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treatment-article1

Luxatio articuli acromioclaviculare

SportNetDoc

Conservative treatment of acromioclavicular dislocation. Evaluation of functional and radiological results after six years follow-up.

Mulier T, Stuyck J, Fabry G. Acta Orthop Belg 1993;59(3):255-62.

Fifty-eight patients with acute acromioclavicular dislocations of Type III, IV and V (Rockwood classification) were examined to assess the late results of conservative treatment. The average age of the patients was 31 years, and the interval between injury and final review was 6.3 years. Seventy-nine percent of the patients had excellent or good late results. Surprisingly the age and activity level of the patients did not influence our late results, nor did the radiological appearance of acromioclavicular osteoarthritis or periarticular calcification. The radiological appearance of the acromioclavicular joint improved in 41% of patients. In 10 failed cases, excision of the distal end of the clavicle with reconstruction of the coracoclavicular ligament (Weaver and Dunn procedure) resulted in 90% excellent or good results after a 3-year follow-up. A high percentage of excellent results can be expected after this procedure, as long as it is correctly performed.

treatment-article

Fracture of the upper arm

SportNetDoc

Results of non-operative and operative treatment of humeral shaft fractures. A series of 104 cases.

Osman N, Touam C, Masmejean E, Asfazadourian H, Alnot JY. Chir Main 1998;17(3):195-206.

The aim of this study was to examine the results of different modalities applied in the treatment of 104 fresh diaphyseal fractures of the adult humerus treated in the department between January 1994 and March 1997. These results were classified according to the criteria described by Stewart and Hundley. 32 patients (30.8%) were treated non-operatively using a sling and a moulded plaster splint. The type of treatment had to be changed in 12 of these patients due to 14 different complications that occurred during the course of non-operative treatment. Thus, 20 patients (62.5%) underwent non-operative treatment until fracture-union. The results in this group were: very good in 12 cases (60%), good in 5 cases (25%), fair in 3 cases (15%). 28 fractures were treated using plates and screws. 4 events (14%) occurred during in the post-operative period and, apart from 2 cases of non-union, the overall result in the 26 patients in whom the fracture united was: very good in 23 cases (88.5%) and good in 3 cases (11.5%). 22 patients (21.1%) underwent fixation using multiple flexible intramedullary wires via a supracondylar approach. Apart from one case of non-union, the final result in the 21 patients in whom the fracture united was: very good in 9 cases (42.8%), good in 9 cases (42.8%), fair in 2 cases (9.5%) and poor in 1 case (4.9%). 22 fractures were treated using an intramedullary Seidel nail. The final result in these patients was: very good in 11 cases (50%), good in 9 cases (41%) and poor in 2 cases (9%). The indications for treatment should be eclectic. Non-operative treatment remains the method of choice for undisplaced or minimally-displaced fractures or comminuted fractures with multiple parallel longitudinal fracture-lines over the middle-third, while surgical treatment is considered for displaced fractures and essentially depends upon the type and level of the fracture. Transverse and short oblique fractures are treated using a plate or a Seidel nail. Fractures with a third fragment require plate osteosynthesis. Multiple flexible intramedullary wires are used for segmental fractures or for diaphyseal fractures associated with fractures of the neck of the humerus. Comminuted fractures are realigned using an intramedullary Seidel nail or multiple flexible wires. As far as the site of fracture is concerned, those of the proximal and middle thirds of the humerus are well treated using an intramedullary nail or multiple wires or with a plate, while plating is most often the method of choice for fractures of the distal-third.

treatment-article

Fracture of the collar bone

SportNetDoc

Complications of plate fixation in fresh displaced midclavicular fractures.

Bostman O, Manninen M, Pihlajamaki H. J Trauma 1997 Nov;43(5):778-83.

BACKGROUND.
The role of plate fixation in the management of fresh displaced midclavicular fractures is unsettled. The objective of this study was to evaluate the drawbacks and pitfalls of this treatment method.

METHODS.
We analyzed the complications encountered in 103 consecutive adult patients with severely displaced fresh fractures of the middle third of the clavicle who were treated by open reduction and internal fixation using AO/ASIF plates. These 103 patients accounted for 9.5% of the 1,081 patients with fresh midclavicular fractures seen between 1989 and 1995. The mean age of the 103 patients was 33.4 years (range, 19-62 years).

