Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequen...Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.展开更多
Purpose: There have been many studies on the effects of different types of backpacks on posture from a biomechanical perspective and on the center of gravity. Considering the effects of autonomic nervous system activi...Purpose: There have been many studies on the effects of different types of backpacks on posture from a biomechanical perspective and on the center of gravity. Considering the effects of autonomic nervous system activity and mood associated with backpacks in mountaineering and hiking, research is also needed from a psychological perspective. In this study, the effects of adjusting the backpack shoulder stabilizer were preliminarily tested in terms of subjective fatigue and changes in autonomic nervous activity after hiking. Methods: The experimental 15 healthy participants hiked the mountain under two conditions: 1) without adjusting the stabilizer, a feature of the backpack (NAH condition), and 2) with the stabilizer adjusted (AH condition). First, all participants hiked the mountain in the NAH condition, and after a 30-minute break, they began the hike in the AH condition after confirming that a) their heart rate had recovered and b) they were in good physical condition. Results: HR was significantly lower after each hiking session than during the session. RMSSD was significantly lower pre-AH and post-AH than the NAH condition, but there was no significant difference between the NAH condition and either post-NAH or post-AH. Additionally, RMSSD was significantly lower in the AH condition than pre-AH or post-AH. The shoulders and back were significantly more burdened in the NAH condition than in the AH condition. The pleasure level was significantly higher in the AH condition than in the NAH condition. Conclusion: The results showed that also adjusting the position of the waist belt when adjusting the shoulder stabilizer, which is mainly used for the neck and shoulders, has a significant positive effect on the subjective burden on the upper body and parasympathetic nervous system activity after hiking.展开更多
BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher ...BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher accuracy in young,slender,healthy volunteers than the classical“Cyriax technique”.AIM To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.METHODS We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone,lidocaine,and air.After the injection,the shoulder was moved to determine whether a squishing sound could be produced.The squishing sound was interpreted as an accurate injection.The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.RESULTS Squishing was heard after 87%of the injections.This was 13%(10%points)more than the 77%in the previous study(P=0.004).CONCLUSION The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis.We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.展开更多
BACKGROUND Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears.The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to...BACKGROUND Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears.The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site.Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.AIM To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.METHODS In this study,24 adult patients with rotator cuff tears(13 patients)or anterior shoulder instability(11 patients)were included.All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology.The second operation was performed in 8 patients due to mild but persistent pain or stiffness,in 3 patients for recalcitrant stiffness,in 5 patients for secondary biceps tenotomy,in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding.Soft tissue healing was evaluated visually and by probing,whereas clinical outcomes were evaluated using the University of California–Los Angeles(UCLA)and Rowe rating scales.RESULTS In almost all patients,complete soft tissue healing occurred at the site of tissue reattachment,either on the glenoid articular surface or the greater humeral tuberosity.The strongest repair,as confirmed by probe palpation,was encountered at the site of suture passage through the soft tissue.All suture material was covered with bursal synovial tissue,with no cases of knot impingement or cartilage fraying.The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354±3205 and 2931±2898,respectively(P<0.001),whereas for shoulder instability patients,the mean Rowe scores preoperatively and postoperatively were 2591±1338 and 9272±754,respectively(P<0.001).The use of bioabsorbable implants did not cause synovitis or other tissue reactions.CONCLUSION Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.展开更多
Sickle cell disease(SCD)is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises(VOCs),leading to musculoskeletal complications that significantly affect quality of life.Among these,shoulder ...Sickle cell disease(SCD)is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises(VOCs),leading to musculoskeletal complications that significantly affect quality of life.Among these,shoulder complications are a concern,with humeral head avascular necrosis(AVN)being the second most common site of involvement after the femoral head.Other shoulder pathologies,including osteomyelitis and septic arthritis,further contribute to morbidity.However,these conditions remain underdiagnosed and understudied,often due to overlapping symptoms with VOC-related bone infarctions.Imaging,particularly magnetic resonance imaging,is crucial for early diagnosis and accurate differentiation.Management strategies range from conservative pain control to surgical interventions,including core decompression for early-stage AVN and arthroplasty for advanced joint destruction.Surgical outcomes in SCD,however,remain inconsistent due to higher complication rates and a lack of standardized guidelines.Despite advancements in diagnosis and treatment,shoulder pathology in SCD remains an area of limited research.This review highlights the need for larger,long-term studies with a homogeneous etiology to support and refine current treatment strategies and improve patient outcomes.展开更多
