¿Efectividad de la técnica de liberación miofacial en el aumento del rango articular en restricción glenohumeral? Una comparación con la kinesioterapia tradicional / Effectiveness of the myofascial release technique in increasing joint range in glenohumeral restriction? A comparison with traditional kinesiotherapy

OBJETIVO: comparar la kinesioterapia tradicional con la técnica miofacial en pacientes con restricción articular interna glenohumeral. MÉTODO: estudio comparativo de 8 pacientes en un grupo de intervención (GI) y kinésico (GC), durante 8 semanas. Se comparó el pre y post test del ROM interno glenohumeral en ambos grupos mediante t de student. RESULTADOS: el grupo de la técnica miofascial demostró una amento significativo de ROM interno glenohumeral de 15,2º (p < 0,001), mientras que el grupo control no fue significativo (p > 0,05) sólo de de 6,4º. CONCLUSIONES:Un tratamiento de terapia con la Técnicas Liberación Miofascial en pacientes con déficit rotacional interno de hombro es más eficaz para aumentar el rango de movimiento articular de rotación interna glenohumeral que una técnica tradicional y conservadora.

OBJETIVE: to compare traditional kinesiotherapy with myofacial technique in patients with glenohumeral internal joint restriction. METHODS: comparative study of 8 patients in an intervention (IG) and kinesiotherapy (CG) group for 8 weeks. The pre- and post-test of glenohumeral internal ROM in both groups was compared using Student's t-test. RESULTS: the myofascial technique group showed a significant increase in glenohumeral internal ROM of 15.2º (p < 0.001), while the control group was not significant (p > 0.05) only 6.4º. CONCLUSIONS: A therapy treatment with Myofascial Release Techniques in patients with shoulder internal rotational deficit is more effective in increasing glenohumeral internal rotational joint range of motion than a traditional, conservative technique.

Factores asociados con rigidez de las articulaciones del hombro y la cadera en adultos mayores / Factors associated with stiffness of the shoulder and hips joints in the elderly

Introducción: mantener el nivel adecuado de flexibilidad en la edad adulta es importante para realizar las actividades básicas de la vida diaria; sin embargo, esta puede verse afectada negativamente por distintos factores, como el sedentarismo, la artrosis, la diabetes y el estado emocional. Objetivo: analizar la prevalencia de la rigidez en las articulaciones del hombro y coxofemoral, con factores asociados en los adultos mayores de la ciudad de Cuenca, Ecuador. Metodología: estudio analítico transversal con una muestra de 160 adultos mayores de las residencias geriátricas de la ciudad de Cuenca, Ecuador. La información se recolectó aplicando dos tests que valoran la flexibilidad, incluidos en la batería Senior fitness test (SFT): el Back scratch (TBS) y el test Chair sit and reach (TCSAR), para valorar el grado de rigidez de las articulaciones del hombro y coxofemoral. El nivel de actividad física se evaluó utilizando el test Rapid Assessment of Physical Activity (RAPA), y se utilizaron el test Yesavege para valorar el grado de depresión y la historia clínica de cada paciente, para conocer antecedentes de diabetes mellitus o artrosis. Se analizaron los datos con el programa SPSS versión 20.0®, por medio de medidas de frecuencia, dispersión, análisis bivariado (OR, IC, valor P). Resultados: se evidenció la inactividad física como factor de riesgo importante para padecer rigidez de articulación del hombro p=0,023, articulación coxofemoral p<0,001; además, la artrosis como factor de riesgo para rigidez en miembros superiores. La pre-valencia de rigidez articular fue de 40,6% en miembros inferiores y el 70,6%en los miembros superiores. Conclusión: los hallazgos de esta investigación corroboran que la inactividad física pue-de llevar a la pérdida progresiva de la flexibilidad en adultos mayores, con disminución en el rango de movimiento articular y limitación funcional. (AU)

