The Action of the Short Rotators on the Normal Abduction of the Arm, With a Consideration of Their Action in Some Oases of Subacromial Bursitis and Allied Conditions

Stevens, James H.

doi:10.1097/00000441-190912000-00010

Cited by 17 publications

(3 citation statements)

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“…Explanations for poor results after conservative treatment of fractures of the greater tuberosity have included loss of shoulder elevation and painful movement. 2,3,5,7 An alteration of the function of the rotator cuff 8 and a direct mechanical block 3,7 may compromise abduction. Prominence of the greater tuberosity with superior or posterior displacement may contribute to symptomatic subacromial impingement.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Most authors advocate conservative treatment of fractures with less than 0.5 cm of displacement and surgery for injuries in which it is more than 1.0 cm, 1,2,4,6 but the optimal management of fragments with distraction of between 0.5 and 1.0 cm is unclear. With displacement there is often loss of shoulder abduction 2,4,7 which has been attributed to an alteration of the function of the rotator cuff 8 and a direct mechanical block. 3,7 In addition, superior or posterior malalignment of the greater tuberosity can lead to its prominence causing painful impingement.…”

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confidence: 99%

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Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder

Bono¹,

Renard²,

Levine³

et al. 2001

The Journal of Bone and Joint Surgery

107

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Using a dynamic biomechanical model of malunion of the shoulder, we have determined the change in deltoid force required for abduction with various combinations of superior and posterior displacement of fractures of the greater tuberosity of the humerus. We tested eight fresh human cadaver shoulders in a dynamic shoulder-testing apparatus during cycles of glenohumeral abduction from 0 degrees to 90 degrees. The greater tuberosities were osteotomised and stabilised to represent malunion with combinations of superior and posterior displacements of 1 cm and less. The peak force was measured for each displacement in each specimen and statistically compared with values of no displacement using a repeated-measures analysis of variance. The abduction force was significantly increased by 16% (p = 0.006) and 27% (p = 0.0001) by superior displacements of 0.5 cm and 1 cm, respectively, while combined superior and posterior displacement of 1 cm gave an increase in force of 29% (p = 0.001). While treatment criteria for acceptable residual displacement of the greater tuberosity are widely used, there is little information on the direct biomechanical effects of displacement on shoulder mechanics. Although the results of conservative treatment are influenced by a number of factors, including associated injuries, rehabilitation and the pre-existing function of the shoulder, our data suggest that small amounts of residual displacement may alter the balance of forces required to elevate the arm at the glenohumeral joint.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of displacement of fractures of the greater tuberosity on the mechanics of the shoulder

Bono¹,

Renard²,

Levine³

et al. 2001

The Journal of Bone and Joint Surgery

107

View full text Add to dashboard Cite

show abstract

“…Long before Neer, in 1909, Goldthwait, who would later lead the Surgeons of the American Expeditionary Forces and help create the division of orthopaedics, discussed the length and slope of the acromion as possible contributors to impingement. Also in 1909, Stevens 48 described the biomechanics of the rotator cuff and how alteration in the force couple might contribute to subacromial symptoms.…”

mentioning

confidence: 99%