Acute traumatic injuries to the glenohumeral articulation are common.The types of injuries depend on age,muscle strength,bone density,and biomechanics of the traumatic event.Understanding the different mechanisms of t...Acute traumatic injuries to the glenohumeral articulation are common.The types of injuries depend on age,muscle strength,bone density,and biomechanics of the traumatic event.Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions.Therefore,when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns.Here,we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation,dislocation with fracture of the humeral head,and the proximal humerus fracture.We have focused on common injury mechanisms and the correlation with radiological diagnostics.Radiological and laboratory findings of distinct types of injury were also discussed.展开更多
Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the hum...Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the humeral head, depending upon the pathological process involved. Degenerative glenohumeral arthritis with mild to moderate involvement of subchondral bone allowed for a resurfacing option, while severe humeral head involvement required a partial or full humeral head replacement attached to an intramedullary stem for fixation. All components evolved from cemented to cementless application by 1982. The purpose of this paper is to describe the progression of Buechel-Pappas (B-P) shoulder replacement development from the early 1970’s in both cemented and cement less applications. Methods: Clinical evaluations of “Floating-Socket” TSR, followed by B-P stem-type, resurfacing types, bipolar-type and revision components, all of which comprise the B-P Shoulder Replacement System, were performed over a 49-year period. Results: “Floating-Socket” implants improved the results of simple, constrained ball-in-socket designs, but generally failed by glenoid component loosening in both chimpanzee and human applications. Unconstrained resurfacing-type components, both anatomical humeral head and full proximal humeral components, were quite successful, with minimal failures observed in long-term studies. Bipolar salvage implants, used for severe proximal deficiencies, revisions and massive rotator cuff arthropathy, were also very successful;providing overhead range of motion in many patients. Conclusions: Resurfacing hemiarthroplasty, in patients with intact or repairable rotator cuff mechanisms, gave the most satisfactory results and were the least technically complicated to perform, requiring minimal instrumentation. Resurfacing of full proximal humeral deficiencies, using femoral resurfacing components, gave similar clinical results to more complex semi-constrained devices, also with less technical difficulties and simple instrumentation.展开更多
BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroa...BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.METHODS We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023.Patients were grouped using the envelope method.RESULTS After treatment,the study group’s treatment effective rate was 94.90%(46/49 patients),significantly higher than that in the control group(79.17%,38/48 cases;P<0.05).Before treatment,there was no difference in Constant Murley Score(CMS)scores,shoulder mobility,or 36-Item Short Form Health Survey(SF-36)scale scores(P>0.05).Compared with those before treatment,the CMS scores(including pain,daily living ability,shoulder mobility,and muscle strength),all aspects of shoulder mobility(forward flexion,posterior extension,external rotation,internal rotation),and SF-36 scale scores(including physiological,psychological,emotional,physical,vitality,and health status)were higher in both groups after treatment and significantly higher in the study group(P<0.05).There was no difference in the occurrence of complications between the two treatment groups(P>0.05).CONCLUSION Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries,helps accelerate the recovery of shoulder function,improves the quality of life,and is highly safe.展开更多
2A14-T62 butt joint was successfully welded by stationary shoulder friction stir welding(SSFSW)method.The results showed that using a pin with small shoulder could broaden the process window,and under a rotation speed...2A14-T62 butt joint was successfully welded by stationary shoulder friction stir welding(SSFSW)method.The results showed that using a pin with small shoulder could broaden the process window,and under a rotation speed of 2000 r/min and welding speed of 30 mm/min,joint with smooth surface,small reduction in thickness and little inner defects was obtained.The weld nugget zone was approx-imately circular,which was a unique morphology for SSFSW.The heat-affected zone(HAZ)and thermo-mechanically affected zone(TMAZ)were both quite narrow due to the lower heat input and slight mechanical action of the stationary shoulder.The fraction of high angle grain boundaries(HAGBs)exhibited a“W”shape along horizontal direction(from advancing side to retreating side),and the minim-um value located at HAZ.The average ultimate tensile strength and elongation of the joint were 325 MPa and 4.5%,respectively,with the joint efficiency of 68.3%.The joint was ductile fractured and the fracture surface contained two types of dimples morphology in different re-gions of the joint.Microhardness distribution in the joint exhibited a“W”shape,and the difference along the thickness direction was negli-gible.The joint had strong stress corrosion cracking susceptibility,and the slow stain rate tensile strength was 139 MPa.Microcrack and Al2O3 particulates were observed at the fracture surface.展开更多
Total shoulder arthroplasty is a standard restorative procedure practiced by orthopedists to diagnose shoulder arthritis in which a prosthesis replaces the whole joint or a part of the joint.It is often challenging fo...Total shoulder arthroplasty is a standard restorative procedure practiced by orthopedists to diagnose shoulder arthritis in which a prosthesis replaces the whole joint or a part of the joint.It is often challenging for doctors to identify the exact model and manufacturer of the prosthesis when it is unknown.This paper proposes a transfer learning-based class imbalance-aware prosthesis detection method to detect the implant’s manufacturer automatically from shoulder X-ray images.The framework of the method proposes a novel training approach and a new set of batch-normalization,dropout,and fully convolutional layers in the head network.It employs cyclical learning rates and weighting-based loss calculation mechanism.These modifications aid in faster convergence,avoid local-minima stagnation,and remove the training bias caused by imbalanced dataset.The proposed method is evaluated using seven well-known pre-trained models of VGGNet,ResNet,and DenseNet families.Experimentation is performed on a shoulder implant benchmark dataset consisting of 597 shoulder X-ray images.The proposed method improves the classification performance of all pre-trained models by 10–12%.The DenseNet-201-based variant has achieved the highest classification accuracy of 89.5%,which is 10%higher than existing methods.Further,to validate and generalize the proposed method,the existing baseline dataset is supplemented to six classes,including samples of two more implant manufacturers.Experimental results have shown average accuracy of 86.7%for the extended dataset and show the preeminence of the proposed method.展开更多
