Adult Shoulder Research Articles

Periarticular neural elements in the shoulder joint.

Due to its unconstrained nature, the glenohumeral joint must necessarily have several mechanisms to regulate its position in space. The neural mechanisms associated with this positioning have not been fully evaluated anatomically. In this study, three fresh-frozen human cadaveric adult shoulders were dissected. Specimens were excised from the proximal biceps insertion, the superior, middle, and inferior glenohumeral ligaments, and the capsule superior to the glenohumeral ligaments. In two specimens, a portion of glenoid labrum was analyzed using a modified gold chloride staining method and light microscopy. A portion of mid-biceps tendon was used as a control. In the superior glenohumeral ligament, 45% of sections contained neural elements consisting of Golgi's, Ruffini's, and Pacini's corpuscles as well as free nerve endings. The predominant types were Ruffini's and Golgi's. The middle glenohumeral ligament sections revealed all four receptor types in 42%, with the most common elements being Pacini's and Ruffini's receptors. The inferior glenohumeral ligament specimens contained the four receptor types in 48% of sections, with Ruffini's, Pacini's, and Golgi's types equally distributed. The shoulder capsule specimens revealed Ruffini's and Pacini's receptors in 47.5% of sections. Only free nerve endings were identified in the biceps tendon and glenoid labral tissue. These findings suggest that the pattern of neural elements does not appear to be random in nature and may have some correlation with the specific functions of some of the glenohumeral ligaments.

1〜2歳児の歩行獲得過程における運動力学的変化

The aim of this research is to examine the kinetic and kinematic changes of infant gait by longitudinal observation of infants at the onset of bipedal walking. We are especially interested in the trajectory of the foot force as a kinetic parameter which is important in determining the developmental stage of an infant. Six infants, ranging from 10 months to 2 years and 1 month of age, were examined longitudinally by means of a force plate system and a three-dimensional motion analysis system. Two characteristics of the trajectory of foot force distinguish an infant from an adult during a single stance phase. First, the sagittal track length of the trajectory of the infant, standardized by foot length, is shorter than that of the adult. The length is correlated with the duration of single stance phase. Second, the transverse sway of the trajectory is characteristic of the infant gait. The above results are related to displacement of the joints, that is, transverse displacement of the hip joint, vertical displacement of knee joint, and the pattern of transverse movements of shoulder, hip, and knee joints. The transverse displacement of the hip joint during stance phase is larger in the infant gait than in the adult gait. It decreases with development. Rapid decrease is observed between 10 months and 15 months. The vertical drop of the knee joint is conspicuous at the earlier month of independent walking. This action of the knee joint causes an impact to the force plate. The pattern of transverse movements of shoulder and hip joints differs between infants and adults. The shoulder and hip joints of infants sway together during stance phase. The shoulder and hip joints of adults first begin to move laterally following heel contact. When the load acts on one foot, the adult shoulder joint moves in the opposite direction. The knee joints of infants and adults both move in the opposite direction to the shoulder joints at that time. The sway of each joint causes instability of the center of gravity and changes the trajectory of foot force. The trajectory of foot force and the displacement of joints accordingly express the stability of the center of gravity. They can be added to the series of parameters useful in judging the developmental stage of the infant gait.

Laboratory Tests for Adult Red Shoulder Bug Control with Beauveria Bassiana Fungus, 1996

Abstract Red shoul der bug is a household nuisance pest across the range of its primary host, Chinaberry. When Chinaberry is present in the landscape, this pest often reaches high populations on the developing yellow berries. A large number of adults migrate into houses throughout the summer and early fall. Adults were collected on 23 Jul as they migrated up/down the trunk of 3 Chinaberry trees on the campus at Texas A&M Univ. Res. & Ext. Ctr., Dallas, TX. In the lab, 5 randomly selected adults were introduced into 9 cm diam X 15 mm deep plastic feeding chambers labeled for each treatment in a RCB design with 5 replicates. Each chamber received 2 water-saturated 7.5 cm diam filter papers, to provide high humidity, and two chinaberry fruits as a food source during the study. Four concentrations of BioCide-TRF™ (Mycotrol GH-ES) Beauveria bassiana (2.0 X 1013 conidia/qt), oneof Dursban (standard), and an untreated check were evaluated. Adults within each chamber were anesthetized with CO2 gas, and a 2.5 μ/ droplet of the respective test material was applied to the prothorax of each adult. Silwet (0.04%) was added to each material as a wetting agent to ensure adherence to the normally hydrophobic insect cuticle. Treated insects were observed daily for mortality; all dead insects were held for several days to confirm the fungus activity, as indicated by an expression of mycelia from the joints of dead insects.

