BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favo...BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.展开更多
BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investig...BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.AIM To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip,knee,or shoulder surgery.METHODS A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Studies were included if they reported patients employed in farming or heavy labor,RTW rates after orthopedic surgery of the hip,knee,or shoulder,and had a minimum 6-month follow-up.A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.RESULTS Ten studies were included,and 101 farmers were identified among 440 total patients.One study involved hip surgery,two studies involved knee surgery,and seven studies involved shoulder surgery.RTW rates across studies varied by type of surgery and follow-up interval,ranging from 24%to 100%.The RTW rate was only 53.6%at 1 year following total hip arthroplasty.No studies investigated RTW in farmers following total knee arthroplasty.Among non-comparative studies,meta-analysis revealed a pooled RTW rate of 89%following arthroscopic shoulder surgery,with low heterogeneity(I^(2)=30.1%).Among comparative studies,one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty(odds ratio=5.45).Overall,surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques,with particularly favorable outcomes for anatomic total shoulder arthroplasty.CONCLUSION This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery.However,our findings also underscore the need for more rural-specific research to guide patient counseling,rehabilitation expectations,and shared decision-making in this underserved population,particularly for orthopedic surgery of the hip and knee.展开更多
肩关节周围炎(Periarthritis of the shoulder,PAS)指肩周软组织病变引起的以肩关节疼痛和活动功能障碍为特征的疾病^([1-2])。据调查,中国中年女性患病率较高^([3-5]),且糖尿病等可显著增加PAS患病率^([6-7])。目前,临床上治疗PAS的方...肩关节周围炎(Periarthritis of the shoulder,PAS)指肩周软组织病变引起的以肩关节疼痛和活动功能障碍为特征的疾病^([1-2])。据调查,中国中年女性患病率较高^([3-5]),且糖尿病等可显著增加PAS患病率^([6-7])。目前,临床上治疗PAS的方法主要包括药物、针灸、推拿、针刀、康复手法、手术等,均可不同程度地改善肩关节疼痛及活动功能障碍,而针刀技术在PAS所致被动运动功能障碍的恢复中具有良好效果。重庆市忠州纯针刀特色技术创新团队通过30余年临床诊疗经验、20余年针刀临床实践积累及多项省部级重点及省部级针刀临床研究等发现,在非臂丛、非静脉麻醉条件下,采用针刀技术治疗本病,可快速解除其被动运动功能障碍,具有独特的优势^([8])。展开更多
BACKGROUND Acinic cell carcinoma(ACC)is a malignant epithelial neoplasm that commonly occurs in the parotid gland.It is known to have a high recurrence rate and the potential to metastasize to the lung or cervical lym...BACKGROUND Acinic cell carcinoma(ACC)is a malignant epithelial neoplasm that commonly occurs in the parotid gland.It is known to have a high recurrence rate and the potential to metastasize to the lung or cervical lymph nodes.However,few cases of ACC with bone metastasis have been reported in the medical literature.CASE SUMMARY The clinical significance of this case report lies in the unique site of occurrence of the metastasis:To the best of our knowledge,this report is the only literature documenting ACC arising in a shoulder mass.CONCLUSION Unusual presentations of uncommon malignancies can present diagnostic challenges for both surgeons and histopathologists.It is important to be aware of these rare occurrences in order to provide the best possible treatment for patients.展开更多
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
Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the pre...Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.展开更多
Perched on crimson shoulders,Potala ascends a celestial stairway.Alabaster walls cradle golden roofs.Ancient stones murmur mantras,corridors breathe incense.Shadows dance with prayer flags,weaving time into silk.A sac...Perched on crimson shoulders,Potala ascends a celestial stairway.Alabaster walls cradle golden roofs.Ancient stones murmur mantras,corridors breathe incense.Shadows dance with prayer flags,weaving time into silk.A sacred place in pilgrims'hearts,it guards the soul of this snowy plateau stretching vastly across western China.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
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 Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior s...BACKGROUND Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare.Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.CASE SUMMARY A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident.He reported that he braced his fall with his right hand.Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss.Six days after the injury,the patient exhibited pseudoparalysis and active forward flexion limited to 10°.Two weeks after the injury,magnetic resonance imaging revealed complete tears of the supraspinatus,infraspinatus,and subscapularis muscles as well as dislocation of the long head of the biceps tendon.Arthroscopic rotator cuff repair was performed 6 weeks after injury.The tendon quality was acceptable with minimal fatty infiltration.At the 12-month surgical follow-up,the patient had recovered full strength and complete range of motion.CONCLUSION Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.展开更多
BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the ef...BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.展开更多
BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan...BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.展开更多
This paper presents a novel rehabilitation robot designed to address the challenges of Passive Range of Motion(PROM)exercises for frozen shoulder patients by integrating advanced scapulohumeral rhythm stabilization.Fr...This paper presents a novel rehabilitation robot designed to address the challenges of Passive Range of Motion(PROM)exercises for frozen shoulder patients by integrating advanced scapulohumeral rhythm stabilization.Frozen shoulder is characterized by limited glenohumeral motion and disrupted scapulohumeral rhythm,with therapist-assisted interventions being highly effective for restoring normal shoulder function.While existing robotic solutions replicate natural shoulder biomechanics,they lack the ability to stabilize compensatory movements,such as shoulder shrugging,which are critical for effective rehabilitation.Our proposed device features a 6 Degrees of Freedom(DoF)mechanism,including 5 DoF for shoulder motion and an innovative 1 DoF Joint press for scapular stabilization.The robot employs a personalized two-phase operation:recording normal shoulder movement patterns from the unaffected side and applying them to guide the affected side.Experimental results demonstrated the robot’s ability to replicate recorded motion patterns with high precision,with Root Mean Square Error(RMSE)values consistently below 1 degree.In simulated frozen shoulder conditions,the robot effectively suppressed scapular elevation,delaying the onset of compensatory movements and guiding the affected shoulder to move more closely in alignment with normal shoulder motion,particularly during arm elevation movements such as abduction and flexion.These findings confirm the robot’s potential as a rehabilitation tool capable of automating PROM exercises while correcting compensatory movements.The system provides a foundation for advanced,personalized rehabilitation for patients with frozen shoulders.展开更多
Recently,we read a retrospective study by Chen et al,which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function,pro...Recently,we read a retrospective study by Chen et al,which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function,promoting repair of rotator cuff injuries.This study provides a new way to the conservative treatment of early rotator cuff injuries.In the present letter,we review the current treatment of rotator cuff injury with electroacupuncture combined with rehabilitation techniques and propose our views.展开更多
Purpose–MxV Rail conducted multiple single tie push tests(STPTs)between 2020 and 2023 to assess the changes in lateral tie resistance from tonnage accumulation,dynamic track stabilizers(DTS),tie type and ballast cond...Purpose–MxV Rail conducted multiple single tie push tests(STPTs)between 2020 and 2023 to assess the changes in lateral tie resistance from tonnage accumulation,dynamic track stabilizers(DTS),tie type and ballast condition.High lateral tie resistance is necessary for preventing lateral misalignments and track buckles.Therefore,understanding how various factors affect the lateral tie resistance will aid in the development of track buckling risk assessments and ballast maintenance best practices.Design/methodology/approach–The test involved tamping a section of track that consisted of both concrete and wood ties and then increasing the lateral tie resistance,using either tonnage during speed restrictions or a DTS.The STPTs and top-of-rail(TOR)elevation measurements were taken at multiple stages,including immediately after tamping and then after different tonnage increments or DTS.The results from this test were then added to a compiled measurement from previous tests,and the results from all the tests were used to develop general guidelines for ballast maintenance best practices and trade-off considerations.Findings–The results showed multiple factors affect the lateral track strength and therefore the susceptibility to misalignments and track buckles.The disturbance from ballast tamping can reduce the lateral track strength by 20–80%(∼45%median)and can be compacted from either tonnage(25–50%regain in strength after 0.1 m gross ton or MGT)or DTS(33–78%regain in strength).The amount of ballast(shoulder width and crib height),tie type and ballast characteristics all have a meaningful role in lateral track strength.Originality/value–This paper is based on the testing programs conducted by authors at MxV Rail.展开更多