The meaning of each part of the screw-on curve,the definition of shoulder torque,and the common characteristics of the screw-on curve are introduced.Moreover,the principle and shortcomings of the commonly used method ...The meaning of each part of the screw-on curve,the definition of shoulder torque,and the common characteristics of the screw-on curve are introduced.Moreover,the principle and shortcomings of the commonly used method of curve curvature radius are discussed.A new method of sealing surface deformation is proposed based on the requirements of shoulder torque recognition.The calculation method and principle of PW value are elucidated and the advantages of this method are summarized.The proposed method considers the difference value of tightening torque and calculates the elastic deformation of the sealing surface,accurately reflecting the state of the thread compound and the correlation between torque change and elastic deformation of the sealing surface after compression.展开更多
BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be u...BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.展开更多
Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of ...Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of chronic anterior shoulder instability treated in our institution by Latarjet technique. Methods: We report our experience with the intervention of Latarjet modified by the analysis of a retrospective study of 40 cases. They were all young athletic men, with an average age of 29 years with a predominance of the dominant shoulder. Results: Eighty percent had bone lesions, the first dislocation being traumatic (plating). One patient had a recurrence of his instability due to a new trauma and 67% resumed sport within an average period of eight months, some of whom still had functional discomfort in sports practice (9 patients). After an average follow-up of 75 months, 93% of patients were satisfied with their intervention. Only two mechanical complications were observed. Conclusion: Chronic anterior shoulder instability is pathology of young and active subjects. The preregulenoid coracoid block according to Latarjet represents the therapeutic method of choice in the treatment of chronic anterior instabilities of the shoulder, especially in young and athletic subjects. The result of this intervention remains good despite the complications that can occur such as pseudarthrosis, osteoarthritis, lysis or mobility of the screw.展开更多
Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate fail...Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate failure, 38% of which are due to instability. The primary stability the base plate ensures is a crucial factor and, thus, is the subject of much debate in clinical studies and biomechanical research. This study is aimed to provide data that will contribute to the base plate’s pri-mary stability and glenoid longevity by clarifying the stresses at the scapular fossa and base plate interface associated with elevation after RSA. A 3D finite element model was created from the DICOM data for the scapulohumeral joint and SMR shoulder system. For loading conditions, 30 N was applied for each posi-tion with abduction angles of 0, 45, 90, and 135 degrees. A three-dimensional fi-nite element analysis was performed using the static implicit method with LS-DYNA. The von Mises stresses in the scapular fossa were found not to exceed the yield stress on the bone even after elevation to an abduction angle of 135 de-grees after RSA. It is rough to uniformly compare the yield stress and the von Mises stress, but it was inferred that the possibility of fracture is low unless a large external force is applied. A maximum von Mises stress showed 0 degrees of abduction, suggesting that the lowered position is in a more severe condition than the elevated position. If better improvement is desired, it may be necessary to devise ways to reduce the stress on the upper screw. .展开更多
Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time peri...Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.展开更多
Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound le...Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound lesions of the rotator cuff in cases of non-fracture shoulder trauma at the CHUYO in Ouagadougou. Methodology: This was a prospective descriptive cross-sectional study running from August 1 to November 30, 2017, in the medical imaging department of CHUYO. The study population consisted of patients received in the department for ultrasound in the context of non-fracture shoulder trauma. Results: We collected 20 cases (66.67%) of rotator cuff lesions out of 30 non-fracture shoulder injuries. The mean age of the patients was 27.6 years. Road traffic accidents accounted for 60% of injuries, sports accidents for 30%, and domestic accidents for 10%. Ultrasound lesions were mainly tendon ruptures (36.67%) and tendinitis (23.33%). Ruptures were non-transfixing in 90.90% of cases. The supraspinatus was the most affected (81.81%). Conclusion: Ultrasound can help diagnose rotator cuff injuries, particularly in non-fractured shoulder trauma.展开更多
