Shoulder muscle strength and fatigability in patients with frozen shoulder syndrome: the effect of 4-week individualized rehabilitation.

The effect of 4-week individualized rehabilitation on shoulder muscle strength and fatigability was evaluated in 10 patients with frozen shoulder syndrome (FSS) in comparison of 10 age- and gender-matched healthy control subjects. Isometric maximal voluntary contraction (MVC) force of the shoulder flexors was measured by hand-held dynamometer. Isometric endurance of the shoulder muscles was characterized by endurance time and net impulse (NI) assessed during weight (30% MVC) holding in hand until exhaustion. Fatigability of deltoideus, infraspinatus and trapezius muscles during isometric endurance test was assessed by electromyogram (EMG) power spectrum median frequency (MF) slope per minute. Rehabilitation in patients with FSS consisted of exercise therapy in swimming pool and gymnasium, electrical therapy and massage. Before rehabilitation, patients with FSS had less (p < 0.05) isometric MVC force and NI during endurance test compared to the control. MF slope in patients with FSS for involved extremity was higher (p <0.05) for the deltoideus muscle and less for the infraspinatus muscle before rehabilitation compared to the controls. Shoulder pain was decreased (p < 0.05) and isometric MVC force and NI in endurance test in patients for involved extremity were increased after rehabilitation. No significant changes in endurance time and MF slope for infraspinatus and trapezius muscles in patients for involved extremity were observed after rehabilitation, whereas MF slope for deltoideus muscle was increased. It was concluded that in patients with FSS, 4-week rehabilitation decreased shoulder pain and improved MVC force of the shoulder flexors and isometric working capacity of these muscles during endurance test.

The anterior glenohumeral joint capsule: macroscopic and MRI anatomy of the fasciculus obliquus or so-called ligamentum glenohumerale spirale.

The purpose of this study was to demonstrate the macroscopic and MRI anatomy of the fasciculus obliquus, otherwise known as the ligamentum glenohumerale spirale or spiral GHL of the anterior shoulder joint capsule. Conventional and MR arthrography (1.5-T device Somatom Symphony, Siemens with shoulder coil) images in standard planes were compared with gross anatomic dissection findings in six fresh shoulder specimens from three cadavers. The MR imaging protocol included T1, PD and DESS 3D WI sequences. The macroscopically recognisable band-the spiral GHL-was identified by anatomic dissection and MRI in all the specimens. It was best visualised by MR arthrography on axial and oblique sagittal planes (T1; PD WI) and appeared as a low signal intensity stripe within the superficial layer of the anterior joint capsule. The absence of the variable middle glenohumeral ligament did not influence the anatomic properties and the MR imaging of the spiral GHL. Diagnostic visualisation of the normal anatomic structures is a prerequisite to distinguish between normal and pathologic conditions. Anatomy of the spiral GHL can be used by radiologists for more detailed interpretation of the anterior shoulder joint capsule ligaments on MR images.

High-load coordination dynamics in athletes, physiotherapists, gymnasts, musicians and patients with CNS injury.

High-load coordination dynamics were measured in athletes, physiotherapists, gymnasts, musicians, patients with spinal cord injury and a patient with multiple sclerosis during exercise on a special coordination dynamic therapy device to quantify improvement in the central nervous system (CNS) organization due to therapy in patients and to quantify differences in the CNS organization between healthy subjects and patients with CNS injury. The values of high-load coordination dynamics for the group of athletes were two times better than those of physiotherapists, gymnasts and musicians, but still two times poorer than the best value achieved so far in a patient with a spinal cord injury after 10 months of continuous intensive coordination dynamics therapy. Especially the physiotherapists, gymnasts and musicians had poor coordination between arms and legs for the difficult intermediate coordinations between pace and trot gait for high load. Exhaustion of the CNS and improvement of CNS functioning in the short-term memory could be made visible using hysteresis-like curves for load increase and decrease. When not receiving therapy, patients with CNS injury could not turn at high loads, and showed poor coordination at lower loads only. After exercising 7,000 coordinated arm and leg movements per month, the CNS organization for high load improved in 3 healthy subjects by 36%. In patients with CNS injury, such improvements of high-load coordination dynamics took several months of intensive coordination dynamics therapy including 350,000 coordinated movements per months. The rate of learning may differ in healthy subjects and patients very approximately by a factor of 50 depending on the severity of the injury. On the other hand however, the high-load coordination between arms and legs, necessary for walking could be improved during therapy even in patients with multiple sclerosis, with the consequence that they could manage better in every day life.

