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A 35-year-old Chinese man with no risk factors for stroke presented with a 2-day history of expressive dysphasia and a 1-day history of right-sided weakness. The presentation was preceded by multiple sessions of neck, shoulder girdle and upper back massage for pain relief in the prior 2 weeks. CT of the brain demonstrated an acute left middle cerebral artery infarct and left internal carotid artery dissection. MRI cerebral angiogram confirmed left carotid arterial dissection and intimal oedema of bilateral vertebral arteries. In the absence of other vascular comorbidities and risk factors, massage-induced internal carotid arterial dissection will most likely precipitate the near-fatal cerebrovascular event. The differential diagnosis of stroke in a younger population was consequently reviewed and discussed.

Context: Lumbopelvic-hip complex (LPHC) exercises are used to increase stabilization within the human body. Torso-elevated side support (TESS), foot-elevated side support (FESS), prone bridge plank (PBP), and V-sit are common LPHC exercises. Objective: To evaluate muscle activation in the shoulder girdle and LPHC during 4 LPHC exercises and evaluate the reasoning for termination. Study Design: Cross-sectional study. Setting: Laboratory. Patients or Other Participants: Seventeen healthy participants (12 males and 5 females; age: 21.47 [3.16] y, height: 179.73 [8.92] cm, mass: 76.89 [11.17] kg). Main Outcome Measures: Participants completed 2 repetitions of the TESS, FESS, PBP, and V-sit until failure. Surface electromyography of the middle deltoid, latissimus dorsi, middle trapezius, rectus abdominis, erector spinae, external oblique, and gluteus medius were recorded and normalized to maximum voluntary isometric contraction (MVIC). The duration of exercise and subjective reasoning for termination of exercise was completed following the 4 tasks. Results: The TESS and PBP had significantly greater middle deltoid muscle activation (TESS: 55.66% [24.45%] MVIC and PBP: 42.63% [18.25%] MVIC) compared with the FESS (10.10% [10.04%] MVIC) and V-sit (2.21% [1.94%] MVIC), P P Conclusions: The V-sit resulted in isolated activity of the abdominal portion of the LPHC. The FESS had increased global co-contraction of the LPHC compared with the TESS. The PBP and TESS had significant muscle activation in the upper-extremity.

Scapulothoracic dissociation, particularly in combination with open fractures of the shoulder girdle, can be associated with significant soft tissue injury and present challenges with coverage and fixation. A single case of an open scapulothoracic dissociation was reviewed. Case presentation, clinical course and initial outcomes are discussed. A 22-year-old patient presented with an open left segmental clavicle fracture, sternoclavicular dislocation and scapulothoracic dissociation after being ejected in a motor vehicle collision. The shoulder girdle was initially stabilized with trans-clavicular trans-manubrial plating followed by staged pedicled rotational rectus abdominis flap. Follow-up at 1 month revealed well healed wounds and 90 degrees of forward flexion. Patients with open fractures and scapulothoracic dissociation can present multiple challenges when considering fixation and soft tissue coverage. A viable option in these patients is a pedicled rotational rectus abdominis flap when more typical coverage options are precluded from associated injuries.

Knowing the frequency of spasticity patterns in different muscles allows correcting the botulinum neurotoxin (BoNT) administration schemes and creating spasticity models that could predict the drug consumption and treatment cost.Objective: to develop clinical spasticity models based on the frequencies of the spastic syndrome in the muscles of the extremities in post-stroke patients to optimize BoNT administration.Patients and methods. We examined 129 patients of both sexes aged 61.2±8.0 years with post-stroke spasticity (mean time after the stroke – 4.6±2.2). Twenty-seven muscles were tested for spasticity: shoulder girdle (n=3), upper (n=9) and lower (n=15) extremities. We used the original manual testing methods (MTM) of spasticity and the Tardieu scale (TS).Results and discussion. We observed the following frequencies of spasticity in the arm muscles: pectoralis major, brachioradialis, pronator teres, fl. carpi radialis, fl. digitorum profundus et superfacialis, fl. pollicis long. – over 70%, subscapularis – 61%, brachialis – 56.6%, biceps brachii – 35.8%. Frequencies of spasticity in the leg muscles were: semitendinosus, semimembranosus, fl. digitorum long. – 37.5%, gracilis – 21.4%, cap. med. gastrocnemius – 48%, tibialis post. – 39.2%, soleus – 19.6%, fl. halluces long. – 23%. There was no spasticity in the hip adductors; low spasticity incidence was seen in fl. digitorum brev. et fl. halluces brev. (Conclusion. We propose several spasticity models, which allow calculating the treatment costs, considering the frequency of involvement of specific muscles in spasticity evaluation, and tracking the rehabilitation follow-up of the patient's transition from one clinical model to another.

