Shoulder Adduction Research Articles

Analysis of the 5 iron golf swing when hitting for maximum distance

Most previous research on golf swing mechanics has focused on the driver club. The aim of this study was to identify the kinematic factors that contribute to greater hitting distance when using the 5 iron club. Three-dimensional marker coordinate data were collected (250 Hz) to calculate joint kinematics at eight key swing events, while a swing analyser measured club swing and ball launch characteristics. Thirty male participants were assigned to one of two groups, based on their ball launch speed (high: 52.9 ± 2.1 m · s−1; low: 39.9 ± 5.2 m · s−1). Statistical analyses were used to identify variables that differed significantly between the two groups. Results showed significant differences were evident between the two groups for club face impact point and a number of joint angles and angular velocities, with greater shoulder flexion and less left shoulder internal rotation in the backswing, greater extension angular velocity in both shoulders at early downswing, greater left shoulder adduction angular velocity at ball contact, greater hip joint movement and X Factor angle during the downswing, and greater left elbow extension early in the downswing appearing to contribute to greater hitting distance with the 5 iron club.

Shoulder tenotomies to improve passive motion and relieve pain in patients with spastic hemiplegia after upper motor neuron injury

Shoulder adduction and internal rotation contractures commonly develop in patients with spastic hemiplegia after upper motor neuron (UMN) injury. Contractures are often painful, macerate skin, and impair axillary hygiene. We hypothesize that shoulder tenotomies are an effective means of pain relief and passive motion restoration in patients without active upper extremity motor function. A consecutive series of 36 adults (10 men, 26 women) with spastic hemiplegia from UMN injury, shoulder adduction, and internal rotation contractures, and no active movement, who underwent shoulder tenotomies of the pectoralis major, latissimus dorsi, teres major, and subscapularis were evaluated. Patients were an average age of 52.2 years. Pain, passive motion, and satisfaction were considered preoperatively and postoperatively. Average follow-up was 14.3 months. Preoperatively, all patients had limited passive motion that interfered with passive functions. Nineteen patients had pain. After surgery, passive extension, flexion, abduction, and external rotation improved from 50%, 27%, 27%, and 1% to 85%, 70%, 66%, and 56%, respectively, compared with the normal contralateral side (P < .001). All patients with preoperative pain had improved pain relief at follow-up, with 18 (95%) being pain-free. Thirty-five (97%) were satisfied with the outcome of surgery, and all patients reported improved axillary hygiene and skin care. Age, gender, etiology, and chronicity of UMN injury were not associated with improvement in motion. We observed improvements in passive ROM and high patient satisfaction with surgery at early follow-up. Patients who had pain with passive motion preoperatively had significant improvements in pain after shoulder tenotomy. Shoulder tenotomy to relieve spastic contractures resulting from UMN injury can be an effective means of pain relief and improved passive range of motion in patients without active motor function.

Influence of Moderately Intense Strength Training on Flexibility in Sedentary Young Women

The present study is the first to examine whether moderately intense resistance training improves flexibility in an exclusively young, sedentary women population. Twenty-four, young, sedentary women were divided into 3 groups as follows: agonist/antagonist (AA) training group, alternated strength training (AST) group, or a control group (CG). Training occurred every other day for 8 weeks for a total of 24 sessions. Training groups performed 3 sets of 10 to 12 repetitions per set except for abdominal training where 3 sets of 15 to 20 reps were performed. Strength (1 repetition maximum bench press) and flexibility were assessed before and after the training period. Flexibility was assessed on 6 articular movements: shoulder flexion and extension, horizontal shoulder adduction and abduction, and trunk flexion and extension. Both groups increased strength and flexibility significantly from baseline and significantly when compared with the CG (p ≤ 0.05). The AST group increased strength and flexibility significantly more than the AA group (p ≤ 0.05) in all but one measurement. This study shows that resistance training can improve flexibility in young sedentary women in 8 weeks.

Muscle moment arms and function of the siamang forelimb during brachiation

Moment arms have an important modulating impact on muscle function, as they represent the capacity of the muscle to convert muscle action into limb movements. In the current paper, we provide muscle moment arm data of the forelimb of four siamangs, collected by detailed dissections on unfixed cadavers. The aim of this study is to assess the role of different forelimb muscles during brachiation. Moment arm data are compared with similar published data of non-brachiating primates such as macaques, chimpanzees and humans. Our data show that shoulder adductors and endorotators and the elbow flexors are built for force generation, whereas the shoulder abductors, flexors and exorotators are best suited to gain speed and to change direction. Compared to non-brachiating species, both elbow and wrist flexors are particularly noticeable in terms of moment of force-generating capacity. However, the moment of force-generating capacity of the elbow extensor is not negligible, which indicates that the triceps also plays an active role, especially at the end of the support phase. Except for the elbow flexors, all muscles reach their maximum moment of force-generating capacity during the support phase of brachiation. When brachiating on a more complex setup, the siamang will flex the elbows to angles that induce maximum moment arms as well.

