Shoulder Weakness Research Articles

Spontaneous detachment of the deltoid muscle origin

Three patients with four affected shoulders with spontaneous detachment of the deltoid origin are reported. In this group spontaneous detachment of the deltoid origin was associated with chronic massive rotator cuff defects. Detachment of the deltoid origin was associated with an acute, sudden onset of shoulder weakness. Pain was not a prominent complaint, and shoulder function was poor because of weakness. Spontaneous detachment of the deltoid origin can occur with chronic massive rotator cuff tears and can be responsible for an acute onset of shoulder weakness.

SHOULDER WEAKNESS - GERIATRIC GOLFER

247 HISTORY - An active 73 year old male recreational golfer presented with a chief complaint of right sided neck pain and shoulder weakness of one week duration. The pain started insidiously, was exacerbated by neck movement, and was maximally relieved by rest. He denied antecedent trauma or previous shoulder injury though related a prior history of left cervical radiculopathy twenty years ago. The right shoulder weakness significantly affected his back-swing and was most obvious when he attempted any overhead motions. Furthermore, he reported a vague numbness in the right hand and on rare occasion experienced pain radiating to the right elbow. Additional past medical history included chronic obstructive pulmonary disease, hypothyroidism, hypertension, and an elevated prostate specific antigen(PSA). PHYSICAL EXAMINATION - Neck range of motion (ROM) was full in all planes but precipitated right posterior neck and trapezius muscle pain. On palpation there was minimal cervical paraspinal and shoulder girdle muscle tenderness. Passive right shoulder ROM was normal however, active ROM was limited to 80 degrees of forward flexion and abduction. Shoulder impingement tests were mildly to moderately provocative. Reflexes were normal except for an equivocally reduced right biceps reflex. Manual muscle testing revealed moderate weakness in the right deltoid, biceps and supraspinatus. Sensory examination was normal. Foraminal compression maneuvers were negative. DIFFERENTIAL DIAGNOSIS: Cervical radiculopathy Rotator cuff tendonitis or tear Brachial plexopathy (traumatic, neoplastic, idiopathic) TESTS AND RESULTS: Serology - CBC and sTSH were normal, PSA was highly elevated at 50.9 X-rays cervical spine (with flexion/extension) - Mild degenerative changes with no evidence of instability. MRI cervical spine - No disk herniations or neuroforaminal stenosis. EMG - Consistent with right upper trunk brachial plexopathy. MRI brachial plexus - No evidence of mass lesion or traumatic plexopathy. FINAL/WORKING DIAGNOSIS: Neuralgic Amyotrophy (Idiopathic Brachial Plexopathy) Probable prostate cancer. TREATMENT: Modalities (heat and ice) for pain control as needed. Non-steroidal anti-inflammatory drugs or acetaminophen as needed. Shoulder ROM exercises. Review proper shoulder biomechanics to normalize glenohumeral and scapulothoracic rhythm. Sub-maximal rotator cuff strengthening. Sub-maximal biceps and deltoid strengthening. Recommend Urologic Consultation for prostate evaluation.

Pain and Weakness of the Shoulder in a 16-Year-Old Boy

Pain and Weakness of the Shoulder in a 16-Year-Old Boy

きょく下筋単独麻ひ症例の臨床的検討

We report 6 patients with entrapment of the infraspinatus branch of the suprascapular nerve and discuss the diagnosis, pathology, treatment, and outcome over a mean follow-up period of 5 years. Each patient presented shoulder pain and weakness. EMG disclosed denervation and motor unit loss restricted to the infraspinatus muscle, with the supraspinatus muscle remaining normal. 2 patients were seen to have spaceoccupying lesions at the spinoglenoid notch by MRI, and ganglia were confirmed and removed surgically in 3 patients. Good results were seen in 3, but 1 required reoperation because of recurrence. We performed neurolysis and shaving of the spinoglenoid notch on a patient without ganglia. The other 2 patients without ganglia were treated conservatively. Our patients required 1 to 2 years to recover from paralysis of the infraspinatus muscle. Suprascapular neuropathy at the spinoglenoid notch should be included in the differential diagnosis of patients presenting shoulder pain and weakness.