Background: Physical, neuropathic, or secondary causes can all contribute to neck difficulty. Any other illness might be acute 6 weeks, subacute 3 months, or chronic (lasting more than 6 weeks) (lasting up to three months). Physical consequences, life-distressing or non-life- distressing causes, large and small factors, reliable and inaccurate neck pain. Motor control is a motor retraining programme that focuses on the neck flexors, extensors, and shoulder girdle muscle's coordination and holding skills. MET is a treatment method that makes use of the patient's muscles contracting in a specific, directed manner against a therapist-applied counterforce. Methodology: The participants in the study will be enrolled of 50 patients who suffer from prolonged neck pain. And each group will be split into 25 people. One group will get MET for four weeks, whilst the other will get MCE and traditional treatment. Pain, ROM, and Functional Disability will be reviewed using a methodical approach. Conclusion: We need to see how this experiment affects people of MET versus MCT in addition to conventional therapy core on pain, ROM and functional Impairment on neck discomfort that persists. In conclusion, the focus of this research is to find out the efficacy of MET versus MCT in addition to standard therapy, as well as its impact on chronic Neck discomfort has a negative impact on one's quality of life. This study will aid in the relief of chronic neck pain.

Brachial plexus birth injury can lead to irreversible neuromuscular dysfunction and skeletal deformity of the upper extremity and shoulder girdle, ultimately resulting in glenohumeral dysplasia. Diagnosis and treatment of affected infants requires a multi-disciplinary approach in which imaging plays a vital role. While MRI is excellent for assessing both the shoulder and spine of these children, it is costly and requires sedation and is thus typically reserved for preoperative planning. US, however, is inexpensive, dynamic and readily available and provides excellent visualization of the largely cartilaginous glenohumeral joint. As such, it has become a highly useful modality during early diagnosis and follow-up of children with brachial plexus birth injuries. In this review, we describe the relevant anatomy of the glenohumeral joint, outlining the normal sonographic appearance as well as providing tips and tricks for identifying and characterizing pathology.

Brachial plexus injury (BPI) occurs when the brachial plexus is compressed, stretched, or avulsed. Although rodents are commonly used to study BPI, these models poorly mimic human BPI due to the discrepancy in size. The objective of this study was to compare the brachial plexus between human and Wisconsin Miniature SwineTM (WMSTM ), which are approximately the weight of an average human (68-91 kg), to determine if swine would be a suitable model for studying BPI mechanisms and treatments. To analyze the gross anatomy, WMS brachial plexuses were dissected both anteriorly and posteriorly. For histological analysis, sections from various nerves of human and WMS brachial plexuses were fixed in 2.5% glutaraldehyde, and postfixed with 2% osmium tetroxide. Subsequently paraffin sections were counter-stained with Masson's Trichrome. Gross anatomy revealed that the separation into three trunks and three cords is significantly less developed in the swine than in human. In swine, it takes the form of upper, middle, and lower systems with ventral and dorsal components. Histological evaluation of selected nerves revealed differences in nerve trunk diameters and the number of myelinated axons in the two species. The WMS had significantly fewer myelinated axons than humans in median (p = 0.0049), ulnar (p = 0.0002), and musculocutaneous nerves (p = 0.0454). The higher number of myelinated axons in these nerves for humans is expected because there is a high demand of fine motor and sensory functions in the human hand. Due to the stronger shoulder girdle muscles in WMS, the WMS suprascapular and axillary nerves were larger than in human. Overall, the WMS brachial plexus is similar in size and origin to human making them a very good model to study BPI. Future studies analyzing the effects of BPI in WMS should be conducted.

