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Background: Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation. Methods: Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation. Results: The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application. Conclusions: Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.

Background: Atraumatic rotator cuff tears (ARCTs) are frequently concomitant with adduction restriction of the glenohumeral joint (GHJ). Adduction manipulation (AM) removes the restriction and relieves pain. The present study aimed to investigate the clinical efficacy of AM versus physiotherapy (PT) in ARCTs. Methods: Eighty-eight patients with adduction restriction were allocated to the AM and PT groups (n = 44 per group). The glenohumeral adduction angle (GAA) was calculated using X-rays at the first and last follow-up appointments. We recorded pain severity (visual analog scale, VAS), flexion, abduction, external rotation (ER), internal rotation (IR), and American Shoulder and Elbow Society (ASES) and Constant scores at baseline and at 1-, 3-, 6-, and 12- month follow-ups. Results: Forty-three patients (23 males, average age 71.3 years) in the AM group and 41 (16 males, average age 70.7 years) in the PT group were consequently analyzed. At the 1-month follow-up, VAS, shoulder motion except ER, ASES and Constant scores were much better in the AM group than in the PT group, whereas those in the PT group improved gradually up to 12 months. At the final follow-up, flexion, abduction, and Constant score were significantly better in the AM group than in the PT group. The GAA at the initial and final examinations was −21.6° and −3.2°, respectively, in the AM group, and −21.1° and −14.4°, respectively, in the PT group. Conclusions: The AM procedure, which had better clinical efficacy than PT, is recommended as the first conservative treatment option for ARCTs.

Abstract Ultrasound guidance is valuable for performing precise joint interventions. Joint interventions may be requested for therapeutic and diagnostic pain injections, joint aspiration in the setting of suspected infection, or contrast injection for arthrography. In practice, interventions of the shoulder girdle, elbow, and hand/wrist joints may be performed without any imaging guidance. However, imaging guidance results in more accurate interventions and better patient outcomes than those performed by palpation alone. When compared to other modalities used for imaging guidance, ultrasound has many potential advantages. Radiologists should be prepared to perform ultrasound-guided upper extremity joint interventions utilizing recommended techniques to optimize clinical practice and patient outcomes. Key points 1. Ultrasound-guided injections of the glenohumeral, acromioclavicular, sternoclavicular, elbow, and hand/wrist joints have higher accuracy than injections performed without imaging guidance. 2. Ultrasound-guided aspirations of upper extremity joints have advantages to fluoroscopic-guided aspirations because of the potential to identify effusions, soft tissue abscess, or bursitis. 3. Ultrasound-guided contrast injection prior to MR arthrography is as accurate as fluoroscopic-guided injection for upper extremity joints.

The glenohumeral joint (GHJ) is one of the most critical structures in the shoulder complex. Lesions of the superior labral anterior to posterior (SLAP) cause instability at the joint. Isolated Type II of this lesion is the most common, and its treatment is still under debate. Therefore, this study aimed to determine the biomechanical behavior of soft tissues on the anterior bands of the glenohumeral joint with an Isolated Type II SLAP lesion. Segmentation tools were used to build a 3D model of the shoulder joint from CT-scan and MRI images. The healthy model was studied using finite element analysis. Validation was conducted with a numerical model using ANOVA, and no significant differences were shown (p = 0.47). Then, an Isolated Type II SLAP lesion was produced in the model, and the joint was subjected to 30 degrees of external rotation. A comparison was made for maximum principal strains in the healthy and the injured models. Results revealed that the strain distribution of the anterior bands of the synovial capsule is similar between a healthy and an injured shoulder (p = 0.17). These results demonstrated that GHJ does not significantly deform for an Isolated Type II SLAP lesion subjected to 30-degree external rotation in abduction.

The shoulder joint participates in different resistance training due to its high mobility. In previous studies, deltoid muscle force was investigated by the electromyography method. However, the effects of increasing exercise weight on deltoid biomechanics have not been adequately studied. In this study, shoulder biomechanics in dumbbell fly movements performed with different dumbbell weights were investigated. Accordingly, the biomechanical model of the upper extremity was prepared and the motion analysis of the dumbbell fly exercise was performed. Then, the exercise was simulated with MATLAB Simscape tools. As a result of the simulation, shoulder joint moment and deltoid muscle force were calculated. Thus, the finite element model was performed to examine the mechanical behavior of the deltoid muscle during exercises. In dumbbell fly exercises performed with different weights, the maximum joint moment was 42.82 Nm, 54.32 Nm and 65.83 Nm, respectively. Additionally, the highest muscle force was calculated as 1378 N, 1750 N, and 2121 N, respectively. When the weight of the dumbbell increased by 33.33%, maximum joint moment increased by 26.85% and 21.18%, and maximum muscle force increased by 26.99% and 21.20%, respectively. However, although the dumbbell weight increased by 25%, the maximum stress in the deltoid muscle increased strikingly by 33.33%. Consequently, it was observed that increasing the weight of the dumbbell did not cause the same increase in shoulder joint moment and deltoid muscle force. Moreover, it was found that increasing the weight of the dumbbell increases the stress in the deltoid muscle to a higher extent. © 2022, The Author(s), under exclusive licence to The Brazilian Society of Mechanical Sciences and Engineering.

Background Many researchers have questioned whether shoulder kinematics such as the glenohumeral position and scapular kinematics would be different in different age groups. However, studies comparing shoulder kinematics between different age groups have been rare. The aim of this study was to analyze and compare the three-dimensional (3D) glenohumeral position, scapular kinematics, and scapulohumeral rhythm (SHR) during scapular plane arm abduction between a normal young male group and a normal older male group. Methods Twenty normal men (10 young and 10 older) were enrolled in this controlled laboratory study. Fluoroscopic images were obtained using a single plane X-ray system. Bilateral computed tomography scans were taken to create a 3D model. A 3D-2D registration technique was used to determine the 3D position and orientation of the bones of the shoulder. Results During scapular plane arm abduction, there were significant differences in scapular kinematics between the groups. The older male group showed more upward rotation, posterior tilt, and external rotation than the young male group. On the other hand, the glenohumeral position such as superior inferior translation, anterior posterior translation, and external rotation of the humeral head did not show significant difference between the groups. The mean value of SHR for the overall arm elevation range from start to maximum elevation angle for the older group and young group was 2.298 ± 0.964 and 2.622 ± 0.931, respectively, showing a significant difference between the two groups (p = 0.035). Conclusions Scapular kinematics and SHR were significantly different between the older male group and the young male group. Our study could provide reference values of shoulder kinematics for older men aged 55-65 years.

Background The overhead throwing motion repetitively stresses the dominant arm in baseball players, frequently altering normal range of motion (ROM) in multiple directions. Baseball players regularly perform a combination of static stretches (SS) and dynamic tubing (DT) resistance exercises in pre-throwing warm-up routines intended to improve shoulder ROM and reduce injuries. Purpose The purpose of this study was to compare acute changes in dominant shoulder ROM improvements between SS and DT warm-up exercise protocols. The DT exercises were hypothesized to elicit greater improvements in shoulder ROM. Study Design Two-way crossover study. Methods Twenty-five healthy collegiate baseball players (mean age = 19.8 ±1.0 years) presenting with glenohumeral internal rotation deficit (GIRD) >20° and total rotational range of motion (TRROM) losses >5° completed the SS and DT interventions on different days. Dominant arm internal rotation (IR), external rotation (ER) and TRROM were measured before, immediately after, 30-minutes after, and 60-minutes after each treatment session. A two-way repeated measures analysis of variance (ANOVA) compared the effect of SS and DT over time on IR, ER and TRROM. Results IR improved on average 10.68 ± 0.82° (p < .001) post intervention, 11.18 ± 0.79° (p < .001) 30-min post intervention, and 9.03 ± 0.95° (p < .001) 60-min post intervention. ER improved on average 8.60 ± 0.67° (p < .001) post intervention, 8.25 ± 0.85° (p < .001) 30-min post intervention, and 6.65 ± 0.91° (p < .001) 60-min post intervention. TRROM improved on average 19.28 ± 1.09° (p < .001) post intervention, 19.43 ± 1.36° (p < .001) 30-min post intervention, and 15.68 ± 1.55° (p < .001) 60-min post intervention. There were no significant differences between the main effects of treatment and time for IR, ER, and TRROM. For IR, SS improved by an average of 1.73 ± 0.55° (p = .005) more than DT. For ER and TRROM, there were no differences between SS and DT. Conclusion Both SS and DT exercises improve glenohumeral IR, ER and TRROM up to one-hour post intervention, with no significant differences noted between interventions for treatment or time. Baseball players can benefit equally from performing SS or DT exercises to acutely improve shoulder ROM. Level of Evidence Level 3, The purpose of this study was to compare acute changes in dominant shoulder ROM improvements between statice and dynamic warm-up exercise protocols in college baseball players.

