Shoulder

Ultrasound of the shoulder is a powerful and accurate method for the examination of the rotator cuff, biceps mechanism and the synovium. This article describes the anatomy, standard examination technique, indications, pitfalls and potential errors. It lists suggested imaging algorithms for a range of shoulder pathology.

Motor improvements in chronic stroke recovery accrue from coupled protocols of bilateral movements and active neuromuscular stimulation. This experiment investigated coupled protocols and within-limb transfer between distal and proximal joint combinations. The leading question focused on within-limb transfer of coupled protocols on distal joints to a bimanual aiming task that involved proximal joints. Twenty-six volunteers completed one of three motor

Today advances in techniques and materials for rotator cuff surgery allow the repair of a large variety of types or extensions of cuff lesions in patients from a wide range of age groups who have different kinds of jobs and participate in different kinds of sports, and who have widely different expectations in terms of recovery of functions and pain relief. A large number of factors must be taken into account before implementing a rehabilita- tion protocol after rotator cuff surgery. These mainly include the technique (materials and procedure) used by the surgeon. Moreover, tissue quality, retraction, fatty infiltration and time from rupture are important biologi- cal factors while the patient’s work or sport or daily activities after surgery and expectations of recovery must also be assessed. A rehabilitation protocol should also take into account the timing of biological healing of bone to tendon or tendon to tendon interface, depending on the type of rupture and repair. This timing should direct the therapist’s choice of correct passive or assisted exercise and mobilisation manoeuvres and the teaching of correct active mobilisation movements the patient has to do. Following accepted knowledge about the time of biolog- ical tissue healing, surgical technique and focused reha- bilitation exercise, a conceptual protocol in four phases could be applied, tailoring the protocol for each patient. It starts with sling rest with passive small self-assisted arm motion in phase one, to prevent post-op stiffness. In phase two passive mobilisation by the patient dry or in water, integrated with scapular mobilisation and stabilis- er reinforcement, are done. Phase three consists of pro- gressive active arm mobilisation dry or in water integrat- ed with proprioceptive exercise and “core” stabilisation. In phase four full strength recovery integrated with the recovery of work or sports movements will complete the protocol. Because of the multi-factorial aspects of the problem, the best results can be obtained through a full transfer of information from the surgeon to the therapist to optimise timing and sizing of the individual rehabilita- tion protocol for each patient.

To delineate factors that differentiate shoulder dystocia with and without brachial plexus injury (BPI). A case-control study culled from an established shoulder dystocia database. Cases of shoulder dystocia-related BPI were identified and matched (1:1) with a control group of shoulder dystocia in which BPI did not result. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. From 1980 to 2002, there were 89 978 deliveries with 46 cases of dystocia and BPI. The rate of dystocia with BPI was 0.5 per 1000 births and of permanent BPI, 0.9/10 000 deliveries. The two groups were similar for maternal demographics, diabetes, gestational age, induction, use of epidural, the duration of labor, operative vaginal delivery, rate of macrosomia, and maneuvers used to relieve the dystocia. Fracture of the clavicle occurred significantly less often among those without (2%) vs. with BPI (17%; OR 0.10, 95% CI 0.01, 0.88). Neither antepartum nor intrapartum factors can differentiate the ...

In recent years the popularity of disabled sports and competition among disabled athletes has grown considerably. With this rise in exposure of, and participation in wheelchair sports comes an increase in related stressors, including musculoskeletal load. External mechanical loading may increase the risk of shoulder complaints. The objective of this literature review was to 1) identify and describe the prevalence and/or incidence of shoulder complaints in wheelchair athletes in the literature, to 2) examine the factors and underlying mechanisms that could be potentially involved, and 3) provide some insights into the development of preventative measures. A literature search was conducted using PubMed, Scopus and Embase databases, to identify relevant published articles. All articles in the English language that contained any type of shoulder complaint in relation with a wheelchair sports player, at any level of status (recreational to elite), of any sport, were included. Articles we...

