Evaluating Differences Between Participants With Various Forward Head Posture With and Without Postural Neck Pain Using Craniovertebral Angle and Forward Shoulder Angle.

OBJECTIVE: The purpose of this study was to investigate differences between individuals with various forward head posture (FHP) severities with and without postural neck pain using craniovertebral angle and forward shoulder angle. METHOD: Ninety participants age 20 to 50 years were categorized into the following 4 groups based on observational method and presence or absence of postural neck pain: (1) slight FHP group without pain, (2) slight FHP group with pain, (3) moderate-to-severe FHP group without pain, and (4) moderate-to-severe FHP group with pain. A digital imaging technique was used to measure the craniovertebral angle and forward shoulder angle in a standing position. RESULTS: A 1-way analysis of variance test showed a significant difference for craniovertebral angle in the 4 groups (F = 22.04, P < .001). Tukey's test showed the difference in this variable was significant between slight FHP groups (with or without pain) and moderate-to-severe FHP groups (with or without pain) (P < .001). Although overall F indicated a significant difference (F = 4.11, P < .009) of the forward shoulder angle in 4 groups, Tukey's test revealed this was only significantly different in 2 groups: slight FHP with pain and moderate-to-severe FHP with pain (P = .005). CONCLUSION: The craniovertebral angle in the 2 groups of moderate-to-severe FHP was significantly smaller than that in the 2 groups of slight FHP. However, the forward shoulder angle in the group of moderate-to-severe FHP with pain was only significantly smaller than that in slight FHP with pain. The results showed that including pain as a factor of categorization did not lead to a significant difference between various groups regarding craniovertebral angle and forward shoulder angle.

Forces and translation distance during an inferior glide of the shoulder in asymptomatic individuals measured with the novel pliance glove and ultrasound imaging.

BACKGROUND: There has been limited research on how the variance of force affects manual therapy outcomes and what the best practices should be. No specific force threshold necessary to achieve a predetermined translational distance within the joint has been quantified within the literature. PURPOSE: To quantify the amount of force necessary to perform an inferior glide to the glenohumeral joint and reach to end range. A secondary aim was to determine the impact of co-variables, such as gender, height, weight, and age, on the amount of force required to translate the humeral head within the glenohumeral joint. METHODS: A convenience sample of 64 healthy subjects were recruited. Musculoskeletal ultrasound imaging using the GE LogiQe was used to measure the translation of the humeral head. The manipulation force was measured using the novel pliance glove device and software. The ANOVA was used to determine if there was a difference in translation distance and force between trials. The Pearson's correlation was used to correlate translation and force and between covariables. RESULTS: There was no significant difference in translation distance between trials (p = .14). There was no significant difference in the mean force for this translation (p = .45). There was a poor correlation between age and force (r = 0.28) and weight and force (r = 0.12). CONCLUSION: An average force of 14.27 N (n = 61) was needed to displace the humeral head to reach end range. This was the first study using the combination of a flexible force sensor technology and real-time ultrasound imaging to measure humeral head translation.

Brachial plexopathy as a consequence of nerve root swelling after shoulder trauma in a patient following an acute seizure.

BACKGROUND: Epileptic seizures might be associated with an increased risk of fractures, either as a result of trauma after a fall or as a result of excessive muscle contraction. In the pediatric population, excessive muscle contraction is a more significant risk factor for fractures, due to the lack of maturity in the musculoskeletal system, while antiepileptic therapy itself can lead to a reduction of bone density. Proximal humeral fractures in the pediatric population are not frequent but both proximal humeral fractures and shoulder dislocation increase the chance of brachial plexus injuries and peripheral nerve lesions. CASE: In this case report, we present a patient who suffered both avulsive greater tuberosity humeral fracture and anterior shoulder dislocation, initially diagnosed by radiography, with consequent brachial plexus injury of the left arm after an epileptic seizure followed by excessive muscle contraction. Electromyoneurography initially showed amplitudes` reduction in tested nerves along with signs of muscle denervation as well as clinical examination signs of the left arm muscular hypotrophy and hypoesthesia, especially in the left humero-scapular region. Electrotherapy and kinesitherapy as well as intramuscular dexamethasone injections administered three weeks after the injury finally improved the clinical examination findings in the patient. CONCLUSION: The early detection of swelling compression, accompanied with appropriate therapy may prevent the progression of axonal damage and preserve the functional status of the affected limb.