Objective:To study the effect of repetitive peripheral magnetic stimulation(rPMS)combined with conventional rehabilitation measures on shoulder dysfunction in early stroke.Methods:60 patients with shoulder dysfunction...Objective:To study the effect of repetitive peripheral magnetic stimulation(rPMS)combined with conventional rehabilitation measures on shoulder dysfunction in early stroke.Methods:60 patients with shoulder dysfunction in early stroke were selected,and all of them were admitted to our hospital from August 2021 to August 2023.The patients were randomly grouped into a control group(conventional rehabilitation measures intervention,30 cases)and an intervention group(rPMS and conventional rehabilitation measures intervention,30 cases)according to the lottery method.The pain scores,shoulder mobility,and motor function scores of the two groups were compared.Results:The pain score was lower in the intervention group,and the shoulder mobility and motor function scores were higher in the intervention group(P<0.05)as compared to that of the control group.Conclusion:The effect of combining rPMS and conventional rehabilitation measures in treating shoulder dysfunction in early stroke was remarkable and should be popularized.展开更多
A frozen shoulder is a common cause of shoulder pain and stiffness.The etiology and pathology of frozen shoulders is not fully understood yet.Frozen shoulderis characterized by a decrease in intra-articular volume and...A frozen shoulder is a common cause of shoulder pain and stiffness.The etiology and pathology of frozen shoulders is not fully understood yet.Frozen shoulderis characterized by a decrease in intra-articular volume and capsular compliance.This can lead to significant limitations in daily life.The majority of the patients can be treated conservatively,with functional recovery to be expected in two to three years.However,if conservative treatment fails,manipulation under anaesthesia and arthroscopic capsular release can both be considered as appropriate treatments.Manipulation is a traditionally well-established technique but in recent years it seems that arthroscopic capsular release has gained popularity.Manipulation is a relative time efficient and technically low-demanding procedure in which the glenohumeral joint is forced into different directions under general anaesthesia to release the capsular contracture,thereby increasing the range of motion of the joint.In arthroscopic capsular release the glenohumeral capsule can be released in a more controlled manner under direct vision.There are no prospective comparative trials available to display superiority of one procedure over the other.In addition,the optimal timing of both these interventions still has to be determined.An overview of the literature concerning this topic and a description of both procedures with its own advantages and disadvantages is provided.展开更多
BACKGROUND Many patients prioritize the ability to return to work(RTW)after shoulder replacement surgeries such as total shoulder arthroplasty(TSA),reverse TSA(rTSA),and shoulder hemiarthroplasty(HA).Due to satisfacto...BACKGROUND Many patients prioritize the ability to return to work(RTW)after shoulder replacement surgeries such as total shoulder arthroplasty(TSA),reverse TSA(rTSA),and shoulder hemiarthroplasty(HA).Due to satisfactory clinical and functional long-term outcomes,the number of shoulder replacements performed will continue to rise into this next decade.With younger individuals who compose a significant amount of the workforce receiving shoulder replacements,patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.AIM To summarize RTW outcomes following TSA,rTSA,and HA,and analyze the effects of workers’compensation status on RTW rates and ability.METHODS This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search regarding RTW following shoulder arthroplasty was performed using four databases(PubMed,Scopus,Embase,and Cochrane Library),and the Reference Citation Analysis(https://www.referencecitationanalysis.com/).All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included.Nonclinical studies,literature reviews,case reports,and those not reporting on RTW after shoulder arthroplasty were excluded.RESULTS The majority of patients undergoing TSA,rTSA,or HA were able to RTW betweenone to four months,depending on work demand stratification.While sedentary or light demand jobs generally have higher rates of RTW,moderate or heavy demand jobs tend to have poorer rates of return.The rates of RTW following TSA(71%-93%)were consistently higher than those reported for HA(69%-82%)and rTSA(56%-65%).Furthermore,workers’compensation status negatively influenced clinical outcomes following shoulder arthroplasty.Through a pooled means analysis,we proposed guidelines for the average time to RTW after TSA,rTSA,and HA.For TSA,rTSA,and HA,the average time to RTW regardless of work demand stratification was 1.93±3.74 mo,2.3±2.4 mo,and 2.29±3.66 mo,respectively.CONCLUSION The majority of patients are able to RTW following shoulder arthroplasty.Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.展开更多
文摘Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.
文摘Purpose: There have been many studies on the effects of different types of backpacks on posture from a biomechanical perspective and on the center of gravity. Considering the effects of autonomic nervous system activity and mood associated with backpacks in mountaineering and hiking, research is also needed from a psychological perspective. In this study, the effects of adjusting the backpack shoulder stabilizer were preliminarily tested in terms of subjective fatigue and changes in autonomic nervous activity after hiking. Methods: The experimental 15 healthy participants hiked the mountain under two conditions: 1) without adjusting the stabilizer, a feature of the backpack (NAH condition), and 2) with the stabilizer adjusted (AH condition). First, all participants hiked the mountain in the NAH condition, and after a 30-minute break, they began the hike in the AH condition after confirming that a) their heart rate had recovered and b) they were in good physical condition. Results: HR was significantly lower after each hiking session than during the session. RMSSD was significantly lower pre-AH and post-AH than the NAH condition, but there was no significant difference between the NAH condition and either post-NAH or post-AH. Additionally, RMSSD was significantly lower in the AH condition than pre-AH or post-AH. The shoulders and back were significantly more burdened in the NAH condition than in the AH condition. The pleasure level was significantly higher in the AH condition than in the NAH condition. Conclusion: The results showed that also adjusting the position of the waist belt when adjusting the shoulder stabilizer, which is mainly used for the neck and shoulders, has a significant positive effect on the subjective burden on the upper body and parasympathetic nervous system activity after hiking.