BACKGROUND It is expected that transfer of spinal accessory nerve to suprascapular nerve,which is widely used in the restoration of the shoulder function in brachial plexus birth injury(BPBI),impairs the trapezius fun...BACKGROUND It is expected that transfer of spinal accessory nerve to suprascapular nerve,which is widely used in the restoration of the shoulder function in brachial plexus birth injury(BPBI),impairs the trapezius function.AIM To hypothesize that the lower trapezius muscle remains functional after this neve transfer.METHODS In a retrospective cross-sectional study,patients with BPBI who underwent nerve transfer from accessory nerve to supraclavicular were followed for at least six months following the operation and demographic data were extracted from the database.To assess the lower trapezius function,shoulder abduction and external rotation were examined,and electromyography and nerve conduction velocity(EMG-NCV)was performed.RESULTS A total of 19 patients with a mean age of 2.69±1.40 years and a mean follow-up of 10.5 months were included in the study.Shoulder abduction was disabled completely only in one patient(5.26%);10(52.63%)had good,3(15.78%)moderate,and 5(26.31%)had poor shoulder abduction.Regarding external rotation,one(5.26%)was unable to externally rotate the shoulder;among 18(94.73%)patients who had satisfactory results,8(42.10%)were evaluated to be good,5(26.31%)moderate,and 5(26.31%)poor.EMG-NCV showed functional lower trapezius in all patients;its function was evaluated to be good in 11(57.89%),moderate in 6(31.57%),and poor in 2(10.52%)cases.CONCLUSION This study supports the hypothesis that the lower trapezius muscle has a dual motor innervation which provides the possibility of further trapezius tendon transfer to restore a better shoulder function.展开更多
Objective:To evaluate the therapeutic effect of dynamic fixation with a hook plate-double loop plate internal fixation system for high-energy acromioclavicular joint complex dislocation(denoted as HACD,i.e.,Rockwood t...Objective:To evaluate the therapeutic effect of dynamic fixation with a hook plate-double loop plate internal fixation system for high-energy acromioclavicular joint complex dislocation(denoted as HACD,i.e.,Rockwood type III-V dislocation).Methods:Fifty-eight patients with HACD were selected and evenly divided by drawing lots.The experimental group underwent ligament reconstruction treatment,while the reference group received hook plate fixation treatment.The efficacy and other indicators were compared between the groups.Results:The overall effective rates between the groups were similar(P>0.05).The experimental group had a longer surgical duration,lower pain scores at 6 months postoperatively,higher shoulder joint function scores,and a lower complication rate,with P<0.05 when compared between groups.Conclusion:The effectiveness of the double loop plate internal fixation system ligament reconstruction treatment for patients with HACD is comparable to that of hook plate fixation treatment.Although the surgical duration is slightly longer,postoperative pain is milder,facilitating the recovery of shoulder joint function in patients and offering higher safety.展开更多
Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared t...Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.展开更多
文摘BACKGROUND The optimal surgical approach for patients with primary glenohumeral osteoarthritis(GHOA)and an intact rotator cuff remains debated.While anatomic total shoulder arthroplasty(TSA)has traditionally been favoured,reverse TSA(RTSA)is increasingly utilized.AIM To systematically compare the outcomes of RTSA and TSA in this specific patient population.METHODS A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines.Retrospective comparative studies evaluating RTSA and TSA in patients with GHOA and intact rotator cuff were included.Key outcomes assessed included complication and reoperation rates,patient-reported outcome measures(PROMs),and range of motion.Risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool.RESULTS Twelve studies encompassing 1608 patients(580 RTSA,1028 TSA)met inclusion criteria.RTSA was associated with a lower reoperation rate compared to TSA[odds ratio=0.37;95%confidence interval(CI):0.14-0.94;P value=0.04],while no significant difference in overall complication rates was observed(odds ratio=0.47;95%CI:0.19-1.16;P value=0.10).RTSA patients showed superior outcomes in University of California Los Angeles,Simple Shoulder Test,and Shoulder Pain and Disability Index scores;however,the differences did not exceed the minimal clinically important difference.TSA patients had significantly better external rotation(mean difference=-9.0°;95%CI:-13.21 to-5.02;P value<0.0001).No significant differences were found in other range of motion measures or satisfaction scores.The overall methodological quality of included studies was moderate to serious.CONCLUSION In patients with GHOA and an intact rotator cuff,RTSA may offer comparable or improved outcomes to TSA with lower reoperation rates and similar complication profiles.Functional outcomes favour RTSA in certain patientreported outcome measures,while TSA retains an advantage in external rotation.Surgical decision-making should remain individualized based on patient characteristics and functional demands.