Background Although fracture of the coracoid process (CF) used to be considered rare, it is now more commonly encountered due to increased awareness and advances in imaging methods. This review aimed to analyze reported cases of CF to determine its mechanism and appropriate treatment. Methods PubMed and Scopus were searched using the terms "scapula fracture" and "coracoid fracture." The inclusion criteria were English full-text articles concerning CF that described patient characteristics with appropriate images. The exclusion criteria included cases without appropriate images and those with physeal injury or nonunion. Citation tracking was conducted to find additional articles and notable full-text articles in other languages. Fractures were mainly classified using Ogawa's classification. Results Ninety-seven studies were identified, including 197 patients (131 men, 33 women; average age 37.0±16.9 years). CF was classified as type I in 77%, type II in 19%, and avulsion fracture at the angle in 5%. Concurrent shoulder girdle injuries included acromioclavicular injury in 33%, clavicular fracture in 17%, acromion or lateral scapular spine fracture in 15%, and anterior shoulder instability in 11%. Among patients with type I CF, 69% had multiple disruptions of the superior shoulder suspensory complex. Conservative treatment was applied in 71% of isolated type I CF, while surgical treatment was applied in 76% of type I CF with multiple disruptions. Although the evaluation methods varied, 60% of patients were followed up for more than 6 months, and the outcomes were generally satisfactory for both conservative and surgical treatments. Conclusion CF occurred commonly in the age group with higher social activity. The most common fracture type was type I. The possible mechanism of CF is violent traction of the attached muscles, except for avulsion fracture at the angle. Type I CF with multiple disruptions of the superior shoulder suspensory complex requires surgical treatment, whereas conservative care is recommended for isolated type I and type II CFs.

The Biceps Brachia is an anterior arm muscle consisting of two heads that bridge the shoulder girdle to the forearm. The distal biceps tendon from both heads may converge or remain anatomically separate before attachment to the radial tuberosity. The incidence of distal biceps rupture is 1.2/100,000 per year and is mostly seen in middle-aged men. The rupture of the biceps tendon is a relatively less common lesion making this case unique. Physiotherapy rehabilitation post-surgery is found to be effective; it includes management of pain, increase range of motion exercises, strengthening exercises, muscle energy technique, cardiovascular fitness, all these together helps to improve patient outcomes. A case of the 40-year-old female is presented in this case report who underwent traumatic glass-cut injury in proximal forearm resulting in distal bicep-tendon repair with ulnar artery injury and ulnar nerve neuropathy. After surgical reconstruction patient presented with pain in the shoulder, elbow, and wrist, reduced range of motion, strength, and grip strength leading to difficulty in performing activities of daily living. Surgical history, clinical findings, outcomes, and rehabilitation are mentioned in this report. We report that there is a significant improvement in stability, range of motion, muscle strength, relief from pain, and improvement in the patient's functional level and outcomes.

INTRODUCTION: Altered motor control and proprioceptive deficits are associated with kinematics dysfunctions and may cause alterations in subacromial space (SAS) that could lead to shoulder pathologies. Dimensions of the subacromial space, as well as interventions aimed at its normal restitution, can be explored by ultrasound (US). OBJECTIVE: To describe the effect of two shoulder girdle motor control exercises with cognitive training strategies on SAS dimensions, measured with US. METHODS: Cognitive movement control strategies, with visual and haptic feedback were applied on 21 healthy participants. SAS dimensions were measured through in vivo variations of acromiohumeral (AHD) and coracohumeral distances (CHD) using US. RESULTS: Our results show that as exercise repetitions are performed, an increasing trend in both measures can be observed, being wider for AHD (i.e. humeral head descent exercise) than CHD (i.e. scapular retraction exercise). CONCLUSION: Specific cognitive and motor control exercises improve congruence joint and centering of the humeral head.

Introduction: Upper crossed syndrome is a common postural dysfunctional pattern that describes the dysfunctional tone of the musculature of the shoulder girdle/ cervicothoracic region of the body. Objective: To determine association of Upper Crossed Syndrome and Neck pain among general population in Islamabad. Materials & Methods: A cross sectional survey was conducted from December 2017 to February 2018 in Rawal General and Dental Hospital Islamabad, and National Institute of Rehabilitation Sciences Islamabad after approval of synopsis from Advanced Studies and Research Board. Convenience sampling was used to collect data from male and female participants having neck pain after obtaining informed consent. The questionnaires provided for a subjective assessment from the patient and an objective measure for the clinician. REEDCO scale was used to analyze the proper alignment of head, neck and shoulder, while wall push test was used to assess the abnormal protrusion of scapula. Data were analyzed for descriptive and inferential statistics by SPSS 20; continuous variables were expressed as mean ± SD, and categorical variables as frequency and percentage. A p≤0.05 denoted significance. Results: The occurrence of upper crossed syndrome was 24.1%. Out of 340 respondents, 143 (42.06%) had poor posture whereas 197 respondent (57.94%) had good posture. There was strong association between posture and upper crossed syndrome (p˂0.05). Conclusion: Most patients with neck pain are exposed to the risk of adopting poor posture which can lead to Upper Crossed Syndrome in future; hence the importance of postural awareness among general population of Islamabad.