Arthroscopic acromioclavicular resection

Injury to the acromioclavicular joint is common and represents the source of many shoulder-related symptoms.Frequently, nonoperative treatment regimens such as physical therapy, oral antiinflamatory medication, and corticosteroid injections resolve symptoms. However, certain patients with cases refractory to conservative therapy require an operative intervention. The traditional open resection of the distal clavicle, as described independently by Mumford and Gurd has been a reproducible and reliable surgical method of treatment in patients with posttraumatic, degenerative disease of the acromioclavicluar joint associated with osteoarthritis, distal clavicle osteolisis, fractures and separations, and shoulder impingement syndrome. Advances in arthroscopic shoulder surgery and subacromial decompression have made debridement of the acromioclavicular joint and resection of the distal clavicle a viable alternative to the open approach, avoiding complication such as AC joint instability and residual postoperative shoulder weakness, and with distinct advantages like 1) evaluation of glenohumeral joint, 2) evaluation and treatment of coexistent impingement and rotator cuff pathology, 3) generally, performed on an outpatient basis, which decreases hospital cost and increases patient convenience.

Sidestepping Burners

If you play football or any other contact sport, you might have experienced or heard about "burners" or "stingers." These are nerve injuries that can result from a blow to or a fall on the head, neck, or shoulder. Burning and stinging in the neck and arm are common symptoms, but some athletes also experience numbness, tingling, or shoulder weakness.

Burner Syndrome

Burner syndrome (brachial plexus injury) is common in contact sports, especially on the football field, but not always benign. Our case report describes a 15-year-old football player who suffered burner symptoms that resolved quickly but led to shoulder weakness and neck pain a few days later. Detailed serial clinical examinations are imperative for proper classification of burner injuries. Cervical root lesions, shoulder injuries, and other plexus or nerve involvement must be excluded. Rehabilitation includes physical modalities and range-of-motion, stretching, and strengthening exercises for cervical, shoulder, and elbow muscles. Prevention measures include preseason strengthening exercises and protective devices.

Burner Syndrome.

In brief Burner syndrome-brachial plex us injury-is common in contact sports, especially on the football field, but not always benign. Our case report describes a 15-year-old football player who suffered burner symptoms that resolved quickly but led to shoulder weakness and neck pain a few days later. Detailed serial clinical examinations are imperative for proper classification of burner injuries. Cervical root lesions, shoulder injuries, and other plexus or nerve involvement must be excluded. Rehabilitation includes physical modalities and range-of-motion, stretching, and strengthening exercises for cervical, shoulder, and elbow muscles. Prevention measures include preseason strengthening exercises and protective devices.

Acute brachial neuropathy--electrophysiological study and clinical profile.

Acute brachial neuropathy (ABN) is a rare disease, characterized by an acute or subacute onset of pain followed by weakness of shoulder or arm muscles without trauma or traction injury. So the diagnosis of this clinical entity is not easy. The purpose of this study was to analyze retrospectively the ABN in 14 cases focusing on the clinical profile and to evaluate the effectiveness of electrophysiologic study in diagnosis of ABN with a new result helpful in localizing a brachial plexus disorder. The most helpful electrophysiologic data of ABN in my patients seemed to be abnormalities of low amplitude, abnormal right to left difference of compound motor action potentials (CMAPs) and sensory nerve action potentials (SNAPs) in axillary nerve, ulnar or median nerves. Results of nerve conduction velocity, terminal and F-wave latency were not as useful. But the electromyogram was most helpful in localization of upper or lower plexus lesions and cervical radiculopathy. The most striking clinical feature of ABN was the rapid onset of pain followed by the development of muscle weakness of shoulder girdle after a variable period or within four days. In contrast to other reports, intrinsic hand muscle weakness was observed in 3 cases with sensory changes in ulnar nerve distribution. The cervical radiculopathies (C5-C7 roots) were simultaneously combined with ipsilateral axillary neuropathy in 3 cases. In this study, decreased amplitude, abnormal right to left difference of SNAPs and CMAPs, and neurogenic EMG findings with normal data of NCV, terminal and F-wave latencies suggest that the pathology of ABN might not be a demyelinating process, but axonopathy.

Paresthesia and Motor Weakness of Left Shoulder after Interscalene Nerve Block: A case report

Paresthesia and Motor Weakness of Left Shoulder after Interscalene Nerve Block: A case report

Measurement of isometric elbow and shoulder moments: position-dependent strength of posterior deltoid-to-triceps muscle tendon transfer in tetraplegia.