文摘BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.AIM To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip,knee,or shoulder surgery.METHODS A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Studies were included if they reported patients employed in farming or heavy labor,RTW rates after orthopedic surgery of the hip,knee,or shoulder,and had a minimum 6-month follow-up.A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.RESULTS Ten studies were included,and 101 farmers were identified among 440 total patients.One study involved hip surgery,two studies involved knee surgery,and seven studies involved shoulder surgery.RTW rates across studies varied by type of surgery and follow-up interval,ranging from 24%to 100%.The RTW rate was only 53.6%at 1 year following total hip arthroplasty.No studies investigated RTW in farmers following total knee arthroplasty.Among non-comparative studies,meta-analysis revealed a pooled RTW rate of 89%following arthroscopic shoulder surgery,with low heterogeneity(I^(2)=30.1%).Among comparative studies,one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty(odds ratio=5.45).Overall,surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques,with particularly favorable outcomes for anatomic total shoulder arthroplasty.CONCLUSION This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery.However,our findings also underscore the need for more rural-specific research to guide patient counseling,rehabilitation expectations,and shared decision-making in this underserved population,particularly for orthopedic surgery of the hip and knee.
文摘肩关节周围炎(Periarthritis of the shoulder,PAS)指肩周软组织病变引起的以肩关节疼痛和活动功能障碍为特征的疾病^([1-2])。据调查,中国中年女性患病率较高^([3-5]),且糖尿病等可显著增加PAS患病率^([6-7])。目前,临床上治疗PAS的方法主要包括药物、针灸、推拿、针刀、康复手法、手术等,均可不同程度地改善肩关节疼痛及活动功能障碍,而针刀技术在PAS所致被动运动功能障碍的恢复中具有良好效果。重庆市忠州纯针刀特色技术创新团队通过30余年临床诊疗经验、20余年针刀临床实践积累及多项省部级重点及省部级针刀临床研究等发现,在非臂丛、非静脉麻醉条件下,采用针刀技术治疗本病,可快速解除其被动运动功能障碍,具有独特的优势^([8])。
文摘BACKGROUND Acinic cell carcinoma(ACC)is a malignant epithelial neoplasm that commonly occurs in the parotid gland.It is known to have a high recurrence rate and the potential to metastasize to the lung or cervical lymph nodes.However,few cases of ACC with bone metastasis have been reported in the medical literature.CASE SUMMARY The clinical significance of this case report lies in the unique site of occurrence of the metastasis:To the best of our knowledge,this report is the only literature documenting ACC arising in a shoulder mass.CONCLUSION Unusual presentations of uncommon malignancies can present diagnostic challenges for both surgeons and histopathologists.It is important to be aware of these rare occurrences in order to provide the best possible treatment for patients.