Background Push-ups (PU) are a common closed chain exercise used to enhance shoulder girdle stability, with variations that alter the difficulty or target specific muscles. To appropriately select and prescribe PU exercises, an understanding of muscle activity during variations of the PU is needed. The purpose of this scoping review was to identify common PU variations and describe their muscle activation levels. Methods Databases searched included PubMed, CINAHL, Scopus, and SPORTDiscus for articles published between January 2000 and November 2019. Results Three hundred three articles were screened for eligibility with 30 articles included in the analysis. Six PU types and five muscles met the criteria for analysis. Weighted mean electromyography (EMG) amplitude was calculated for each muscle across PU types and for each PU type as a measure of global muscle activity. Triceps and pectoralis major had the highest EMG amplitude during unstable, suspension, incline with hands on a ball and the standard PU. Serratus anterior had the highest EMG amplitude during PU plus and incline PU. The greatest global EMG amplitude occurred during unstable surface PU. Discussion These results provide clinicians with a framework for prescribing PU to target specific muscles and scale exercise difficulty to facilitate rehabilitation outcomes.

Background Approximately 9% of shoulder girdle injuries involve the acromioclavicular joint (ACJ). There is no clear gold standard or consensus on surgical management of these injuries, in part perpetuated by our incomplete understanding of native ACJ biomechanics. We have therefore conducted a biomechanical study to assess the stabilizing structures of the ACJ in superior-inferior (SI) translation and anterior-posterior (AP) translation. Methods Twenty fresh frozen cadaveric specimens were prepared and mounted onto a robotic arm. The intact native joint was tested in SI translation and AP translation under a 50-N displacing force. Each specimen was retested after sectioning of its stabilizing structures in the following order: investing fascia, ACJ capsular ligaments, trapezoid ligament, and conoid ligament. Their contributions to resisting ACJ displacements were calculated. Results In the intact native ACJ, mean anterior displacement of the clavicle was 7.9 ± 4.3 mm, mean posterior displacement was 7.2 ± 2.6 mm, mean superior displacement was 5.8 ± 3.0 mm, and mean inferior displacement was 3.6 ± 2.6 mm. The conoid ligament was the primary stabilizer of superior displacement (45.6%). The ACJ capsular ligament was the primary stabilizer of inferior displacement (33.8%). The capsular ligament and conoid ligament contributed equally to anterior stability, with rates of 23% and 25.2%, respectively. The capsular ligament was the primary contributor to posterior stability (38.4%). Conclusion The conoid ligament is the primary stabilizer of superior displacement of the clavicle at the ACJ and contributes significantly to AP stability. Consideration should be given to reconstruction of the ACJ capsular ligament for complete AP stability in high-grade and horizontally unstable ACJ injuries.

Background: Frozen shoulder is a condition in which movement of the shoulder becomes restricted.It can be described as either primary (idiopathic) whereby the aetiology is unknown, or secondary,when it can be attributed to another cause. It is commonly a self-limiting condition, of approximately1 to 3 years' duration, though incomplete resolution can occur. The aetiology of shoulder pain isdiverse and includes pathology originating from the neck, glenohumeral joint, acromioclavicularjoint, rotator cuff, and other soft tissues around the shoulder girdle. The most common source ofshoulder pain is the rotator cuff, accounting for over two-thirds of cases. Material and methods:This was a prospective study with 50 patients coming to our OPD. Patients of all stages wereincluded and randomized into two groups. Group 1: Single Site Injection (SSI) group receivedsteroid injection through posterior approach and Group 2: Novel three-site ( NTS )group receivedthe same dose of steroid in diluted doses at three sites (posterior capsule, subacromial andsubcoracoid). The second sitting was repeated after 3 weeks. Both groups had received the samephysiotherapy. The patients were evaluated by the CONSTANT score at initial, 3 weeks, 6 weeks and6 months. Results: Patients of Group 2 (NTS group) had significant pain relief and earlyimprovement in activities of daily living (p < 0.005) as compared to Group 1 (SSI Group). Also,although there was an improvement in shoulder movements in both the groups but in Group 2 (NTS)patients, early near-normal scores were attained and sustained even after 6 months. About 40% inGroup 1 (SSI) could not attain near-normal levels and had relapses. Conclusion: The Novel three-site approach of steroid injections in frozen shoulder provides early recovery, better pain relief andbetter improvement in shoulder function with fewer relapses.