Introduction: maintaining the appropriate level of flexibility in adulthood is important to carry out the basic activities of daily life; however, this can be negatively affected by different factors, such as a sedentary lifestyle, osteoarthritis, diabetes and emotional state. Objective: to analyze the prevalence of stiffness in the shoulder and coxofemoral joints, with associated factors in older adults in the city of Cuenca, Ecuador. Methodology: cross-sectional analytical study with a sample of 160 older adults from nursing homes in the city of Cuenca. The information was collected by applying two tests that assess flexibility, included in the senior fitness test (SFT) battery: the back scratch (TBS) and the chair sit and reach test (TCSAR), to assess the degree of stiffness of the knee joint. shoulder and coxofemoral. The level of physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) test, the Yesavege test was used to assess the degree of depression and the clinical history of each patient to determine a history of diabetes mellitus or osteoarthritis. The data were analyzed with the SPSS version 20.0 program, through measures of frequency, dispersion, and bivariate analysis (OR, CI, P value). Results: physical inactivity was evidenced as an important risk factor for shoulder joint stiffness p=0.023, coxofemoral joint p=<0.001; in addition, osteoarthritis as a risk factor for stiffness in the upper limbs. The prevalence of joint stiffness was 40.6% in the lower limbs and 70.6% in the upper limbs. Conclusion: the findings of this research corroborate that physical inactivity can lead to progressive loss of flexibility in older adults, with decreased range of joint movement and functional limitation. (AU)

Parálisis obstétrica del plexo braquial: resultados preliminares de la transferencia del nervio espinal accesorio al nervio supraescapular en 10 casos / Accessory nerve to suprascapular nerve transfer in obstetrical brachial plexus palsy: prelininary results in 10 cases

Objetivo: Evaluar los resultados preliminares en 10 casos de transferencias del nervio espinal accesorio al nervio supraescapular en parálisis obstétricas del plexo braquial. Materiales y Métodos: Entre 2010 y 2012, se realizaron 16 transferencias del nervio espinal accesorio al nervio supraescapular en parálisis obstétricas del plexo braquial. Se incluyeron 10 casos con un seguimiento mínimo de 18 meses. Se evaluó la fuerza muscular del hombro según la escala de Gilbert y se usaron escalas funcionales de Mallet y de Gilbert. Se compararon valores preoperatorios y posoperatorios, así como las diferencias entre parálisis de tipo parcial y total. Se usó la prueba de Student para valorar la significancia estadística de los datos. Resultados: El seguimiento promedio fue de 20.9 meses. Se hallaron valores medios preoperatorios de fuerza de abducción de 0,48 M, y posoperatorios de 2,70 M; los valores de rotación externa preoperatorios fueron de 0 M y, al final del seguimiento, de 2,4 M. Todos los pacientes mostraban patrones preoperatorios de tipo 1 tanto de la escala de Mallet como la de Gilbert, con valores posoperatorios promedio de 3,2 y 3,5, respectivamente. Se hallaron diferencias estadísticamente significativas entre estos valores. Conclusiones: Esta serie presenta valores preliminares con un seguimiento corto y su principal crítica es el bajo número de casos. Los resultados funcionales obtenidos coinciden con los de otros reportes, y avalan su uso en las reconstrucciones del plexo braquial que requieran aporte extraplexual.

Background: To evaluate the preliminary results of spinal accessory nerve to suprascapular nerve transfer in obstetric brachial plexus palsy. Methods: Between 2010 and 2012, 16 transfers of spinal accessory nerve to suprascapular nerve were performed in obstetric brachial plexus palsy. Ten patients with a minimum follow-up of 18 months were included. Values of muscle power were assessed according to the Gilbert scale, and functional scales of the shoulder (Mallet and Gilbert) were used. Preoperative and postoperative values, and the differences between partial and total paralysis results were compared. Student test was used for the statistical analysis. Results: The average follow-up was 20.9 months. Preoperative shoulder abduction power was 0.48 M, preoperative external rotation power was 0 M, and those values at the end of the follow-up were 2.70 M and 2.4 M, respectively. All patients had type 1 patterns of the Gilbert and Mallet scales, with mean postoperative values of 3.2 and 3.5, respectively. Statistically significant differences were found between these values. Conclusions: Limitations of this preliminary report are the short follow-up and the low number of cases. However, the functional results obtained are consistent with those from other reports, and they support the use of the spinal accessory nerve to suprascapular nerve transfer in brachial plexus reconstructions requiring an extra-plexual contribution.

