Shoulder Involvement Research Articles

Heterotopic Ossification

Heterotopic ossification is becoming increasingly recognized as a phenomenon that can complicate trauma to the head and spinal cord. It can be a disabling accompaniment of thermal injury, and it may seriously compromise results in hip arthroplasty and the treatment of acetabular fractures. Etiologic factors, which are imprecise and incompletely understood, vary with the clinical situation. The five cases reported here illustrate the radiologic appearances, complications, and diagnostic problems, including the difficulty in determining the timing of surgical resection. Reported for the first time are cases of neurogenic heterotopic ossification associated with bilateral shoulder involvement and bilateral ulnar nerve entrapment at the elbow. Heterotopic ossification may mimic acute arthritis.

Cervical Spine and Shoulder Pain

The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.

Postburn Heterotopic Ossification

An analysis of 1,478 consecutive admissions to the University of Kansas Burnett Burn Center revealed 18 patients who developed heterotopic ossification (1.2% incidence). Seventeen patients developed this disease in the elbows; one patient had shoulder involvement. Two patients eventually developed bilateral elbow disease. All patients initially presented with pain and limitation of joint motion. The diagnosis was then confirmed radiographically. All patients suspected of heterotopic ossification received physical therapy consisting of active range of motion only. Ten patients responded to conservative treatment and regained functional range of motion, and eight patients developed refractory ankylosis requiring surgical management. All surgically managed patients achieved a functional range of motion with an average followup of 35.0 months.

Restriction fragment length polymorphism analysis in ankylosing spondylitis

We utilized the technique of restriction fragment length polymorphism (RFLP) analysis in order to examine class I major, histocompatibility complex genes in 52 Alabama ankylosing spondylitis patients and 107 local control subjects. A 9.2-kilobase PvuII RFLP was identified using the class I-specific B7 cDNA probe pDP001 that was closely associated with ankylosing spondylitis, most specifically with peripheral joint (including shoulder and hip) involvement. This fragment is associated with human leukocyte antigen A3 and A9 alleles, and segregation analysis in 11 multiplex families showed the RFLP to frequently segregate independently of B27 haplotypes. Two more recent studies have not confirmed the association of the 9.2-kilobase PvuII RFLP with ankylosing spondylitis per se, believed to be due to clinical and possibly genetic differences between the patient groups studied. These data strongly suggest at least one other major histocompatibility complex class I gene to be operative in predisposition to or modification of ankylosing spondylitis.

The arthritis of Behçet's disease: a prospective study.

A prospective study of arthritis was performed in 47 patients with Behçet's disease followed up over a 47-month period (mean 19.25 months, SD 14.09). These patients had a total of 80 episodes of arthritis, which were analysed for joint distribution and symmetry, in 56 of which the duration could also be determined. Attacks were oligoarticular, affecting up to 4 joints per patient, 54 (68%) being monoarticular. Knees, ankles, and wrists were the most commonly involved joints. Involvement of spinal, shoulder, hip, and sacroiliac joints was rare. The arthritis was usually not deforming and subacute; 82% (46/56) of the attacks lasted for 2 months or less and 18% (10/56) for between 3 months and 4 years. The ESR was moderately elevated during the attacks. In 32 specimens the synovial fluid was inflammatory (cell count 14.7 +/- 10.1 x 10(9)/l), but in 19 (59%) a good mucin clot formed. Synovial biopsy in 12 patients revealed superficial ulceration, paucity of plasma cells, and in 5 instances lymphoid follicle formation.

Rheumatologic Aspects of Painful Conditions Affecting the Shoulder

Patients with shoulder arthritis present to the orthopedic surgeon due to joint pain and loss of shoulder motion. A differential diagnosis is established, based on the history and physical examination and selected laboratory tests and roentgenograms. Synovial fluid analysis is often very helpful in the diagnosis of shoulder arthritis and critical for differential diagnosis of inflammatory, degenerative, and septic arthritis. Shoulder involvement in primary osteoarthritis is uncommon. The shoulder is rarely the initial joint involved in rheumatoid arthritis. Several uncommon conditions, e.g., amyloid arthropathy and reflex sympathetic dystrophy syndrome, may present early and frequently in the form of shoulder pain. The results of treatment are determined by etiology of shoulder joint disease. Patients with shoulder involvement in rheumatoid arthritis generally respond to the basic management for rheumatoid arthritis. Physical therapy to improve the range of motion of the shoulder and anti-inflammatory medications, including intra-articular corticosteroids, are helpful in most cases.

Neonatal functioning and the sudden infant death syndrome

A male infant, diagnosed as a Sudden Infant Death Syndrome (SIDS) at 5 months, 3 weeks, had been extensively tested as a part of a larger sample in a longitudinal study. The longitudinal sample was comprised of 137 clinically normal neonates, born to intact upper middle-class families, living in a large metropolitan area. A neonatal assessment consisted of 5 hours of polygraphic recordings of heart and respiratory rate during sleep and waking cycles, and 1 hour of behavioral testing. At 3 months of age the infant was observed for 12 hours in the home. Retrospective analyses of these data suggested that: (a) neonatal respiratory behavior during sleep did not distinguish this infant from a sample of control infants; (b) the infant lacked strength in movements requiring the involvement of shoulder and neck muscles (head lift from a prone position); and (c) informal observations by skilled and experienced observers distinguished this infant from the sample of controls.