This report describes an apparatus which has been developed to measure several isometric elbow and shoulder forces and moments simultaneously and also allows this characterization to be performed across a range of shoulder and elbow joint angles in a horizontal plane. This apparatus was used to characterize the elbow extension strength in individuals with tetraplegia resulting from cervical level spinal cord injury. In all of these individuals, voluntary elbow extension was provided exclusively by the posterior deltoid muscle, which had previously been surgically transferred to the tendon of the paralyzed triceps muscle. Elbow extension is essential for many daily activities, such as reaching above shoulder level and pushing objects away from the body; the widely used posterior deltoid-to-triceps muscle tendon transfer surgery restores some degree of voluntary control to this important function. The apparatus contained a six-axis force-moment transducer to which the arm of each subject was attached. The six outputs of the transducer were transformed to correspond to physiological elbow and shoulder moments and forces. A customized table allowed the shoulder and elbow angles of the subject to be varied over a wide range in a horizontal plane so that the effects of posterior deltoid muscle length could be characterized over the likely functional range of the subject within this plane. It was found that elbow extension strength varied widely across subjects with C5 or C6 tetraplegia, from quite weak to strong enough to propel a manual wheelchair. Furthermore, the elbow extension strength of most subjects showed a strong dependence on both elbow and shoulder angles. Elbow extension was typically weak when the upper arm was elevated to shoulder level at the side, which unfortunately corresponds to the position often adopted by these individuals due to shoulder weakness.

肩申上神経絞やく性障害の３例

The authors report three cases of suprascapular nerve entrapment occurring as the nerve passed around the lateral border of the spine of the scapula. The cardinal finding included shoulder pain, weakness and wasting of the infraspinal muscle, as well as a positive electromyogram showing fibrillation, polyphasic potential, giant spike, and delayed distal latency. Ultrasonography was a very useful diagnostic test in cases caused by ganglion. All cases were operated on. Ganglion were extirpated in 2 cases and the inferior transverse scapular ligament was excised in the other case. The shoulder pain disappeared postoperatively and at follow-up external rotation strength of the affected shoulder had almost returned to normal.

Isolated paralysis of the infraspinatus muscle

We report six patients with isolated paralysis of the infraspinatus and discuss the diagnosis, pathology, treatment, and outcome over a mean follow-up period of 33 months. Four patients were shown to have space-occupying lesions at the spinoglenoid notch by MRI or ultrasonography or both, and ganglia were confirmed and removed surgically in three, with good results. Ganglia at this site are not uncommon and should be included in the differential diagnosis of patients presenting with shoulder pain and weakness.

476 Shoulder pain and weakness ??? Softball

476 Shoulder pain and weakness ??? Softball

Long-Term Results of Flap Reconstruction in Median Sternotomy Wound Infections

Reconstruction of infected median sternotomy wounds using muscle and omental flaps has been shown to result in significantly reduced morbidity, mortality, and length of hospital stay. Despite these benefits, very little is known about the potential long-term sequelae of such procedures. The purpose of this study was therefore to evaluate the ultimate functional outcome in such patients. One-hundred and thirty-three consecutive patients underwent debridement and flap reconstruction of their infected median sternotomy wounds over an 8-year period. Eighty patients were available for follow-up and responded to a questionnaire. Forty-eight patients consented to a physical examination. The length of follow-up ranged from 15 to 108 months (average 48 months). Healed wounds were obtained in 99 percent of patients. Fifty-one percent of patients noted persistent pain or discomfort, particularly in the chest and shoulder. Forty-four percent noted areas of numbness/paresthesias, mainly on the chest. Thirty-four patients (42.5 percent) noted symptoms of sternal instability; of those consenting to an examination, 45 percent were confirmed to have instability. Twenty-six patients (32.5 percent) claimed postoperative weakness (shoulder/abdomen). Significant shoulder weakness was not demonstrated; however, abdominal weakness was substantial. Thirty-six percent of patients reported an inability to perform the same preoperative activities that were of importance to them (sports, housework, etc.). Of those patients eligible to return to work, 52 percent did not. Patients younger than age 60 had a somewhat higher chance of not returning to work. Scars were noted to be good to excellent in 75 percent, but contour abnormalities of the chest and abdomen were found in 85 percent.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthroscopic Distal Clavicle Excision Technique and Early Results