Hammersmith Infant Neurological Examination (HINE) is a set of tests used for grading neurological development of infants on a scale of 0 to 3. These tests help in assessing neurophysiological development of babies, especially preterm infants who are born before (the fetus reaches) the gestational age of 36 weeks. Such tests are often conducted in the follow-up clinics of hospitals for grading infants with suspected disabilities. Assessment based on HINE depends on the expertise of the physicians involved in conducting the examinations. It has been noted that some of these tests, especially pulled-to-sit and lateral tilting, are difficult to assess solely based on visual observation. For example, during the pulled-to-sit examination, the examiner needs to observe the relative movement of the head with respect to torso while pulling the infant by holding wrists. The examiner may find it difficult to follow the head movement from the coronal view. Video object tracking based automatic or semi-automatic analysis can be helpful in this case. In this paper, we present a video based method to automate the analysis of pulled-to-sit examination. In this context, a dynamic programming and node pruning based efficient video object tracking algorithm has been proposed. Pulled-to-sit event detection is handled by the proposed tracking algorithm that uses a 2-D geometric model of the scene. The algorithm has been tested with normal as well as marker based videos of the examination recorded at the neuro-development clinic of the SSKM Hospital, Kolkata, India. It is found that the proposed algorithm is capable of estimating the pulled-to-sit score with sensitivity (80%-92%) and specificity (89%-96%).

Background: Shoulder osteoarthritis (OA) is a painful condition in which movement of
the shoulder becomes restricted. Treatment is aimed at pain reduction and maintain
or improve functions. Intra-articular steroid injections have proven to be an effective
and cost-effective treatment option. However, long-term use can weaken the shoulder
tendons and cause histological changes. Recently, botulinum toxin has been evaluated
for the treatment of the chronic joint pain. Its injection into the painful shoulder joints
may inhibit the inflammatory mediators and the neuropeptide release which act on
articular nociceptors and produce pain.
Objective: The present study compared the efficacy of ultrasound-guided intra-articular
Botox and corticosteroid injections in glenohumeral joint in terms of reduction of pain
scores and enhancing range of movement in patients with shoulder OA.
Methodology: Fifty eligible patients with shoulder OA were randomly assigned to two
groups of Botox and corticosteroid (each with 25 patients). Ultrasound-guided intraarticular injections were randomly performed in all participants. Patients were evaluated in terms of effect on pre-procedure pain scores, range of abduction, internal rotation and external rotation, at 2 weeks and 12 weeks after injection. Two-way ANOVA and t-tests were utilized to analyze the data.
Results: The study results indicated that the injection of Botox and corticosteroid in
the shoulder joint cause reduction in pain and increased range of movements of the
patients with glenohumeral OA. Botox injection exerts more long-lasting effects in
comparison to the corticosteroid group. Mean pain scores were lower in Botox group in comparison to the steroid group (2.75 vs. 4.24); patients in the Botox group experienced more pain reduction at week-12 and more increase in range of abduction, internal rotation and external rotation.
Conclusion: It is concluded that intra-articular Botox injection can be more useful than
intra-articular steroid injection in terms of pain reduction and function improvement.
Key words: Osteoarthritis; Botulinum toxin; Pain management; Acetylcholine; Receptors, Cholinergic
Citation: Hashemi SM, Khamene SMH, Nabi BN, Ghasemi M. Effects of ultrasound guided intraarticular botox vs. corticosteroids for shoulder osteoarthritis. Anaesth
Pain & Intensive Care 2018;22(3):355-360

The purpose of this study was to determine the biomechanical and anthropometric factors contributing to elbow valgus torque during pitching. Video data of 14 youth pitchers throwing fastballs were used to calculate shoulder and elbow kinematics and kinetics. Peak elbow valgus torque averaged 18 Nm and occurred just before maximal shoulder external rotation. The magnitude of valgus torque was most closely correlated with the thrower's weight. When subject weight and height were controlled for, maximum shoulder abduction torque and maximum shoulder internal rotation torque were most strongly associated with elbow valgus torque, accounting for 85% of its variance (P <.001). When only kinematic variables were considered, maximum shoulder external rotation accounted for 33% of the variance in valgus torque. Given that the biomechanical variables correlated with peak valgus torque are not easily modifiable, limiting the number of innings pitched is likely the best way to reduce elb...