A biomechanical analysis of the Olympic-style flatwater kayak stroke

To investigate the biomechanics of flatwater kayaking, the technique of nine Olympic caliber K-1 paddlers was analyzed using cinematographic and computer procedures. Results indicated that, during paddle-water contact, the horizontal arm action was one of push-then-pull with the push coming from the arm farthest from the water (thrust segments) followed by the pull coming from the arm closest to the water (draw segments). During this action, the center of paddle rotation shifted up the paddle shaft as the stroke progressed, which increased the time the paddle was in the power phase of the stroke. The horizontal movement patterns of the individual segments indicated that the push was accomplished by an integrated movement of the thrust wrist and elbow, with minimal shoulder involvement. Subsequently, the pull was accomplished by an integrated movement of the draw wrist, elbow, shoulder, as well as the thrust shoulder. During the latter stages of water contact, since the performers were unable to generate additional useful power, the paddle was rapidly withdrawn to avoid dragging. Subject stability in the frontal plane was maintained by shifting the body mass toward the water contact side at paddle entry and away from it at exit. This action opposed the vertical forces produced as a by-product of the stroke. The final outcome of this stroke technique was the maintenance of the body center of gravity velocity while the boat oscillated under the performer.

Radiologic Features of Reiter Disease

The radiologic manifestations of Reiter disease in 56 patients are described. Although the findings are often nonspecific, certain features are distinctive, particularly when present in combination. These include subtle periosteal bone apposition at bony prominences, the infrequency of regional panarthritis and hip and shoulder involvement, the tendency for destructive arthritis to be confined to small joints, particularly in the feet, and a typically "discontinuous" spondylitis characterized by eccentric, laterally positioned vertebral hyperostoses which tend to bridge around the contigous disk. Attention is drawn to similar hyperostoses which occur above the true sacroiliac joints. The significance of these features, particularly in terms of differential diagnosis, is discussed.

Shoulder Problems In Juvenile Chronic Polyarthritis

A high incidence of shoulder involvement was seen in severely disabled young people suffering from juvenile chronic polyarthritis who were undergoing surgical procedures on the lower limbs. The progressive nature of the radiological changes is described. Possible lines of surgical management are considered.

The modified Bristow procedure for recurrent dislocation of the shoulder

A review of fifty-one cases of the modified Bristow procedure for recurrent anterior shoulder instability is presented. The results were favorable. The redislocation rate was 2% with few complications. The average limitation of motion was 11 degrees of external rotation. Athletic individuals with involvement of the dominant shoulder were not capable of returning to high performance levels of overhead sports activity (particularly throwing) after the operation.

LIMB-GIRDLE MUSCULAR DYSTROPHY: CLINICAL MANIFESTATIONS AND DETECTION OF PRECLINICAL DISEASE

The clinical picture of limb-girdle muscular dystrophy is described as seen in 37 affected individuals from two large Amish kindreds. The disease is characterized by an autosomal recessive mode of inheritance with as many females as males being affected, and with affected individuals being the product generally of consanguineous matings. The age of onset was observed to be between 4 and 15 years of age (average 8½) with a quite variable age of confinement to a wheelchair (12 to 44 years ). The disease was compatible with a life span in one patient to 67 years of age. The involvement of proximal shoulder and pelvic girdle muscles was similar to that in the X-linked recessive, Duchenne type of muscular dystrophy; however, the zygomaticus muscles of the face are preserved and a normal upturned smile is noted in this type of muscular dystrophy rather than the flat transverse smile noted in the X-linked recessive type. Muscle biopsy abnormalities in two individuals very early in the course of their disease suggest that biopsy would probably be useful in detection of preclinical disease in this type of muscular dystrophy. Gross abnomalities of serum enzymes in 12 younger siblings of affected individuals in these two families suggest that these enzyme determinations are useful in detecting preclinical, limb-girdle muscular dystrophy. When therapy for muscular dystrophy becomes available, the determination of preclinical disease by these techniques will become of greater clinical significance.

Arthralgia in Pulmonary Tuberculosis during Chemotherapy

SUMMARY Twenty-four patients treated for pulmonary tuberculosis with isoniazid and streptomycin are presented who developed arthralgia between two to six months after initiation of chemotherapy. Complete discontinuation of isoniazid caused regression of symptoms. Pyridoxine was ineffective in the treatment of this syndrome. An interference with serotonin metabolism by isoniazid seems to be an alternate pathway of its toxicity. Corticosteroid and salicylate offer temporary relief; however, physiotherapy proved most effective in those with shoulder involvement.

Ankylosing Spondylitis with Subcutaneous Nodules

IS ankylosing spondylitis a distinct entity1 2 3 4 5 6 7 8 9 10 or a variant of rheumatoid arthritis?11 12 13 14 15 16 17 McEwen et al.18 regard spondylitis restricted to sacroiliac joints and spine, with or without hip and shoulder involvement, as a distinct disorder; spondylitis with peripheral joint disease is considered a variant of rheumatoid arthritis. There seem to be sufficient differences between the two conditions clinically, radiologically, serologically and therapeutically to justify Graham's7 conclusion that ". . . The enforced marriage of rheumatoid arthritis and ankylosing spondylitis should be annulled on the basis of incompatibility."A striking difference between ankylosing spondylitis and rheumatoid arthritis cited by proponents of the . . .