Evaluation of the Effusion within Biceps Long Head Tendon Sheath Using Ultrasonography

BACKGROUND: Many shoulder diseases are related to glenohumeral joint synovitis and effusion. The purpose of the present study is to detect effusion within the biceps long head tendon sheath as the sign of glenohumeral joint synovitis using ultrasonography, and to evaluate the clinical meaning of effusion within the biceps long head tendon sheath. METHODS: A consecutive series of 569 patients who underwent ultrasonography for shoulder pain were reviewed retrospectively and ultimately, 303 patients were included. The authors evaluated the incidence and amount of the effusion within the biceps long head tendon sheath on the ultrasonographic short axis view. Furthermore, the authors evaluated the correlation between the amount of effusion within the biceps long head tendon sheath and the range of motion and the functional score. RESULTS: The effusion within the biceps long head tendon sheath was detected in 58.42% of the patients studied: 69.23% in adhesive capsulitis, 56.69% in rotator cuff tear, 41.03% in calcific tendinitis, and 33.33% in biceps tendinitis. The average amount of the effusion within the biceps long head tendon sheath was 1.7 +/- 1.6 mm, and it was measured to be the largest in adhesive capsulitis. The amount of effusion within biceps long head tendon sheath showed a moderate to high degree of correlation with the range of motion, and a low degree of correlation with the functional score and visual analogue scale for pain in each type of shoulder disease. CONCLUSIONS: The effusion within the biceps long head tendon sheath is closely related to the range of motion and clinical scores in patients with painful shoulders. Ultrasonographic detection of the effusion within the biceps long head tendon sheath might be a simple and easy method to evaluate shoulder function.

A Comparison of Conventional Ultrasonography and Arthrosonography in the Assessment of Cuff Integrity after Rotator Cuff Repair

BACKGROUND: This study was designed to perform conventional ultrasonography, magnetic resonance arthrography (MRA) and arthrosonography exams after rotator cuff repair to compare the results of conventional ultrasonography and arthrosonography with those of MRA as the gold standard. METHODS: We prospectively studied 42 consecutive patients (14 males, 28 females; average age, 59.4 years) who received arthroscopic rotator cuff repair due to full-thickness tears of the supraspinatus tendon from 2008 to 2010. The integrity assessment of the repaired rotator cuff was performed 6 months postoperatively using conventional ultrasonography, MRA, and arthrosonography. RESULTS: The diagnostic accuracy of the conventional ultrasonography compared to MRA was 78.6% and the McNemar test results were 0.016 in full-thickness tear and 0.077 in partial-thickness tear. The diagnostic accuracy of arthrosonography compared to MRA was 92.9% and the McNemar test results were 0.998 in full-thickness tear and 0.875 in partial-thickness tear. CONCLUSIONS: It was found that the integrity assessment of the repaired rotator cuff by ultrasonography must be guarded against and that arthrosonography is an effective alternative method in the postoperative integrity assessment. Also, an arthrosonography seems to be a suitable modality to replace the conventional ultrasonography.

Reabilitação na paralisia parcial do plexo braquial / Rehabilitation after partial brachial plexus palsy

Muitas transferências musculares têm sido defendidas para restaurar os movimentos do membro superior após paralisia grave do plexo braquial. A paralisia dos músculos deltoide e supraespinal pode ser tratada por meio de transferência do músculo trapézio. A paralisia dos músculos extensores de punho, mão e dedos, quando o nervo mediano está preservado, pode ser corrigida com emprego dos músculos pronador redondo, flexor ulnar do carpo e palmar longo. Os autores descrevem um caso de reabilitação de paciente portador de lesão parcial antiga do plexo braquial à direita, de predomínio em tronco superior, principalmente da raiz de C6 e de fascículo posterior. Foi evidenciada fraqueza dos músculos deltoide e extensores do punho e dos dedos, sem antecedentes de reparo microcirúrgico do plexo braquial. Foi realizada, inicialmente, cirurgia de transferência tendínea para ganho de extensão de punho, mão e dedos e, após um ano, transferência do músculo trapézio, para estabilização do ombro. O sucesso na transferência para tratamento de paralisia do plexo braquial requereu especialização do cirurgião, motivação do paciente e programa de reabilitação.

