Long-Lever-Arm Manipulation Under Anesthesia With Resultant Traumatic Anterior Shoulder Dislocation.

The patient was a 61-year-old woman who underwent long-lever manipulation under anesthesia (MUA) for adhesive capsulitis. Two weeks following MUA, the constellation of clinical findings raised concern for possible adverse outcomes. Radiographs were obtained, as well as subsequent magnetic resonance imaging and computed tomography scans. Images revealed anterior shoulder dislocation with Bankart and Hill-Sachs lesions, and an anterior rotator cuff tear. J Orthop Sports Phys Ther 2016;46(8):707. doi:10.2519/jospt.2016.0412.

A noninvasive mechanical treatment to reduce the visible appearance of cellulite.

Cellulite is a cosmetic condition of subcutaneous fat herniation through fibrous connective tissue that results in a dimpled appearance of the skin. Occurring in approximately 85% to 90% of all women worldwide, cellulite has been well studied. The result has been the development of a plethora of treatment protocols yielding little to no success. We describe a noninvasive mechanical treatment for women with cellulite, evaluating the safety and effectiveness of a technique that utilizes a unique patented device for the reduction of the visible appearance of cellulite.

Translational manipulation after failed arthroscopic capsular release for recalcitrant adhesive capsulitis: a case report.

OBJECTIVE: This article reports the use of translational manipulation after failed arthroscopic capsular release for adhesive capsulitis. CLINICAL FEATURES: The patient was a 40-year-old woman, insulin-dependent diabetic with the insidious onset of right shoulder adhesive capsulitis. The patient underwent physical therapy 3 times a week for 6 weeks with minimal changes in her range of motion or pain. After failing physical therapy, the patient had arthroscopic capsular release and long-lever arm rotational manipulation of the right shoulder. The patient participated in physical therapy again, failing to regain her range of motion. INTERVENTION AND OUTCOME: Subsequently, the patient underwent interscalene block and translational manipulation by the same therapist followed by physical therapy. The patient's range-of-motion measures, strength testing, pain scale measurements, and functional scoring were recorded throughout her rehabilitation. She returned 2 years postdischarge for the same tests and measurements. CONCLUSION: Adhesive capsulitis in association with diabetes mellitus poses a serious treatment dilemma. Arthroscopic release may have limited benefits secondary to limited release and/or postoperative pain limiting rehabilitation. Translational manipulation under interscalene block may be considered in this difficult treatment group.

Shoulder outcome measures: a comparison of 6 functional tests.

BACKGROUND: Several shoulder function scores are used in research, with no universally adopted standard. This study compares 6 shoulder outcome scales. HYPOTHESIS: Correlations exist between shoulder outcome scales, allowing conversion between scales. Shoulder scales are correlated with age. STUDY DESIGN: Regression and correlation study. METHODS: Seventy subjects with shoulder pain completed 6 shoulder outcome scales. Pearson correlations were calculated between the total scores of the 6 instruments, between the components of the scales, and with age. Regression equations were calculated between scales. RESULTS: The range of r values for total scores was 0.495 < or = r < or = 0.770, P < or = .01. In general, a scale's components were themselves highly correlated and added little new information to the scale (0.260 < or = r < or = 0.705, P < or = .05). Most of the scale scores were highly correlated with age (0.291 < or = r < or = 0.582, P < or = .05). Constant's reported corrections for age reduced (from r = -0.582 to r = -0.250, P < .05) but did not eliminate age as a confounding variable. CONCLUSIONS: Correlations exist between shoulder outcome scales, but existing shoulder scales are not equivalent in their assessments of function; they contain redundant information and, in some cases, may reflect a patient's age better than his/her shoulder function. The utility of conversion equations is minimized as a result of low to moderate correlations between scales.

Predicting shoulder strength using allometry: implications for shoulder outcome assessments.

INTRODUCTION: Shoulder strength is an integral component of shoulder function. In assessing shoulder function many functional scales rely on direct or indirect measures of strength. Strength, and thus these scales, is often highly correlated with age. We propose an allometric method for assessing shoulder strength. Allometric modeling has provided accurate predictions of biologic growth and physiologic function in both human and animal studies. Allometry utilizes the relationship between the two homologous structures on the left and right sides of the body, providing in effect an internal control and thus eliminating many confounding effects, e.g. age and level of activity. METHODS: Twenty patients with unilateral shoulder dysfunction underwent strength testing of their affected and unaffected shoulder. Strength testing of the bilateral shoulders was also assessed in twenty people without shoulder pain in order to delineate the effect of hand dominance on strength in those without shoulder pain. Absolute and predicted strength deficits of the involved shoulder were calculated via regression analysis. Pearson's correlation coefficients were computed between age and strength. RESULTS: Utilizing the contralateral extremity as an internal control eliminates age as a confounding variable in predicting strength outcomes (r = 0.093). CONCLUSION: Allometric concepts, applied to shoulder strength assessment, eliminates age as a confounding variable. Strength testing of both shoulders should be considered in the development of future shoulder outcome scales in order to eliminate the strong influence of age.

Theory and technique of translational manipulation for adhesive capsulitis.

Manipulation of the glenohumeral joint with the patient under anesthesia has long been used as a treatment modality for refractory shoulder stiffness. Recently, translational manipulation of the glenohumeral joint under interscalene brachial plexus regional block has been shown to be efficacious in the treatment of adhesive capsulitis and to present a low risk of iatrogenic injury. The theory and technique of glenohumeral translational manipulation for the treatment of adhesive capsulitis are presented here.