9. Painful Shoulder Complaints

Painful shoulder complaints have a high incidence and prevalence. The etiology is not always clear. Clinical history and the active and passive motion examination of the shoulder are the cornerstones of the diagnostic process. Three shoulder tests are important for the examination of shoulder complaints: shoulder abduction, shoulder external rotation, and horizontal shoulder adduction. These tests can guide the examiner to the correct diagnosis. Based on this diagnosis, in most cases, primarily a conservative treatment with nonsteroidal anti-inflammatory drugs possibly in combination with manual and/or exercise therapy can be started. When conservative treatment fails, injection with local anesthetics and corticosteroids can be considered. In the case of frozen shoulder, a continuous cervical epidural infusion of local anesthetic and small doses of opioids or a pulsed radiofrequency treatment of the nervus suprascapularis can be considered.

타이치(Tai-Chi) 운동이 유방암 수술환자의 어깨관절 가동범위와 심박동수 변화에 미치는 영향

본 연구는 타이치 운동이 유방암 수술 후 환자의 어깨관절 가동범위 및 심박동수에 미치는 영향을 규명하는데 그 목적이 있다. 대상자는 유방암 1~2기 진단을 받고 유방암 수술 후 2개월 이내의 B광역시에 거주하는 환자 40명을 대상으로 타이치 운동을 12주간, 주4회, 1회 60분씩 실시하여 실험 전 후 어깨관절 가동범위 및 심박동수를 측정하였다. 본 연구결과 어깨관절 가동범위의 굴곡, 선전, 내전, 외전 모두 유의하게 증가하였고(p<0.05), 심박동수도 유의하게 감소하였다(p<0.05). 이상의 결과로 타이치 운동은 유방암 수술 후 환자들에게 어깨관절 가동범위를 향상시키고 심장기능을 강화시킴으로써 심혈관질환을 예방할 수 있고 유방암 수술 후 환자들의 건강증진을 도모할 수 있는 권장할 만한 운동으로 사료된다. Good health-related quality of life is regarded as the goal of elderly residential care. Treatment for breast cancer produces side effects that diminish functional capacity and quality of life among survivors. Tai-Chi exercise offers the benefits of fitness and health. Tai-chi has been claimed to generate beneficial effects with respect to a wide range of diseases. The object of this research is to evaluate the effects of tai chi exercise on shoulder joint movement and cardiovascular function in elderly breast cancer patients. The subjects were 40 patients residing in B metropolitan city, who had undergone surgery for breast cancer within 2 months. They underwent post-operative radiotherapy and an anti-cancer chemical treatment. They practiced tai-chi exercise for 60 min a day, four times a week for 12 weeks under the direction of a special tai-chi instructor. Shoulder joint movement and heart rate, were measured before and after the experiment. The results were as follows; Shoulder joint movement, including flexion, extention, adduction and abduction, significantly increased (p<0.05) after treatment, and heart rates significantly decreased after treatment (p<0.05). From the results, Tai-Chi exercise was shown to be extremely effective in improving shoulder joint movement and heart rate in elderly breast cancer patients. Further study is needed in this area.

고령운전자 시트 벨트 뻗침 거동 특성 분석

The purvose of this study is to understand motion characteristics of older drivers during reaching seat belt compared to young drivers and to provide design guidelines in order to reduce discomfort for the elderly. The whole body kinematics of each subject was captured using 12-camera motion analysis system. Subjective ratings on discomfort levels were obtained simultaneously using a questionnaire. This paper first presents the result of motion characteristics of elderly drivers' reach motion to seat belt. Compared to young drivers, older drivers performed seat belt reach motions less efficiently and moved slower due to mostly the movement error. Older drivers also made use of reduced joint range of motion in cervical left rotation, lumbar left rotation and right shoulder adduction, which can be explained by their reduced active range of motions (AROMs). To compensate for their reduced joint range of motion, older drivers rotated pelvis more.

