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The architecture of the glenohumeral joint makes it the most common large joint to become dislocated, accounting for approximately 45% of all dislocations. Anterior dislocation constitutes more than 95% of [...]

Glenohumeral subluxation (GHS) is a recognized complication in people with poststroke hemiplegia. The reported incidence of GHS ranges from 17% to 81% of patients, depending on the measurement methods used [...], Background. Glenohumeral subluxation (GHS) is a common poststroke complication. Treatment of GHS is hampered by the lack of objective, real-time clinical measurements. Objective. The aims of this study were: (1) to compare an ultrasound method of GHS measurement with the fingerbreadth palpation method using a receiver operating characteristic curve (ROC) and (2) to report the sensitivity and specificity of this method. Design. A prospective study was conducted. Setting. The study was conducted in local hospitals and day centers in the southwest of England. Patients. One hundred five patients who had one-sided weakness following a first-time stroke (51 men, 54 women; mean age=71 years, SD=11) and who gave informed consent were enrolled in the study. Measurements. Ultrasound measurements of acromion-greater tuberosity (AGT) distance were used for the assessment of GHS. Measurements were undertaken on both shoulders by a research physical therapist trained in shoulder ultrasound with the patient seated in a standardized position. Fingerbreadth palpation assessment of GHS was undertaken by a clinical physical therapist based at the hospital, who also visited the day centers. Results. The area under the ROC curve was 0.73 (95% confidence interval [95% CI] =0.63, 0.83), suggesting that the ultrasound method has good agreement compared with the fingerbreadth palpation method. A cutoff point of ≥ 0.2 cm AGT measurement difference between affected and unaffected shoulders generated a sensitivity of 68% (95% 0=51%, 75%), a specificity of 62% (95% 0=47%, 80%), a positive likelihood ratio of 1.79 (95% 0=1.1, 2.9), and a negative likelihood ratio of 0.55 (95% 0=0.4, 0.8). Limitations. Clinical therapists involved in the routine care of patients conducted the fingerbreadth palpation method. It is likely that they were aware of the patients' subluxation status. Conclusion. The ultrasound method can detect minor asymmetry (≤ 0.5 cm) and has the potential advantage over the fingerbreadth palpation method of identifying patients with minor subluxation.

The potential relationship of scapular position and motion to shoulder disorders has made them of great interest to many clinicians and researchers. (1-6) Studies using 3-dimensional motion analysis clarified the [...], Background and Purpose. Lengthening of the pectoralis minor muscle (PMi) during passive shoulder motions and the effect of stretching techniques for this muscle are unclear. The purposes of this study were: (1) to investigate the amount and pattern of the lengthening between passive shoulder motions and (2) to determine which stretching technique effected the greatest change in PMi length. Methods. Nine fresh cadaveric transthoracic specimens were used. Lengthening in the lateral and medial fiber group of the PMi was directly measured during 3 passive shoulder motions (flexion, scaption, and external rotation at 90° of abduction) and 3 stretching techniques (scapular retraction at 0° and 30° of flexion and horizontal abduction) for this muscle. The measurement was conducted by using a precise displacement sensor. Results. Although the length of the PMi linearly increased during all shoulder motions, lengthening during flexion and scaption was steeper and significantly larger than that during external rotation at 90 degrees of abduction. For the stretching techniques, scapular retraction at 30 degrees of flexion and horizontal abduction stretched the PMi more than scapular retraction at 0 degrees of flexion. In comparison with lengthening at 150 degrees of flexion, scapular retraction at 30 degrees of flexion significantly stretched the medial fiber group of the muscle. Discussion and Conclusion. The extensive lengthening of the PMi is necessary during shoulder motions, especially flexion and scaption. Scapular retraction at 30 degrees of flexion makes the greatest change in PMi length. This study suggests the importance of the PMi in shoulder motion and provides anatomical and biomechanical evidence that might guide appropriate selection of stretching techniques.