Anatomical composition of the anterior shoulder joint capsule. A cadaver study on 12 glenohumeral joints.

Twelve right cadaver shoulder joints were investigated after alcohol-formalin-glycerol fixation. The tendons of the "rotator cuff" were separated from the joint capsule. The capsulo-ligamentous structures: Lig. coracohumerale, Lig. coracoglenoidale and Ligg. glenohumeralia were dissected. In addition to the Ligg. glenohumerale superius, medium et inferius, an "unknown glenohumeral ligament" coursed in the midline of the superficial layer of the anterior shoulder joint capsule. It arose from the axillary part of the Lig. glenohumerale inferius and the insertion tendon of the Caput longum m. tricipitis brachii, coursed upwards laterally and fused with the Lig. glenohumerale medium. Between the Ligg. glenohumerale medium et inferius it was connected with the shoulder joint capsule by loose connective tissue. Craniolaterally it melted into the superior portion of the M. subscapularis and inserted together with its tendon to the Tuberculum minus of the Humerus. The ascending fibres of the "unknown glenohumeral ligament" and the oblique, descending fibres of the Ligg. glenohumeralia medium et inferius crossed twice and formed X-shape connections between the ligaments. In external rotation and abduction or anteversion the course of fibres of the "unknown glenohumeral ligament" was spiral. According to the shape and anatomical position of the "unknown glenohumeral ligament" we propose to name it "Lig. glenohumerale spirale".

Anatomy of the coracohumeral and coracoglenoidal ligaments.

The Ligg. coracohumerale and coracoglenoidale are constant anatomical structures, represented in all the 34preparations investigated. The Lig. coracoglenoidale is a strong band of dense connective tissue, running from the Processus coracoideus to the Tuberculum supraglenoidale. In 27 specimens out of 34 it was the continuation of the M. pectoralis minor tendon. The Lig. coracohumerale consists of two separate parts. The "inferior part" originates from the Processus coracoideus and the Lig. coracoglenoidale, which separates it from the base of the coracoid process. It is composed of the joint capsule anteriorly and a remnant of the M. pectoralis minor tendon posteriorly. The "superior part" arises from the medio-posterior surface of the Processus coracoideus, just below the Lig. coracoacromiale. Both parts of the Lig. coracohumerale run into the shoulder joint capsule under the M. supraspinatus tendon and insert into a capsular semicircular band. According to the shape and course of fibres between the greater and lesser tubercles of the Humerus, we propose to name it the "Lig. semicirculare humeri". None of the two parts of the Lig. coracohumerale begins from the base of the Processus coracoideus, and fibres of the Lig. coracohumerale do not reach the Tuberculum majus et minus directly.

The structure and vascularization of the biceps brachii long head tendon.

In the present study we examined the structure and the blood supply of the long biceps tendon as well as the surface of the intertubercular sulcus, using tissue samples from children and adults. The applied methods were light and electron microscopy, immunohistochemistry, and arterial injection techniques. The tendon represents a sliding tendon with the intertubercular sulcus and humeral head as hypomochlion. The parts facing the humerus show some ultrastructural features of fibrous cartilage, the ovoid chondrocyte-like cells of the tendon lying within felt-like matrix. In the opposite part adjacent to the capsule, the tendon resembles a traction tendon. The intertubercular sulcus is covered by fibrous cartilage. The tendon is supplied with arteries from three different sources. The density of intratendinous vessels in the traction zone is comparable to that of other tendons, while in the sliding zone it is markably decreased. The immediate vicinity of the sliding surface is avascular. Our findings show that the long biceps tendon is structurally adapted to both its functions as sliding and traction tendon. The blood supply seems to be related to the metabolic requirements of the different parts of the tendon.

A note on the anatomy of the supraspinatus muscle.

The muscles and tendons of the rotator cuff of 37 fixed cadaver shoulder joints were dissected. In ten shoulder joints devoid of gross pathological lesions it was found that the supraspinatus muscle was inserted at two points--mainly into the major tubercle and partly into the lesser tubercle of the humerus. In one case of six, an additional insertion clearly occurred in a shoulder joint with rotator cuff tear.