A variety of muscle transfer techniques have been proposed to restore motion of the upper extremities following severe brachial plexus palsy. Paralysis of the deltoid and supraspinatus muscles can be treated with transfer of the trapezius muscle. Paralysis of the wrist, hand, and digital extensor muscles can be corrected using the pronator teres, flexor carpi ulnaris, and palmaris longus muscles if the median nerve is preserved. Here we describe the rehabilitation of a patient with an old partial injury to the right brachial plexus that primarily involved the upper trunk from the C6 root to the posterior cord. Weakness of the deltoid muscle, wrist, and digital extensor muscles was observed. Microsurgical repair of the brachial plexus had not been performed. Tendon transfer surgery was performed to improve wrist, hand, and digital extension. One year later, transfer of the trapezius muscle was performed to stabilize the shoulder. The success of muscle transfer in the treatment of the brachial plexus palsy required the surgeon's specialization, the patient's motivation, and a rehabilitation program.

Three-dimensional kinematic analysis of upper and lower limb motion during gait of post-stroke patients

The aim of this study was to analyze the alterations of arm and leg movements of patients during stroke gait. Joint angles of upper and lower limbs and spatiotemporal variables were evaluated in two groups: hemiparetic group (HG, 14 hemiparetic men, 53 ± 10 years) and control group (CG, 7 able-bodied men, 50 ± 4 years). The statistical analysis was based on the following comparisons (P ≤ 0.05): 1) right versus left sides of CG; 2) affected (AF) versus unaffected (UF) sides of HG; 3) CG versus both the affected and unaffected sides of HG, and 4) an intracycle comparison of the kinematic continuous angular variables between HG and CG. This study showed that the affected upper limb motion in stroke gait was characterized by a decreased range of motion of the glenohumeral (HG: 6.3 ± 4.5, CG: 20.1 ± 8.2) and elbow joints (AF: 8.4 ± 4.4, UF: 15.6 ± 7.6) on the sagittal plane and elbow joint flexion throughout the cycle (AF: 68.2 ± 0.4, CG: 46.8 ± 2.7). The glenohumeral joint presented a higher abduction angle (AF: 14.2 ± 1.6, CG: 11.5 ± 4.0) and a lower external rotation throughout the cycle (AF: 4.6 ± 1.2, CG: 22.0 ± 3.0). The lower limbs showed typical alterations of the stroke gait patterns. Thus, the changes in upper and lower limb motion of stroke gait were identified. The description of upper limb motion in stroke gait is new and complements gait analysis.

Análise da amplitude de movimento dos ombros antes e após a intervenção Hatha-Yoga em mulheres mastectomizadas / Survey over shoulders' movement amplitude in mastectomyzed women before and after Hatha-Yoga intervention

Introdução: Diversos benefícios decorrentes da intervenção Hatha-Yoga às mulheres mastectomizadastêm sido estudados, mas não há exploração dos ganhos obtidos na recuperação da amplitude demovimento dos ombros (ADM) dessas mulheres. Objetivos: Observar a ADM dos ombros homolaterais(OHL) e contralaterais (OCL) à cirurgia das mulheres mastectomizadas, antes e após a intervençãoHatha-Yoga. Método: Trata-se de um ensaio piloto randomizado e controlado, em 45 mulheresmastectomizadas, atendidas no Hospital Santa Rita de Cássia (HSRC), em Vitória (ES), Brasil, entremarço e novembro de 2010. Todas as voluntárias foram submetidas à avaliação inicial da ADM deflexão, extensão, abdução e adução horizontal nos OHL e OCL à cirurgia. O grupo experimental participoude 6 intervenções e foi reavaliado após esse período, enquanto o grupo controle foi reavaliadoem período proporcional. Resultados: Houve melhora significativa na ADM dos OHL nos 2 gruposna flexão e abdução, enquanto a adução e abdução não tiveram comprometimentos tão expressivos.Conclusão: Os resultados não demonstraram a relevância da intervenção Hatha-Yoga na melhora daADM das mulheres mastectomizadas. Sugerimos estudos com maior amostra e com maior período detempo a fim de avaliar melhor os efeitos musculoesqueléticos dessa intervenção nessa população.

