Detection of avian leukosis virus subgroup J using the polymerase chain reaction

PURPOSE: To compare neutral, external rotation, and abduction external rotation positions of the glenohumeral joint during magnetic resonance (MR) arthrography in the assessment of the joint capsule, biceps-labral complex, and glenohumeral ligaments. MATERIALS AND METHODS: MR imaging with intraarticular administration of gadopentetate dimeglumine was performed in 10 adult cadaveric glenohumeral joints. Fat-suppressed oblique coronal, oblique sagittal, and axial. T1-weighted spin-echo imaging and axial three-dimensional spoiled gradient-recalled imaging were performed with each shoulder in the neutral, external rotation, and abduction external rotation positions. Shoulders were sectioned in the planes that yielded optimal MR images. Anatomic and MR imaging findings were correlated. RESULTS: The biceps-labral complex was best visualized on oblique coronal and axial images obtained in external rotation. Oblique axial abduction external rotation imaging best delineated the inferior glenohumeral ligament but did not improve assessment of the superior and middle glenohumeral ligaments in comparison with findings in neutral and external rotation. CONCLUSION: Although MR arthrography of the glenohumeral joint clearly delineates the biceps-labral complex and glenohumeral ligaments, external rotation of the shoulder optimizes visualization of the former structures. Abduction external rotation is the best position for evaluation of the inferior glenohumeral ligament and anterior capsular attachment.     

Stabilising function of the biceps in stable and unstable shoulders

We studied the contributions of the long and short heads of the biceps (LHB, SHB) to anterior stability in 13 cadaver shoulders. The LHB and SHB were replaced by spring devices and translation tests at 90 degrees abduction of the arm were performed by applying a 1.5 kg anterior force. The position of the humeral head was monitored by an electromagnetic tracking device with or without an anterior translational force; with 0 kg, 1.5 kg or 3 kg loads applied on either LHB or SHB tendons in 60 degrees, 90 degrees or 120 degrees of external rotation; and with the capsule intact, vented, or damaged by a Bankart lesion. The anterior displacement of the humeral head under 1.5 kg force was significantly decreased by both the LHB and SHB loading in all capsular conditions when the arm was in 60 degrees or 90 degrees of external rotation. At 120 degrees of external rotation, anterior displacement was significantly decreased by LHB and SHB loading only when there was a Bankart lesion. We conclude that LHB and SHB have similar functions as anterior stabilizers of the glenohumeral joint with the arm in abduction and external rotation, and that their role increases as shoulder stability decreases. Both heads of the biceps have been shown to have a stabilising function in resisting anterior head displacement, and consideration should therefore be given to strengthening the biceps during rehabilitation programmes for chronic anterior instability of the shoulder.     

Valgus osteotomy of the humeral neck: a technique for the treatment of humerus varus

Proximal humerus varus is defined by both its radiographic and clinical characteristics. Clinically significant humerus varus has a proximal humeral neck-shaft angle less than 140 degrees and causes limited active abduction or forward flexion as a result of impingement of the greater tuberosity on the acromion. Weakness of the shoulder girdle is often present as well. The condition may be congenital, developmental, idiopathic, or posttraumatic in origin. Previous treatments for humerus varus have included acromionectomy and wedge osteotomy with placement of the extremity in a shoulder spica cast. This article describes a technique for treatment involving valgus osteotomy of the humeral neck and tension-band fixation. Correction of the deformity allows markedly improved function of the extremity with significant increases in active and passive abduction, forward flexion, and internal rotation.     

Long-term effectiveness of translational manipulation for adhesive capsulitis

Long term effects of glenohumeral joint translational (gliding) manipulation on range of motion, pain, and function in patients with adhesive capsulitis were studied. Thirty-one patients underwent brachial plexus block followed by translational manipulation of the glenohumeral joint. Changes in range of motion and pain were assessed before manipulation with the patient under anesthesia, immediately after manipulation with the patient still under anesthesia, at early followup (5.3 +/- 3.2 weeks), and at long term followup (14.4 +/- 7.3 months). Passive range of motion increased significantly for flexion, abduction, external rotation, and internal rotation. Significant decreases in visual analog pain scores between initial evaluation and the followup assessments also occurred. Furthermore, Wolfgang's criteria score increased significantly between initial evaluation and followup assessments. Translational manipulation provides a safe, effective treatment option for adhesive capsulitis.     