Introduction: Tuberculosis (TB) of the shoulder joint is a sparse entity. Here, we are presenting a case of glenohumeral joint TB (caries exudata variant) with 1-year follow-up. Case Presentation: Our patient, a 65-year-old male individual, came to the outpatient department with complaints of swelling and pain in the right shoulder of 6 months duration. Patient's systemic examination and vitals were within normal limits, and local examination of the shoulder joint revealed massive dumbbell-shaped swelling, tenderness along the joint line, and grossly restricted range of movements. Radiograph of the shoulder joint showed osteolytic lesions in the humeral head and glenoid with a reduction in glenohumeral joint space. We treated the case with the aspiration of the abscess followed by three sessions of injection streptomycin into the cavity at monthly intervals. The patient also received anti-tubercular drugs as per the Revised National Tuberculosis Control Program guidelines for 1 year. After 12 months, the patient was disease-free and had a functional range of motion. Conclusion: In adults, the classical dry type of shoulder TB (caries sicca) has been described, while the fulminating variety rarely has been reported. The latter type of shoulder TB is much more common in children. We report a fulminant variety of shoulder joint TB in an old-aged patient who presented with massive dumbbell-shaped cold abscess and destruction of glenohumeral joint. Keywords: caries sicca, caries exudate, glenohumeral joint, injection streptomycin.

International audience; BackgroundThe critical shoulder angle (CSA) has been shown to be correlated with shoulder disease states. The biomechanical hypothesis to explain this correlation is that the CSA changes the shear and compressive forces on the shoulder. The objective of this study is to test this hypothesis by use of a validated computational shoulder model. Specifically, this study assesses the impact on glenohumeral biomechanics of modifying the CSA.MethodsAn inverse dynamics 3-dimensional musculoskeletal model of the shoulder was used to quantify muscle forces and glenohumeral joint forces. The CSA was changed by altering the attachment point of the middle deltoid into a normal CSA (33°), a reduced CSA of 28°, and an increased CSA of 38°. Subject-specific kinematics of slow and fast speed abduction in the scapular plane and slow and fast forward flexion measured by a 3-dimensional motion capture system were used to quantify joint reaction shear and compressive forces.ResultsIncreasing the CSA results in increased superior-inferior forces (shearing forces; integrated over the range of motion; P < .05). Reducing CSA results in increased lateromedial (compressive) forces for both the maximum and integrated sum of the forces over the whole motion (P < .01).Discussion/ConclusionChanges in the CSA modify glenohumeral joint biomechanics with increasing CSA producing higher shear forces that could contribute to rotator cuff overuse, whereas reducing the CSA results in higher compressive forces that contribute to joint wear.

The aims of this study were to compare muscle activity of the anterior deltoid, medial deltoid, and posterior deltoid in the bench press, dumbbell fly, shoulder press, and lateral raise exercises. Thirteen men experienced in strength training volunteered for the study. Muscle activation was recorded during maximum isometric voluntary contraction (MVIC) for data normalization, and during one set of 12 repetitions with the load of 60% 1RM in all exercises proposed. One-way repeated-measures ANOVA with Bonferroni’s posthoc was applied using a 5% significance level. For anterior deltoid, the shoulder press (33.3% MVIC) presented a significantly higher level of activation when compared to other exercises. Also, no significant difference was found between the bench press (21.4% MVIC), lateral raise (21.2% MVIC), and dumbbell fly (18.8% MVIC). For the medial deltoid, the lateral raise (30.3% MVIC) and shoulder press (27.9% MVIC) presented a significantly higher level of activity than the bench press (5% MVIC) and dumbbell fly (3.4% MVIC). Besides, no significant difference was found between the bench press and the dumbbell fly. For the posterior deltoid, the lateral raise (24% MVIC) presented a significantly higher level of activation when compared to other exercises. For the posterior deltoid portion, the shoulder press (11.4% MVIC) was significantly more active than the bench press (3.5% MVIC) and dumbbell fly (2.5% MVIC). Moreover, no significant difference was found between the bench press and the dumbbell fly. In conclusion, the shoulder press and lateral raise exercises showed a higher level of muscle activation in the anterior deltoid and medial deltoid when compared to the bench press and dumbbell fly exercises.

Background: The pathophysiology of atraumatic rotator cuff tears (ATTs) has not been fully understood. Adduction restriction of the glenohumeral joint can cause pain and disability in patients with ATTs. We aimed to use our adduction test (pushing the humerus toward the side in the coronal plane with scapular fixation) to fluoroscopically measure the glenohumeral adduction angle (GAA) and to assess the effectiveness of adduction manipulation. Materials and methods: Fifty-five patients with ATTs were included in the study. The GAAs of the patients vs. healthy subjects without ATTs were measured fluoroscopically and compared. During the test, patients showed restriction and expressed pain. The visual analog scale (VAS) score, passive range of motion (ROM), and the American Shoulder and Elbow Surgeons score at the initial visit were compared with those after adduction manipulation. Results: Of the patients, 41 (75%) had positive adduction test results. A higher percentage of positive adduction test results was observed in smaller tears. The average GAA was –21.4° on the affected side, which was smaller than that on the unaffected side, at –2.8° (P < .001), and that in healthy subjects, at 4.8° (P < .001). After manipulation, the GAA was –0.8° (P < .001) and the VAS score, the American Shoulder and Elbow Surgeons score, and all ROM values significantly improved up to the level on the unaffected side. Conclusion: Adduction restriction of the glenohumeral joint was identified in 75% of all the patients with ATTs. Adduction manipulation significantly reduces the VAS score and restores the ROM. Adduction restriction is considered a crucial pathophysiology of ATTs.

Background: Recent studies have reported high rates of recurrence of shoulder instability in patients with glenoid bone defects greater than 20% after capsulolabral reconstruction. The purpose of the present study was to evaluate the failure rate of arthroscopic capsulolabral reconstruction for the treatment of anterior instability in the presence of glenoid bone deficits >20%. Methods: Retrospective analyses were conducted among cases with anterior shoulder instability and glenoid bone defects of >20% that were treated by arthroscopic capsulolabral reconstruction with a minimum 2-year follow-up (30 cases). We included the following variables: age, bone defect size, instability severity index score (ISIS), on-/off-track assessment, incidence recurrent instability, and return to sports. Results: The mean glenoid bone defect size was 25.8% ± 4.2% (range, 20.4%–37.2%), and 18 cases (60%) had defects of >25%. Bony Bankart lesions were identified in 11 cases (36.7%). Eleven cases (36.7%) had ISIS scores >6 points and 21 cases (70%) had off-track lesions. No cases of recurrent instability were identified over a mean follow-up of 39.9 months (range, 24–86 months), but a sense of subluxation was reported by three patients. Return to sports at the preinjury level was possible in 24 cases (80%), and the average satisfaction rating was 92%. Conclusions: Arthroscopic soft tissue reconstruction was successful for treating anterior shoulder instability among patients with glenoid bone defects >20%, even enabling return to sports. Future studies should focus on determining the range of bone defect sizes that can be successfully managed by soft tissue repair.

Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05–0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force. info:eu-repo/semantics/publishedVersion

After mastectomy, women might lose mobility and develop kinematic changes in the shoulder. The objective of this research was to compare the kinematics of the glenohumeral joint in women, before and after unilateral breast cancer surgery. This was a longitudinal study with a pre- and post-evaluation design; in total, 15 Mexican women who had a mastectomy for breast cancer and who received a physical therapy program after surgery were evaluated. Flexion–extension and abduction–adduction movements of the glenohumeral joint were evaluated (15 days before and 60 days after mastectomy). For the kinematic analysis of the glenohumeral joint, an optoelectronic motion capture system was used to monitor 41 reflective markers located in anatomical landmarks. There was no significant difference in the range of motion of the glenohumeral joint when comparing pre- and post-mastectomy, flexion–extension (p = 0.138), and abduction–adduction (p = 0.058). Furthermore, patients who received chemotherapy (53%) before mastectomy were more affected (lower range of motion) than those who did not receive it. There were no significant differences in the kinematics of the glenohumeral joint after mastectomy in this group of patients who received a physical therapy program after surgery. Moreover, patients who received chemotherapy treatment before breast cancer surgery tended to have a lower range of motion than those who did not receive it. Therefore, it is necessary for the physical rehabilitation team to attend to these patients even before the mastectomy.

Shoulder pain is a highly prevalent condition, often resulting in major life limitations, and requiring effective treatments. In this work, we explore the anatomical basis of a proposed approach to the regional anesthesia of the shoulder through a single injection under the subscapularis muscle. Bilateral experimental injections in shoulders from body donors (Radiolar (R) and Methylene-Blue) under the subscapular muscle (n = 11) and cadaveric systematic dissections of other 35 shoulders from body donors were performed. Injectate spread was then qualitatively assessed. Long axis of permeable foramina in the anterior aspect of the shoulder joint capsule was measured in centimeters using a digital caliper. More than 40% of specimens had at least one permeable space (Weitbrech and/or Rouviere foramina) communicating the subscapular bursa and the articular space. We further demonstrate that an ultrasonography-guided injection under the subscapularis muscle allows the spread of the injectate through the anterior, inferior and posterodorsal walls of the articular capsule, the subacromial bursa, and the bicipital groove, as well as into the articular space for some injections. The odds of accidental intraarticular injection decrease when injecting with low volumes. This anatomical study provides a detailed description of foramina between glenohumeral ligaments. Furthermore, the data shown in this work supports, as a proof of concept, a safe alternative for rapid and specific blockade of terminal sensory branches innervating the shoulder joint capsule. (c) 2021 Elsevier GmbH. All rights reserved.

Muscle activation helps stabilize the glenohumeral joint and prevent dislocations, which are more common at the shoulder than at any other human joint. Feedforward control of shoulder muscles is important for protecting the glenohumeral joint from harm caused by anticipated external perturbations. However, dislocations are frequently caused by unexpected perturbations for which feedback control is essential. Stretch-evoked reflexes elicited by translations of the glenohumeral joint may therefore be an important mechanism for maintaining joint integrity, yet little is known about them. Specifically, reflexes elicited by glenohumeral translations have only been studied under passive conditions, and there have been no investigations of how responses are coordinated across the functional groupings of muscles found at the shoulder. Our objective was to characterize stretch-evoked reflexes elicited by translations of the glenohumeral joint while shoulder muscles are active. We aimed to determine how these responses differ between the rotator cuff muscles, which are essential for maintaining glenohumeral stability, and the primary shoulder movers, which are essential for the large mobility of this joint. We evoked reflexes using anterior and posterior translations of the humeral head while participants produced voluntary isometric torque in six directions spanning the three rotational degrees-of-freedom about the shoulder. Electromyograms were used to measure the stretch-evoked reflexes elicited in nine shoulder muscles. We found that reflex amplitudes were larger in the rotator cuff muscles than in the primary shoulder movers, in part due to increased background activation during torque generation but more so due to an increased scaling of reflex responses with background activation. The reflexes we observed likely arose from the diversity of proprioceptors within the muscles and in the passive structures surrounding the shoulder. The large reflexes observed in the rotator cuff muscles suggest that feedback control of the rotator cuff augments the feedforward control that serves to compress the humeral head into the glenoid. This coordination may serve to stabilize the shoulder rapidly when preparing for and responding to unexpected disturbances.

Recently, studies have started employing dynamic four-dimensional computed tomography (4DCT) imaging as a biomechanical assessment tool. These studies would benefit from the valuable work that has been done in the past using three-dimensional computed tomography (3DCT). Thus, a structured review was conducted to examine the extent and range of methods employing CT imaging to measure shoulder kinematics. The findings of the review were utilized to conduct a study that employed 4DCT imaging to measure glenohumeral joint congruency and arthrokinematics during internal rotation to the back in a population of healthy individuals. The results of this work show the importance of anterior-posterior translation throughout the motion to achieve maximum range of motion. In conclusion, the use of 4DCT as a biomechanical measuring tool has shown to be a reliable technique in quantifying joint congruency and arthrokinematics of the glenohumeral joint and shows promise for future studies.

Background Examining range of motion deficits across levels of baseball competition can result in a better understanding of the extent of altered range of motion patterns and identify competition levels that may require preventative interventions that target the deficits. Purpose The purpose of this study was to compare shoulder range of motion in baseball players across levels of competition and compare the prevalence of glenohumeral internal rotaton deficit (GIRD) and total arc of motion differences (TAMD) between competition levels in pitchers and position players. Study Design Prospective descriptive cohort Methods Passive internal and external rotation range of motion was measured bilaterally. Individuals with current pain in the arm, shoulder, elbow or shoulder surgery within the prior two years were excluded. Measurements were taken during pre-season physical examinations. Players were divided into seven groups: 12u (11-12 years; n=30), 14u (13-14 years; n=30), High School 1 (HS 1; 15-16 year; n=42), High School 2 (HS 2; 17-18 years; n=25), College (n=22), Professional 1 (Pro1; 17-22 years; n=37) and Professional 2 (Pro2; 23 and older; n=37). Multiple one-way analyses of variance were performed to determine differences between groups. Tukey test for post-hoc analysis was employed to determine which competition levels were significantly different. Results Two-hundred and twenty-three male baseball players ages 11-26 participated. The 12u (53.7°) and 14u (54.2°) groups had significantly less internal rotation than HS1 (65.2°), HS2 (63.9°), College (62.3°), Pro1 (64.9°), and Pro2 (64.5°) players (p5°. Conclusions: Range of motion alterations exist across ages and levels of competition with 12u and 14u players having less internal rotation than the older groups and youth pitchers having less total range of motion than HS1. Level of Evidence 2

Rotator cuff tear arthropathy (CTA) is the most common reason for reverse total shoulder arthroplasty (RSA). There is minimal understanding of the natural progression of osteoarthritis of the shoulder and of the morphologic differences between men and women and between younger and older patients. This trial comprised 309 patients (342 shoulders) who underwent RSA due to CTA in the period between January 2009 and September 2019. The patients were divided into gender and age groups. Preoperative X-rays, computed tomography and magnetic resonance imaging were conducted using various classifications to describe the morphology of the CTA. Of all 342 analyzed shoulders, 209 were right and 133 were left shoulders. A total of 257 female shoulders and 85 male shoulders were assessed. Both mean age and age distribution were significantly different (74.37 years in female and 70.11 years in male patients, p = 0.001; 70.2% female patients in the age group 75.5 years, p = 0.045). A larger extent of progression of the fatty infiltration was detected both in the female cohort (p = 0.006) and in the older age group (p = 0.001). Additionally, older patients had significantly higher levels of muscle retraction (Patte; p = 0.003), a lower acromiohumeral distance (p = 0.042) and more advanced CTA (Seebauer; p = 0.006).