Since 1941, distal clavicle excision has been a reliable technique for alleviating pain caused by acromioclavicular joint arthritis. Disadvantages of the procedure include permanent shoulder weakness, a lengthy recovery time ranging from weeks to months before useful function of the extremity returns, and lack of cosmesis. By modifying the standard portals used to perform arthroscopic subacromial decompression, the authors have successfully excised the distal clavicle of ten consecutive patients. Using this arthroscopic technique, the surgical time averaged approximately one hour 40 minutes, blood loss was negligible, and there were no complications. Operations were performed in an outpatient setting. Five of ten patients missed work only on the day of surgery, and seven of ten patients required no formal physical therapy. All ten patients achieved a good or excellent result on the UCLA. Shoulder Scale for short-term follow-up evaluation. Postoperative radiographs documented adequate bone resection in all cases. In experienced hands, arthroscopic distal clavicle excision is an excellent substitute for the "open" procedure.

Full-Thickness Rotator Cuff Tears: Factors Affecting Surgical Outcome.

Eighty-five percent to 95% of patients who undergo primary surgical repair of full-thickness rotator cuff tears have a significant decrease in shoulder pain and improvement in shoulder function. The results of surgery are dependent on the surgical technique, the extent of pathologic changes in the rotator cuff, and the postoperative rehabilitation protocol. Preoperative factors associated with a less favorable result are the size of the tear, the quality of the tissues, the presence of a chronic rupture of the long head of the biceps tendon, and the degree of preoperative shoulder weakness. Surgical factors associated with a less favorable result include inadequate acromioplasty, residual symptomatic acromioclavicular arthritis, inadequate rotator cuff tissue mobilization, deltoid detachment or denervation, and failure of rotator cuff healing. Clinical evaluation and preoperative imaging of the shoulder will improve patient selection and counseling. Meticulous surgical technique and postoperative rehabilitation will optimize the final result.

Shoulder weakness in professional baseball pitchers

Shoulder weakness in professional baseball pitchers

Long-term spinal cord injury: functional changes over time.

Functional changes were assessed in a group of 279 individuals with long-term spinal cord injuries. All had sustained their initial injuries 20 to 47 years ago and all had received initial and postinjury follow-up care at one of two British spinal cord injury treatment centers. Twenty-two percent reported that the need for physical assistance from others had increased over the years. Most (45%) needed additional help with transfers; others needed more assistance with dressing, mobility, and toileting. When compared to those whose need for help had not increased, significant differences were found by age: as a group, and when separated by level and severity of injury, those needing more help were older, and those with cervical injuries needed help at younger ages than their counterparts with lower level injuries. Those needing more help also had significantly more reports of shoulder pain, fatigue and weakness, weight gain, and postural changes. They used more attendant care, and perceived their quality of life to be lower than those whose level of function had not changed over time.

Electromyographic Activity of Selected Shoulder Muscles in Commonly Used Therapeutic Exercises

The purpose of this study was to evaluate and compare the muscle activity of the supraspinatus, infraspinatus, teres minor, and lower trapezius muscles during commonly prescribed therapeutic exercises in subjects with and without shoulder pathology. Twenty healthy subjects (9 male, 11 female) and 20 subjects with recurrent unilateral shoulder pain and weakness (14 male, 6 female), aged 18 to 40 years (mean = 28, SD = 5.8), participated in this study. Subjects performed each of the following exercises using a hand-held weight: prone lateral (external) rotation, sidelying lateral rotation, and arm elevation in the scapular plane. Indwelling fine-wire electrodes recorded electromyographic (EMG) activity during each exercise. The EMG activity in five phases of concentric contraction of each exercise was averaged and divided into three equal time intervals. Mean EMG values normalized to maximal activity for the entire phase of concentric contraction and for each of the three intervals were used in subsequent analyses. Two-way repeated-measures analyses of variance (ANOVAs) revealed between-group differences only in the prone lateral rotation exercise. Compared with subjects without shoulder pathology, subjects with shoulder pain showed significantly greater EMG activity in the infraspinatus muscle and less activity in the supraspinatus muscle during this exercise. These results suggest that the pattern of muscle activation during specific shoulder movements in patients with shoulder pain may be related to pathology. Future studies are needed to determine whether an imbalance in neuromuscular control is a factor contributing directly to shoulder dysfunction or whether such an imbalance is secondary to some pathology.