OBJECTIVE We sought to determine if white-light three-dimensional (3D) body scanning can identify clinically relevant shoulder girdle deformity after displaced diaphyseal clavicle fracture (DCF). METHODS Adult patients with DCF (OTA/AO 15A) were prospectively enrolled. Four subcutaneous osseous landmarks were used to measure shoulder girdle morphology of the injured and uninjured shoulder. Measurements were made both manually with a tape measure and digitally with a white-light 3D scanner. Bilateral radiographs were obtained, and clavicle length was recorded. Quick-Disabilities of the Arm, Shoulder, and Hand surveys were administered at injury and at 6 and 12 weeks. RESULTS Twenty-two patients were included in the study. At the initial visit, all patients had significant differences in deformity measurements between injured and uninjured shoulders as measured by 3D scanning. There was no difference between shoulders measured using manual measurements. At 6 and 12 weeks, shoulder asymmetry was significantly less in patients treated with surgery compared with nonoperative patients as measured by the 3D scanner alone. Clavicle shortening measured on 3D scanning had weak and moderate positive correlations to radiographs (R = 0.27) and manual measurements (R = 0.53), respectively. Patients treated with surgery had significant functional improvements by 6 weeks, and a similar improvement was not seen until 12 weeks in nonsurgical patients. CONCLUSION White-light 3D scanning was able to identify and monitor clinically relevant shoulder girdle deformity after DCF. This tool may become a useful adjunct to clinical examination and radiographic assessment, when determining clinically relevant deformity thresholds. In the future, quantifying and understanding shoulder deformity may inform clinical decision making in these patients. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Clavicle fracture is a common traumatic injury around shoulder girdle due to their subcutaneous position. It is caused by either low-energy or high-energy impact. Fractures of the clavicle have been traditionally treated non-operatively. Although many methods of closed reduction have been described, it is recognized that reduction is practically impossible to maintain and a certain amount of deformity and disability is expected in adults. 30 patients with mid-shaft clavicle fracture were systematically randomized (alternate patient) into either operative treatment with plate fixation or non-operative treatment with clavicle brace and sling. All fractures were classified using Robinson’s classification for clavicle fractures and only Type 2A2 and 2B1 were considered for the study. Patients were followed up at 3wks, 6wks, 3rd month & 6th month. Functional outcomes were assessed according to the Constant and Murley Scoring and radiologically. Maximum number (90%) of patients had Robinson’s Type 2B1 fracture. The mean duration of hospital stay for patients in Group A(operative) and Group B(non operative) was 3.67 ± 0.90 days and 1.73 ± 0.46 days respectively. In Group A, the mean duration of trauma to surgery was 3.13 ± 2.64 days. While the mean operative time was 104.87 ± 13.52 minutes. The duration of union was significantly lesser in Group A as compared to Group B according to Chi-Square test (p0.05). Primary open reduction and internal fixation with pre-contoured clavicle plate for displaced, middle third clavicle fractures provide a more rigid fixation and allows early mobilization whereas conservative treatment require longer periods of immobilization till fracture union. Functional outcomes are better with surgical management of middle third clavicle fractures with pre-contoured locking compression plate. The successful use of locking compression plate for middle third fractures of clavicle requires careful assessment of fracture pattern, patient selection, meticulous operative technique, appropriate choice of fixation, judicious internal fixation, careful post-operative monitoring and aggressive early institution rehabilitation. So, there is need to individualize the treatment as per the need and functional demand of the patient to give the optimum outcome.

Background Extra-abdominal desmoid tumor fibromatosis (DTF) is a rare, locally aggressive soft tissue tumour. The best treatment modality for this patient cohort is still object of debate. Questions/purpose This paper aimed to (1) to compare the outcomes of DTF after different treatment modalities, (2) to assess prognostic factors for recurrence following surgical excision, and (3) to assess prognostic factors for progression during observation. Methods This was a retrospective multicenter study under the patronage of the European Musculoskeletal Oncology Society (EMSOS). All seven centres involved were tertiary referral centres for soft tissue tumours. Baseline demographic data was collected for all patients as well as data on the diagnosis, tumour characteristics, clinical features, treatment modalities and whether they had any predisposing factors for DTF. Results Three hundred eighty-eight patients (240 female, 140 male) with a mean age of 37.6 (±18.8 SD, range: 3–85) were included in the study. Two hundred fifty-seven patients (66%) underwent surgical excision of ADF, 70 patients (18%) were observed without therapy, the residual patients had different conservative treatments. There were no significant differences in terms of tumour recurrence or progression between the different treatment groups. After surgical excision, younger age, recurrent disease and larger tumour size were risk factors for recurrence, while tumours around the shoulder girdle and painful lesions were at risk of progression in the observational group. Conclusion Local recurrence rate after surgery was similar to progression rates under observation. Hence, observation in DTF seems to be justified, considering surgery in case of dimensional progression in 2 consecutive controls (3 and 6 months) and in painful lesions, with particular attention to lesions around the shoulder girdle.