Rame je najgibljiviji kuglasti zglob ljudskog tijela te omogućuje pokrete kroz sve tri ravnine (frontalnu, sagitalnu i transverzalnu). Iako je najgibljiviji, prisutan je nesrazmjer zglobnih tijela i obilatost zglobne čahure. Zbog svoje anatomske strukture, pokreti iznad ruke uzrokuju najveću aktivaciju stabilizacijskog mehanizma koji se sastoji od ligamentarno-tetivnog i mišićnog kompleksa. Zbog ponavljajućeg stresa uzrokovanog prekomjernom aktivnošću ruke iznad glave razvija se jedan od najčešćih sindroma prenaprezanja u području ramena naziva impingement sindrom ili sindrom subakromijalnog sraza. Obuhvaća cijeli niz oštećenja koja nastaju kao posljedica sudara između kompleksa rotatorne manšete, duge glave m. biceps brachii (lat. caput longum biceps brachii) te subakromijalne burze s jedne strane i akromiona i korakoakromijalnog ligamenta s druge strane s posljedičnim suženjem subakromijalnog prostora. Liječenje je većinski konzervativno. Sastoji se od poštede aktivnosti koje zahtijevaju položaj ruke iznad razine ramena, primjene leda, nesterodinih protuupalnih lijekova u cilju postizanja analgezije, metoda fizioterapije te krajnji korak apliciranje je kortikosteroida u subakromijalni prostor. Kirurško liječenje primjenjuje se ukoliko tijekom šest mjeseci konzervativnog liječenja nije došlo do poboljšanja stanja te ukoliko se prilikom rendgenske obrade ustanovi postojanje rupture tetiva i koštanih promjena. Fizioterapija je neizostavan dio liječenja impingement sindroma. Vježbanje u cilju rehabilitacije glavnina je procesa koji je nadopunjen primjenom fizioterapijskih procedura poput elektroterapije, lasera, ultrazvuka i u novije vrijeme udarnog vala. Program terapijskih vježbi se sastoji od početnih statičkih vježbi, vježbi istezanja koje imaju svoja pravila kako bi bila učinkovitija i vježbi snaženja. Vježbe su namijenjene muskulaturi cijelog ramenog obruča s posebnim naglaskom na mišiće rotatorne manšete. Shoulder is the most flexible spherical joint of the body because of disproportion of articular bodies and abundance of the articular capsule. That allows arm movement in all three axes of motion. Because of their anatomical structure, movements above arm cause the greatest activation of the stabilization mechanism which consists of ligament-labrum and muscular complex. Impigment syndrome or subacronomial collision syndrome is one of the most common syndroms caused by overexertion in the shoulder area. It develops as a result of repetitive stress caused by exessive arm activity above head. This syndrome includes the wholw range of damage which occur as a result of collision of the rotator cuff, long head of the biceps, and subacromial bursa on one side and acromion and coracoacromial ligament on the other side with consequent narrowing of the subacromial space. In most cases, treatment is conservative. It is composed of refraining from activities which demand raising arm above shoulder height, application of ice, nonsteroidal anti-inflammatory medication in order to achieve analgesia, physiotherapy and, in the end, corticosteroid administration to the subacromial space. Unless the condition does not improve in six months from the beginning of the conservative treatment and if the X-rax processing shows tendon rupture and bone changes, the surgical treatment is applied. Physical rehabilitation is indispensable part of impingment syndrome treatment. The majority of the process is excercise for the purpose of rehabilitation and it is complemented with physiotherapy procedures such as electrotherapy, lasers, ultrasound and, lately, shock waves. Kinesitherapy consists of initial static exercises, streching exercises which have their rules in order to be efficient and strengthening exercises in the end. Exercises are intended for the musculature of the entire shoulder girdle eith emphasis on the rotator cuff muscles.

Background and hypothesis Reverse shoulder arthroplasty (RSA) is an increasingly popular treatment modality for glenohumeral joint arthritis in association with rotator cuff arthropathy. A prolonged hospital stay following joint arthroplasty risks increased complications for patients plus financial implications for institutions. We hypothesized that RSA could be safely and effectively carried out as an outpatient procedure with reduced risks to patients and institutional costs. Methods Patients attending our institution for RSA during March 2015 to August 2018 were reviewed preoperatively for consideration for RSA as an outpatient procedure. The inclusion criteria were arthritis of the shoulder having failed conservative management, age older than 50 years, and intact deltoid muscle function. Patients were excluded if they underwent RSA for trauma or for revision following previous total shoulder replacement or hemiarthroplasty. Overall health, social circumstances, and individual wishes were considered. Results A total of 21 patients underwent RSA as an outpatient procedure. The mean age was 74 years (range, 59-84 years). There were 8 male and 13 female patients. No overnight stays were required in patients in whom outpatient surgery was planned. The Oxford Shoulder Score increased from a mean of 16 (range, 4-30) preoperatively to a mean of 31 (range, 7-35) at 6 months postoperatively; it was a mean of 36 (range, 7-48) at 12 months postoperatively. Of the patients, 88% were "very satisfied" or "satisfied" with the service and 81% would undergo the surgical procedure again as a day-case procedure. Conclusion RSA as an outpatient procedure can be carried out effectively with high patient satisfaction rates in carefully selected patients.

Introduction: Acromioclavicular joint (ACJ) separation is a common sports injury. Suture- button repair is favoured technique with a complication rate of 20%. We are the first to report the migration of a suture button into the glenohumeral joint. Case Report: A 28-year-old right-handed rugby player presented with symptoms of laxity and catching within the right shoulder 4 years after reconstruction using an ACJ Dog Bone TM Technique (Arthrex Inc.). Magnetic resonance imaging showed that the coracoid suture button had migrated into the glenohumeral joint. Conclusion: The patient was successfully treated with an arthroscopic examination of the glenohumeral joint and removal of the button. We outline the risk factors and treatment options involved in this unique presentation.

The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.

Calcific tendinitis of the rotator cuff is a common disorder and can be successfully treated with non-operative techniques in most cases, although surgical management should be considered in some patients for adequate calcium removal. No clear consensus exists regarding whether the involved tendinous portion to be repaired or not with suture following the deposit removal. The purpose of this study is to evaluate and compare results of re-fixation and debridement of the rotator cuff tendons after calcium removal. Material and methods The study is a retrospective analysis of case histories, operation protocols, magnetic resonance images and radiographs of the shoulder of 19 consecutive patients diagnosed with calcific tendinitis that was surgically treated at our clinic between 2013 and 2016. The median age of the patients was 52 years. All patients were divided into two groups depending on the surgical treatment performed. Calcium deposit was removed and the rotator cuff sutured in patients of the main group, and calcium was removed and the rotator cuff debrided in controls. Results Outcomes were rated as excellent with OSS in 58.3 %, as good in 33.3 % and satisfactory in 8.4 % of the patients in the main group. Controls showed 28.6 % of excellent outcomes and 71.4 % of good results. Excellent ASES shoulder scores were recorded in 91.6 % of the patients in the main group and 8.4 % had satisfactory results. Excellent results were achieved in 71.4 % of controls and 28.6 % had good results. No poor outcomes were observed in the patients. No statistically significant differences were found between the groups. All patients of the main group completely regained the function up to 100 % at a follow-up visit. However, the median time required to regain function by 50 % was 3 months (interquartile range 2:6) after surgery in patients of the main group and 1.5 months in controls. There was a correlation revealed between persistent history of calcific tendinitis and dimensions of the deposit according to the Bosworth classification. Conclusion A type of calcium deposit identified with radiological classifications was shown to have no impact on outcomes. Patients who underwent no repair of the rotator cuff achieved 50 % recovery of the shoulder function almost twice as quickly as those with repaired tendon. No statistically significant differences in outcomes were found between the groups but patients of the main group showed higher scores measured with patient-reported outcomes. More research needs to be carried out on a variety of techniques before definitive conclusions can be made on strategies of surgical treatment of calcific tendonitis.