Acute calcific tendinitis in a child: A case report

Acute calcific tendinitis is an uncommon condition in which soft tissue calcification is associated with an acute inflammatory reaction that may be confused with an infection. Cohen 1 first described a case of acute calcium deposition at the insertion of the flexor carpi ulnaris in 1924. The condition usually occurs in the adult shoulder, wrist, hand, and, on rare occasions, lower extremity. To our knowledge, there is only one reported case of acute calcific tendinitis in a child. 2 This entity is so rare in children that it may not be considered when one is evaluating a child with a suspected infection.

Arthrodesis of the shoulder following brachial plexus injury

A series of 13 arthrodeses of the shoulder in adults with brachial plexus injuries have been reviewed. Using internal fixation and external splintage we aimed at a final position of 30 ° abduction, 30 ° flexion and 20 ° of internal rotation. Patients were followed up for between 24 and 60 months. In only one was bony union not achieved, although the resulting fibrous union was asymptomatic. All patients had additional procedures including plexus exploration in six, Steindler procedure in two, triceps to biceps transfer in two, latissimus dorsi transfer in two, and above-elbow amputation in three. All patients stated that shoulder fusion had improved the function of their limb. Minimum range of movement was 50 ° abduction and 40 ° flexion. Two patients continued to complain of pain despite solid fusions. Compression arthrodesis of the shoulder is an effective method of achieving fusion and reliably improves the function in adults with brachial plexus injury.

Septic arthritis of the shoulder in adults.

Septic arthritis of the shoulder in adults.

Etude de la vascularisation du tendon du muscle supra-épineux

The vascular supply of the rotator cuff in 22 adult shoulders was studied by way of mixture infusion of gelatin and India ink and vascular cast, in combination with Scanning Electronic Microscopy of the vascular pattern in the supraspinatus tendon. It was found that the vessels of the supraspinatus tendon mainly derive from the anterior circumflex humeral and suprascapular arteries. Macroscopically, an avascular zone or critical zone could be seen on the surface of supraspinatus, and the mean distance of the external edge from the osteo-tendinous attachment was 7.8 mm. The area of the avascular zone increased with age.

Septic arthritis of the shoulder in adults.

Septic arthritis of the shoulder is uncommon in adults. We reviewed the cases of eighteen patients who were followed for a minimum of one year. The patients ranged in age from forty-two to eighty-nine years. All but one patient had at least one serious associated disease. Eight patients had had an injection or aspiration of the shoulder before development of the infection. All but one patient had had a delay in diagnosis. At the time of admission to the hospital, the erythrocyte sedimentation rate was always elevated, but the body temperature and white blood-cell count were not. After treatment, the functional result was usually poor: only five patients regained forward flexion to 90 degrees or more, eight patients had no active motion of the glenohumeral joint, and two patients died. Arthrotomy appeared to afford a better result than did repeated aspiration.

Anterior dislocation of the shoulder in teen-agers and young adults. Five-year prognosis

Two hundred and fifty-six of 257 shoulders in 254 patients who were between the ages of twelve and forty years and who had primary anterior dislocation of the shoulder that was treated by immobilization for at least three weeks or by early movement were followed for five years in a prospective multicenter study. Two or more recurrences had occurred in 55 per cent of the shoulders in patients who were twenty-two years old or younger, in 37 per cent of the shoulders in patients who were twenty-three to twenty-nine years old, and in 12 per cent of the shoulders in patients who were thirty to forty years old. Surgery for the treatment of instability had been performed or was scheduled to be performed in 28, 18, and 5 per cent of the shoulders, respectively, in the three age-groups. The dislocation recurred in only one of thirty-two shoulders that had a fracture of the greater tuberosity (p less than 0.001). The results as regards recurrence after five years were not influenced by immobilization of the shoulder for three to four weeks after the initial dislocation, bilateral dislocation, or the type of initial trauma and athletic activity. A moderate impression fracture of the humeral head (Hermodsson or Hill-Sachs) did not change the prognosis in the younger patients (twenty-two years old or younger). However, in the patients who were twenty-three to forty years old the rate of recurrence was significantly higher (p less than 0.01) when this injury was demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Pyogenic arthritis of the shoulder in adults.