The Acromioclavicular joint represents the link between the clavicle and scapula, which is responsible for synchronized dynamics of the shoulder girdle. Traumatic injuries to acromioclavicular joint (AC joint) are commonly sustained by contact-sports athletes in high impact collisions or falls. Rockwood classified these injuries into types I through VI. Type I to type III injuries are treated conservatively and type IV -VI injuries require surgical management. Injuries of grade III - V require reconstruction of AC and CC ligaments. We present a surgical technique involving harvesting of semintendinosus autograft from hamstrings and using it to anatomically reconstruct the conoid and trapezoid portions of the coraco-clavicular ligament and the superior acromio-clavicular ligament/capsule. This technique is beneficial because it provides both horizontal and vertical stability. The purpose of our study was to find out the functional outcome of the procedure performed in mid-term follow-up. In our study the result was good functional outcome at 5 year follow up and subsequent followups provided proper placement of clavicular and acromian tunnels at the time of surgery.

Single-photon emission computed tomography (SPECT) imaging forms part of the bone scintigraphy examination to significantly improve the detection of skeletal lesions. It has been observed that patients undergoing lumbar spine SPECT scintigraphy frequently complain of general discomfort in the shoulder girdle. Music has been used as an intervention during medical procedures or imaging examinations in an attempt to relieve discomfort and anxiety. The aim of this study was to determine the effect of music, as an intervention, on the perceived discomfort in the shoulder girdle during lumbar spine SPECT scintigraphy. A pretest-posttest quasi-experimental design with two groups was used to conduct this study. Ninety-six consecutive patients routinely referred for lumbar spine SPECT scintigraphy were recruited from two private nuclear medicine practices in Gauteng. Patients were systematically assigned to the control or experimental group. Patients were asked to rate their discomfort at various time points. The results indicate that the group exposed to music as an intervention more frequently reported a decrease in discomfort as compared with the control group. The experimental group also reported less percentage increase in discomfort. There were statistically significant differences in discomfort scores 10 min into the SPECT and after the SPECT between the control and intervention groups. Discomfort scores of the control group had a noticeable increase after the SPECT had started. Music as an intervention during SPECT imaging is more of a distraction than an analgesic and can be used to increase patient comfort and the patients’ experience.

Several articular, muscular and neurological diseases generate mobility loss in the shoulder and pelvis girdles. Joint mobilization contributes to improving shoulder-pelvis girdles dissociation, but current mobilization techniques are not always successful and standardized. A robotic medical device, DPA Med®, by inducing trunk mobilization through lower limb oscillation has been developed for producing such a shoulder-pelvis girdles dissociation and is already used worldwide in rehabilitation hospitals.To determine the optimal lower limb oscillation frequency that generated the best shoulder-pelvis girdles dissociation using the DPA Med® device.Thirty healthy adult volunteers (mean age: 38.6 [SD 15.2] years, mean height: 174 [SD 11.9] cm, mean body mass: 70.3 [SD 14.7] kg) participated in this prospective study. A kinematic analysis quantified pelvic and shoulder girdle mobility (rotation and lateral tilt) at different DPA Med® frequencies, from 0.5 Hz to 1 Hz. A visual analysis of the lower limb movement was also performed, using video sensors, to better understand the kinematics involved.All DPA Med® frequencies have shown significant shoulder-pelvis girdles dissociation (p 0.05). This study established an optimal oscillation frequency with the minimal interindividual variability at 0.808 Hz. It induced pelvic mobility similar to that of normal gait, in the transverse and frontal planes (10.3°, SD 2.9°, and 12.0°, SD 2.2°, respectively). This trunk mobility was achieved by producing a lemniscate-shaped motion in the lower limbs (an eight-shaped motion in the transverse plane).This study has shown that the DPA Med® device is able to induce shoulder-pelvis girdles dissociation similar to that of normal gait and allowed to establish the existence of an optimal DPA Med® oscillation frequency for lower limb mobility at 0.808 Hz. Further studies are required to evaluate its potentially benefits on gait disorders.

