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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Correlation of double contrast arthrotomography (DCAT) of the shoulder and arthroscopic surgery diagnostic results have been undertaken in 55 patients with persistent shoulder pain or involuntary shoulder instability. During the period March 1984 to December 1986, 55 patients underwent DCAT followed by videotaped diagnostic shoulder arthroscopy. The primary indication for DCAT was persistent pain in 36 patients and instability in 17 patients. DCAT was performed according to the method of El-Khoury and Albright, and all arthroscopies were performed in a similar fashion by the senior author (HJS). Both tests were reviewed separately, retrospectively, and their results were correlated. For combined (anterior and posterior) labral pathology, the sensitivity/specificity for the instability group was 0.91/0.91, respectively; sensitivity/specificity for the pain group was 0.63/0.94. DCAT accurately depicted the status of 76% of anterior labrums and 96% of posterior labrums. For complete rotator cuff tears, sensitivity/specificity was 1.0/0.94. The status of a complete rotator cuff tear was accurately depicted in 91% of patients. Partial rotator cuff tears were missed in 83% of patients by DCAT. The presence or absence of loose bodies was accurately represented by 96% of DCAT. Arthroscopy showed that 71% of the instability patients had a labral tear, compared with 44% of the pain patients. Rotator cuff pathology was present in 12% of instability patients and 42% of pain patients. These findings indicate that DCAT may be a conditionally reliable test in the diagnosis of shoulder instability. DCAT must be considered inconclusive, however, in the painful shoulder without instability. Its usefulness as a preoperative screening test is discussed, and a diagnostic algorithm is presented. DCAT does not equal the diagnostic accuracy of shoulder arthroscopy.
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PMID:Correlation of pathology observed in double contrast arthrotomography and arthroscopy of the shoulder. 335 34

Studies on 574 subjects demonstrated the prevalence of shoulder pain and its relationship to occupational work load and psychosocial factors. The prevalence of shoulder pain was 14% (13% men, 15% women). Women had more often myalgias with a tenderness on palpation of the shoulder muscles and rhizopathia-brachialgia type of pain, whereas men had mainly intraarticular pain. Three percent had been on sick leave because of shoulder pain in the year preceding the examination and 5% had a reduced range of shoulder joint motion. The subjects with shoulder pain were less satisfied with their jobs and had been less successful in a childhood intelligence test. No difference could be demonstrated between subjects with or without shoulder pain in estimated overall work load, but women with signs of supraspinatus tendinitis more often had jobs with physical demands.
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PMID:Shoulder pain in middle age. A study of prevalence and relation to occupational work load and psychosocial factors. 337 Aug 78

The diagnosis and treatment of thoracic outlet syndrome based on a personal experience with 473 patients resulted in relief of symptoms in over 90 percent of patients treated operatively. The diagnosis centers on a thorough history and the exclusion of other causes of arm and shoulder pain, utilizing a strict flow pattern of differential diagnosis. Angiography and electromyography are of limited value and should only be performed in selected cases. Operation should be reserved for the thoroughly evaluated patient who continues to have pain despite adequate conservative therapy. Transaxillary removal of the first rib, fibromuscular bands, and cervical rib, when present, is the operation of choice.
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PMID:Thoracic outlet syndrome. 339 94

Paraplegic patients rely almost exclusively on their upper extremities for weight-bearing activities such as transfers and wheelchair propulsion. Eighty-four paraplegic patients whose injury level was T2 or below and who were at least one year from spinal cord injury were screened for upper extremity complaints. Fifty-seven (67.8%) had complaints of pain in one or more areas of their upper extremities. The most common complaints were shoulder pain and/or pain relating to carpal tunnel syndrome. Twenty-five (30%) complained of shoulder pain during transfer activities. Symptoms were found to increase with time from injury. As the long-term survival of spinal cord injured patients continues to improve, an increased awareness of the complications of the weight-bearing upper extremity is necessary to keep these patients functioning in society.
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PMID:Late complications of the weight-bearing upper extremity in the paraplegic patient. 340 18

A clinical analysis of 68 patients diagnosed as suffering from Ernest's syndrome revealed: Injury to the stylomandibular ligament is a real and frequent disorder causing craniomandibular pain. Ages and sex differences, although variable, correspond to those reported elsewhere in the literature for craniomandibular pain. A diagnosis of Ernest's syndrome may be based on an adequate history, palpation of the insertion of the stylomandibular ligament, and a diagnostic local anesthetic block of the affected ligamentous insertion. Symptoms of Ernest's syndrome, in decreasing order of occurrence, are: TMJ and temporal pain, ear and mandibular pain, posterior tooth sensitivity, eye pain, and throat pain. In addition, shoulder pain may be involved. Of the patients in this study, 77.94% were treated successfully via nonsurgical management of their complaints. Resolution of this disorder is usually accomplished by a combination of a diagnostic injection of local anesthetic at the insertion of the ligament, localized injection of cortisone substitute, and placing the patient on a soft diet. Surgical management, if necessary, is best accomplished by a radiofrequency thermoneurolysis procedure in the involved ligamentous insertion.
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PMID:Ernest syndrome as a consequence of stylomandibular ligament injury: a report of 68 patients. 347 63