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Appreciation of soft-tissue thickness(STT)at surgical sites is an increasingly recognized aspect of arthroplasty procedures as it may potentially impacting postoperative outcomes.Recent research has focused on the predictive value of preoperative STT measurements for complications following various forms of arthroplasty,particularly infections,across procedures such as total knee,hip,shoulder,and ankle replacements.Several studies have indicated that increased STT is associated with a higher risk of complications,including infection and wound healing issues.The assessment of STT before surgery could play a crucial role in identifying patients at a higher risk of complications and may be instru-mental in guiding preoperative planning to optimize outcomes in arthroplasty procedures.Standardized measurement techniques and further research are essential to enhance the reliability and clinical utility of STT assessment for arthro-plasty surgery.
文摘Perched on crimson shoulders,Potala ascends a celestial stairway.Alabaster walls cradle golden roofs.Ancient stones murmur mantras,corridors breathe incense.Shadows dance with prayer flags,weaving time into silk.A sacred place in pilgrims'hearts,it guards the soul of this snowy plateau stretching vastly across western China.
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 Posterior shoulder dislocation is a rare injury.It accounts for only 1%-4%of all shoulder dislocation cases.However,this injury is often underdiagnosed.Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare.Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.CASE SUMMARY A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident.He reported that he braced his fall with his right hand.Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss.Six days after the injury,the patient exhibited pseudoparalysis and active forward flexion limited to 10°.Two weeks after the injury,magnetic resonance imaging revealed complete tears of the supraspinatus,infraspinatus,and subscapularis muscles as well as dislocation of the long head of the biceps tendon.Arthroscopic rotator cuff repair was performed 6 weeks after injury.The tendon quality was acceptable with minimal fatty infiltration.At the 12-month surgical follow-up,the patient had recovered full strength and complete range of motion.CONCLUSION Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.
文摘BACKGROUND Sub-acromial injections are a therapeutic option for rotator cuff injuries;however,evidence regarding the most effective drug in this context is unclear,which needs to be investigated.AIM To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.METHODS We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials(RCTs)comparing sub-acromial injections for rotator cuff injuries.The interventions evaluated were hyaluronic acid(HA),platelet-rich plasma(PRP),prolotherapy,and corticosteroids.The outcomes of interest were pain and functional improvement,which were evaluated with standardized scores.The Risk of Bias 2 tool and the Grading of Recommendations,Assessment,Development and Evaluation methodology were used to assess data quality.RESULTS Twenty RCTs,comprising 1479 participants,were included.In the short term,HA achieved the best outcomes[pain mean difference(MD)=-1.48,95%confidence interval(CI)-2.37 to-0.59;function MD=10.18,95%CI:4.96-15.41].In the medium term,HA,PRP,HA+PRP,and corticosteroids were not superior to placebo in improving pain.Based on function,HA+PRP was superior to placebo,corticosteroids,and PRP(MD=26.72;95%CI:8.02-45.41).In the long term,HA,PRP,and corticosteroids were not superior to placebo in reducing pain.However,based on function,HA+PRP,PRP,and HA were superior to placebo,and HA+PRP had the best result(MD=36.64;95%CI:31.66-33.62).CONCLUSION HA provides satisfactory short-term results,while HA with PRP demonstrates functional improvement in the medium and long terms.However,no intervention maintained the pain-relief effect on>3-month follow-up.
基金approved by the National Medical Center Institutional Review Board(approval No.NRC-2023-10-109).
