The distribution of shoulder pathology was as follows: 25 patients with osteoarthritis and 11 patients with rheumatoid arthritis. A preoperative and postoperative evaluation was available for every patient, including a visual analog scale, a questionnaire of activities of daily living, active range of motion, and strength. The American Shoulder and Elbow Surgeons shoulder index and the University of California, Los Angeles rating scale were calculated for all patients. There was an average increase of 46 degrees in forward flexion, 23 degrees in external rotation, 40 points in the American Shoulder and Elbow Surgeons shoulder index, and 17 points in the University of California, Los Angeles scale. The results of this study demonstrate that excellent pain relief, increase in range of motion, as well as improvement in the activities of daily living performance can be obtained with this thirdgeneration shoulder prosthesis.

ISSN:1523-9896    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

&NA;Total elbow arthroplasty is often indicated in patients with fragile bone and soft tissues, such as those with rheumatoid arthritis. Some of the techniques for elbow arthroplasty involve partial or complete detachment of the triceps from the proximal ulna. In these instances, triceps failure can occur, presenting a particular problem for those who need triceps function to get out of a chair or for ambulation.To minimize the risk of triceps failure following elbow arthroplasty, we have implemented a simple, yet extensive “triceps‐on” approach to the elbow and demonstrated its application to total elbow arthroplasty.The skin incision runs over the ulnar nerve, which is dissected free from the ulna and the medial capsule. Through this single skin incision, a complete 360‐degree capsular release is performed through medial and lateral approaches. The ulna is then gently dislocated laterally with the triceps attached to the olecranon, allowing a semiconstrained total elbow prosthesis to be implanted.

ISSN:1523-9896    

出版商:OVID    

年代:2003

数据来源: OVID