Introduction: Several benefits of Hatha-Yoga in mastectomized women have been assessed, although withoutinquiring about the gains obtained after the recovery of their shoulders’ movement amplitude (SMA). Objectives:To observe SMA in homolateral (HLS) and contralateral shoulders (CLS) after surgery, both before andafter Hatha-Yoga intervention. Method: Controlled, randomized pilot-survey in 45 mastectomyzed women,assisted in the Hospital Santa Rita de Cássia (HSRC), in the state of Vitória (ES), Brazil, from March toNovember, 2010. All subjects underwent initial evaluation of SMA for flexion, extension, abdution and horizontaladduction in HLS and CLS to the surgery’s spot. The experimental group underwent 6 interventionsand was reevaluated thereafter, whereas control group was reevaluated after a corresponding period. Results:In both groups, HLS for flexion and abduction improved significantly, whilst neither abduction nor horizontaladduction were severely impaired. Conclusion: The results did not demonstrate the relevance of Hatha-Yogaintervention over the recovery of the mastectomized women. Surveys over a wider sample, during a longerperiod, are suggested in order to better evaluate the muscular effects of such intervention in that population..

Comparison of quality of life, satisfaction with surgery and shoulder-arm morbidity in breast cancer survivors submitted to breast-conserving therapy or mastectomy followed by immediate breast reconstruction

OBJECTIVES: This study was designed to compare the prevalence of shoulder-arm morbidity, patient satisfaction with surgery and the quality of life of women submitted to breast-conserving therapy or modified radical mastectomy and immediate breast reconstruction . METHODS: This study was a cross-sectional study of women who underwent breast-conserving therapy (n=44) or modified radical mastectomy and immediate breast reconstruction (n=26). Quality of life was evaluated with the SF-36 Health Survey Questionnaire. RESULTS: No differences were found in the prevalence of lymphedema. The movements that were most commonly affected by these procedures were abduction, flexion and external rotation. When the two groups were compared, however, we only found a statistically significant difference for the prevalence of restricted internal rotation, which occurred in 32 percent of women in the breast-conserving therapy group and 12 percent of those in the modified radical mastectomy and immediate breast reconstruction group (OR: 7.23; p=0.03 following adjustment for potential confounding factors). No difference in quality of life or satisfaction with surgery was found between the two groups. CONCLUSIONS: These data suggest that the type of surgery did not affect the occurrence of lymphedema. Breast-conserving therapy, however, increased the risk of shoulder movement limitation. No differences were found between the two surgical techniques with respect to quality of life or satisfaction with surgery.

Arthroscopic Suture Bridge Repair Technique for Full Thickness Rotator Cuff Tear

BACKGROUND: The purpose of our study is to evaluate the clinical results of arthroscopic suture bridge repair for patients with rotator cuff tears. METHODS: Between January 2007 and July 2007, fifty-one shoulders underwent arthroscopic suture bridge repair for full thickness rotator cuff tears. The average age at the time of surgery was 57.1 years old, and the mean follow-up period was 15.4 months. RESULTS: At the last follow-up, the pain at rest improved from 2.2 preoperatively to 0.23 postoperatively and the pain during motion improved from 6.3 preoperatively to 1.8 postoperatively (p < 0.001 and p < 0.001, respectively). The range of active forward flexion improved from 138.4degrees to 154.6degrees, and the muscle power improved from 4.9 kg to 6.0 kg (p = 0.04 and 0.019, respectively). The clinical results showed no significant difference according to the preoperative tear size and the extent of fatty degeneration, but imaging study showed a statistical relation between retear and fatty degeneration. The average Constant score improved from 73.2 to 83.79, and the average University of California at Los Angeles score changed from 18.2 to 29.6 with 7 excellent, 41 good and 3 poor results (p < 0.001 and p = 0.003, respectively). CONCLUSIONS: The arthroscopic suture bridge repair technique for rotator cuff tears may be an operative method for which a patient can expect to achieve clinical improvement regardless of the preoperative tear size and the extent of fatty degeneration.