Michael D McKee,1 Robert Litchfield,2 Jeremy A Hall,3 Tawana Wester,4 John Jones,4 Andrew J Harrison51Department of Orthopaedic Surgery, University of Arizona College of Medicine, Phoenix, AZ, USA; 2Department of Surgery, Fowler Kennedy Sport Medicine Clinical, London, ON, Canada; 3Department of Surgery, St Michael’s Hospital, Toronto, ON, Canada; 4Research and Development, Bioventus LLC, Durham, NC 27703, USA; 5Research and Development, Bioventus Cooperatief UA, Hoofddorp, NetherlandsBackground: Osteoarthritis of the shoulder or glenohumeral joint is a painful condition that can be debilitating. Intra-articular injection with hyaluronic acid should be considered for patients not responding adequately to physical therapy or anti-inflammatory medication.Methods: This was a single-arm, open-label, prospective study of a single intra-articular injection of NASHA (non-animal hyaluronic acid) in patients with symptomatic glenohumeral osteoarthritis. Patients were followed up for 26 weeks post-treatment, during which time rescue medication with acetaminophen was permissible. The study objective was to demonstrate that a single injection of NASHA is well tolerated with an over-6-month 25% reduction in shoulder pain on movement, assessed using a 100-mm visual analog scale.Results: Forty-one patients were enrolled, all of whom received study treatment. The mean decrease in shoulder pain on movement score over the 6-month study period was −20.1 mm (95% CI: −25.2, −15.0 mm), corresponding to a mean reduction of 29.5% (22.0, 37.0%). Statistically significant improvements were also observed in shoulder pain at night and patient global assessment. There was no clear change over time in the percentage of patients using rescue medication and mean weekly doses were below 3500 mg. Seventeen patients (41.5%) experienced adverse events, all of which were mild or moderate. Two adverse events (both shoulder pain) were deemed related to study treatment.Conclusion: This study provides preliminary evidence that a single injection of NASHA may be efficacious over 6 months and well tolerated in patients with symptomatic glenohumeral osteoarthritis. Larger studies are needed for confirmation.Keywords: Durolane®, glenohumeral joint, non-animal hyaluronic acid, osteoarthritis, shoulder, viscosupplementation &nbsp

Purpose To evaluate the intra and interobserver reproducibility of a new goniometric method for evaluating the isolated passive range of motion of the glenohumeral joint in an outpatient setting. Methods This is a prospective observational study on healthy subjects. The Glenohumeral ROM Assessment with Scapular Pinch (GRASP) method is a new method for assessing the isolated range of motion (ROM) of the glenohumeral joint (GH) by a single examiner with a clinical goniometer. It measures the isolated glenohumeral passive abduction (GH-AB), passive external rotation (GH-ER) and internal rotation (GH-IR) with the arm at 45º of abduction. These three GH ROM parameters were measured in both shoulders of 30 healthy volunteers (15 males/15 females, mean age:41.6[SD = 10.3] years). The full shoulder passive abduction, passive external rotation and internal rotation 45º of abduction were measured by the same examiners with a goniometer for comparison. One examiner made two evaluations and a second examiner made a third one. The primary outcome was the intra- and interobserver reproducibility of the measurements assessed with intraclass correlation coefficients (ICC) and the Bland–Altman plot. Results The intra-observer ICC for isolated glenohumeral ROM were: 0.84 ± 0.07 for GH-ABD, 0.63 ± 0.09 for GH-ER, and 0.61 ± 0.14 for GH-IR. The inter-observer ICC for isolated glenohumeral ROM were: 0.86 ± 0.06 for GH-ABD, 0.68 ± 0.12 for GH-ER, and 0.62 ± 0.14 for GH-IR. These results were similar to those obtained for full shoulder ROM assessment with a goniometer. Conclusion The GRASP method is reproducible for quick assessment of isolated glenohumeral ROM. Level of evidence III

Introduction and importance The two major etiologies of shoulder superior labral tears anterior to posterior (SLAP) are traumatic and degenerative processes. Bucket handle tears of the superior labrum represent one-third of labral lesions. However, in this article, we present a double bucket handle tear which has been reported once in the literature. Presentation of case A 25-year-old male presented with complaint of chronic pain in his right shoulder with a remote history of traumatic dislocation. Physical examination revealed a positive apprehension test. Shoulder magnetic resonance imaging (MRI) showed a superior labral tear with a Hill-Sach lesion. Arthroscopy showed a double bucket handle tear of superior labrum and mild biceps tendonitis along with Bankart lesion. The tear was resected and the Bankart lesion was repaired followed by supervised physical therapy. Good clinical outcomes in form of resolution of pain and shoulder instability at six months were obtained. Discussion SLAP tears are common shoulder lesion that is reported differently in the literature. Arthroscopic studies had reported the incidence between 3.9%-11.8. The diagnosis of such lesion relies on the clinical presentation and imaging. Knesek et al. classified SLAP lesions based on the integrity of the biceps anchor and the type of labral tear (Knesek et al., 2013). The standard treatment of symptomatic SLAP lesions is Arthroscopic debridement. However, non-operative management was described in the literature. Conclusion Double bucket handle injuries of the superior labrum are reported in literature once. These lesions can be treated with arthroscopic debridement and Bankart repair and followed by supervised physical therapy., Highlights • Superior labrum Anterior to posterior (SLAP) lesions are common cause of shoulder pain. • Various causes for SLAP lesions have been described including micro traumatic and non-traumatic (e.g., degenerative). • The incidence of SLAP tears varies among multiple arthroscopic studies. Snyder et al. reported an incidence of 3.9% to 11.8. • Most of patients with SLAP lesions present with concurrent shoulder injuries such as partial or complete rotator cuff tears. • MR arthrography is the best imaging Modality to evaluate the SLAP lesions. • Arthroscopic SLAP repair remains the gold standard treatment. However, management depends on patient age, functional status.

A 34-year-old woman presented with paroxysmal, insidious shoulder pain with effusion. MRI demonstrated a permeative, intermediate-signal lesion on T1 and T2 sequences involving the glenohumeral joint and biceps tendon sheath. The patient was treated with arthroscopic synovectomy, debridement, and subpectoral biceps tenodesis, with histopathology demonstrating pigmented villonodular synovitis (PVNS). PVNS is an extremely rare lesion of the glenohumeral joint and surrounding extra-articular structures. Awareness of this condition is paramount for timely diagnosis and intervention before joint destruction occurs. Arthroscopic treatment with meticulous attention to surgical technique is a feasible treatment strategy in the absence of end-stage chondral damage.

Background Moment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation. Methods The 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane). Findings We found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane). Interpretation The knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.