文摘BACKGROUND The accuracy of blind intra-articular injections in the shoulder is rather low.Inaccurate injections tend to lead to poorer treatment outcomes.The“Delaware posterior bone touch technique”has shown higher accuracy in young,slender,healthy volunteers than the classical“Cyriax technique”.AIM To investigate whether the Delaware technique would also be more accurate in older patients with capsulitis.METHODS We analyzed the files of 100 consecutive patients with capsulitis who were treated with an intra-articular injection containing a mixture of triamcinolone,lidocaine,and air.After the injection,the shoulder was moved to determine whether a squishing sound could be produced.The squishing sound was interpreted as an accurate injection.The scores with the new Delaware technique were compared against those with the Cyriax technique in a previous study.RESULTS Squishing was heard after 87%of the injections.This was 13%(10%points)more than the 77%in the previous study(P=0.004).CONCLUSION The Delaware technique was significantly more accurate than the Cyriax technique also in middle aged patients with capsulitis.We hypothesize that the difference is caused by a lower risk that a part of the opening of the needle is still outside the capsule.
文摘BACKGROUND Shoulder arthroscopy is commonly used for the repair of glenohumeral ligament avulsions or tendon tears.The success of the operation depends on the ability of the ligaments or rotator cuff tendon to heal to their original attachment site.Soft tissue healing can be evaluated with imaging methods or alternatively with second-look arthroscopy.AIM To investigate shoulder tendon and capsule healing after arthroscopic rotator cuff and instability repair using second-look arthroscopy.METHODS In this study,24 adult patients with rotator cuff tears(13 patients)or anterior shoulder instability(11 patients)were included.All patients were initially subjected to arthroscopic repair using suture anchors and were re-evaluated with second-look arthroscopy for reasons not related to the original pathology.The second operation was performed in 8 patients due to mild but persistent pain or stiffness,in 3 patients for recalcitrant stiffness,in 5 patients for secondary biceps tenotomy,in 6 patients for persistent acromioclavicular joint pain and in 2 patients for suture anchor prominence causing shoulder grinding.Soft tissue healing was evaluated visually and by probing,whereas clinical outcomes were evaluated using the University of California–Los Angeles(UCLA)and Rowe rating scales.RESULTS In almost all patients,complete soft tissue healing occurred at the site of tissue reattachment,either on the glenoid articular surface or the greater humeral tuberosity.The strongest repair,as confirmed by probe palpation,was encountered at the site of suture passage through the soft tissue.All suture material was covered with bursal synovial tissue,with no cases of knot impingement or cartilage fraying.The mean preoperative and postoperative UCLA scores for rotator cuff repair patients were 1354±3205 and 2931±2898,respectively(P<0.001),whereas for shoulder instability patients,the mean Rowe scores preoperatively and postoperatively were 2591±1338 and 9272±754,respectively(P<0.001).The use of bioabsorbable implants did not cause synovitis or other tissue reactions.CONCLUSION Soft tissue healing in the shoulder is successful and strongest at the site of suture anchor placement.
文摘Sickle cell disease(SCD)is a genetic disorder characterized by chronic hemolysis and vaso-occlusive crises(VOCs),leading to musculoskeletal complications that significantly affect quality of life.Among these,shoulder complications are a concern,with humeral head avascular necrosis(AVN)being the second most common site of involvement after the femoral head.Other shoulder pathologies,including osteomyelitis and septic arthritis,further contribute to morbidity.However,these conditions remain underdiagnosed and understudied,often due to overlapping symptoms with VOC-related bone infarctions.Imaging,particularly magnetic resonance imaging,is crucial for early diagnosis and accurate differentiation.Management strategies range from conservative pain control to surgical interventions,including core decompression for early-stage AVN and arthroplasty for advanced joint destruction.Surgical outcomes in SCD,however,remain inconsistent due to higher complication rates and a lack of standardized guidelines.Despite advancements in diagnosis and treatment,shoulder pathology in SCD remains an area of limited research.This review highlights the need for larger,long-term studies with a homogeneous etiology to support and refine current treatment strategies and improve patient outcomes.
文摘Acute traumatic injuries to the glenohumeral articulation are common.The types of injuries depend on age,muscle strength,bone density,and biomechanics of the traumatic event.Understanding the different mechanisms of trauma and how they affect the functional anatomical structures of the shoulder joint is crucial for the treatment of these lesions.Therefore,when clinicians have knowledge of these mechanisms they can accurately diagnose and treat shoulder pathology and predict distinct injury patterns.Here,we have described the fundamentals of the mechanisms of injury of the glenohumeral dislocation,dislocation with fracture of the humeral head,and the proximal humerus fracture.We have focused on common injury mechanisms and the correlation with radiological diagnostics.Radiological and laboratory findings of distinct types of injury were also discussed.