Standard reference values of the upper body posture in healthy young female adults in Germany: an observational study.

OBJECTIVE: Classifications of posture deviations are only possible compared with standard values. However, standard values have been published for healthy male adults but not for female adults. DESIGN: Observational study. SETTING: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University Frankfurt/Main. PARTICIPANTS: 106healthy female volunteers (21-30 years old; 25.1±2.7 years) were included. Their body weight ranged from 46 to 106 kg (60.3±7.9 kg), the heights from 1.53 to 1.82 m (1.69±0.06 m) and the body mass index from 16.9 kg/m² to 37.6 kg/m² (21.1±2.6 kg/m²). OUTCOME MEASURES: A three-dimensional back scan was performed to measure the upper back posture in habitual standing. The tolerance ranges and CI were calculated. Group differences were tested by the Wilcoxon Mann-Whitney U test. RESULTS: In normal posture, the spinal column was marginally twisted to the left, and the vertebrae were marginally rotated to the right. The kyphosis angle is larger than the lumbar angle. Consequently, a more kyphotic posture is observed in the sagittal plane. The habitual posture is slightly scoliotic with a rotational component (scapular depression right, right scapula marginally more dorsally, high state of pelvic right, iliac right further rotated anteriorly). CONCLUSIONS: Healthy young women have an almost ideally balanced posture with minimal ventral body inclination and a marginal scoliotic deviation. Compared with young males, women show only marginal differences in the upper body posture. These values allow a comparison to other studies, both for control and patient data, and may serve as guideline in both clinical practice and scientific studies.

The effects of pressure biofeedback training on infraspinatus muscle activity and muscle thickness.

The aim of this study was to investigate muscle activity in the infraspinatus and posterior deltoid and infraspinatus muscle thickness during a prone external rotation (PER) exercise using pressure biofeedback. Fifteen healthy men participated in this study, performing PER exercise with pressure biofeedback under four conditions (comfortable, 2 mm Hg, 4 mm Hg, and 8 mm Hg). Surface electromyography (EMG) was used to monitor infraspinatus and posterior deltoid muscle activity, and ultrasonography was used to collect infraspinatus muscle thickness data. Infraspinatus activity and muscle thickness were greatest at 2 mm Hg pressure feedback, and both measures were significantly different from those under other pressure feedback conditions (p < 0.05). In contrast, posterior deltoid activity was lower at 2 mm Hg. However, there was no significant difference between any of the four pressure feedback conditions. These findings suggest that PER exercise with pressure biofeedback, particularly at 2 mm Hg, is effective in selectively activating the infraspinatus muscle.

Ultrasound-Guided Intra-articular Injection of the Radio-ulnar and Radio-humeral Joints and Ultrasound-Guided Dry Needling of the Affected Limb Muscles to Relieve Fixed Pronation Deformity and Myofascial Issues around the Shoulder, in a Case of Complex Regional Pain Syndrome Type 1.

BACKGROUND: Complex regional pain syndrome (CRPS) occurs due to different pathophysiological mechanisms. Presently there is no description of definitive treatment that can resolve the especially recalcitrant motor issues of disability in CRPS type 1 (CRPS-1). CASE REPORT: We have herein described the successful management of motor disability with a multimodal approach in a patient with CRPS-1 that occurred as a result of a fracture sustained in the lower end of the radius. Sensory/sudomotor/vasomotor symptoms were relieved completely by medications and stellate ganglion block in 2 weeks. Ultrasound-guided dry needling secured near-complete improvement of shoulder and hand movements in 45 days. Ultrasound guided intra-articular (radio-ulnar and radio-humeral joint) injections with steroid reduced residual pain and improved forearm movements by 50% initially. The patient continued to receive regular sessions of dry needling, physiotherapy, and cognitive behavioral therapy. By the end of 1 year, the functions of the limb improved remarkably, as did the functional outcome scores. CONCLUSION: In this patient with CRPS-1, intra-articular injections with steroid reduced nociception in the affected local structures and sensitization in the nervous system; dry needling resolved the myofascial issues; sustained physiotherapy maintained the motor recovery; and behavioral therapy techniques addressed the cognitive and life stress issues. It was concluded that the presenting symptoms in this case were a consequence of interactions between humoral, nervous, and myofascial systems.