Acromioclavicular (AC) injuries are common, especially in the young and active population. AC joint dislocations account for 8% of all joint dislocations and are even more common in contact sports. These injuries are graded as type I through type VI on the basis of the Rockwood classification method. Types I and II are generally treated without surgery whereas types IV, V, and VI are best treated operatively. Type III dislocations remain controversial in terms of treatment, and many surgeons recommend nonoperative treatment first and operative treatment in case of continued symptoms such as pain, instability, or shoulder girdle dysfunction. The goal of operative treatment is to restore AC joint stability, which involves addressing both the coracoclavicular and coracoacromial ligaments to achieve a desirable patient outcome. The objective of this Technical Note is to describe our technique for management of a failed acromioclavicular stabilization, treated with a coracoclavicular and AC joint capsular reconstruction using tibialis anterior and semitendinosus allografts., Technique Video Video 1 A step-by-step video illustration of the surgical technique of the treatment of failed type-V acromioclavicular (AC) separation caused by coracoid fracture via revision of acromioclavicular-coracoclavicular reconstruction and coracoid fixation. The procedure begins by extending the incision scar from the prior procedure. Next, the prior cortical button from the superior clavicle is removed, and the suture from the inferior clavicle is retrieved. Once the coracoid is exposed, the distal aspect presents as mobile and is resected. Preparation for a 4.75 mm SwiveLock is performed by first drilling and then tapping to later attach the conjoined tendon posterior and superior to the anatomic placement of coracoid. The remaining coracoid base is exposed and used to place a 3 mm cannulated guide pin from posterior to anterior at an angle of 45°. A passing suture is passed through the guide pin tunnel. Two tunnels are drilled in the clavicle. The first clavicular tunnel is drilled in the posterior one third of the clavicle, approximately 35 mm from the AC joint. The second clavicular tunnel is drilled on the anterior one third on the clavicle 25 mm to the distal end and is used for reconstruction. Passing sutures are passed through both tunnels. Another tunnel is drilled at the acromion midline, approximately 14 mm lateral to the AC joint, followed by a passing suture for later graft passage. The TightRope suture for the dog-bone button construct is passed superiorly to inferiorly, first through the coracoid tunnel in the clavicle and the grommet seated. The TightRope is then passed through the base of the coracoid, which is then tightened to the base of the coracoid to secure the clavicle in anatomic position. A 4.75 Peak SwiveLock is placed into the previously drilled hole at the superior glenoid neck and loaded with FiberTape sutures. The conjoined tendon is secured by whipstitching the single limb of the sliding suture within the SwiveLock anchor, then tying the previously placed FiberTape sutures to the tension limb after securing it to the base of the remaining coracoid and superior glenoid neck. Once the two ends of the graft are secured with FiberTape, the posterior graft limb is passed deep into the anterior limb and passed inferior to superior through the lateral clavicle tunnel. This limb is then passed from inferior to superior through the acromion tunnel, and a second tenodesis screw is placed in the acromion to secure the graft. The two free graft limbs are again tensioned over the superior clavicle and sutured together with FiberTape. The excess graft limbs are cut. The final construct creates a soft-tissue hook place. Range of motion of the arm is checked, and the stability of the reconstruction is confirmed.

Purpose The purpose of this case is to describe an exercise program designed for an individual with athetoid cerebral palsy who had difficulties with fine motor control and shoulder girdle stability. Summary of key points ET is a 19-year-old man with dyskinetic-type cerebral palsy with rapidly fluctuating muscle tone and movements that preclude trunk and extremity control necessary for the effective performance of functional activities. The participant underwent a 6-week intense physical therapy program aimed at strength and stability at the shoulder girdle and fine motor movements of the hand. Conclusions ET had improvements on the Performance of Upper Limb Scale, myometry, and from family report after 6 weeks. Recommendations A progressive exercise program aimed at improving proximal stability and fine motor function might be an appropriate intervention for persons with athetoid cerebral palsy. Video abstract For more insights from the authors, see Supplemental Digital Content 1, available at: http://links.lww.com/PPT/A315.

