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Stereophotogrammetry was used to investigate the functional relations between the articular surface geometry, contact patterns, and kinematics of the glenohumeral joint. Nine normal shoulder specimens were elevated in the scapular plane by using simulated muscle forces in neutral rotation (NR) and starting rotation (SR). Motion was quantified by analyzing the translations of the geometric centers of the humeral head cartilage and bone surfaces relative to the glenoid surface. In both NR and SR, the ranges of translations of the center of the humeral head cartilage surface were greatest in the inferior-superior direction (NR 2.0 +/- 0.7 mm, SR 2.9 +/- 1.2 mm). Results of this study also show that joints with less congruence of the articular surfaces exhibit larger translations, and elevation in SR yields greater translations than in NR. Kinematic analyses with the humeral head bone surface data yielded larger values of translation than analyses that used the cartilage surface data, suggesting that similar overestimations may occur in radiographic motion studies. Results of this study demonstrate that small translations of the humeral head center occurred in both SR and NR. The proximity of the origin of the helical axes to the geometric center of the humeral head articular surface confirmed that glenohumeral elevation is mainly rotation about this geometric center with small translations.

A series of 15 patients with concomitant rotator cuff tears and infraclavicular brachial plexus injuries treated between 1 980 and 1 989 were reviewed. There were 6 men and 9 women with a mean age of 65 years. Seventeen nerve injuries were identified, including 12 axillary nerves, 4 suprascapular nerves, and 1 musculocutaneous nerve. One patient had an injury to all three nerves. Thirteen patients underwent operative repair of the torn rotator cuff, and 2 patients who refused surgery were treated conservatively. The average time from injury to surgery was 7.7 months. Follow-up averaged 5.5 years (range: 2-10 years). Clinical results were graded according to pain, range of motion, and strength. Postoperatively, mean active forward elevation was 1 37° and mean active external rotation was 40°. Clinically, 8 patients achieved complete nerve recovery and 7 had an incomplete recovery. Satisfactory pain relief was achieved in 87% of patients with 60% having excellent or good function. Overall, the results of rotator cuff repair with concurrent nerve injury are less favorable than those of isolated cuff repairs. Careful preoperative assessment of concomitant nerve injury should be performed to better predict outcome.

The purpose of this study was to determine the position of the normal patella during routine magnetice resonance imaging (MRI). The literature indicates that the normal patella is positioned laterally relative to the trochlea when the knee is fully extended. As such, a laterally positioned patella on MRI is often interpreted as normal. Yet, in our experience, patients with a normal extensor mechanism show a patella that is centered over the trochlea on MRI, and we set out to formally study this. The MRIs of 60 patients without knee extensor pathology were analyzed. In 59 patients, the patella was centered over the underlying femur. The discrepancy between these results and those in the literature can probably be accounted for by the following: (1) Knees in general are somewhat flexed during MRI, and (2) relative to patients in other studies, patients in this study were subject to stricter criteria of normality. The results of this study strongly suggest that the normal patella is centered over the underlying trochlea during routine MRI. A laterally positioned patella, although possibly common, should not be automatically dismissed as a (medically) normal finding.

In this paper we, first, briefly review existing efforts to integrate adult development theory into psychodynamic psychotherapy. Next, we examine the concept of life structure and discuss its evolution across the eras and periods of the adult years. We explore the added concepts of the core self, the vital life structure, and life structure management skills. In so doing, we provide a context for proposing a new definition of the primary task of treatment: to help patients develop life structures that ensure a good fit between internal aspects of the self and the roles, relationships, and activities that comprise their lives. The creation of a life structure that is as fully expressive of the core self as reality permits increases patients' sense of vitality and well-being.

(1971). Abstinence as a Role Requirement in Psychotherapy. Psychiatry: Vol. 34, No. 4, pp. 391-400.

The attempt to reduce discrimination against women in work settings has received new strength from the re-emergent feminist movement. Women are now more often being considered for positions of genuine organizational authority. We present and analyze a case example-a woman manager and her staff within a mental health center-that illustrates some basic problems arising from such social change. Our approach to the exercise of authority is sociopsychological: We seek to interrelate organizational structure, leadership style, and staff group dynamics.