文摘Background: Early exploration of the semi constrained “Floating-Socket” total shoulder replacement (TSR) in 1974 led to a proliferation of various unconstrained designs that allowed resection or retention of the humeral head, depending upon the pathological process involved. Degenerative glenohumeral arthritis with mild to moderate involvement of subchondral bone allowed for a resurfacing option, while severe humeral head involvement required a partial or full humeral head replacement attached to an intramedullary stem for fixation. All components evolved from cemented to cementless application by 1982. The purpose of this paper is to describe the progression of Buechel-Pappas (B-P) shoulder replacement development from the early 1970’s in both cemented and cement less applications. Methods: Clinical evaluations of “Floating-Socket” TSR, followed by B-P stem-type, resurfacing types, bipolar-type and revision components, all of which comprise the B-P Shoulder Replacement System, were performed over a 49-year period. Results: “Floating-Socket” implants improved the results of simple, constrained ball-in-socket designs, but generally failed by glenoid component loosening in both chimpanzee and human applications. Unconstrained resurfacing-type components, both anatomical humeral head and full proximal humeral components, were quite successful, with minimal failures observed in long-term studies. Bipolar salvage implants, used for severe proximal deficiencies, revisions and massive rotator cuff arthropathy, were also very successful;providing overhead range of motion in many patients. Conclusions: Resurfacing hemiarthroplasty, in patients with intact or repairable rotator cuff mechanisms, gave the most satisfactory results and were the least technically complicated to perform, requiring minimal instrumentation. Resurfacing of full proximal humeral deficiencies, using femoral resurfacing components, gave similar clinical results to more complex semi-constrained devices, also with less technical difficulties and simple instrumentation.
文摘BACKGROUND The rotator cuff is located below the acromion and deltoid muscles and comprises multiple tendons that wrap around the humeral head,maintaining shoulder joint stability.AIM To explore the effect of electroacupuncture combined with rehabilitation techniques on shoulder function in patients with rotator cuff injuries.METHODS We selected 97 patients with rotator cuff injuries treated in the People's Hospital of Yuhuan from February 2020 to May 2023.Patients were grouped using the envelope method.RESULTS After treatment,the study group’s treatment effective rate was 94.90%(46/49 patients),significantly higher than that in the control group(79.17%,38/48 cases;P<0.05).Before treatment,there was no difference in Constant Murley Score(CMS)scores,shoulder mobility,or 36-Item Short Form Health Survey(SF-36)scale scores(P>0.05).Compared with those before treatment,the CMS scores(including pain,daily living ability,shoulder mobility,and muscle strength),all aspects of shoulder mobility(forward flexion,posterior extension,external rotation,internal rotation),and SF-36 scale scores(including physiological,psychological,emotional,physical,vitality,and health status)were higher in both groups after treatment and significantly higher in the study group(P<0.05).There was no difference in the occurrence of complications between the two treatment groups(P>0.05).CONCLUSION Electroacupuncture combined with rehabilitation techniques has a good treatment effect on patients with rotator cuff injuries,helps accelerate the recovery of shoulder function,improves the quality of life,and is highly safe.
基金supported by the Research and Development Project of“Jianbing”in Zhejiang Province(2024C01085)Natural Science and Foundation of Ningbo(2022J052).
文摘2A14-T62 butt joint was successfully welded by stationary shoulder friction stir welding(SSFSW)method.The results showed that using a pin with small shoulder could broaden the process window,and under a rotation speed of 2000 r/min and welding speed of 30 mm/min,joint with smooth surface,small reduction in thickness and little inner defects was obtained.The weld nugget zone was approx-imately circular,which was a unique morphology for SSFSW.The heat-affected zone(HAZ)and thermo-mechanically affected zone(TMAZ)were both quite narrow due to the lower heat input and slight mechanical action of the stationary shoulder.The fraction of high angle grain boundaries(HAGBs)exhibited a“W”shape along horizontal direction(from advancing side to retreating side),and the minim-um value located at HAZ.The average ultimate tensile strength and elongation of the joint were 325 MPa and 4.5%,respectively,with the joint efficiency of 68.3%.The joint was ductile fractured and the fracture surface contained two types of dimples morphology in different re-gions of the joint.Microhardness distribution in the joint exhibited a“W”shape,and the difference along the thickness direction was negli-gible.The joint had strong stress corrosion cracking susceptibility,and the slow stain rate tensile strength was 139 MPa.Microcrack and Al2O3 particulates were observed at the fracture surface.
文摘Total shoulder arthroplasty is a standard restorative procedure practiced by orthopedists to diagnose shoulder arthritis in which a prosthesis replaces the whole joint or a part of the joint.It is often challenging for doctors to identify the exact model and manufacturer of the prosthesis when it is unknown.This paper proposes a transfer learning-based class imbalance-aware prosthesis detection method to detect the implant’s manufacturer automatically from shoulder X-ray images.The framework of the method proposes a novel training approach and a new set of batch-normalization,dropout,and fully convolutional layers in the head network.It employs cyclical learning rates and weighting-based loss calculation mechanism.These modifications aid in faster convergence,avoid local-minima stagnation,and remove the training bias caused by imbalanced dataset.The proposed method is evaluated using seven well-known pre-trained models of VGGNet,ResNet,and DenseNet families.Experimentation is performed on a shoulder implant benchmark dataset consisting of 597 shoulder X-ray images.The proposed method improves the classification performance of all pre-trained models by 10–12%.The DenseNet-201-based variant has achieved the highest classification accuracy of 89.5%,which is 10%higher than existing methods.Further,to validate and generalize the proposed method,the existing baseline dataset is supplemented to six classes,including samples of two more implant manufacturers.Experimental results have shown average accuracy of 86.7%for the extended dataset and show the preeminence of the proposed method.