Static functional study with magnetic resonance of anterior shoulder instability

We studied the glenohumeral joint, in its different components, with cine MRI. Ten asymptomatic volunteers and 6 patients with recurrent shoulder instability were examined with T2-weighted GE MR sequences on the axial plane with the subjects' arms rotated in different positions. The sections corresponding to the subcoracoid space and bicipital groove were recorded in closed-loop video format for cine display. Normal morphological glenoid labrum changes were demonstrated in different degrees of humerus rotation. The subscapularis tendon and the capsule were redundant and infolded toward the joint on internal rotation in 4/6 patients. We found capsular detachment in 2 patients, humeral head subluxation in 3 and subcoracoid impingement in 2 patients. Cine MRI permitted the accurate study of the changes in the glenoid labrum, capsule and subscapularis tendon in all patients and it also showed narrowed coracohumeral distance (< 11 mm) on internal rotation.     

Indirect MR arthrography of anterior shoulder instability in the ABER and the apprehension test positions: a prospective comparative study of two different shoulder positions during MRI using intravenous gadodiamide contrast for enhancement of the joint fluid

OBJECTIVE: The value of MRI for the evaluation of anterior shoulder instability can be enhanced by shoulder positions that stress the stabilising structures. The ABER position is one that has been described in combination with intra-articular gadopentetate dimeglumine arthrography. We believe that MRI in the Apprehension test position with 90 degrees abduction and maximal tolerable external rotation provides maximum tension on the anterior stabilising structures and with this technique it is sufficient to use indirect gadodiamide arthrography following intravenous injection of the contrast medium. The purpose of this study was to make a prospective comparative evaluation of the ABER and Apprehension test positions when using indirect arthrography with intravenous gadodiamide administration in shoulders with anterior instability. DESIGN AND PATIENTS: Sixteen patients with persistent anterior instability after recurrent shoulder dislocations were examined in an open MRI unit (0.2 T) following 0.1 mmol/kg of intravenous gadodiamide. Oblique axial T1-weighted imaging was used for analysis. Operative findings were used for correlation. RESULTS: Both the ABER and the Apprehension test position were useful techniques in detecting capsulolabral pathology and Hill-Sachs lesions. The Apprehension test position produced significantly better gadodiamide-enhanced joint fluid in the region of pathology in both the capsulolabral lesion and the Hill-Sachs lesion. It also visualised the size of the Hill-Sachs lesion significantly better than did the ABER position. CONCLUSION: MRI examination of anterior shoulder instability in the Apprehension test position was more beneficial than examination in the ABER position in visualising capsulolabral and Hill-Sachs lesions when using indirect arthrography.     

Closed reduction and tendon transfer for treatment of dislocation of the glenohumeral joint secondary to brachial plexus birth palsy

Dislocation of the glenohumeral joint developed, in the first few years of life, in eight children who had brachial plexus birth palsy. The palsy involved the fifth and sixth cervical nerve roots in six children and the fifth, sixth, and seventh cervical nerve roots in two. All of the children had a release of the insertions of the pectoralis major, latissimus dorsi, and teres major followed by a closed reduction of the glenohumeral joint. The latissimus dorsi and the teres major were then transferred to the rotator cuff. All of the children had a well located glenohumeral joint with at least 25 degrees (mean, 51 degrees) of external rotation and at least 135 degrees (mean, 164 degrees) of abduction at the latest follow-up examination, at least two years postoperatively. Strength in abduction increased at least one grade, and strength in external rotation increased at least two grades. The improved motion and strength allowed the children to place the hands more effectively above the head and helped them to perform activities of daily living easily.     

Prolonged survival in patients with advanced melanoma treated with neoadjuvant chemotherapy followed by resection