The cause of shoulder pain can usually be diagnosed after a pertinent history has been obtained and a relevant physical examination performed. To carry out such an evaluation, the examiner must understand the salient anatomic relationships of the shoulder. Causes of shoulder pain include supraspinatus tendinitis (the most common), bicipital tendinitis, impingement syndromes, supraspinatus rupture, subacromial bursitis, arthritis, frozen shoulder, and various conditions that refer pain to the shoulder. Treatment in most cases consists of rest and administration of a nonsteroidal antiinflammatory drug or injection of a corticosteroid preparation, or both.
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PMID:Shoulder pain. Guidelines to diagnosis and management. 360 35

In this study, we investigated the applicability of thermography as a technique for evaluating the painful postcerebrovascular accident (CVA) shoulder in hemiplegic patients. A thermographic series was taken of the upper extremities and upper trunk of 27 female subjects. The four groups we evaluated were nonhemiplegic subjects (n = 9), post-CVA subjects with recovered function (n = 6), hemiplegic subjects with upper extremity motor impairment (n = 6), and hemiplegic subjects with both motor impairment and ipsilateral shoulder pain (n = 6). The data revealed a normal thermographic series in 8 of the 9 nonhemiplegic subjects, but only in 1 of the 18 post-CVA subjects. The majority of the abnormal thermographic series of post-CVA subjects showed a 1 degree to 5 degree C coolness on the involved side. No consistent thermographic patterns emerged that could be related to the severity or location of pain. Further studies are needed to evaluate the efficacy of thermography as a means of determining the relationship between ipsilateral post-CVA coolness and hemiplegic shoulder pain.
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PMID:Thermographic evaluation of the painful shoulder in the hemiplegic patient. 374 69

Cervical spine pathosis and pain can be referred to the shoulder and can actually result in a frozen shoulder or a tendinitis pattern. Concomitant cervical spine pathosis can coexist with primary shoulder pathosis and can present a diagnostic and therapeutic dilemma. Conservative programs usually require an aggressive attack on the cervical spine, often with therapy to the shoulder. Surgical considerations rely on diagnostic acumen to sort out accurately where the predominant problem exists. The usual scenario of shoulder pain referred from the cervical spine involves an appropriate history, physical examination, selective subacromial injection, appropriate roentgenograms of the cervical spine and shoulder and finally a cervical discogram to document the level of the disorder followed occasionally by an anterior cervical fusion.
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PMID:Cervical spine and the shoulder. 383 38

Chronic neck and shoulder pain is a complex, multifactorial problem. Often many months have passed since its onset. During this time the patient may have seen many physicians and tried many medications, some with abuse potential. Most patients are depressed and have lost their ability to cope with the stresses of daily life. The goals of therapy are to enable patients to deal with the problem and to bring them to the point where pain is no longer the dominant factor in their lives. For patients with chronic neck and shoulder pain of myofascial origin, this is accomplished with a multi-disciplinary approach that incorporates use of psychotherapeutic techniques, nonsteroidal antiinflammatory medications, antidepressant drugs, trigger-point injection, and several physical therapy modalities.
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PMID:Chronic neck and shoulder pain. Focusing on myofascial origins. 397 80

All 132 participants in a 500 mile, 8 day bicycle tour were surveyed by questionnaire to characterize the demographics and bicycling experience of the riders, and to determine the frequency and severity of nontraumatic injuries they experienced. Riders who developed significant symptoms were interviewed and/or examined. Eighty-six percent of ride participants responded to the survey. The average age of the riders was 41.4 years (+/- 11.7 years). They rode an average of 95.8 miles per week on a routine basis, but the majority were new to long distance touring. Most were healthy, but 5% had serious cardiovascular disease and bicycled as part of a rehabilitation program. The most common nontraumatic injury was buttocks pain (experienced by 32.8% of riders); four had skin ulceration of the buttocks. Knee problems occurred in 20.7% of riders; patellar pain syndromes and lateral knee complaints were the most common knee problems. One cyclist withdrew from the tour because of knee pain. Neck-shoulder pain occurred in 20.4% of the riders. Groin numbness and palmar pain or paresthesias each occurred in approximately 10%. Other less common problems were foot and ankle symptoms and sunburn.
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PMID:Nontraumatic injuries in amateur long distance bicyclists. 401 34


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