T2 relaxation time for intervertebral disc degeneration in patients with upper back pain: initial results on the clinical use of 3.0 Tesla MRI.

BACKGROUND: Magnetic resonance imaging (MRI) is a useful non-invasive tool for evaluating abnormalities of intervertebral discs. However, there are few studies which applied functional MRI techniques to investigate degenerative changes in cervical and cervicothoracic junction (CTJ) spine among adults. The aim of this study was to compare T2 relaxation time measurement evaluation with morphological grading for assessing cervical and CTJ intervertebral discs (IVD) in the patients suffering neck, shoulder, and upper back pain. METHODS: Sixty-three patients (378 IVDs) and 60 asymptomatic volunteers (360 IVDs) of the cervical and CTJ discs were assessed using a 3.0 T magnetic resonance imaging (MRI) protocol, including an sagittal T2 relaxation time protocol. The relaxation time values of the nucleus pulposus (NP) were recorded and all discs were visually graded according to Pfirrman's grading system. The correlation between T2 relaxation time values and qualitative clinical grading of degeneration, patient age, sex and anatomic level were analyzed RESULTS: There is a clear trend of decreasing mean T2 values of the NP associate with increasing Pfirrmann grades (C2-T1) for both patients and asymptotic volunteers. Significant T2 differences were seen among grades I-V (P < 0.05). However, grade V was not observed in the CTJ. Linear correlation analysis revealed a strong negative association between T2 values of the NP and Pfirrmann grade (r = -0.588, r = -0.808) of C2-7 and C7T1. Age were also significantly correlated NP T2 values (r = -0.525, r = -0.723) for patients and volunteers. Moreover, the receiver operating characteristic analysis for average measures in a range from 0.70-0.79 (C2-7) to 0.84-0.89 (C7T1) for patients. CONCLUSIONS: T2 quantitation provides a more sensitive and robust approach for detecting and characterizing the early stage of IVD degeneration and age-associated disc changes.

The development of a shoulder specific left/right judgement task: Validity & reliability.

BACKGROUND: Disruption of cortically-held working body schema has been associated with a variety of pain conditions. A motor imagery technique - the left right judgement task (LRJT) - has been used as an indirect assessment of the integrity of the working body schema. To date there is no LRJT specifically designed to investigate the body schema of persons with shoulder pain. OBJECTIVES: To develop a shoulder specific LRJT and assess its validity and reliability. DESIGN: Cross-sectional repeated measures. METHODS: Shoulder images were developed representing the shoulder in a variety of postures of graded complexity/awkwardness and degree of rotation. These images were digitally mirrored to represent both left and right shoulders. Participants viewed the images on a computer and determined whether images were of a left or right shoulder. RESULTS: 1413 participants were recruited worldwide and performed the shoulder LRJT (laterality judgement). Mean response time (SD) for the task was 1738(741) ms. Mean accuracy (SD) was 93.5(9.2)%. Chronbach's Alpha for shoulder image response times was 0.95. Participants were fastest responding to images of simple postures and slowest to images corresponding to the more awkward postures (mean difference 520 ms, 95%CI 469-570 ms). Participants were fastest responding to the least rotated images and slowest responding to inverted images, (mean difference 981 ms, 95%CI 919-1043 ms). CONCLUSIONS: The shoulder specific LRJT proved to be highly reliable. Response times increased with complexity and rotation of images, implying a motor imagery strategy was used to complete the task, validating the task as a measure of shoulder joint implicit motor imagery. Abnormal performance cut-offs for age were reported. This result will enable further research examining the relationship between shoulder pain and body schema.