[Normalized electromyography of shoulder muscles during selected functional tasks of upper limb in patients with shoulder impingement syndrome]

Precise muscle activity pattern is required to maintain normal shoulder function and any alteration in muscle activity can result in movement impairment. The purpose of this study was to assess normalized electromyography [EMG] of shoulder muscles during selected functional tasks of upper limb in patients with shoulder impingement syndrome. Test group consisted of 15 subjects with shoulder impingement syndrome selected by nonprobability convenient sampling and control group consisted of 15 matched healthy subjects. In each group selected exercises including open kinetic chain with and without external load and closed kinetic chain with axial load were done and during each exercise surface EMG from selected muscle was recorded. There was significant difference between the two groups in the activities of upper trapezius, infraspinatus and three regions of deltoid muscle [P<0.05].changes in normalized EMG were task dependent. Among all selected exercises, D2E showed minimum changes and tripod showed maximum changes in muscle activity domain. Decrease in activity domain of infraspinatus and trapezius muscles in patients with shoulder impingement syndrome causes impairment of shoulder function. D2E with causing minimum changes and Tripod with causing maximum changes in muscles activity domain are suggested respectively as the first and the last activity patterns in the treatment of these patients

Mucopolissacaridose tipo VI (síndrome de Maroteaux-Lamy): avaliação da mobilidade articular e das forças de garra e de pinça / Mucopolysaccharidosis type VI (Maroteaux-Lamy syndrome): assessment of joint mobility and grip and pinch strength

OBJETIVO: Descrever o perfil de mobilidade articular e das forças de garra e de pinça de indivíduos com MPS VI, além de sua correlação com a excreção urinária de glicosaminoglicanos, atividade da ARSB e distância percorrida no teste de caminhada de 6 minutos. MÉTODOS: Estudo observacional de 28 pacientes com MPS VI, não submetidos a tratamento específico. Todos os pacientes foram avaliados em relação à amplitude da mobilidade articular, forças de garra e de pinça, excreção urinária de glicosaminoglicanos, atividade da ARSB e teste de caminhada de 6 minutos. RESULTADOS: Demonstrou-se maior comprometimento de flexão de ombro, sem correlação com a idade, e da extensão de joelho e flexão de cotovelo, estas últimas correlacionadas negativamente com a idade. A força de garra mostrou-se comprometida em todos os pacientes, e a força de pinça apresentou correlação positiva com idade. CONCLUSÕES: A restrição da flexão de ombro, sem correlação com a idade, sugere que este achado esteja presente precocemente na MPS VI e se constitua em sinal clínico importante para suspeita diagnóstica desta doença. A amplitude da extensão de joelho e da flexão de cotovelo, por sua vez, por apresentarem correlação negativa com a idade, são possíveis marcadores da evolução da doença. Estudos adicionais são necessários para confirmação dessas hipóteses.

OBJECTIVE: To describe the profile of joint mobility and grip and pinch strength of MPS VI patients and to correlate this with urinary excretion of glycosaminoglycans (GAGs), ARSB activity, and the distance covered in a 6-minute walking test (6MWT). METHODS: This was an observational study of 28 patients with MPS VI, who had not undergone specific treatment. All patients were assessed for amplitude of joint mobility (shoulder, elbow, and knee), grip and pinch strength and urinary GAG excretion and also performed the 6MWT. RESULTS: Shoulder flexion exhibited the greatest limitation, with no correlation with age, followed by knee extension and elbow flexion, both of which were correlated inversely with age. Hand grip strength was compromised in all patients, and pinch strength exhibited a positive correlation with age. CONCLUSIONS: The fact that restricted shoulder flexion was not correlated with age suggests that this finding is present early on in MPS VI and that it constitutes an important clinical sign that should arouse diagnostic suspicion of this disease. The amplitude of knee extension and elbow flexion, in turn, are possible markers of disease progression since they have a negative correlation with age. Further studies are needed to confirm these hypotheses.

Testes para avaliação dos movimentos do ombro: confiabilidade e influência do número de repetições / Tests for assessing shoulder movements reliability and influence of the number of repetitions

O estudo visou investigar a confiabilidade intra e interexaminadores de quatro testes que avaliam os movimentos do complexo articular do ombro e a influência do número de repetições na confiabilidade dos testes...

This study aimed at investigating intrarater and interrater reliability of four clinical assessment test of movements of the shoulder articular complex, also investigating the influence of the number of repetitions on tests reliability...