RESULTS.
Seventy-nine patients had an uneventful recovery, whereas 24 (23%) suffered one or several complications. The major complications included deep infection, plate breakage, nonunion, and refracture after plate removal. The most common of the minor complications was plate loosening resulting in malunion. The infection rate was 7.8%. A total of 14 reoperations were performed because of the complications. Permanent nonunion ensued in two patients. A severely comminuted fracture (relative risk of failure, 5.15) as well as a state of alcohol intoxication on admission (relative risk of failure, 3.12) were identified as markers of increased complication risk.

CONCLUSIONS.
Patient noncompliance with the postoperative regimen could be suspected to have been a major cause of the failures. The high complication rate supports a reserved attitude toward plate fixation of fresh midclavicular fractures. The method should be reserved for patients who have trustworthy personal motives for quick pain relief and functional recovery.

KONDITION

step4

Frozen shoulder

[Back]

Training ladder for:
FROZEN SHOULDER
(PERIARTROSIS HUMEROSCAPULARIS)

STEP 4
As it is often pain which has provoked the “frozen shoulder”, it is very important that the exercises do not bring about any pain, neither during nor after the exercises, or the next day.
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(20 min)

Sit on a chair with your arms outstretched behind your back with hands together. Lift your arms up and backwards so that the front of the shoulders becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand in a doorframe. Press your arms against the frame so that the front of your shoulders become increasingly stretched. Move your arms up and down the doorframe so that different parts of your muscles are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands together behind your back. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Bend your injured arm behind your head and using the opposite hand, pull the elbow of the injured arm towards the opposite shoulder so that you feel increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

STYRKE
(40 min)

Go down on all fours. Lift your toes from the floor and do push-ups.

Lie on your back with the injured arm by your side. Move the arm up and over your head before slowly retuning the arm again. The arm must be outstretched the whole time.

Stand with the good shoulder against a wall. Hold the elastic with the injured arm and move the outstretched arm to the side and away from your body so that the elastic becomes taut.

Stand holding a firm round cushion against the wall with the injured arm. Slowly move the cushion up the wall above 90 degrees.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm outwards so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm in over your stomach so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand with your side against a wall holding the elastic with the injured arm. Stretch the elbow with the upper arm at 90 degrees to your body and the hand above shoulder height. Draw the arm downwards and in over your stomach.

Stand with your side against the wall, holding the elastic with the injured arm. Move your arm away from your body so that the elastic becomes taut, before slowly drawing your arm in towards your body again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step3

Frozen shoulder

[Back]

Training ladder for:
FROZEN SHOULDER
(PERIARTROSIS HUMEROSCAPULARIS)

STEP 3
As it is often pain which has provoked the “frozen shoulder”, it is very important that the exercises do not bring about any pain, neither during nor after the exercises, or the next day.
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(10 min)

Sit on a chair with your arms outstretched behind your back with hands together. Lift your arms up and backwards so that the front of the shoulders becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your hands together behind your back. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(50 min)

Support with both hands against a wall. Put your weight on your hands and draw your shoulder blades backwards and forwards.

Support with both hands against a wall. Move slowly towards the wall and push away again. The exercise is performed like standing push-ups.

Hold an elastic band with the injured arm at a 90-degree angle from the body. Slowly draw the elastic towards yourself so that it tightens.

Hold the elastic with the injured arm with elbow bent and your hand at shoulder level. Stretch your arm forwards so that the elastic is tightened.

Stand with your side against a wall. Hold the elastic with the injured arm with elbow bent, upper arm 90 degrees away from your body and your hand at shoulder height. The palm of your hand should face the floor. Drawn your arm downwards and in front of your stomach.

Lie on your back with the injured arm raised upwards. Hold the elastic between your hands with the good arm against your chest. Stretch the injured arm further upwards so that the shoulder blade lifts from the floor.

Lie on your stomach on a bench or table with the injured arm hanging over the edge. Raise the injured arm stretched horizontally while drawing the shoulder blade in towards your body. A weight or bottle can be held in the hand to increase the load.

Stand with the injured arm stretched down against your body. Move your arm out from your body to maximum 90 degrees.

Stand with the elastic under your foot. Hold the elastic with the injured arm and drawn the arm slowly back and upwards so that the elastic is taut.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm outwards so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm in over your stomach so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand with the good shoulder against a wall. Hold the elastic with the injured arm and move the outstretched arm to the side and away from your body so that the elastic becomes taut.