Introduction Glenohumeral dislocation is an important cause of shoulder injuries seen in the emergency department (ED) (1,2) and is the most frequent type of dislocation reduced by emergency physicians (EPs). [...], Objective: We prospectively derived a clinical decision rule to guide pre- and postreduction radiography for emergency department (ED) patients with anterior glenohumeral dislocation. Methods: This prospective cohort derivation study took place at 4 university-affiliated EDs over a 3-year period and enrolled consenting patients with anterior glenohumeral dislocation who were 18 years of age or older. We compared patients with a clinically important fracture-dislocation with those who had an uncomplicated dislocation to provide the clinical decision rule components using recursive partitioning. The final rule involved age, mechanism, prior dislocation and humeral ecchymosis. Results: A total of 222 patients were included in the study. Forty (18.0%) had clinically important fracture-dislocation. A clinical decision rule using 4 factors reached a sensitivity of 100% (95% confidence interval [CI] 89.4%-100%), a specificity of 34.2% (95% CI 27.7%-41.2%), a negative predictive value of 99.2% (95% CI 92.8%-99.9%) and a negative likelihood ratio of 0.04 (95% CI 0.002-0.27). Patients younger than 40 years are at high risk for clinically important fracturedislocation only if the mechanism of injury involves substantial force (i.e., a fall greater than their own height, a sport injury, an assault or a motor vehicle collision). Patients 40 years of age or older are at high risk only in the presence of humeral ecchymosis or after their first dislocation. Projected use of the rule would reduce the absolute number of prereduction radiographs by 27.9% and of postreduction by 81.9%. Conclusion: The Quebec shoulder dislocation rule for patients with acute anterior glenohumeral dislocation holds promise to reduce unnecessary imaging, pending validation. Keywords: anterior shoulder dislocation, emergency medicine, clinical decision rules, shoulder fractures Objectif : Notre etude visait a etablir de facon prospective une regle de decision clinique afin de guider le recours aux radiographies precedant et suivant la reduction chez les patients se presentant a l'urgence avec une luxation glenohumerale anterieure. Methode : Cette etude de derivation sur une cohorte prospective s'est deroulee sur une periode de 3 ans, dans 4 services d'urgence d'hopitaux universitaires. Nous avons inscrit des patients consentants de 18 ans ou plus qui presentaient une luxation glenohumerale anterieure. Nous avons compare les patients ayant une luxation ou une fracture cliniquement importante avec ceux qui avaient une luxation sans complication en vue d'etablir les criteres d'une regle de decision clinique en utilisant le partitionnement recursif. Les criteres de la regle definitive etaient l'age, le mecanisme de blessure, les antecedents de luxation et une ecchymose au niveau de l'humerus. Resultats : L'etude comptait 222 patients. Quarante (18,0 %) presentaient une fracture ou une luxation cliniquement importante. La regle de decision clinique fondee sur 4 facteurs avait une sensibilite de 100 % [intervalle de confiance (IC) a 95 % de 89,4 a 100 %), une specificite de 34,2 % (IC a 95 % de 27,7 a 41,2 %), une valeur predictive negative de 99,2 % (IC a 95 % de 92,8 a 99,9 %) et un rapport de vraisemblance negatif de 0,04 (IC a 95 % de 0,002 a 0,27). Les patients de moins de 40 ans presentent un risque eleve de fracture ou de luxation cliniquement importante seulement si le mecanisme de blessure implique une force d'impact importante (c'est-a-dire chute d'une hauteur superieure a celle de la victime, blessure liee a un sport, agression ou accident automobile). Les patients de 40 ans ou plus sont exposes a un risque eleve seulement en presence d'une ecchymose au niveau de l'humerus ou apres une premiere luxation. Les projections quant a l'utilisation de cette regle permettent de croire qu'on reduirait le nombre absolu de radiographies pre-reduction de 27,9 % et celui des radiographies post-reduction de 81,9 %. Conclusion : La regle concernant les luxations d'epaule appliquee au Quebec pour les patients presentant une luxation glenohumerale anterieure aiguest prometteuse. Elle pourrait en effet reduire le recours a l'imagerie, dans l'attente de sa validation.