The effects of isometric contraction of shoulder muscles on cervical multifidus muscle dimensions in healthy office workers.

It is argued that cervical multifidus muscles (CMM) are responsible for providing neck stability. However, whether they are actually activated during the tasks performed by the upper extremities to the neck is still unknown. Therefore, the aim of this study was to examine the effects of isometric contraction of shoulder muscles on the dimensions of CMM. Twenty three healthy males voluntarily participated in this study. Ultrasonography imaging of CMM was conducted at rest and at 25%, 50%, 75%, and 100% of maximal voluntary contraction of shoulder muscles in 6 directions of shoulder movements. Anterior-posterior dimension (APD), lateral dimension (LD), shape ratio and multiplied linear dimension (MLD) of cervical multifidus were measured. The APD of CMM was increased while LD and shape ratio were decreased by shoulder muscles contraction (P < 0.01).

Rehabilitative ultrasound imaging of the supraspinatus muscle: Intra- and interrater reliability of thickness and cross-sectional area.

OBJECTIVE: To examine intra- and interrater reliability of thickness and cross-sectional area (CSA) measurements of the supraspinatus muscle using rehabilitative ultrasound imaging (RUSI). METHODS: Two physical therapists acquired b-mode images of the supraspinatus muscles in twenty-five healthy subjects. Thickness and CSA were measured. Intra- and interrater reliability were examined. RESULTS: Intrarater reliability for thickness was high, (ICC1.1 0.91) for rater 1 and (ICC1.1 0.92) for rater 2. Intrarater reliability for CSA was also high, (ICC1.1 0.90) for rater 1 and (ICC1.1 0.85) for rater 2. Interrater reliability for the thickness was high, (ICC3.1 0.86). For CSA, interrater reliability was moderate, (ICC3.1 0.70). CONCLUSION: Supraspinatus muscle thickness and CSA can be reliably measured by physical therapists in healthy subjects. These findings confirm that RUSI has an interesting potential for physiotherapy clinical practice, especially to assess morphometric changes in skeletal muscles. Further research is needed in subjects with shoulder disorders.

Physiological and clinical changes after therapeutic massage of the neck and shoulders.

Little is known regarding the physiological and clinical effects of therapeutic massage (TM) even though it is often prescribed for musculoskeletal complaints such as chronic neck pain. This study investigated the influence of a standardized clinical neck/shoulder TM intervention on physiological measures assessing α-motoneurone pool excitability, muscle activity; and the clinical measure of range of motion (ROM) compared to a light touch and control intervention. Flexor carpi radialis (FCR) α-motoneurone pool excitability (Hoffmann reflex), electromyography (EMG) signal amplitude of the upper trapezius during maximal muscle activity, and cervical ROM were used to assess possible physiological changes and clinical effects of TM. Sixteen healthy adults participated in three, 20 min interventions: control (C), light touch (LT) and therapeutic massage (TM). Analysis of Covariance indicated a decrease in FCR α-motoneurone pool excitability after TM, compared to both the LT (p = 0.0003) or C (p = 0.0007) interventions. EMG signal amplitude decreased after TM by 13% (p < 0.0001), when compared to the control, and 12% (p < 0.0001) as compared to LT intervention. The TM intervention produced increases in cervical ROM in all directions assessed: flexion (p < 0.0001), lateral flexion (p < 0.0001), extension (p < 0.0001), and rotation (p < 0.0001). TM of the neck/shoulders reduced the α-motoneurone pool excitability of the flexor carpi radialis after TM, but not after the LT or C interventions. Moreover, decreases in the normalized EMG amplitude during MVIC of the upper trapezius muscle; and increases in cervical ROM in all directions assessed occurred after TM, but not after the LT or C interventions.

Comparison of extended field-of-view reconstructions in C-arm flat-detector CT using patient size, shape or attenuation information.