文摘BACKGROUND Clinical pathways(CPs)are structured guidelines introduced to improve healthcare quality and efficiency.In South Korea,CPs for Korean medicine have been developed since 2016 under the 3rd Comprehensive Plan for Korean Medicine Promotion,with limited studies on their clinical application.Neck and shoulder pain are common conditions frequently treated at Korean medicine clinics,often by patients dissatisfied with conventional treatments.The demand for Korean medicine treatments for neck and shoulder pain is on the rise.AIM To evaluate the clinical applicability and effectiveness of Korean medicine CPs for neck pain and shoulder pain in public healthcare institutions in South Korea.METHODS We collected and analyzed data from patients aged 19 years and older who visited the outpatient clinic of the Department of Korean Medicine at the National Medical Center in Korea from March 1,2023 to August 31,2023.CP completion rates,along with patient satisfaction,clinical outcomes,and economic outcomes between the CP-implemented and non-CP groups were assessed.RESULTS The CP completion rates were 93.3%for neck pain and 96.8%for shoulder pain.Patient satisfaction scores showed an improvement of 17.7%for neck pain and 18.0%for shoulder pain in the CP-implemented group compared to the non-CP group.For neck pain,significant improvements were observed in the numerical rating scale(NRS)and the neck disability index,while for shoulder pain,only the University of California-Los Angeles shoulder rating scale showed notable progress,with no substantial change in NRS scores.CONCLUSION This study partially confirms the clinical applicability and effectiveness of the Korean medicine CPs for neck pain and shoulder pain.Further research is required to enhance and validate these findings.
基金supported in part by the Technology Innovation Program(20017345)funded by the Ministry of Trade,Industry and Energy(MOTIE),Republic of Korea.
文摘This paper presents a novel rehabilitation robot designed to address the challenges of Passive Range of Motion(PROM)exercises for frozen shoulder patients by integrating advanced scapulohumeral rhythm stabilization.Frozen shoulder is characterized by limited glenohumeral motion and disrupted scapulohumeral rhythm,with therapist-assisted interventions being highly effective for restoring normal shoulder function.While existing robotic solutions replicate natural shoulder biomechanics,they lack the ability to stabilize compensatory movements,such as shoulder shrugging,which are critical for effective rehabilitation.Our proposed device features a 6 Degrees of Freedom(DoF)mechanism,including 5 DoF for shoulder motion and an innovative 1 DoF Joint press for scapular stabilization.The robot employs a personalized two-phase operation:recording normal shoulder movement patterns from the unaffected side and applying them to guide the affected side.Experimental results demonstrated the robot’s ability to replicate recorded motion patterns with high precision,with Root Mean Square Error(RMSE)values consistently below 1 degree.In simulated frozen shoulder conditions,the robot effectively suppressed scapular elevation,delaying the onset of compensatory movements and guiding the affected shoulder to move more closely in alignment with normal shoulder motion,particularly during arm elevation movements such as abduction and flexion.These findings confirm the robot’s potential as a rehabilitation tool capable of automating PROM exercises while correcting compensatory movements.The system provides a foundation for advanced,personalized rehabilitation for patients with frozen shoulders.
基金Supported by Zhejiang Administration of Traditional Chinese Medicine,No.2023ZF019Natural Science Foundation of Zhejiang Province,No.(2020)56+1 种基金Cultivation of Health High-level Talents in Zhejiang Province in 2022,No.(2019)58and National Natural Science Foundation of China,No.H02710.
文摘Recently,we read a retrospective study by Chen et al,which demonstrated that electroacupuncture is highly effective in relieving pain due to rotator cuff injuries and accelerating the recovery of shoulder function,promoting repair of rotator cuff injuries.This study provides a new way to the conservative treatment of early rotator cuff injuries.In the present letter,we review the current treatment of rotator cuff injury with electroacupuncture combined with rehabilitation techniques and propose our views.
文摘Purpose–MxV Rail conducted multiple single tie push tests(STPTs)between 2020 and 2023 to assess the changes in lateral tie resistance from tonnage accumulation,dynamic track stabilizers(DTS),tie type and ballast condition.High lateral tie resistance is necessary for preventing lateral misalignments and track buckles.Therefore,understanding how various factors affect the lateral tie resistance will aid in the development of track buckling risk assessments and ballast maintenance best practices.Design/methodology/approach–The test involved tamping a section of track that consisted of both concrete and wood ties and then increasing the lateral tie resistance,using either tonnage during speed restrictions or a DTS.The STPTs and top-of-rail(TOR)elevation measurements were taken at multiple stages,including immediately after tamping and then after different tonnage increments or DTS.The results from this test were then added to a compiled measurement from previous tests,and the results from all the tests were used to develop general guidelines for ballast maintenance best practices and trade-off considerations.Findings–The results showed multiple factors affect the lateral track strength and therefore the susceptibility to misalignments and track buckles.The disturbance from ballast tamping can reduce the lateral track strength by 20–80%(∼45%median)and can be compacted from either tonnage(25–50%regain in strength after 0.1 m gross ton or MGT)or DTS(33–78%regain in strength).The amount of ballast(shoulder width and crib height),tie type and ballast characteristics all have a meaningful role in lateral track strength.Originality/value–This paper is based on the testing programs conducted by authors at MxV Rail.