文摘The meaning of each part of the screw-on curve,the definition of shoulder torque,and the common characteristics of the screw-on curve are introduced.Moreover,the principle and shortcomings of the commonly used method of curve curvature radius are discussed.A new method of sealing surface deformation is proposed based on the requirements of shoulder torque recognition.The calculation method and principle of PW value are elucidated and the advantages of this method are summarized.The proposed method considers the difference value of tightening torque and calculates the elastic deformation of the sealing surface,accurately reflecting the state of the thread compound and the correlation between torque change and elastic deformation of the sealing surface after compression.
文摘BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.
文摘Purpose: Surgical treatment of chronic anterior shoulder instability is a difficult therapeutic challenge for contact athletes. The aim of our study is to evaluate the clinical and radiological results of 40 cases of chronic anterior shoulder instability treated in our institution by Latarjet technique. Methods: We report our experience with the intervention of Latarjet modified by the analysis of a retrospective study of 40 cases. They were all young athletic men, with an average age of 29 years with a predominance of the dominant shoulder. Results: Eighty percent had bone lesions, the first dislocation being traumatic (plating). One patient had a recurrence of his instability due to a new trauma and 67% resumed sport within an average period of eight months, some of whom still had functional discomfort in sports practice (9 patients). After an average follow-up of 75 months, 93% of patients were satisfied with their intervention. Only two mechanical complications were observed. Conclusion: Chronic anterior shoulder instability is pathology of young and active subjects. The preregulenoid coracoid block according to Latarjet represents the therapeutic method of choice in the treatment of chronic anterior instabilities of the shoulder, especially in young and athletic subjects. The result of this intervention remains good despite the complications that can occur such as pseudarthrosis, osteoarthritis, lysis or mobility of the screw.
文摘Reverse shoulder arthroplasty (RSA) is an effective treatment for rotator cuff tears. Despite its advantages, complications occur at a high rate. Complications requiring revision include a high rate of base plate failure, 38% of which are due to instability. The primary stability the base plate ensures is a crucial factor and, thus, is the subject of much debate in clinical studies and biomechanical research. This study is aimed to provide data that will contribute to the base plate’s pri-mary stability and glenoid longevity by clarifying the stresses at the scapular fossa and base plate interface associated with elevation after RSA. A 3D finite element model was created from the DICOM data for the scapulohumeral joint and SMR shoulder system. For loading conditions, 30 N was applied for each posi-tion with abduction angles of 0, 45, 90, and 135 degrees. A three-dimensional fi-nite element analysis was performed using the static implicit method with LS-DYNA. The von Mises stresses in the scapular fossa were found not to exceed the yield stress on the bone even after elevation to an abduction angle of 135 de-grees after RSA. It is rough to uniformly compare the yield stress and the von Mises stress, but it was inferred that the possibility of fracture is low unless a large external force is applied. A maximum von Mises stress showed 0 degrees of abduction, suggesting that the lowered position is in a more severe condition than the elevated position. If better improvement is desired, it may be necessary to devise ways to reduce the stress on the upper screw. .
基金Supported by State Administration of Traditional Chinese Medicine of the People’s Republic of China "Twelfth FiveYear Plan" key specialty construction projectMajor scientific project of Changning District Science and Technology Commission:CNKW2013Z05+1 种基金Traditional Chinese medicine scientific research fund project of Shanghai Municipal Commission of Health and Family Planning:2014LQ021ATCM of Shanghai style heritage research base project of Shanghai Municipal Health Bureau:ZYSNXD-CCHPGC-JD-004
文摘Objective To observe the correlation between analgesic effect and duration of analgesic effect of superficial needling for shoulder pain of shoulderhand syndrome（SHS） after stroke, so as to screen the best time period of analgesia. Methods A total of 120 patients with SHS after stroke（stage I） were recruited and superficial needling therapy was applied. Two obvious tenderness points on the affected shoulder of patients were found out. The site 80–100 mm down each tenderness point was selected for superficial needling. Bimanual needling technique was applied after inserting needles. The surrounding of tenderness points was pinched and grasped by left hand above the needling, and the technique of green dragon swaying tail was applied by right hand. The needles at each acupoint were manipulated for3 min and retained for 30 min. The analgesic effect was evaluated dynamically by visual analogue scale（VAS） in 120 patients before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The analgesic effects at different time were statistically analyzed by generalized estimating equation. Results The mean values of VAS were 7.483, 3.950, 4.767, 5.917 and 7.217, respectively, before treatment, immediately after treatment, 30 min after treatment, 1 h after treatment and 24 h after treatment. The difference of analgesic effect at different time was statistically significant（P〈0.01）; the difference of analgesic effect of superficial needling in treatment of SHS after stroke was significant between immediately after treatment and 30 min after treatment（both P〈0.05）, while there was no significant difference between 1 h after treatment and 24 h after treatment（both P〈0.05）. Conclusion Analgesic effect of superficial needling for shoulder pain of SHS after stroke was different at different time points and decreased over time; analgesic effect was the most significant immediately after treatment and the optimal duration of analgesic effect was from immediately to 30 min after superficial needling therapy.
