a difficult birth (see dystocia) in which the anterior or, less commonly, the posterior fetal shoulder impacts on the maternal symphysis or sacral promontory. It is an obstetric emergency and is diagnosed when the shoulders fail to deliver after the fetal head and when gentle downward traction has failed. Additional obstetric manoeuvres (e.g. *McRobert’s manoeuvre) are required to release the shoulders from below the pubic symphysis. It occurs in approximately 1% of vaginal births. There are well-recognized risk factors, such as maternal diabetes and obesity and fetal *macrosomia. There can be a high *perinatal mortality rate and morbidity associated with the condition; the most common fetal injuries are to the brachial plexus, causing an *Erb’s palsy or *Klumpke’s paralysis. Maternal morbidity is also increased, particularly *postpartum haemorrhage.
A painful condition of the shoulder accompanied by sti?ness and considerable limitation of movement. The usual age-incidence is between 50 and 70. The cause is in?ammation and contracture of the ligaments and muscles of the shoulder joint, probably due to overuse. Treatment is physiotherapy and local steroid infections. There is practically always complete recovery, even though this may take 12–18 months.... frozen shoulder
Pain and stiffness affecting one shoulder and the hand on the same side; the hand may also become hot, sweaty, and swollen. Arm muscles may waste through lack of use (see Sudeck’s atrophy). The cause of shoulder–hand syndrome is unknown, but it may occur as a complication of myocardial infarction, stroke, herpes zoster, or shoulder injury. Recovery usually occurs in about 2 years. This period may be shortened by physiotherapy and corticosteroid drugs. In rare cases, a cervical sympathectomy is performed.... shoulder–hand syndrome
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