Synovitis of the glenohumeral joint (GHJ) and subacromial space (SAS) is one of the most common findings during arthroscopic rotator cuff repair (RCR). The purpose of this study is to determine clinical factors associated with the degree of synovitis in patients with a rotator cuff tear and whether macroscopic synovitis affects early clinical outcomes following arthroscopic RCR. Arthroscopic videos of 230 patients treated with arthroscopic RCR were randomly reviewed by two experienced shoulder surgeons. The synovitis scores of the GHJ using Davis's grading system and the SAS using Jo's grading system were rated with a consensus. Univariate and multivariate analyses were used to identify the associations between the synovitis scores and various parameters, including demographics, preoperative, and postoperative clinical outcomes. Univariate analyses revealed that age, side, body mass index, duration of symptoms, preoperative stiffness, diabetes, muscle atrophy, fatty infiltration, tear size, preoperative clinical scores, and preoperative range of motion were significantly associated with the GHJ synovitis score (all p

The mobility of the healthy shoulder depends on complex interactions between the muscles spanning its glenohumeral joint. These interactions ensure the stability of this joint. While previous studies emphasized the complexity of the glenohumeral stability, it is still not clear how the kinematics and muscles interact and adapt to ensure a healthy function of the glenohumeral joint. To understand the function of each muscle and degree of freedom of the glenohumeral joint in executing an above-the shoulder box handling task while ensuring stability, we adapted an index-based approach previously used to characterize the functions of the lower limb joints and muscles during locomotion. Forty participants lifted two loads (6 Vs. 12 kg) from hip to eye level. We computed the mechanical powers of the glenohumeral joint and its spanning muscles. We characterized the function of muscles and degrees of freedom using function indices. The function of the glenohumeral joint underlined its compliancy and design for a large range of motion, while the rotator cuff indices emphasized their stabilizing function. The overall muscle functions underlined the complexity of the glenohumeral stability that goes beyond the rotator cuff. Additionally, the load increase was compensated with changes in the functions that seem to favor joint stability. The implemented approach represents a synthetized tool that could quantify the glenohumeral joint and muscles behavior during tridimensional upper limb tasks, which might offer additional insight into motor control strategies and functional alterations related to pathologies or external parameters (e.g., load).

Due to the complex coupling motion of shoulder mechanism, only a small amount of quantitative information is available in the existing literature, although various kinematic models of the shoulder complex have been proposed. This study focused on the specific motion coupling relationship between glenohumeral (GH) joint center displacement variable quantity relative to the thorax coordinate system and humeral elevation angle to describe the shoulder complex. The mechanism model of shoulder complex was proposed with an algorithm designed. Subsequently, twelve healthy subjects performed right arm raising, lowering, as well as raising and lowering (RAL) movements in sixteen elevation planes, and the motion information of the markers attached to the thorax, scapula, and humerus was captured by using Vicon motion capturing system. Then, experimental data was processed and the generalized GH joint with floating center was quantized. Simultaneously, different coupling characteristics were detected during humerus raising as well as lowering movements. The motion coupling relationships in different phases were acquired, and a modified kinematic model was established, with the description of overall motion characteristics of shoulder complex validated by comparing the results with a prior kinematic model from literature, showing enough accuracy for the design of upper limb rehabilitation robots.

Combined injuries of the glenohumeral joint that involve biceps tendon subluxation associated with isolated greater tuberosity fracture and bony Bankart lesion are extremely rare. As per our knowledge, this is the first case report that includes such combined injuries that were treated arthroscopically. We present the case of a 48-year-old male patient who sustained shoulder trauma after being thrown against the rocks by a wave, was found to have biceps tendon subluxation associated with isolated greater tuberosity fracture and bony Bankart lesion. The operative management resulted in complete restoration of the range of motion of the shoulder, and uneventful healing of the fracture. The patient recovered normal activity including his surfing.

BackgroundAnterior shoulder dislocations (ASD) are commonly seen in Emergency Departments (ED). ED overcrowding is increasingly burdening many healthcare systems. Little is known about factors influencing ED length-of-stay (LOS) for ASD. This study defines the factors influencing ED LOS for ASD patients.MethodsRetrospective chart reviews were performed on all patients ≥12 years admitted with an anterior shoulder dislocation at two regional hospitals in the Netherlands between 2010 and 2016. The electronic patient records were reviewed for baseline patient characteristics, trauma mechanism, reduction methods, medication used, complications and the LOS at the ED. The main objective was determining factors influencing the LOS in patients with an anterior shoulder dislocation at the ED.ResultsDuring the study period, 716 ASD occurred in 574 patients, 374 (65.2%) in males. There were 389 (54.3%) primary ASD; the remainder (327, 45.7%) were recurrent. Median LOS was 92 min (IQR 66 min), with a significantly shorter LOS in those with recurrent dislocations (p p p ConclusionTo our knowledge this study is the largest of its kind, demonstrating ED LOS in ASD patients is influenced by age, the need for medication and dislocation history, primary versus recurrent. Notably, we found that biomechanical reduction techniques, which are not primarily traction-countertraction or leverage techniques, e.g. scapular manipulation and Cunningham, were associated with less ED medication use. Further research is needed to define how reduction methods influence ED medication use, patient satisfaction and ED throughput times.

Due to the complex coupled motion of the shoulder mechanism, the design of the guiding movement rules of rehabilitation robots generally lacks specific motion coupling information between the glenohumeral (GH) joint center and humeral elevation angle. This study focuses on establishing a kinematic model of the shoulder complex obtained from a wearable detection system, which can describe the specific motion coupling relationship between the GH joint center displacement variable quantity relative to the thorax coordinate system and the humeral elevation angle. A kinematic model, which is a generalized GH joint with a floating center, was proposed to describe the coupling motion. Twelve healthy subjects wearing the designed detection system performed a right-arm elevation in the sagittal and coronal planes respectively, and the motion information of the GH joint during humeral elevation in the sagittal and coronal planes was detected and quantized, with the analytical formulas acquired based on the experimental data. The differences in GH joint motion during humeral elevation in the sagittal and coronal planes were also evaluated respectively, which also verified the effectiveness of the proposed kinematic model.

Alterations of scapular kinematics affect the whole kinematic chain, potentially leading to the impingement syndrome. This is crucial in overhead sports, where athletes perform frequent and quick upper limb actions. In this manuscript, we aimed to assess the extent to which fatigue alters scapulo-thoracic and scapulo-humeral ranges of motion (RoM), as well as scapulo-humeral movement onset during different upper limb actions. Twenty-four young healthy males aged 22 ± 2 years (height: 1.82 ± 0.06 m, body mass: 78.0 ± 7.8 kg) performed three movements (upper limb elevation, scapular-plane abduction, and intra-extra rotation) before and after an isokinetic fatigue protocol (upper limb intra/extra rotation, 32 repetitions at 120 degrees/s). Pre vs. post fatigue RoM of humeral elevation and rotation, scapular retraction/protraction, and rotation and tilt were computed. Humerus-scapula movement delay was also determined. Humerus elevation range reduced during intra/extra humerus rotation in fatigued conditions (p = 0.006). Scapular tilt RoM increased after the fatigue protocol (p = 0.063, large effect). Humerus-scapular movement onset delay reduced in fatigued conditions of about 80 ms (p < 0.001, large effect). In sum, fatigued intra/extra upper limb rotators altered the scapulohumeral rhythm, and joints RoM in movements outside the scapular plane. Rather, movements close to the scapular plane were less prone to fatigue-induced alterations.