In C-arm-based flat-detector computed tomography (FDCT) it frequently happens that the patient exceeds the scan field of view (SFOV) in the transaxial direction because of the limited detector size. This results in data truncation and CT image artefacts. In this work three truncation correction approaches for extended field-of-view (EFOV) reconstructions have been implemented and evaluated. An FDCT-based method estimates the patient size and shape from the truncated projections by fitting an elliptical model to the raw data in order to apply an extrapolation. In a camera-based approach the patient is sampled with an optical tracking system and this information is used to apply an extrapolation. In a CT-based method the projections are completed by artificial projection data obtained from the CT data acquired in an earlier exam. For all methods the extended projections are filtered and backprojected with a standard Feldkamp-type algorithm. Quantitative evaluations have been performed by simulations of voxelized phantoms on the basis of the root mean square deviation and a quality factor Q (Q = 1 represents the ideal correction). Measurements with a C-arm FDCT system have been used to validate the simulations and to investigate the practical applicability using anthropomorphic phantoms which caused truncation in all projections. The proposed approaches enlarged the FOV to cover wider patient cross-sections. Thus, image quality inside and outside the SFOV has been improved. Best results have been obtained using the CT-based method, followed by the camera-based and the FDCT-based truncation correction. For simulations, quality factors up to 0.98 have been achieved. Truncation-induced cupping artefacts have been reduced, e.g., from 218% to less than 1% for the measurements. The proposed truncation correction approaches for EFOV reconstructions are an effective way to ensure accurate CT values inside the SFOV and to recover peripheral information outside the SFOV.

A prospective, randomized, controlled trial comparing ultrasound versus nerve stimulator guidance for interscalene block for ambulatory shoulder surgery for postoperative neurological symptoms.

BACKGROUND: Visualization with ultrasound during regional anesthesia may reduce the risk of intraneural injection and subsequent neurological symptoms but has not been formally assessed. Thus, we performed this randomized clinical trial comparing ultrasound versus nerve stimulator-guided interscalene blocks for shoulder arthroscopy to determine whether ultrasound could reduce the incidence of postoperative neurological symptoms. METHODS: Two hundred thirty patients were randomized to a standardized interscalene block with either ultrasound or nerve stimulator with a 5 cm, 22 g Stimuplex insulated needle with 1.5% mepivacaine with 1:300,000 epinephrine and NaCO3 (1 meq/10 mL). A standardized neurological assessment tool (questionnaire and physical examination) designed by a neurologist was administered before surgery (both components), at approximately 1 wk after surgery (questionnaire), and at approximately 4-6 weeks after surgery (both components). Diagnosis of postoperative neurological symptoms was determined by a neurologist blinded to block technique. RESULTS: Two hundred nineteen patients were evaluated. Use of ultrasound decreased the number of needle passes for block performance (1 vs 3, median, P < 0.001), enhanced motor block at the 5-min assessment (P = 0.04) but did not decrease block performance time (5 min for both). No patient required conversion to general anesthesia for failed block, and patient satisfaction was similar in both groups (96% nerve stimulator and 92% ultrasound). The incidence of postoperative neurological symptoms was similar at 1 wk follow-up with 11% (95% CI of 5%-17%) for nerve stimulator and 8% (95% CI of 3%-13%) for ultrasound and was similar at late follow-up with 7% (95% CI of 3%-12%) for nerve stimulator and 6% (95% CI of 2%-11%) for ultrasound. The severity of postoperative neurological symptoms was similar between groups with a median patient rating of moderate. Symptoms were primarily sensory and consisted of pain, tingling, or paresthesias. CONCLUSIONS: Ultrasound reduced the number of needle passes needed to perform interscalene block and enhanced motor block at the 5 min assessment; however, we did not observe significant differences in block failures, patient satisfaction or incidence, and severity of postoperative neurological symptoms.

Acromionectomy and deltoid deficiency: a solution.