We conducted this cadaveric study to define a biomechanical rationale for rotator cuff function in several deficiency states. A dynamic shoulder testing apparatus was used to examine change in middle deltoid muscle force and humeral translation associated with simulated rotator cuff tendon paralyses and various sizes of rotator cuff tears. Supraspinatus paralysis resulted in a significant increase (101%) in the middle deltoid force required to initiate abduction. This increase diminished to only 12% for full glenohumeral abduction. The glenohumeral joint maintained ball-and-socket kinematics during glenohumeral abduction in the scapular plane with an intact rotator cuff. No significant alterations in humeral translation occurred with a simulated supraspinatus paralysis, nor with 1-, 3-, and 5-cm rotator cuff tears, provided the infraspinatus tendon was functional. Global tears resulted in an inability to elevate beyond 25 degrees of glenohumeral abduction despite a threefold increase in middle deltoid force. These results validated the importance of the supraspinatus tendon during the initiation of abduction. Glenohumeral joint motion was not affected when the "transverse force couple" (subscapularis, infraspinatus, and teres minor tendons) remained intact. Significant changes in glenohumeral joint motion occurred only if paralysis or anatomic deficiency violated this force couple. Finally, this model confirmed that rotator cuff disease treatment must address function in addition to anatomy.     

Compatibility problems after intravenous immunoglobulin--a case report

The purpose of this study was to determine whether there are changes in anterior and posterior glenohumeral translation after arthroscopic, nonablative, thermal capsuloplasty with a laser. Two anteriorly and two posteriorly directed loads were sequentially applied to the humerus of nine cadaveric glenohumeral joints, and anterior and posterior translation of the humerus on the glenoid was measured. The glenoid was rigidly fixed, and the glenohumeral joint was positioned simulating 90 degrees of shoulder abduction and 90 degrees of external rotation. Using the holmium:yttrium-aluminum-garnet laser, thermal energy was then applied to the anterior capsuloligamentous structures and anterior and posterior translation measurements were then repeated. The results showed a significant reduction in anterior and posterior translation after laser anterior capsuloplasty. Anterior translation decreased from 10.9 +/- 2.0 mm (mean +/- SEM) to 6.4 +/- 1.5 mm with the 15-N load; and from 13.4 +/- 2.1 mm to 8.9 +/- 1.8 mm with the 20-N load. Posterior translation decreased from 7.2 +/- 1.2 mm to 4.4 +/- 0.6 mm with the 15-N load and from 10.4 +/- 1.4 mm to 6.5 +/- 0.9 mm with the 20-N load. These results indicate that the holmium:yttrium-aluminum-garnet laser can be used to decrease glenohumeral joint translation and may be an effective treatment for glenohumeral joint instability.     

Management of haemophilia in the developing world

We used a dynamic shoulder-testing apparatus and nine fresh-frozen, entire upper extremities from cadavera to evaluate the effects of varying degrees of capsulolabral injury on the kinematics of the glenohumeral joint during abduction in the scapular plane and external rotation. Joint kinematics were recorded with use of a six-degrees-of-freedom magnetic tracking device before and after the creation of each capsulolabral lesion in a progressive manner. Dislocation did not occur after simulation of a large Bankart lesion or even after sectioning of the anterior aspect of the joint capsule. However, division of the entire joint capsule (that is, both the anterior aspect and the posterior aspect) resulted in a significant increase (p < 0.05) in posterior translation during abduction in the scapular plane, and two of the nine shoulders dislocated posteriorly. External rotation of the abducted extremity produced no increase in anterior or posterior translation.     

The new partnership of genomics and chemistry for accelerated drug development

The Grashey shoulder position is used to demonstrate damage to the glenohumeral joint caused by osteoarthritis, sclerosis, tumors, fractures, osteophytes and cystic changes. However, it can be difficult to assess loss of articular cartilage using the Grashey shoulder position because little axial load is applied to the glenohumeral joint. This article describes a method of creating a loading force across the glenohumeral joint by adding weighted arm abduction during the Grashey position to demonstrate loss of the articular cartilage. Case studies and radiographs are presented to discuss the advantages of using the Grashey position with weighted abduction.     

Endoscopic mucosal resection of gastric tumors located in the lesser curvature of the upper third of the stomach

Between July 1991 and February 1995, 33 patients underwent bipolar shoulder arthroplasty for painful rotator cuff arthropathy of the shoulder. Twenty-two of these patients have been followed for an average of 28 months (range 24 to 48 months) and comprised the study group. All patients had massive, irreparable rotator cuff tears and presented with preserved passive motion, good deltoid function, and obliterated glenohumeral joint surfaces. Function and comfort were dramatically improved in all patients, with an average increase in active forward elevation of 29 degrees and a gain in active external rotation of 39 degrees. There was one complication requiring reoperation at 4 years. Utilizing the UCLA and Swanson scoring systems, all patients were rated fair or better.     

Illusory changes in head position induced by neck muscle vibration can alter the perception of elbow position.