Muscle coordination plays an important role in glenohumeral stability. The rotator cuff and the long head of the biceps are considered the primary dynamic stabilizers muscles. However, the fact that a subgroup of patients with a massive tear in the rotator cuff were able to keep a normal function, should make us question this traditional view. We hypothesize that the teres major which is also a monoarticular scapulohumeral muscle, although it is not part of the conjoined tendon of the rotator cuff, can play a role in glenohumeral stability by a direct support of the humeral head generated by the particular posteroanterior location of this muscle under the humeral head and which, as far as we know, has not been written up previously. This particular effect could appear while the arm is being lifted and the humeral head could be leaning on against the teres major muscle belly underneath it. An anatomical a radiological study was carried out to substantiate our hypothesis. Two cadaver specimens were used for the anatomical study. Frist body was studied through conventional dissection. The second body was analysed through sectional anatomy. Then a radiological study was carried out using magnetic resonance imaging in a healthy male volunteer. Both anatomically and radiologically, the anteroinferior surface of the humeral head was showed firmly resting against the muscle belly of the teres major, to the point of misshaping it from 110 degrees of arm elevation with external rotation. The specific contribution of this effect to the glenohumeral stability needs to be confirmed by further studies and can help us to prevent the high incidence of glenohumeral dislocations. info:eu-repo/semantics/publishedVersion

Traumatic anterior dislocation of the shoulder is one of the most common directions of instability following a traumatic event. Although the incidence of shoulder dislocation is similar between young and elderly patients, most studies have traditionally focused on young patients due to relatively high rates of recurrent dislocations in this population. However, shoulder dislocations in older patients also require careful evaluation and treatment selection because they can lead to persistent pain and disability due to rotator cuff tears and nerve injuries. This article provides an overview of the nature and pathology of acute primary anterior shoulder dislocation, widely accepted management modalities, and differences in treatment for young and elderly patients.

The aim of this manuscript is to present a modification of the current arthroscopic implantation technique of a biodegradable subacromial spacer. This modified ultrasound-guided technique was intended to maximally reduce the invasiveness of the procedure. The ultrasound technique was used to measure the subacromial space for an optimal fit and to verify subacromial spacer placement in the sagittal and frontal planes. This finding is of particular importance for patients with contraindications to general or regional anesthesia. The follow-up (5 months) of subacromial spacer implantation using ultrasound in a patient with an irreparable rotator cuff tear showed correct spacer placement.

Posteriyor glenohumeral eklemdeki gangliyon kistinin supraskapular sinire basısı nadiren karşılaşılan bir omuz ağrısı nedenidir. Bu çalışmada supraskapular sinir sıkışmasına neden olan gangliyon kistlerine yönelik farklı tedavi yöntemlerinin uygulanabilirliğini ilgili literatür ışığında tartışmayı amaçladık. Manyetik rezonans (MR) görüntülemede travma öyküsü olmayan ve omuz ağrısından yakınan üç hastada sağ glenohumeral eklem arkasında gangliyon kisti görünümü ile uyumlu kistik yapı gözlemledik. Glenohumeral eklemde ağrı ve güçsüzlüğe neden olan gangliyon kistleri için literatürde konservatif ve cerrahi tedavi yöntemleri önerilmiştir. Medikal tedaviye yanıtsız hastalarda supraskapular sinirin dekompresyonu için kist nedeninin artroskopik tamirinin veya ortadan kaldırılmasının başarılı sonuçlar verdiği gözlenmiştir. Artroskopik teknik daha az morbidite görülmesi, fonksiyonların daha hızlı düzelmesi, eklem içi patolojilerin daha kolay tespit ve tedavi edilebilmesi nedeniyle açık cerrahiye göre daha avantajlıdır.

Background: Shoulder biomechanics cannot be measured directly in living persons. While different glenohumeral joint simulators have been developed to investigate the role of the glenohumeral muscles in shoulder biomechanics, a standard for these simulators has not been defined. With this scoping review we want to describe available ex-vivo experimental strategies for assessing unconstrained shoulder biomechanics. Objective: The scoping review aims at identifying methodological and/or experimental studies describing or involving ex-vivo simulators that assess unconstrained shoulder biomechanics and synthesizing their strengths and limitations. Inclusion criteria: All unconstrained glenohumeral joint simulators published in connection with ex-vivo or mechanical simulation experiments will be included. Studies on glenohumeral simulators with active components to mimic the muscles will be included. We will exclude studies where the experiment is static or the motion is induced through an external guide, e.g., a robotic device. Methods: We will perform database searching in PubMed, Embase via Elsevier and Web of Science. Two reviewers will independently assess full texts of selected abstracts. Direct backward and forward citation tracking on included articles will be conducted. We will narratively synthesize the results and derive recommendations for designing ex-vivo simulators for assessing unconstrained shoulder biomechanics.

Author: Désirée Ginger Bertron-Simpson Title: Case Study of Physiotherapy: Treatment of a patient after Arthroscopic Bankart Repair. Objectives: This thesis is divided in two general parts. The first one consists of overviewing the shoulder anatomy, kinesiology, and biomechanics. The patient's diagnosis is also presented, including the underwent surgery. The second part presents the case study, with respective examinations provided, treatments and results after providing all the therapies. Clinical findings: The patient is a 16 years old female rugby athlete, 5 weeks after undergoing an Arthroscopic Bankart repair, performed on the 18th of December 2019 on her right shoulder. Her range of motion is limited in all directions with slight muscle atrophy around her right deltoid area, movement pattern in abduction is altered, constant hypertonicity on the upper trapezius area, bilaterally. Methods: All examination and treatment are based of the knowledge I have acquired in the Faculty of Sport and Physical Education of Charles University, in Prague. These include postural examination, ARoM and PRoM, muscle length and strength test, PIR, joint mobilization, soft tissue techniques, and physical activity programs adapted the patient's need. The goals of the therapies are to control existing range of...

Introduction: Frozen shoulder is a condition of uncertain etiology characterised by progressive loss of both active and passive range of motion in the Glenohumeral (GH) joint. It is clear that the GH joint and the scapula do not function independently. Obviously, dysfunction in either joint has a direct impact on the other. Reverse scapulohumeral rhythm means that the scapula moves more than the humerus and it is evident with frozen shoulder. Current manual therapies for the frozen shoulder focus primarily on GH joint mobilisation. Very few studies have addressed the scapular restriction. Aim: To evaluate the effectiveness of scapular mobilisation in patients with frozen shoulder by comparing with conventional treatment. Materials and Methods: A total of 30 subjects with frozen shoulder were selected based on the selection criteria. The participants were then randomly allocated into two groups A and B. Group A were given wax therapy, capsular stretching, scapular mobilisation and home exercises and Group B were given wax therapy, capsular stretching, home exercises. Pain, Range of motion (ROM) and functional disability was measured using a Numerical Pain Rating Scale (NPRS), universal goniometer and shoulder constant score for both the groups. The two groups received therapy for five days in a week for two weeks. Pre and post treatment evaluation were compared and statistically analysed. Results: Group A had significant improvement in NPRS (Z=4.39, p=0.001), shoulder abduction (Z=3.51, p=0.001), shoulder external rotation (Z=4.08, p=0.001) and shoulder constant score (Z=5.39, p=0.001) when compared to group B. Conclusion: Both the treatment approaches are effective in reducing pain, improving ROM and functional disability in patients with frozen shoulder. However the patients who received scapular mobilisation had significantly higher improvement than the control group.