文摘Introduction: Ultrasound is the imaging technique of choice for the study of rotator cuff lesions. However, in the case of shoulder trauma, it is rarely requested in our context. This study aimed to show ultrasound lesions of the rotator cuff in cases of non-fracture shoulder trauma at the CHUYO in Ouagadougou. Methodology: This was a prospective descriptive cross-sectional study running from August 1 to November 30, 2017, in the medical imaging department of CHUYO. The study population consisted of patients received in the department for ultrasound in the context of non-fracture shoulder trauma. Results: We collected 20 cases (66.67%) of rotator cuff lesions out of 30 non-fracture shoulder injuries. The mean age of the patients was 27.6 years. Road traffic accidents accounted for 60% of injuries, sports accidents for 30%, and domestic accidents for 10%. Ultrasound lesions were mainly tendon ruptures (36.67%) and tendinitis (23.33%). Ruptures were non-transfixing in 90.90% of cases. The supraspinatus was the most affected (81.81%). Conclusion: Ultrasound can help diagnose rotator cuff injuries, particularly in non-fractured shoulder trauma.
文摘Objective:To study the effect of repetitive peripheral magnetic stimulation(rPMS)combined with conventional rehabilitation measures on shoulder dysfunction in early stroke.Methods:60 patients with shoulder dysfunction in early stroke were selected,and all of them were admitted to our hospital from August 2021 to August 2023.The patients were randomly grouped into a control group(conventional rehabilitation measures intervention,30 cases)and an intervention group(rPMS and conventional rehabilitation measures intervention,30 cases)according to the lottery method.The pain scores,shoulder mobility,and motor function scores of the two groups were compared.Results:The pain score was lower in the intervention group,and the shoulder mobility and motor function scores were higher in the intervention group(P<0.05)as compared to that of the control group.Conclusion:The effect of combining rPMS and conventional rehabilitation measures in treating shoulder dysfunction in early stroke was remarkable and should be popularized.
文摘A frozen shoulder is a common cause of shoulder pain and stiffness.The etiology and pathology of frozen shoulders is not fully understood yet.Frozen shoulderis characterized by a decrease in intra-articular volume and capsular compliance.This can lead to significant limitations in daily life.The majority of the patients can be treated conservatively,with functional recovery to be expected in two to three years.However,if conservative treatment fails,manipulation under anaesthesia and arthroscopic capsular release can both be considered as appropriate treatments.Manipulation is a traditionally well-established technique but in recent years it seems that arthroscopic capsular release has gained popularity.Manipulation is a relative time efficient and technically low-demanding procedure in which the glenohumeral joint is forced into different directions under general anaesthesia to release the capsular contracture,thereby increasing the range of motion of the joint.In arthroscopic capsular release the glenohumeral capsule can be released in a more controlled manner under direct vision.There are no prospective comparative trials available to display superiority of one procedure over the other.In addition,the optimal timing of both these interventions still has to be determined.An overview of the literature concerning this topic and a description of both procedures with its own advantages and disadvantages is provided.
文摘BACKGROUND Many patients prioritize the ability to return to work(RTW)after shoulder replacement surgeries such as total shoulder arthroplasty(TSA),reverse TSA(rTSA),and shoulder hemiarthroplasty(HA).Due to satisfactory clinical and functional long-term outcomes,the number of shoulder replacements performed will continue to rise into this next decade.With younger individuals who compose a significant amount of the workforce receiving shoulder replacements,patients will begin to place a higher priority on their ability to RTW following shoulder arthroplasty.AIM To summarize RTW outcomes following TSA,rTSA,and HA,and analyze the effects of workers’compensation status on RTW rates and ability.METHODS This systematic review and analysis was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A literature search regarding RTW following shoulder arthroplasty was performed using four databases(PubMed,Scopus,Embase,and Cochrane Library),and the Reference Citation Analysis(https://www.referencecitationanalysis.com/).All studies in English relevant to shoulder arthroplasty and RTW through January 2021 that had a level of evidence I to IV were included.Nonclinical studies,literature reviews,case reports,and those not reporting on RTW after shoulder arthroplasty were excluded.RESULTS The majority of patients undergoing TSA,rTSA,or HA were able to RTW betweenone to four months,depending on work demand stratification.While sedentary or light demand jobs generally have higher rates of RTW,moderate or heavy demand jobs tend to have poorer rates of return.The rates of RTW following TSA(71%-93%)were consistently higher than those reported for HA(69%-82%)and rTSA(56%-65%).Furthermore,workers’compensation status negatively influenced clinical outcomes following shoulder arthroplasty.Through a pooled means analysis,we proposed guidelines for the average time to RTW after TSA,rTSA,and HA.For TSA,rTSA,and HA,the average time to RTW regardless of work demand stratification was 1.93±3.74 mo,2.3±2.4 mo,and 2.29±3.66 mo,respectively.CONCLUSION The majority of patients are able to RTW following shoulder arthroplasty.Understanding outcomes for rates of RTW following shoulder arthroplasty would assist in managing expectations in clinical practice.