The rotator cuff muscles are activated at low levels during shoulder adduction: an experimental study

During isometric shoulder adduction in normal subjects, do the rotator cuff muscles activate more than other shoulder muscles? Are the activation patterns influenced by shoulder abduction angle or load? A within-participant, repeated measures experimental study. 15 healthy adults. Participants performed an isometric adduction exercise at 30°, 60°, and 90° abduction in the scapular plane and at 25%, 50%, 75%, and 100% load. During the exercises, a combination of indwelling and surface electromyographic recordings were taken from 11 shoulder muscles: supraspinatus, infraspinatus, subscapularis, pectoralis major, teres major, latissimus dorsi, rhomboid major, serratus anterior, lower trapezius, upper trapezius, and deltoid. At 100% load, mean rotator cuff activation levels were low (supraspinatus at 3% of its maximum voluntary contraction, infraspinatus 27%, and subscapularis 27%) and significantly less than the activation levels of rhomboid major (81%), latissimus dorsi (103%), and teres major (76%) (F₁₀,₁₄₀ = 15.5, p < 0.01). No significant difference in activity levels of the rotator cuff muscles were recorded when isometric adduction was performed at 30°, 60°, or 90° abduction (p > 0.89). Among the muscles activated above minimum levels (> 10% of maximum voluntary contraction), mean activation levels increased as load increased (F₃,₄₂ = 72.0, p < 0.01) Since isometric adduction in normal subjects does not produce moderate to high activation levels in any of the rotator cuff muscles tested, these results do not support the use of shoulder adduction to identify rotator cuff muscle dysfunction or strengthen the rotator cuff muscles.

E-2 慣性センサによる投球時上半身の3次元動作計測(生体治療・医療,バイオ操作・検査)

Estimation method of three-dimensional (3D) motion of upper limb, trunk and shoulder torque during pitching using body-mounted sensor is discussed The body-mounted sensor is composed of 3D accelerometer and 3D gyroscope with different dynamic range and is attached on upper arm, forearm and chest. The 3D trajectory is obtained by numerical integration of acceleration and angular velocity. Initial posture of the subject such as setup position is derived by performing four pre-determined movements^ rotation of whole body around vertical axis, flexion and extension of elbow, adduction and abduction of shoulder and keeping upper limb on suspending. Shoulder joint torque is estimated as internal/external torque, adduction/abduction torque and varus/valgus torque. Three subjects participated in the pitching experiment and the experimental results show that estimated 3D trajectory is highly correlated with that from motion capture system and shoulder torque is reasonably estimated.

Obesity effect on male active joint range of motion

Despite the prevalence of obesity, how obesity affects human physical capabilities is not well documented. As an effort toward addressing this, the current study investigated the obesity effect on joint range of motion (RoM) based on data collected from 20 obese and 20 non-obese males. In total, 30 inter-segmental motions occurring at the shoulder, elbow, knee and ankle joints and lumbar and cervical spine areas were examined. The obesity effect was found to be non-uniform across the joint motions. Obesity significantly reduced RoM for nine of the 30 motions: shoulder extensions and adductions, lumbar spine extension and lateral flexions and knee flexions. The largest significant RoM reduction was 38.9% for the left shoulder adduction. The smallest was 11.1% for the right knee flexion. The obesity-associated RoM reductions appear to be mainly due to the mechanical interposition and obstruction of inter-segmental motions caused by excess fat in the obese body. Statement of Relevance: Currently, obesity is prevalent worldwide and its prevalence is expected to increase continually in the near future. This study empirically characterised the obesity effects on joint RoM to provide better understanding of the physical capabilities of the obese. The study findings will facilitate designing man–artefact systems that accommodate obese individuals.

Interferência do vestuário no desempenho, na amplitude de movimento e no conforto na ginástica laboral

The objective of this descriptive case study was to analyze the interference of clothing with exercise performance, joint range of motion (ROM), and comfort during a session of labor gymnastics wearing a uniform (UNI) and specific exercise clothes (SEC). Twenty female workers (28.9±10.2 years) from a company in Florianópolis were studied. A photo camera, Wells bench, a questionnaire, and interview were used for data collection. The subjects were submitted to seven types of exercise wearing UNI and SEC: hip flexion, shoulder flexion, trunk flexion-hips and ankle angles, shoulder extension, modified trunk flexion-hips and ankle angles, horizontal shoulder adduction, and a sit-and-reach test. The results were analyzed using the paired t-test, chi-square test, and Fisher’s exact test (p≤0.05). Seven women wearing UNI tended not to show the body, 17 removed some part of UNI, and 13 noted movement limitation. Discomfort was lower in the upper body part during hip flexion and horizontal shoulder adduction and in the lower part during shoulder flexion, extension and horizontal shoulder adduction. Lower ROM values were observed for subjects wearing UNI compared to those wearing SEC during hip flexion (p=0.017), shoulder flexion (p=0.0075), trunk flexion (hips and ankle angles), modified trunk flexion (ankle angles), and the sit-and-reach test (linear and angular values) (p&lt;0.001). Trunk flexion performance (ankle angles) was better in the UNI condition (p=0.001), probably because the subjects were wearing shoes. In conclusion, clothing tends to interfere with ROM and comfort, but not with exercise performance.

