Excursion of the Rotator Cuff Under the Acromion

Nine fresh-frozen, human cadaveric shoulders were el evated in the scapular plane in two different humeral rotations by applying forces along action lines of rotator cuff and deltoid muscles. Stereophotogrammetry deter mined possible regions of subacromial contact using a proximity criterion; radiographs measured acromio humeral interval and position of greater tuberosity. Con tact starts at the anterolateral edge of the acromion at 0° of elevation; it shifts medially with arm elevation. On the humeral surface, contact shifts from proximal to dis tal on the supraspinatus tendon with arm elevation. When external rotation is decreased, distal and poste rior shift in contact is noted. Acromial undersurface and rotator cuff tendons are in closest proximity between 60° and 120° of elevation; contact was consistently more pronounced for Type III acromions. Mean acro miohumeral interval was 11.1 mm at 0° of elevation and decreased to 5.7 mm at 90°, when greater tuberosity was closest to the acromion. Radiographs show bone- to-bone relationship; stereophotogrammetry assesses contact on soft tissues of the subacromial space. Con tact centers on the supraspinatus insertion, suggesting altered excursion of the greater tuberosity may initially damage this rotator cuff region. Conditions limiting ex ternal rotation or elevation may also increase rotator cuff compression. Marked increase in contact with Type III acromions supports the role of anterior acromioplasty when clinically indicated, usually in older patients with primary impingement.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67283/2/10.1177_036354659402200609.pd

What difference does ("good") HRM make?

The importance of human resources management (HRM) to the success or failure of health system performance has, until recently, been generally overlooked. In recent years it has been increasingly recognised that getting HR policy and management "right" has to be at the core of any sustainable solution to health system performance. In comparison to the evidence base on health care reform-related issues of health system finance and appropriate purchaser/provider incentive structures, there is very limited information on the HRM dimension or its impact. Despite the limited, but growing, evidence base on the impact of HRM on organisational performance in other sectors, there have been relatively few attempts to assess the implications of this evidence for the health sector. This paper examines this broader evidence base on HRM in other sectors and examines some of the underlying issues related to "good" HRM in the health sector. The paper considers how human resource management (HRM) has been defined and evaluated in other sectors. Essentially there are two sub-themes: how have HRM interventions been defined? and how have the effects of these interventions been measured in order to identify which interventions are most effective? In other words, what is "good" HRM? The paper argues that it is not only the organisational context that differentiates the health sector from many other sectors, in terms of HRM. Many of the measures of organisational performance are also unique. "Performance" in the health sector can be fully assessed only by means of indicators that are sector-specific. These can focus on measures of clinical activity or workload (e.g. staff per occupied bed, or patient acuity measures), on measures of output (e.g. number of patients treated) or, less frequently, on measures of outcome (e.g. mortality rates or rate of post-surgery complications). The paper also stresses the need for a "fit" between the HRM approach and the organisational characteristics, context and priorities, and for recognition that so-called "bundles" of linked and coordinated HRM interventions will be more likely to achieve sustained improvements in organisational performance than single or uncoordinated interventions

Acromioclavicular joint dislocation: a comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models

<p>Abstract</p> <p>Background</p> <p>Acromioclavicular injuries are common in sports medicine. Surgical intervention is generally advocated for chronic instability of Rockwood grade III and more severe injuries. Various methods of coracoclavicular ligament reconstruction and augmentation have been described. The objective of this study is to compare the biomechanical properties of a novel palmaris-longus tendon reconstruction with those of the native AC+CC ligaments, the modified Weaver-Dunn reconstruction, the ACJ capsuloligamentous complex repair, screw and clavicle hook plate augmentation.</p> <p>Hypothesis</p> <p>There is no difference, biomechanically, amongst the various reconstruction and augmentative methods.</p> <p>Study Design</p> <p>Controlled laboratory cadaveric study.</p> <p>Methods</p> <p>54 cadaveric native (acromioclavicular and coracoclavicular) ligaments were tested using the Instron machine. Superior loading was performed in the 6 groups: 1) in the intact states, 2) after modified Weaver-Dunn reconstruction (WD), 3) after modified Weaver-Dunn reconstruction with acromioclavicular joint capsuloligamentous repair (WD.ACJ), 4) after modified Weaver-Dunn reconstruction with clavicular hook plate augmentation (WD.CP) or 5) after modified Weaver-Dunn reconstruction with coracoclavicular screw augmentation (WD.BS) and 6) after modified Weaver-Dunn reconstruction with mersilene tape-palmaris-longus tendon graft reconstruction (WD. PLmt). Posterior-anterior (horizontal) loading was similarly performed in all groups, except groups 4 and 5. The respective failure loads, stiffnesses, displacements at failure and modes of failure were recorded. Data analysis was carried out using a one-way ANOVA, with Student's unpaired t-test for unpaired data (S-PLUS statistical package 2005).</p> <p>Results</p> <p>Native ligaments were the strongest and stiffest when compared to other modes of reconstruction and augmentation except coracoclavicular screw, in both posterior-anterior and superior directions (p < 0.005).</p> <p>WD.ACJ provided additional posterior-anterior (P = 0. 039) but not superior (p = 0.250) stability when compared to WD alone.</p> <p>WD+PLmt, in loads and stiffness at failure superiorly, was similar to WD+CP (p = 0.066). WD+PLmt, in loads and stiffness at failure postero-anteriorly, was similar to WD+ACJ (p = 0.084).</p> <p>Superiorly, WD+CP had similar strength as WD+BS (p = 0.057), but it was less stiff (p < 0.005).</p> <p>Conclusions and Clinical Relevance</p> <p>Modified Weaver-Dunn procedure must always be supplemented with acromioclavicular capsuloligamentous repair to increase posterior-anterior stability. Palmaris-Longus tendon graft provides both additional superior and posterior-anterior stability when used for acromioclavicular capsuloligamentous reconstruction. It is a good alternative to clavicle hook plate in acromioclavicular dislocation.</p

Rehabilitation of the athletic shoulder: a proposed functional evaluative form

peer reviewedSports activity involving the upper limb implies some powerful movements leading to the development of specific adaptations of the shoulder. These adaptive patterns increase the risk of injury. Shoulder rehabilitation in athletes should be guided by the results of a specific physical examination of the shoulder. In this article we propose an original evaluative form specifically designed for the athletic shoulder which takes into consideration the morphostatic and physical features as well as the possible bilateral asymmetries. The functional evaluation includes measurement of range of motion, flexibility, isometric muscle strength, position and motion patterns of the scapula. Progress achieved during rehabilitation programs can be monitored with successive evaluations which are helpful for determining the most suitable treatment