Acuity for elbow joint position sense (JPS) is reduced when head position is modified. Movement of the head is associated with biomechanical changes in the neck and shoulder musculoskeletal system, which may explain changes in elbow JPS. The present study aimed to determine whether elbow JPS is also influenced by illusory changes in head position. Simultaneous vibration of sternocleidomastoid (SCM) and the contralateral splenius was applied to 14 healthy adult human subjects. Muscle vibration or passive head rotation was introduced between presentation and reproduction of a target elbow position. Ten out of 14 subjects reported illusions consistent with lengthening of the vibrated muscles. In these 10 subjects, absolute error for elbow JPS increased with left SCM/right splenius vibration but not with right SCM/left splenius vibration. Absolute error also increased with right rotation, with a trend for increased error with left rotation. These results demonstrated that both actual and illusory changes in head position are associated with diminished acuity for elbow JPS, suggesting that the influence of head position on upper limb JPS depends, at least partially, on perceived head position. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of coordination training on proprioception of the functionally unstable ankle

Exercises to improve joint proprioception and coordination of the functionally unstable ankle are advocated throughout the literature, yet there is little evidence that these exercise have any effect on proprioception and balance. The purpose of this study was to determine the effects of a 6-week coordination and balance training program on proprioception of subjects with functional ankle instability. Forty-five subjects (age = 22.53 +/- 3.95 years, height = 172.04 +/- 10.0 cm, weight = 71.72 +/- 15.7 kg) were randomly placed into a control (Group 1), sham (Group 2), or experimental (Group 3) group. The experimental group trained 3 days per week, 10 minutes each day, performing various balance and proprioception exercises. Postural sway and active and passive joint position sense were assessed. Analysis of variance for postural sway modified equilibrium score for anterior and posterior sway, as well as medial and lateral sway revealed significant four-way interactions. Tukey post hoc analyses revealed that Group 3 performed significantly better (p < .05) than Group 1 and Group 2 on the posttests. There were no significant differences for joint position sense or postural sway index. Results suggest that balance and coordination training can improve some measures of postural sway. It is still unclear if joint position sense can be improved in the functionally unstable ankle.     

Proprioceptive capacities of patients with retropatellar knee pain with special reference to effectiveness of an elastic knee bandage

In the presented study, knee joint proprioception of 43 patients with a patellar pain syndrome of the knee joint was evaluated. In a control group, the proprioception of 30 healthy volunteers with clinical and an-amnestic inconspicous knee joints was examined. We tested the proprioceptive capability of the subjects with a passive angle reproduction test. Additionally, all knee joints were measured with and without an elastic knee bandage. The patient group showed significant deterioration of angle reproduction capability (13.2 degrees +/- 6.1 degrees) compared to the control group (7.8 degrees +/- 2.8 degrees). After applying an elastic knee bandage, the angle reproduction capability significantly improved to 9.2 degrees +/- 4.5 degrees. Proprioception of the contralateral, noninvolved knee joint in the patients (11.6 degrees +/- 6.3 degrees) was worse compared to the control group. Applying an elastic knee bandage did not significantly improve the proprioception of the uninjured knee joint.     

Measurements of scapular position and rotation: a reliability study

Smooth motion of the scapula and humerus with respect to the thorax is essential for shoulder function and abnormalities may indicate clinical entities. Recent studies have made an attempt to devise simple, practical means of quantifying scapular position. The aim of this study was to examine the intra-tester and inter-tester reliability of two methods and to determine if significant differences existed between the dominant versus non-dominant extremity. Seventeen healthy volunteers (4 M; 13 F) were examined by two testers. The tape measurements consisted of the classic methods of Kibler and DiVeta in three sitting postures, expanded by the measurement of the linear distance from the medial border to the thoracic mid-line, and the scapular size measure. The SAS software package was used for data analysis. The Intraclass Correlation Coefficient (ICC) intra-tester reliability ranged between 0.96-0.8 for both methods without significant differences, whereas the ICC for inter-tester reliability ranged between 0.42-0.9 with higher values (moderate and good) for the Kibler technique. In the additional tests high values were also obtained for ICC intra-tester, except for the measurements of the linear distance of the medial border of the scapula to the thoracic mid-line and the distance of the inferior process of the acromion to the third vertebra, both in 90 degrees abduction and internal rotation. The ICC for inter-tester was only acceptable for the DiVeta measurement on 45 degrees abduction. Significant differences were noted between both testers on the following measures: Kibler in 45 degrees abduction, DiVeta in 45 degrees abduction and 90 degrees abduction and the scapular size measure. The comparison of dominant versus non-dominant extremity revealed larger but not significantly different means for the dominant extremity in the classic methods. Significant differences occurred for Tester 1 in the measurement of the distance of the medial border to the thoracic mid-line and Tester 2 in DiVita in 45 degrees abduction. The SEM values never exceeded 1 cm. We believe that the Kibler technique holds promise for further studies, has the advantage of measuring in three positions and with some familiarisation can be reliable. Further research is necessary in patients with pathological conditions.     