9 YEAR OLD GIRL WITH PROGRESSIVE WEAKNESS

A 9-year-old female patient experienced progressive weakness and myalgias of shoulders and back of several months duration. Her medical history was notable for spina bifida in association with a Chiari type II malformation and hydrocephalus. Developmental motor milestones were delayed whereby walking began at age 2. She had mild bowel and bladder dysfunction. At presentation, her neurological exam was notable for weak shoulder adduction, hip and knee flexion and she demonstrated a partial Gower's maneuver. A muscle biopsy showed dystrophic changes and immunohistochemical findings of a Duchenne's mosaic which was confirmed by DNA analysis. The proposed pathogenesis in this case is unfavourable lyonization, which was corroborated by X-inactivation studies.

Measurement of upper extremity joint moments in walker-assisted gait

Although walkers are commonly prescribed to improve user stability and ambulatory ability, quantitative study of the basic biomechanical and functional requirements for effective walker use is limited. To investigate the changes in upper extremity joint moments that occur with the use of a front-wheeled walker, a strain gauge-based walker instrumentation system was developed and integrated with an upper extremity biomechanical model for the load measurement. The designed system performance was testified via non-linearity validation, crosstalk test and force measurement accuracy check, which were found to be better than 2.90, 3.19 and 1.01%, respectively. Preliminary system data were collected for 12 healthy, right-handed young adults following informed consent. Bilateral upper extremity kinematic data were acquired with a six- camera motion analysis system. Internal joint moments at the upper extremity were determined in the three clinical planes using the inverse dynamics method. Results showed that during a basic walker-assisted gait there were several typical demands occurring in walker stance period, including shoulder adductor in the coronal plane, elbow extensor in the sagittal plane and external rotator in the transverse plane. The greatest moment demands are recorded in the shoulder-coronal plane as 0.431 N m/kg m for the study group. Complete description of upper extremity joint moments during basic walker-assisted gait may provide insight into walker use parameters and rehabilitative strategies.

우리나라 청년층의 어깨 및 상지관절을 이용한 근력 측정

The muscle strengths in various postures are used in our daily life with or without our recognition. Also, many works are still performed with strengths, although mechanization and automation have been fairly accomplished at the industry site. Since the late seventies, various body measurements have been conducted periodically in Korea, however, muscle strengths have not been measured actively. For this reason, the muscle strength data have been hardly accumulated. The aims of this study are to learn more about the physical strength of young-aged Koreans and to provide basic information for designing equipments, tools and facilities in the work site and daily life. The muscle strengths that are related to shoulder and upper limbs joints, which are used frequently, are measured in this study. Eighteen muscle strengths, from seven different movements such as elbow flexion, elbow extension, shoulder abduction(seated), shoulder adduction(seated), shoulder rotation(internal and external), lifting a tray, and turning a key(inward and outward) were measured. For every movement, the muscle strengths for both hands were measured. In each measurement, five seconds averaged value and peak value were collected. Comparing the average value, the strength of shoulder adduction was the strongest for male and female, while strength of turning a key inward with left hand was the weakest for male and female. Strengths of preferred hand in elbow extension, shoulder abduction, shoulder external rotation, lifting a tray, and turning a key were stronger than those of non-preferred hand for both male and female. Rohrer's index considerably had an effect on muscle strength. The results of this study can provide some basic information not only in designing the equipment and facilities in work site or daily life, but also in selection, training and management of workers.