UNLABELLED: Deltoid insufficiency after iatrogenic or traumatic acromionectomy results from separation of the deltoid from its origin and mechanical fulcrum. Subsequent retraction of the tendon and formation of subdeltoid adhesions to the cuff and humerus result in stiffness and pain. We evaluated clinical outcomes of patients treated with autogenous tricortical iliac crest bone graft combined with deltoid reconstruction or deltoidplasty for deltoid insufficiency after acromionectomy. We retrospectively reviewed four patients, three males, and one female treated with deltoidplasty reconstructions as revision surgery. Their mean age was 41 years, and the minimum followup was 41 months (mean, 50 months; range, 41-66 months). There were three work-related injuries. Outcomes evaluated were pain relief (visual analog score), American Shoulder and Elbow Surgeons score, cosmesis, and complications. The mean pain score improved from 8 (range, 3-10) preoperatively to 1 (range, 0-3) postoperatively. The mean American Shoulder and Elbow Surgeons score improved from 31 +/- 14 to 68 +/- 13. One patient required revision deltoidplasty for abductor weakness. Three patients underwent hardware removal. One patient who underwent concurrent latissimus dorsi transfer had limited functional improvement but decreased pain. Two patients had improved cosmesis. All had CT scans with three-dimensional reconstructions documenting union. All patients stated they would undergo the procedure again. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Adding ultrasound in the management of soft tissue disorders of the shoulder: a randomized placebo-controlled trial.

BACKGROUND AND PURPOSE: There is still a lack of evidence about the beneficial effects of ultrasound (US) intervention for the management of soft tissue problems. Thus, this study was designed to assess the effectiveness of US over a placebo intervention when added to other physical therapy interventions and exercise in the management of shoulder disorders. SUBJECTS AND METHODS: Forty patients who were diagnosed by ultrasonography or magnetic resonance imaging to have a periarticular soft tissue disorder of the shoulder were randomly assigned to either a group that received true US (n=20; mean time since onset of pain=8.7 months, SD=8.8, range=1-36) or a group that received sham US (n=20; mean time since onset of pain=8.1 months, SD=10.8, range=1-42). Besides true or sham US (10 minutes), superficial heat (10 minutes), electrical stimulation (15 minutes), and an exercise program (15-30 minutes) were administered to both groups 5 days each week for 3 weeks. RESULTS: Subjects showed within-group improvements in pain, range of motion, Shoulder Disability Questionnaire scores, and Health Assessment Questionnaire scores with the intervention, but the differences did not reach significance when compared between the groups. DISCUSSION AND CONCLUSION: The results suggest that true US, compared with sham US, brings no further benefit when applied in addition to other physical therapy interventions in the management of soft tissue disorders of the shoulder.

Efficient object scatter correction algorithm for third and fourth generation CT scanners.

X-ray photons which are scattered inside the object slice and reach the detector array increase the detected signal and produce image artifacts as "cupping" effects in large objects and dark bands between regions of high attenuation. The artifact amplitudes increase with scanned volume or slice width. Object scatter can be reduced in third generation computed tomography (CT) geometry by collimating the detector elements. However, a correction can still improve image quality. For fourth generation CT geometry, only poor anti-scatter collimation is possible and a numeric correction is necessary. This paper presents a correction algorithm which can be parameterized for third and fourth generation CT geometry. The method requires low computational effort and allows flexible application to different body regions by simple parameter adjustments. The object scatter intensity which is subtracted from the measured signal is calculated with convolution of the weighted and windowed projection data with a spatially invariant "scatter convolution function". The scatter convolution function is approximated for the desired scanner geometry from pencil beam simulations and measurements using coherent and incoherent differential scatter cross section data. Several examples of phantom and medical objects scanned with third and fourth generation CT systems are discussed. In third generation scanners, scatter artifacts are effectively corrected. For fourth generation geometry with poor anti-scatter collimation, object scatter artifacts are strongly reduced.

A conservative management protocol for calcific tendinitis of the shoulder.