Abduction Motion Analysis of Hemiplegic Shoulders with a Fluoroscopic Guide

PURPOSE: We investigated the usefulness of video based, fluoroscopically guided abduction motion analysis of hemiplegic shoulders. PATIENTS AND METHODS: Twenty-two stroke patients with Brunnstrom stages 3-4 (Group 1) or 5-6 (Group 2) were enrolled in this study. Patients with shoulder pain and significant spasticity (MAS 2) were excluded. We recorded motion pictures of the abductions of affected and unaffected shoulder joints under an AP fluoroscopic guide. Lateral scapular slide distances (D1: T2- superior angle, D2: T3- scapular spine, D3: T7-inferior angle) were measured at 30 degrees, 60 degrees, 90 degrees during glenohumeral abduction in a captured photographic image. The angles of scapular rotation and trajectory (stromotion) of the humeral head center, relative to the 3rd thoracic spine in the abduction motion were analyzed. RESULTS: In Group 1, a significant difference was found in the lateral scapular slide distance between the affected and sound sides. However, no significant side to side difference was found in Group 2. Scapular angles in abduction were also increased in Group 1. Patients with a more synergistic movement pattern showed less scapular stabilizing muscle activity and, instead, exhibited a compensatory "shrugging" like motion accomplished by spinal tilting. CONCLUSION: The present findings support the notion that the above parameters of fluoroscopically guided shoulder abduction motion analysis correlate well with clinical findings. These parameters should be useful for evaluations of hemiplegic shoulder biomechanics.

Forensic identification of floating shoulder injury / 法医学杂志

OBJECTIVE@#To discuss forensic identification of floating shoulder injury (FSI).@*METHODS@#To analyze fifteen cases of FSI which were accepted from Jan. 1993 to Jan. 2006, including 15 shoulder neck fracture, 13 clavide stem fracture and 2 distal end clavide fracture, the function of shoulder joint was evaluated six months after injure considering the following three aspects: result of forensic examination such as X-ray photograph, CT and MRI, the injurers' symptom, objective sign and joint function, shoulder joint territory, degree of pain and local muscle power.@*RESULTS@#Basing on the curative effect standard of Herscovic, all cases were divided into good. Modest, worst, which included 2, 4, 9 cases respectively; referring the standard of GA35-92, GB18667-2002, all cases were divided into six, seven, eight, nine and ten degree, which included 2,9,2,1,1 cases respectively.@*CONCLUSION@#As a special powerful injure, FSI always companied with concurrent and multiple injure, and characterized by missed, incorrect and delayed diagnosis and infelicitous treatment, which lead to the high frequency and degree of injure. To prevent missed and incorrect forensic identification, we should have a full realization of the particularity of FSI, and evaluate the function of shoulder all-sidely, objectively and synseticaly.

Luxação recidivante do ombro: do papiro de Edwin Smith à capsuloplastia térmica / Shoulder recurrent dislocation: from Edwin Smith's papyrus to thermal capsuloplasty

O primeiro registro de luxação glenoumeral remonta ao papiro de Edwin Smith (3000-2500 a.C.), sendo conhecida e estudada por Hipócrates (470-377 a.C.). Desde então, houve grande evolução no diagnóstico, entendimento e, especialmente, no tratamento dessa patologia e das lesões a ela associadas. Os avanços dos métodos diagnósticos e o conhecimento anatômico permitiram que novas lesões associadas fossem reveladas (SLAP, GLAD, ALPSA, HAGL), modificando o método de tratamento. O entendimento da avulsão do lábrum, conhecida como lesão de Bankart, e denominada "lesão essencial", foi fundamental para o aprimoramento da técnica cirúrgica. As técnicas cirúrgicas antigas, que visavam a estabilização através de encurtamento capsular ou bloqueio da rotação externa, sem corrigir a lesão labral, foram substituídas pela reinserção do lábrum, restaurando a anatomia. O emprego das âncoras de sutura diminuiu o tempo cirúrgico e facilitou tecnicamente o procedimento. O entendimento dos conceitos de instabilidade e de frouxidão capsuloligamentar foram igualnente importantes na escolha da técnica apropriada. As técnicas cirúrgicas atuais visam a reconstrução das lesões associadas, sem causar restrição da mobilidade ou de atividade do paciente. A análise de diversas publicações demonstra que a técnica aberta para o tratamento da luxação recidivante é um procedimento com resultados conhecidos e com baixo índice de recidiva e outras complicações, sendo considerado ainda como o golden standard. A técnica artroscópica, minimamente invasiva, sem dúvida trouxe grande avanço, com melhor conhecimento das lesões associadas, melhor cosmese e com preservação do músculo subescapular. Apresenta resultados comparáveis aos da técnica aberta, quando a adequada seleção do paciente é realizada. A cirurgia de Bristow permanece sendo um procedimento de "salvação", nos casos de grande fratura do rebordo da glenóide e falha da técnica convencional. A capsuloplastia térmica produz resultados incertos e seu uso vem sendo abandonado