The cases of fifteen patients with sixteen septic glenohumeral joints were evaluated. In each of the patients there was at least one predisposing factor, and each patient was treated by either repeated aspiration (eleven shoulders) or arthrotomy (five shoulders), combined with parenteral antibiotics. The most significant factors leading to poor results of treatment were delay in instituting treatment, virulence of the infecting organism, and a serious underlying disease process. In eight of ten shoulders in which treatment was begun four weeks or less after symptoms appeared, a satisfactory functional outcome was obtained, while all six patients who were treated after a delay of more than four weeks had poor results. All six patients infected with Streptococcus or coagulase-negative Staphylococcus had satisfactory results. Two of the eight patients with Staphylococcus aureus or gram-negative organisms also had a satisfactory result, while the other six did not. The two successfully treated patients with Staphylococcus aureus were diagnosed within three days of the onset of symptoms, whereas the others had delays in instituting treatment.

Fibrous Contracture of Muscles Following Intramuscular Injections in Adults

Periarticular fibrous muscle contractures in adults from repeated injections in the same site is predictable. The causes of joint contracture in children are many and complex, but in adults it seems certain that this phenomenon is the result of repeated injections of analgesics or other agents into 1 muscle area. Any drug if repeatedly injected locally may cause fibrosis of the muscle and subsequent joint contracture. Five cases of bilateral abduction contracture of the shoulder in adults including the first case of bilateral abduction contractures of shoulder and hip plus bilateral flexion contracture of elbow and extension contracture of a knee are reported. No underlying disease which might predispose to this fibrosis of muscles was noted. The frequency and period of injections were variable over several years. In all patients the interference in activtities of daily living were serious, but the deformities were corrected by release of the fibrous band with relief of discomfort and restoration of joint motion without recurrence. Noting the potential complication of repeated intramuscular injections in one area, this practice should be avoided whenever possible in adults, as well as in children.

AUTOMOTIVE RESTRAINT DEVICES FOR THE PEDIATRIC PATIENT

Last year 6,300 children under 15 years of age died in motor vehicle accidents. This number would have been reduced if all children and infants had been properly restrained. The purpose of this paper is to give information and suggestions to help enable the practicing physician to understand what restraining devices to prescribe. It is recommended that children from birth to the time they are 12 lb in weight be transported in a rear seat bassinet or car bed held in place by front and rear seat safety belts. The bassinet should be parallel to the long axis of the car, with the infant in a feet-forward position. Children from 12 to 24 lb should be placed in a properly constructed rear seat safety harness. Children from 24 to 48 lb should be placed in a rear seat, shield-type system. Children weighing more than 50 lb should use the adult lap belt, and, when their height exceeds 55 in., the adult shoulder harness should also be used. The physician is in a position to be effective in prescribing the proper device.

Fundamentals of Orthopaedics.

Basic Science. Overview of Anatomy, The History and Physical Examination and Diagnostic Tests. Musculoskeletal Conditions of Adults. General Principles of Fractures and Dislocations. Pediatric Orthopaedics. Medical Considerations. Orthopaedic Devices and Implants. The Adult Shoulder. The Adult Arm. The Adult Elbow. The Adult Forearm. The Adult Wrist. The Adult Hand. The Adult Cervical Spine. The Adult Thorocolumbar Spine. The Adult Pelvis (Pelvis, Acetabulum, Sacrum, Coccyx). The Adult Hip. The Adult Thigh. The Adult Knee. The Adult Leg. The Adult Ankle. The Adult Foot.

TREATMENT OF TUBERCULOSIS OF THE SHOULDER

Some uncertainty exists as to the most suitable treatment for tuberculosis of the shoulder in adults. This is due partly to the relative rarity of this condition and partly to the inadequate follow-up after treatment. In the case of children the problem seems simpler, because there is almost complete agreement that treatment should be conservative. In this paper treatment will be evaluated on the basis of the experience at the Lakeville State Sanatorium. Since tuberculosis is a systemic illness with local manifestations, the general treatment of the patient is of great importance. If possible, a period of sanatorium care should be instituted before operative procedures are undertaken. Fresh air, an adequate and balanced diet and regular rest periods are important in restoring the patient to his optimum physical condition. Immobilization of the affected shoulder in a plaster cast is orthodox therapy. For children a long period of conservative treatment is