OBJECTIVE: This paper presents a management protocol for calcific tendinitis and describes its effective application in 2 cases of calcific tendinitis of the supraspinatus tendon in middle-aged women. CLINICAL FEATURES: Two patients presented to a chiropractic clinic with previously diagnosed calcific tendinitis of the supraspinatus tendon. Both patients complained of chronic pain and tenderness in the shoulder region and had a limited range of shoulder motion as a result of the pain. Radiographs demonstrated calcific deposits in the region of the supraspinatus tendon. INTERVENTION AND OUTCOMES: Both patients were admitted to a treatment protocol involving approximately 20 sessions of phonophoresis (driving of medication into tissue by ultrasound) with Movelat cream followed by cross-friction massage to the supraspinatus tendon and range of motion exercises. A second set of radiographs was requested. The calcific deposits, clearly seen on the previous radiographs, were no longer visible, and symptoms were resolved. At 4-month follow up, both patients continued to be symptom-free. CONCLUSION: The result of these studies indicates that the management of calcific tendinitis falls within the scope of chiropractic practice and supports the use of a trial period of conservative management in cases of calcific tendinitis before consideration of surgical treatment.

Shoulder subluxation after stroke: a comparison of four supports.

OBJECTIVE: Shoulder subluxation is a well-known sequela of stroke. This study quantitatively compares the reduction of shoulder subluxation using four supports: the single-strap hemisling, the Bobath roll, the Rolyan humeral cuff sling, and the Cavalier support. DESIGN/SETTING: Anteroposterior shoulder radiographs of 20 consecutive first-time stroke survivors in a freestanding rehabilitation hospital were taken within 6 weeks of stroke onset. Vertical, horizontal, and total asymmetries of glenohumeral subluxation compared with the unaffected shoulders were measured before and after fitting of each support. MAIN OUTCOME MEASURES: Group means were compared to find which supports altered subluxation asymmetries and approximated the unaffected shoulder. Individual data were tallied to detect how often each support best reduced subluxation asymmetries. RESULTS: The single-strap hemisling eliminated the vertical asymmetry of subluxation over the entire study group, but each support corrected the vertical asymmetry best in some subjects (55%, 20%, 40%, and 5%, respectively). The Bobath roll and the Cavalier support produced lateral displacements of the humeral head of the affected shoulder (p = 0.005, 0.004, respectively). The Rolyan humeral cuff sling significantly reduced total subluxation asymmetry (p = 0.008), whereas the single-strap hemisling, Bobath roll, and Cavalier support did not alter total asymmetry (p = 0.091, 0.283, 0.502, respectively). CONCLUSION: When treating shoulder subluxation, several different types of supports should be evaluated to optimize the function of the affected extremity and the reduction of the shoulder subluxation.

[Tendinosis calcarea--results of treatment with needling]. / Tendinosis calcarea--Behandlungsergebnisse mit dem Needling.

In a prospective study, 33 patients with calcifying tendinitis had a needling in local anaesthesia performed under control of an image converter. There was at least a one year follow-up period. Resorption of the hydroxyapatite deposits was seen in 23 instances; 75% of all patients were free of symptoms or had considerably improved (Table 3). For better assessment of these results we embarked on an additional retrospective study observing the spontaneous evolution of 235 hydroxyapatite deposits for 3 years on average. On the x-ray, these deposits had a characteristic appearance and could be classified into one of three types: either sharply outlined and densely structured (type I), or with cloudy limitations and transparent in structure (type III). In addition we saw deposits combining the features of both of the above named types (type II) (Table 5, Fig. 6). Based on this classification, a clear correlation was revealed to exist between initial x-ray findings and the frequency of resorption after needling: with type I, complete resorption was seen in 33% of the cases, with type II in 71%, and with type III in 85% of the cases (Table 6). With type II, however, only half of the patients were free of symptoms. Surgical removal of the hydroxyapatite deposits became necessary in 3 patients because of persisting heavy pains. As complication we observed intraoperatively an incomplete tear of the rotator cuff, the relation of which to the needling remained unsure. In this context, the question is discussed whether calcifying tendinitis and rupture of the rotator cuff may represent two disease entities of identical origin.(ABSTRACT TRUNCATED AT 250 WORDS)