Effects of a Comprehensive Rehabilitation Program for Mastectomy Patients / 간호학회지

PURPOSE: The purpose of this study was to investigate the effect of a comprehensive rehabilitation program on physical function, immune response, fatigue and quality of life in mastectomy patients. METHOD: The subjects included fifty-five patients with breast cancer (27 in the control group and 28 in the experimental group). The subjects in the experimental group participated in a comprehensive rehabilitation program for10 weeks, which was composed of 1 session of education, 2 sessions of stress management, 2 sessions of exercise, and 1 session of peer support group activity per week. RESULT: The results revealed anincrease in shoulder extension, abduction, external rotation, and internal rotation of the affectedupper extremity, and in shoulder extension and abduction of the healthy upper extremity. Also an increase in quality of life and a decrease in fatigue were significantly higher in the experimental group than the control group. However, the results revealed that the natural killer cell ratio of the experimental group increased but there was no significant difference from that of the control group. CONCLUSION: The 10-week comprehensive rehabilitation program showed a large affirmative effect on physical function, fatigue and quality of life of breast cancer patients after a mastectomy.

Effects of a Comprehensive Rehabilitation Program for Mastectomy Patients / 간호학회지

PURPOSE: The purpose of this study was to investigate the effect of a comprehensive rehabilitation program on physical function, immune response, fatigue and quality of life in mastectomy patients. METHOD: The subjects included fifty-five patients with breast cancer (27 in the control group and 28 in the experimental group). The subjects in the experimental group participated in a comprehensive rehabilitation program for10 weeks, which was composed of 1 session of education, 2 sessions of stress management, 2 sessions of exercise, and 1 session of peer support group activity per week. RESULT: The results revealed anincrease in shoulder extension, abduction, external rotation, and internal rotation of the affectedupper extremity, and in shoulder extension and abduction of the healthy upper extremity. Also an increase in quality of life and a decrease in fatigue were significantly higher in the experimental group than the control group. However, the results revealed that the natural killer cell ratio of the experimental group increased but there was no significant difference from that of the control group. CONCLUSION: The 10-week comprehensive rehabilitation program showed a large affirmative effect on physical function, fatigue and quality of life of breast cancer patients after a mastectomy.

A capsular dilatation facilitated shoulder manipulation for treating patients with frozen shoulder.

Forty patients with a diagnosis of frozen shoulder who had symptom for an average of 8 months and failed conservative treatment of at least 6 weeks of physical therapy were treated with capsular dilatation facilitated shoulder manipulation. Post-manipulation, the patient underwent arthroscopy for visualization, fibrin debridement and bleeding point coagulation. All the essential intra-articular structures ie, glenohumeral ligament, rotator cuff were intact. Post-operatively, all patients revealed substantial gain in shoulder range of motion as well as diminished shoulder pain. The average flexion, abduction, and internal rotation gain were 76.9+/-8.9, 18.1+/-5.7, 9.6+/-7.1 degrees respectively. External rotation gain in the position of 90 degrees shoulder abduction and shoulder adduction were 53.0+/-9.97 and 31.4+/-7.2 degrees respectively. The average pain score by visual analogue scale pre and 6-month post-manipulation were 80.6+/-8.6 and 7.6+/-7.3 respectively with the average of pain score of 73.0+/-10.4. The authors proposed an effective and safe technique employing intra-articular pressure to facilitate shoulder manipulation in order to treat frozen shoulder.