Multijoint Reflex Responses to Constant-Velocity Volitional Movements of the Stroke Elbow

Multijoint reflex coupling could impact the voluntary control of functional arm movements in people post stroke. The multijoint responses to active-assist, constant-velocity movements of the elbow joint were measured in 14 individuals post stroke and 9 neurologically intact controls. Resulting responses in the stroke group illustrated a change in the reflex coupling of the elbow and shoulder muscles compared with passive perturbations of the spastic elbow. Voluntary effort during constant-velocity elbow extension resulted in reflex shoulder abduction, differing from the reflex coupling observed between the elbow flexors and shoulder adductors observed during passive elbow extension. These results suggest that post stroke, voluntary drive alters reflex coupling of the elbow and shoulder. Flexion of the elbow during active-assist also resulted in reflex coupling. Shoulder abduction torque decreased with constant-velocity flexion of the elbow; however, no net adduction was observed at the end of the perturbation. Shoulder flexion/extension and internal/external rotation torque responses demonstrated similar modulations to imposed active-assist perturbations of the elbow in subjects post stroke. Responses were absent during passive perturbations of the control elbow; however, shoulder torque modulations were observed during constant-velocity, active-assist tasks. The active-assist response patterns in controls were similar to stroke subjects during the extension task but opposite during flexion of the elbow. This study provides evidence of a neural coupling between elbow and shoulder muscles and a modulation of this coupling during voluntary drive of the spastic arm.

Medial pectoral nerve transfer

Dr. Wellons and his colleagues6 report convincing evidence that medial pectoral nerve (MCN) to musculocutaneous nerve (MCN) transfer can improve elbow flexion in infants with birth brachial plexus injury.6 They performed the MPN transfer procedure in a relatively large number of patients and achieved excellent surgical outcomes. Their results corroborate those previously reported by Blaauw and Sloof4 and make a strong case for MPN as a donor nerve that can be used in brachial plexus reconstruction for birth injury. The present report will serve as a valuable reference for many years. I commend the authors for their significant contribution to the treatment of birth-related brachial plexus injury. Some aspects of their report and the use of this particular MPN transfer in infants warrant discussion. As the authors indicate, infants with C8–T1 injury would not be candidates for the nerve transfer procedure because the MPN receives output from C8–T1 nerve roots. Potential candidates are infants with C5–6 or C5–7 injury. In these infants, surgical treatment should be aimed to maximize improvement of both shoulder and elbow function and should be undertaken before 12 months of age. Patients with persistent limited shoulder abduction, arm external rotation, and elbow extension/flexion suffer from life-long disabilities, and they develop fixed shoulder and elbow joint deformities that cannot be corrected. Unless infants show shoulder abduction greater than 90°, the limited shoulder abduction in infancy will lead to worsening shoulder abduction due to increased shoulder adductor contractures. These patients cannot carry out arm movements that require concomitant shoulder movement. Orthopedic procedures for the fixed deformities coupled with muscle weakness do not restore full shoulder and elbow function. For example, rotational osteotomy at a later age can reposition the arm in more external rotation but does not increase the total arc of motion of the arm. Fixed elbow flexion deformities cannot be fully corrected with surgeries. Shoulder subluxation/dislocation and resulting late shoulder deformities cannot be prevented in many patients. Thus, one should not rely on palliative orthopedic procedures later in childhood. Instead, one should employ a broad brachial plexus reconstruction before the patient reaches 12 months of age. When planning a type of brachial plexus reconstruction for C5–6 or C5–7 injury, one should remember favorable surgical outcome of resection of neuroma and nerve grafts, sometimes combined with C-4–suprascular nerve neurotization. Gilbert and colleagues5 reported shoulder abduction of more than 90° in 81% of 241 infants with C5–6 repairs and 76% of 81 infants with C5–7 repairs. Such good improvements were also observed in elbow flexion and extension. We have reported similar outcomes.1 In contrast, the MPN transfer improves only elbow flexion but does not help improve elbow extension and shoulder function. If infants older than 6 months cannot flex their elbow against gravity but can abduct their shoulder more than 90°, the MPN transfer would be a good option. However, I have not seen persistent weakness confined to the biceps in our patients, nor am I aware of reports of such cases in 345 347

규칙적인 태극권의 참여가 유방암 수술환자의 산화-항산화계에 미치는 영향

Treatment for breast cancer produces side effects that diminish functional capacity and quality of life (QOL) among survivors. Tai Chi is a moderate form of exercise that may improve functional capacity, physical activity and oxidative stress. The purpose of this study was to evaluate the effects of regular Tai Chi exercise on malondialdehyde (MDA), SOD and physical fitness (muscle strength, flexibility, flexion, extension, adduction, and abduction). Forty obese women were recruited from a public health center and divided into control (CON: n=20) and trained (EXP: n=20) groups. The Tai Chi exercise group participated in a 12-week (4 times/week) training program. Data were analyzed with T-test. MDA, SOD and physical fitness (muscle strength, flexibility, flexion, extension, adduction, and abduction) were evaluated before and after the Tai Chi program in both groups. There were significant improvements in shoulder flexibility, flexion, extension, abduction, and adduction. However, there was no improvement in muscle strength. There were also significant improvements in MDA and SOD. Based on these results, Tai Chi exercise has been shown to stimulate endogenous antioxidant enzymes and reduce oxidative damage markers. and also be effective in improving physical fitness and QOL. Further study is needed in this area.