文摘BACKGROUND It is expected that transfer of spinal accessory nerve to suprascapular nerve,which is widely used in the restoration of the shoulder function in brachial plexus birth injury(BPBI),impairs the trapezius function.AIM To hypothesize that the lower trapezius muscle remains functional after this neve transfer.METHODS In a retrospective cross-sectional study,patients with BPBI who underwent nerve transfer from accessory nerve to supraclavicular were followed for at least six months following the operation and demographic data were extracted from the database.To assess the lower trapezius function,shoulder abduction and external rotation were examined,and electromyography and nerve conduction velocity(EMG-NCV)was performed.RESULTS A total of 19 patients with a mean age of 2.69±1.40 years and a mean follow-up of 10.5 months were included in the study.Shoulder abduction was disabled completely only in one patient(5.26%);10(52.63%)had good,3(15.78%)moderate,and 5(26.31%)had poor shoulder abduction.Regarding external rotation,one(5.26%)was unable to externally rotate the shoulder;among 18(94.73%)patients who had satisfactory results,8(42.10%)were evaluated to be good,5(26.31%)moderate,and 5(26.31%)poor.EMG-NCV showed functional lower trapezius in all patients;its function was evaluated to be good in 11(57.89%),moderate in 6(31.57%),and poor in 2(10.52%)cases.CONCLUSION This study supports the hypothesis that the lower trapezius muscle has a dual motor innervation which provides the possibility of further trapezius tendon transfer to restore a better shoulder function.
文摘Objective:To evaluate the therapeutic effect of dynamic fixation with a hook plate-double loop plate internal fixation system for high-energy acromioclavicular joint complex dislocation(denoted as HACD,i.e.,Rockwood type III-V dislocation).Methods:Fifty-eight patients with HACD were selected and evenly divided by drawing lots.The experimental group underwent ligament reconstruction treatment,while the reference group received hook plate fixation treatment.The efficacy and other indicators were compared between the groups.Results:The overall effective rates between the groups were similar(P>0.05).The experimental group had a longer surgical duration,lower pain scores at 6 months postoperatively,higher shoulder joint function scores,and a lower complication rate,with P<0.05 when compared between groups.Conclusion:The effectiveness of the double loop plate internal fixation system ligament reconstruction treatment for patients with HACD is comparable to that of hook plate fixation treatment.Although the surgical duration is slightly longer,postoperative pain is milder,facilitating the recovery of shoulder joint function in patients and offering higher safety.
文摘Operative management of humeral shaft fractures demonstrates superior early functional recovery(6-month Disabilities of the Arm,Shoulder,and Hand scores)and significantly lower nonunion rates(63.9%reduction)compared to functional bracing,particularly in complex cases,while conservative treatment remains viable for low-demand patients.Surgical techniques,including open reduction internal fixation,intramedullary nailing,and minimally invasive plate osteosynthesis,offer trade-offs between anatomic precision and complication risks(e.g.,radial nerve injury vs rotator cuff damage),with over 90%of radial nerve injuries resolving spontaneously.Ultrasound-guided diagnosis(89%sensitivity,95%specificity)optimizes decision-making for nerve entrapment.Individualized treatment selection,prioritizing fracture complexity and patient needs,is critical to balance accelerated rehabilitation with minimized complications.