Stand with your side against the wall, holding the elastic with the injured arm. Move your arm away from your body so that the elastic becomes taut, before slowly drawing your arm in towards your body again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step2

Frozen shoulder

[Back]

Training ladder for:
FROZEN SHOULDER
(PERIARTROSIS HUMEROSCAPULARIS)

STEP 2
As it is often pain which has provoked the “frozen shoulder”, it is very important that the exercises do not bring about any pain, neither during nor after the exercises, or the next day.
KONDITION
Unlimited: Cycling. Swimming. Running.

UDSPÆNDING
(10 min)

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your arms outstretched at your sides with the palms of your hands facing forwards. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Stand with the injured arm in front of your body. With the opposite hand, press the elbow of the injured arm towards the opposite shoulder, so that the upper part of the arm and the outer shoulder experiences increased stretching. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(50 min)

Lie on your back with the injured arm pointing upwards. Stretch the arm further up so that the shoulder blade lifts from the floor, and go down again. The arm must be outstretched the whole time.

Hold an elastic band with the injured arm, with the arm by your side and the elbow bent. Slowly draw the elastic towards yourself so that the elastic tightens. The elbow must be bent the whole time.

Hold an elastic band in the good arm. Take hold of the other end of the elastic with the injured arm and draw the injured arm downwards.

Put the elastic under your foot, and with the injured arm draw the other end upwards by bending your arm.

Hold the elastic with the injured arm with your upper arm alongside your body with the elbow bent. Stretch your arm forwards so that the elastic tightens.

Stand with the elastic under your foot. Hold the elastic with the injured arm and draw your shoulder upwards. The arm should be kept stretched in against your body the whole time.

Stand slightly bent over a chair, with your weight on the good arm and the injured arm hanging loosely downwards holding a weight or a filled bottle. Lift your arm/shoulder upwards by using the shoulder blade’s muscles. Using heavier objects or weights can increase the load.

Lie on your stomach on a bench or table with the injured arm hanging over the edge holding a weight or bottle. Slowly draw the hand up to the shoulder joint.

Sit with the injured arm on a table with your hand on a cloth. Polish the tabletop backwards and forwards while applying slight pressure with your arm.

Stand at a table with both hands on a firm round cushion with elbows slightly bent. Apply slight pressure to the cushion and roll the cushion away from yourself so that the upper body bends in over the table. Roll the cushion back again to the starting position.

Stand with the good shoulder against a wall. Hold the elastic with the injured arm and move the outstretched arm to the side and away from your body so that the elastic becomes taut.

Stand and bounce a ball on the floor backwards and forwards from the injured to the good hand.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm outwards so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand holding the elastic with the upper arm against your body and elbow bent at 90 degrees. Twist your lower arm in over your stomach so that the elastic is taut and draw your arm slowly back again. The elbow must be held against your body the whole time.

Stand with your side against the wall, holding the elastic with the injured arm. Move your arm away from your body so that the elastic becomes taut, before slowly drawing your arm in towards your body again.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

KONDITION

step1

Frozen shoulder

[Back]

Training ladder for:
FROZEN SHOULDER
(PERIARTROSIS HUMEROSCAPULARIS)

STEP 1
As it is often pain which has provoked the “frozen shoulder”, it is very important that the exercises do not bring about any pain, neither during nor after the exercises, or the next day.
KONDITION
Unlimited: Cycling. Running.

UDSPÆNDING
(10 min)

Sit on a chair with one hand on your head and the other holding the chair seat. Slowly draw your head to the side while resisting with the opposite arm so that the muscles on the side of the neck become increasingly stretched. Draw your head in different directions so that all the muscles around the neck are stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating.

Stand with your arms outstretched at your sides with the palms of your hands facing forwards. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Sit on a chair holding the back of your hands under the lower part of the back. Press your elbows forwards and inwards so that the muscles on the back of the shoulder joint become increasingly stretched. Hold the position for 20 seconds and follow by pressing the elbows backwards so that increased stretching occurs on the front of the shoulder joint. Hold the position for 20 seconds.

STYRKE
(50 min)

Stand slightly bent over a chair, with your weight on the good arm and the injured arm hanging loosely downwards. Lift your arm/shoulder upwards by using the shoulder blade’s muscles. You can bend your arm if you have difficulty in locating the shoulder blade muscles.