Functional reorganization in the brain afar contralateral C7 transfer to the median nerve

Objective To investigate changes in brain function zones following contralateral Co transfer and its possible mechanisms, and provide scientific bases for clinical measurements to improve functional recovery after such nerve transfer. Methods Experiment al group: 6 adult male patients with left brachial plexus total avulsions who underwent contralateral G7 transfer and had recovered M3 or above muscle power of wrist flexors and finger flexors on the injured side under volitional vigorous healthy shoulder (right side) adduction. Control group:6 healthy male adults whose motor task was w adduct the right shoulder. Positron Emission tomography (PET) techniques were applied to acquire scans of the brain for analysis. Results PEI scans showed excitation mainly in the left hemisphere upon right shoulder adduction in the control group. In the experimental group, in addition to excitation in the left hemisphere, right shoulder adduction resulted in excitation in the right frontal lobe and apical lobe, including SMI and SMA, with simultaneous subcortical area activation. Conclusion Functional imaging evidences of transhemispheric plasticity in adult brain were obtained. The cortical areas involved in functional reorganization were delineated. The hypothesis that the brain may try to restore control of an injured limb to its original cortical areas after nerve transfer was put forth. Key words: Nerve transfer; Brachial plexus; Neuronal plasticity; Somatosensory cortex

The Valsalva Maneuver Revisited: The Influence of Voluntary Breathing on Isometric Muscle Strength

We assessed the effects of 4 voluntary breathing conditions on maximal voluntary isometric force of large muscle groups. Ten subjects performed maximum voluntary isometric contractions (MVICs) of knee flexion and extension, shoulder abduction and adduction, and elbow flexion and extension under all breathing conditions: normal breathing, forced inhalation, forced exhalation, and the Valsalva maneuver (VM). Forced exhalation significantly increased peak force during shoulder adduction, elbow extension, and knee extension MVIC tasks (p = 0.001, 0.024, and 0.002, respectively); the peak force during the Valsalva maneuver was not different from forced exhalation for all tested muscle groups. No voluntary breathing condition seemed to influence the peak force during the knee flexion, elbow flexion, and shoulder abduction MVIC tasks. The results demonstrate that voluntary breathing imposes a significant impact on isometric muscle strength. Given the increased cardiovascular risks associated with the Valsalva maneuver, it is highly recommended that forced exhalation be used during exercise at maximal levels, especially in repetitive repetitions.

Elastofibroma dorsi: an unusual cause of shoulder pain

We evaluated patients who underwent surgical treatment for elastofibroma dorsi (ED). The study included 13 patients (11 women, 2 men; mean age 54 years; range 43 to 74 years) who were treated surgically for ED that caused persistent symptoms. Involvement was on the right in six patients, on the left in five patients, and bilateral in two patients. All the patients presented with a mass lesion that became apparent at the lower corner of the scapula on shoulder flexion and adduction. The complaints were swelling and pain on the back in nine patients, and a snapping sound on shoulder movements together with pain in four patients. Diagnosis of ED was made by magnetic resonance imaging (n=10) and computed tomography (n=3), with no utilization of preoperative biopsy. Marginal tumor excision was performed in all cases. Evaluation for recurrence was made by ultrasonography. The mean follow-up period was 32 months (range 8 to 90 months). All the masses were located at the inferior corner of the scapula, with adherence to the thorax between the serratus anterior, rhomboid, and latissimus dorsi muscles. The mean size of the surgical specimens was 9 x 6 x 3 cm (range 5 x 3 x 1 to 14 x 8 x 3 cm). Clinical diagnosis was confirmed by histopathologic examination in all cases. All major complaints resolved after surgery. Hematoma occurred in four cases postoperatively, but resolved without the need for surgical intervention. No recurrence was observed. Even though ED is a rare clinic entity, it should be recalled while evaluating shoulder pathologies. Marginal excision is adequate for the treatment of patients with sustaining complaints.