To compare the long-term effectiveness of non-operative treatment with immediate arthroscopic surgical stabilization in young, active patients after first-time anterior glenohumeral dislocation. Consecutive patients aged 15–25 years who suffered primary traumatic anterior glenohumeral dislocation were enrolled in this prospective, non-randomized investigation. In total, 160 patients were enrolled—64 opted for surgical stabilization (group A), while 96 opted for conservative treatment (group B). At final follow-up of over 6.5 years, 60 patients in group A (96.7% males, age 22.8 ± 3.2) and 70 patients in group B (90.0% males, age 20.8 ± 2.9) were evaluated with physical examination, patient-reported outcome measures (PROMs), and radiological studies. Recurrence and return to sport (RTS) data were collected, and variables were compared between groups. Recurrence rate in group A was 13.3% at mean latency of 3.3 ± 1.9 years, compared to 71.4% at mean latency of 2.1 ± 1.5 years in group B (P

An improved understanding of glenohumeral bone mechanics can be elucidated using computational models derived from computed tomography data. Although computational tools, such as finite element analysis, provide a powerful quantitative technique to evaluate and answer a variety of biomechanical and clinical questions, glenohumeral finite element models (FEMs) have not kept pace with improvements in modeling techniques or model validation methods seen in other anatomic locations. The present work describes the use of multi-level computational modeling to compare, develop and validate FEMs of the glenohumeral joint. Common density-modulus relationships within the literature were evaluated using a multi-level comparative testing methodology to determine if relationships from alternate anatomic locations can accurately replicate the apparent-level properties of glenoid trabecular bone. Two different relationships were able to replicate the micro-level loading to within 1.4%, compared to microFEMs when accounting for homogeneous or heterogeneous tissue moduli. The multi-level comparative methodology was then used to develop a glenoid-specific trabecular density-modulus relationship. This allowed for controlled and consistent development of the relationship that was adapted for use in whole-bone scapular FEMs. The density-modulus relationship developed was able to simulate micro-level apparent loading to within 1.3%, using a QCT-density specific relationship. Micro-level FEM characteristics were then compared to determine the optimal parameters for microFEMs and the effect of down-sampled images as FEM input. This was accomplished by creating glenoid trabecular microFEMs from microCT images at 32 micron, 64 micron or down-sampled 64 micron, spatial resolution. It was found that microFEMs accounting for material heterogeneity at the highest spatial resolution were the most accurate. MicroFEMs generated from down-sampled images at 64 microns were found to differ from those generated from scanned 64 micron images, indicating that caution should be used with down-sampled images as input for microFEMs. The optimal QCT-FEM parameters and material mapping strategies (elemental or nodal) were then explored using the same multi-level computational methodology. Little difference was found when comparing elemental or nodal material mapping strategies for all element types; however, QCT-FEMs generated with hexahedral elements and mapped with elemental material mapping, most accurately replicated micro-level apparent loading. Comparisons by material mapping strategy are also presented for linear and quadratic tetrahedral elements. Experimental validation of whole-bone scapular models was then explored by loading cadaveric scapulae within a microCT and using digital volume correlation (DVC) and a 6-degree of freedom load cell to compare full-field displacements and reaction loads to whole-bone scapular QCT-FEMs generated with different material mapping strategies and density-modulus relationships from the literature. It was found that elemental and nodal material mapping strategies were able to accurately replicate experimental DVC displacement field results. There was only minimal variation between elemental or nodal material mapping, and although percentage errors in reaction forces varied from -46% to 965%, QCT-FEMs mapped with density-modulus relationships from the literature were able to replicate experimental reaction loads to within 3%. Finally, morphometric parameters and apparent modulus between non-pathologic normal and end-stage osteoarthritic humeral trabecular bone was compared. It was found that morphometric differences compared to normal bone only occurred in the most medial aspects of end-stage OA bone, within the subchondral region. Moving distally from the articular surface showed near identical morphometric parameters. The end-stage OA group also exhibited a more linear bone-volume-modulus relationship compared to non-pathologic normal bone. The largest differences were seen at bone volume fractions greater than 0.25. This indicates that if high bone volume OA bone is being modeled, then a linear bone-volume-fraction-modulus (or density-modulus) relationship may more accurately replicate bone loading; however, if the high bone-volume-fraction bone is removed (such as with humeral joint replacement surgery), a power-law relationship similar to normal non-pathologic bone may accurately replicate bone loading.

In recent years a number of studies have investigated shoulder biomechanics in handball throwing. The purpose of this scoping review is to summarize the current handball research in terms of shoulder joint kinematics and kinetics and identify gaps in the current research. Nineteen articles relevant to this topic were identified and included. The handball throw is characterized by large external shoulder rotation followed by a rapid internal rotation with minor changes in shoulder flexion and abduction. Generally timing sequence, joint angles and joint velocities were not affected by different conditions such as throwing type, arm position, ball weight and gender. However, large differences in shoulder angles and angular velocities were found between studies, which most likely are explained by methodological differences. Unfortunately, the information provided in the articles did not make it possible to transform measurements from one study to another and thereby eliminate the methodological differences. Only one study reported shoulder kinetics and found that kinetics were not affected by fatigue. This scoping review highlights the need for better descriptions of the methods used to obtain shoulder kinematics and for studies investigating shoulder kinetics in handball throwing.

ResumenEl hombro es uno de los Sistemas articulares más complejo del cuerpo humano. Conocer su funcionamiento es primordial para entender la biomecánica del cuerpo. El propósito de este estudio ha sido el de analizar la influencia de los Sistemas de Coordenadas Locales en la interpretación de los valores cinemáticos de la articulación GlenoHumeral. Se ha utilizado para ello un método invasivo, colocando pines trabeculares en el hombro y la escápula. El rastreo del movimiento se ha realizado mediante el uso de sensores pasivos. El procesamiento de los datos se ha efectuado mediante el uso de la plataforma de software libre pyFormex. Los desplazamientos de la articulación se han determinado mediante dos variantes diferentes de Sistemas de Coordenadas, detectándose una diferencia de 2 a 12 grados.AbstractThe shoulder is one of the most complex systems in the human body. To know how its work is essential to understand the biomechanics of the body. The purpose of this study was to analyze the influence of Local Coordinate Systems in the kinematic analysis of GlenoHumeral joint. The motion tracking was performed using passive sensors attached to pins. Trabecular pins were placed on the shoulder and scapula. The data processing was performed using the free open software pyFormex. The joint displacements were determined by two different variants of Coordinate Systems, being detected a difference from 2 to 12 degrees.

ResumoJustificativa e objetivoNeste estudo o objetivo foi examinar os efeitos histológicos e morfométricos sobre a estrutura da cartilagem da aplicação intra‐articular de levobupivacaína em articulação do ombro.MétodosTrinta e cinco ombros de 20 coelhos New Zealand, machos e adultos, foram usados para o estudo e divididos em cinco grupos de sete. Os grupos foram definidos como L1, L2, L3 e L4, consistiram em ombros direitos nos quais levobupivacaína a 0,25% e 0,5% foi administrada; o Grupo C, que consistiu em ombros esquerdos, foi o grupo controle; os grupos S1 e S2, que consistiram em ombros esquerdos, receberam solução salina a 0,9%. Os animais foram sacrificados no segundo e no 15̊ dia; as articulações glenoumerais foram avaliadas macroscopicamente e, em seguida, amostras de cartilagem foram coletadas. As amostras foram avaliadas com o escore de Mankin e histomorfometricamente. Mediu‐se a espessura da cartilagem entre a camada superficial e a “linha de maré” (tidemark) e a espessura da cartilagem calcificada entre a tidemark e o osso subcondral.ResultadosMacroscopicamente, observou‐se no 15̊ dia que o líquido articular havia reduzido em todos os grupos. Após a avaliação microscópica, o maior escore de Mankin (média: 3,14±2,1/14) foi observado no grupo L4 (15° dia levobupivacaína a 0,5%), considerado estatisticamente significativo (p

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The theme of this bachelor thesis is pain of shoulder girdle in tetraplegics and paraplegics. The bachelor thesis consists of teoretical and practical part. In the theoretical part of the thesis I present the findings about spinal cord lesions, anatomy and kinesiology of shoulder girdle. The aim of this bachelor thesis is to present causes of shoulder girdle pain in tetraplegics and paraplegics and options how to influence it with physiotherapy. In practical part I present case study of SCI patient with pain of shoulder girdle. The case study consists of entry and final examination and photo-documentation of therapy and wheelchair propulsion.