Stand with your arms outstretched at your sides with the palms of your hands facing forwards. Draw your shoulder blades together (imagine trying to hold a pencil between your shoulder blades). Hold the position for 10 seconds and rest for 10 seconds before repeating.

Sit at a table with the injured arm’s elbow on a ball. Press against the ball with a slow movement for 5 seconds. Rest for 5 seconds before repeating.

Lift both shoulders slowly upwards and down again.

Stand bending forward and supporting a chair back with one hand. Let the other arm hang freely downwards holding a weight. Move the shoulder backwards and forwards and from side to side. It is important that the arm hangs straight down the whole time.

Stand with the injured arm stretched down against your body. First move the arm out from your body 20 degrees and back again, and then out 40 degrees and back again. Finally move the arm out 60 degrees from your body and back again.

Stand with the injured arm against a wall with elbow bent. Press the arm against the wall and hold the pressure for 10 seconds. Rest for 10 seconds before repeating. Repeat the exercise 10 times.

Stand at a table with the injured arm on a ball. Move the ball in all directions while applying slight pressure on the ball.

Kneel facing the wall with the injured arm on a table. The tabletop must be at shoulder height. Hold the elastic with the palm facing the wall and move your elbow up and down.

Kneel facing away from the wall with the injured arm on a table. The tabletop must be at shoulder height. Hold the elastic with the back of your hand facing the wall and move your elbow up and down.

Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements.

treatment-article2

Frozen shoulder

SportNetDoc

Frozen shoulder: a 12-month clinical outcome trial.

Watson L, Dalziel R, Story I. J Shoulder Elbow Surg 2000 Jan-Feb;9(1):16-22.

A prospective study was undertaken of 73 patients with frozen shoulder syndrome who were treated with an arthroscopic capsulotomy. All of the patients were assessed for pain, function, and range of motion before surgery and were monitored through to 1-year follow up. Improvement in all parameters was achieved, with pain taking an average of 2.24 weeks to diminish and range of motion improving to within 10% of the other side at an average of 5.5 weeks after surgery. Patients were discharged with a full range of motion and without pain at an average of 8.9 weeks. There was, however, some mild reaggravation of most patients’ pain within the postoperative period (mean 4.5 weeks). This pain usually settled with appropriate massage within a 2-week period. In 37% of cases, however, an injection of corticosteroid was required as part of the postoperative management. These cases were usually in that subgroup of patients who still had significant night pain and were in stage 2 or 3 of the disease process at the time of surgery. The postoperative results continued to the 12-month follow-up, with 11% of patients having a recurrence of pain or stiffness. This study has demonstrated that arthroscopic capsulotomy is an effective technique in the management of the frozen shoulder. It also has enabled the authors to document postoperative recovery times, which has given prospective patients realistic time frames of functional expectation in their postoperative recovery.

treatment-article1

Frozen shoulder

SportNetDoc

Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens.

de Jong BA, Dahmen R, Hogeweg JA, Marti RK. Clin Rehabil 1998 Jun;12(3):211-5.

BACKGROUND AND PURPOSE.
Although corticosteroid injections have been reported to be effective in capsulitis of the shoulder, the optimal dose has not been established. The purpose of this study was to compare relief of symptoms following a lower dose with that following a higher dose of triamcinolone acetonide given intra-articularly.

SUBJECTS.
Thirty-two patients were given low dose suspension; 25 patients were given high dose suspension.

METHOD.
Randomized, double-blind clinical trial. Each patient was given a course of three injections. Pain, sleep disturbance, functional impairment and passive range of motion (ROM) were assessed at intake and at one, three and six weeks after the initial injection. Data were analysed by independent sample t-tests and nonparametric Mann-Whitney U-tests.

RESULTS.
The group which received the 40 mg dose showed significantly greater improvement than the group receiving the 10 mg dose.

CONCLUSIONS.
The study shows that in the treatment of frozen shoulder greater symptom relief is obtained with a dose of 40 mg triamcinolone acetonide intra-articularly than with a dose of 10 mg. The effect on pain and sleep disturbance was more marked than on ROM. Intra-articular injections with triamcinolone acetonide appear to be an effective method to obtain symptom relief for patients with painful capsulitis of the shoulder.