Central cord syndrome (CCS) results from an injury to the central region of the spinal cord. The injury can be caused by varying etiologies, such as trauma, vascular problems, or [...], Background and Purpose. This case report describes the examination, intervention, and outcome of a patient with central cord syndrome (CCS) who participated in acute rehabilitation that included the use of electrical stimulation (ES) and strapping to address shoulder subluxation. The only literature found describing these interventions for shoulder subluxation was for patients with stroke. Case Description. The patient was a 29-year-old man with CCS and bilateral shoulder subluxation. He received ES over 8 weeks to the anterior and middle deltoid and supraspinatus muscles of the right shoulder. Taping was repeated every 3 to 4 days on both shoulders following over the anterior and middle deltoid muscles up to the acromion. Outcomes. The initial shoulder subluxation measurements were 1.5 cm on the right and 1.0 cm on the left. The final measurements were 0.3 cm on the right and 0.2 cm on the left. The patient's American Spinal Injury Association upper-extremity motor scores were 26/50 initially and 48/50 at discharge. Conclusion. The use of ES and shoulder taping in conjunction with other rehabilitation may have played a role in reducing the patient's shoulder subluxation. [Peterson C. The use of electrical stimulation and taping to address shoulder subluxation for a patient with central cord syndrome. Key Words: Central cord syndrome, Electrical stimulation, Physical therapy, Shoulder subluxation, Taping.

Objective: To identify all available shoulder disability questionnaires designed to measure physical functioning and to evaluate evidence for the clinimetric quality of these instruments. Methods: Systematic literature searches were performed [...]

A 38-YEAR-OLD MAN was brought into our emergency department (ED) after driving his motorcycle at high speed into a tree. The patient, who hadn't been wearing a helmet, was thrown [...]

Doctors often are quick to suggest surgery for muscle and joint disorders brought about by athletic activity. Shoulder dislocations are injuries that do require the attention of doctors. Knowing some muscle exercises can do much to prevent the dislocation of unstable shoulders.

Shoulder dislocations and their treatment have been written about and discussed since at least the 5th century BC, when Hippocrates described a number of methods of reduction.[1] During the Greek [...], The glenohumeral joint of the shoulder is the most commonly dislocated joint in the body. When dislocation occurs, it is usually anterior. The primary care physician usually sees the patient after reduction has been performed. Thus, treatment is directed at recovery of function and preventing recurrences. The prognosis and likelihood of recurrence in a first-time anterior dislocation depends on the mechanism of injury, treatment, rehabilitation, sex, age, and complications. Non-operative treatment after reduction usually involves immobilization and rehabilitation. Studies to date seem to indicate that age and activity level are more important factors for recurrence than length of immobilization. Traditionally, if there are recurrences after conservative treatment, then surgery is contemplated. Key words. Shoulder dislocation; recurrence; immobilization; clinical protocols. J Fam Pract 1992; 35:567-576.

"Cruciate ligament ruptures and shoulder dislocations are often caused by trauma, but predisposing intrinsic factors might also influence the risk. These injuries are more common in those with a previously [...]

My right shoulder is lower than my left. Can I fix the difference with exercise? --Robert, Nashville, TN If you have pain, weakness, or restricted motion in your shoulder that [...]

A case report describes a patient who presented with a rare combination of voluntary posterior shoulder instability combined with superimposed traumatic posterior shoulder instability. The case illustrates the protean nature of posterior shoulder instability and documents the importance of recognizing that the pathologic lesions and their treatment vary according to the type of shoulder instability.

Inferior shoulder dislocation (luxatio erecta) is a rare form of shoulder dislocation. A case involving bilateral luxatio erecta with bilateral brachial plexus injury and rotator cuff tears is reported. A [...]

Objective--To introduce the Spaso technique for reducing anterior shoulder dislocation by reporting the success rate of the Spaso technique performed by junior emergency medicine residents. Design--Retrospective case series. Setting--Urban accident [...]

Like many of the weekend warriors in San Francisco's adult municipal softball league, I fashioned myself an athlete, despite 29 years of evidence to the contrary. So when an opposing [...]

There are new, improved surgical solutions for many common male maladies. Does your doctor know about them? OPERATING ROOMS used to look like butcher shops: all blood, guts, and gleaming [...]

Patients with uncomplicated anterior shoulder dislocations often spend a prolonged period in pain and in the emergency department (ED) because of the frequent need for procedural sedation. These considerations, together [...]