Shoulder muscle moment arms during horizontal flexion and elevation

The instantaneous muscle moment arms of 10 shoulder muscles including the three portions of the deltoid and the rotator cuff and scapulohumeral muscle groups during four specified glenohumeral motions were calculated. Moment arm values were derived from a plot of tendon excursion versus glenohumeral joint rotation angle during horizontal flexion along the 90 degrees elevation plane and elevation in the sagittal, scapular, and coronal planes. The deltoid had the largest moment arm in elevation. The anterior deltoid has a larger moment arm in the anterior planes, whereas the midportion is greater in the scapular and coronal planes. The muscles with the largest depressor (adductor) moment arms are the pectoralis major, latissimus dorsi, and teres major. Contrary to the findings of other investigators, the supraspinatus and infraspinatus have a smaller potential elevation torque in the scapular plane than has been previously reported. Furthermore the subscapularis may potentially be a more important elevator in the scapular plane than either the supraspinatus or infraspinatus, especially in the latter phases of motion. The pectoralis major has the largest horizontal flexion moment arm with the humerus elevated 90 degrees, whereas the posterior deltoid and infraspinatus have the largest horizontal extension moment arms in this plane.     

Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow

Underhand pitching has received minimal attention in the sports medicine literature. This may be due to the perception that, compared with overhead pitching, the underhand motion creates less stress on the arm, which results in fewer injuries. The purpose of this study was to calculate kinematic and kinetic parameters for the pitching motion used in fast pitch softball. Eight female fast pitch softball pitchers were recorded with a four-camera system (200 Hz). The results indicated that high forces and torques were experienced at the shoulder and elbow during the delivery phase. Peak compressive forces at the elbow and shoulder equal to 70-98% of body weight were produced. Shoulder extension and abduction torques equal to 9-10% of body weight x height were calculated. Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion. The demand on the biceps labrum complex to simultaneously resist glenohumeral distraction and produce elbow flexion makes this structure susceptible to overuse injury.     

Arthroscopic shoulder stabilization using transglenoid sutures

The results of arthroscopic stabilization using multiple transglenoid sutures in 24 patients with posttraumatic recurrent anterior shoulder instability are presented with a minimum follow-up of 2 years. No serious complications were recorded. There were 2 recurrences. The remaining 22 patients had good or excellent results according to the modified Rowe score, with a median score of 89. The median value for loss of external rotation was 5 degrees. Seventeen patients were active in sports and 11 returned to the same sports at the same competitive level.     

Neuropathology in cats experimentally infected with feline immunodeficiency virus: a morphological, immunocytochemical and morphometric study

Head flexion and extension movements near the natural head position (NHP) were analysed for the location of the mean instantaneous centre of rotation (ICR). Forty-six healthy young adults (30 women and 16 men) with sound dentitions, free from cranio-cervical disorders, performed habitual movements that were automatically detected and measured by an infrared three-dimensional motion analyser. ICR and curvature radius were calculated for each movement and subject. In both extension and flexion, ICR position changed during the motion. The movement was symmetrical in all subjects. No gender or flexion/extension differences were found for both ICR position and relevant curvature radius. On average, ICR relative to NHP soft-tissue nasion was located at about 150% of the soft-tissue nasion-right tragus distance, with an angle of about 220 degrees relative to the true horizontal. Results suggest that head flexion or extension is always performed with a combination of rotation (atlanto-occipital joint) and translation (cervical spine) even in the first degrees of motion. Moreover, NHP at rest seems to be some degree more flexed and anterior than head position during movements. These relative positions and their muscular determinants could also influence mandibular posture at rest and during functional movements.