Purpose: to substantiate the effectiveness of the author’s program for the development of strength abilities of athletes aged 10-11 engaged in acrobatic rock and roll. Material and methods: the study was conducted in the period from September 2019 to October 2020 on the base of the acrobatic rock and roll club “SUMMIT” in Kharkiv. The study involved 20 young athletes from 10 to 11 years old (10 boys and 10 girls). All studied athletes were engaged in the group of preliminary basic training of the 1st year of training. The following methods were used in the work: analysis and generalization of scientific and methodological literature; pedagogical experiment; methods of mathematical statistics. Results: considering the level of physical fitness of athletes, a training program was developed for the integrated development of strength abilities of young athletes aged 10-11 years, who are engaged in acrobatic rock and roll. The program provided for an increase in the level of development of the strength abilities of the muscles: arms, shoulder girdle, neck, torso, and legs. The introduction of the training program helped to increase the level of development of muscle strength: the upper shoulder girdle by 17.5% in boys and 22% in girls; torso muscles by 12.6% in boys and 10.2% in girls; explosive force of leg muscles by 0.9% in boys and 0.6% of girls. Conclusions: because of the ascertaining experiment with the use of a specially developed training program in young men there was a significant increase of the development strength abilities level of the muscles of the upper shoulder girdle and torso (p

BACKGROUND: Abnormal movement patterns due to compensatory mechanisms have been reported in patients with rotator cuff tears. The long head of the biceps tendon may especially be overactive and a source of pain and could induce abnormal muscle activation in these patients. It is still unknown why some patients with a rotator cuff tear develop complaints and others do not.QUESTIONS/PURPOSES: (1) Which shoulder muscles show a different activation pattern on electromyography (EMG) while performing the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with a symptomatic rotator cuff tear compared with age-matched controls with an intact rotator cuff tear? (2) Which shoulder muscles are coactivated on EMG while performing the FIT-HaNSA?METHODS: This comparative study included two groups of people aged 50 years and older: a group of patients with chronic symptomatic rotator cuff tears (confirmed by MRI or ultrasound with the exclusion of Patte stage 3 and massive rotator cuff tears) and a control group of volunteers without shoulder conditions. Starting January 2019, 12 patients with a chronic rotator cuff tear were consecutively recruited at the outpatient orthopaedic clinic. Eleven age-matched controls (randomly recruited by posters in the hospital) were included after assuring the absence of shoulder complaints and an intact rotator cuff on ultrasound imaging. The upper limb was examined using the FIT-HaNSA (score: 0 [worst] to 300 seconds [best]), shoulder-specific instruments, health-related quality of life, and EMG recordings of 10 shoulder girdle muscles while performing a tailored FIT-HaNSA.RESULTS: EMG (normalized root mean square amplitudes) revealed hyperactivity of the posterior deltoid and biceps brachii muscles during the upward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 111% ± 6% versus 102% ± 10%, mean difference -9 [95% confidence interval -17 to -1]; p = 0.03; biceps brachii: 118% ± 7% versus 111% ± 6%, mean difference -7 [95% CI -13 to 0]; p = 0.04), and there was decreased activity during the downward phase in patients with rotator cuff tears compared with controls (posterior deltoid: 89% ± 6% versus 98% ± 10%, mean difference 9 [95% CI 1 to 17]; p = 0.03; biceps brachii: 82% ± 7% versus 89% ± 6%, mean difference 7 [95% CI 0 to 14]; p = 0.03). The posterior deltoid functioned less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than in the control group.CONCLUSION: Patients with a symptomatic rotator cuff tear show compensatory movement patterns based on abnormal activity of the biceps brachii and posterior deltoid muscles when compared with age-matched controls. The posterior deltoid functions less in conjunction with the other deltoid muscles, and lower coactivation was seen in the remaining intact rotator cuff muscles in the rotator cuff tear group than the control group.CLINICAL RELEVANCE: This study supports the potential benefit of addressing the long head biceps tendon in the treatment of patients with a symptomatic rotator cuff tear. Moreover, clinicians might use these findings for conservative treatment; the posterior deltoid can be specifically trained to help compensate for the deficient rotator cuff.

Introduction One of the most common injuries in children is clavicle fractures. They account for up to 14 % of all pediatric bone injuries. Aim Comparative evaluation of the effectiveness of surgical and conservative methods of treating closed clavicle fractures in children. Materials and methods Between 2011 and 2018, 1,800 children with clavicle fractures referred to the traumatology and orthopedic department at the Children's Clinical Hospital No. 9 in Yekaterinburg.Most of them were treated conservatively, and 94 (5.2 %) children were hospitalized for surgical treatment. Depending on age and type of displacement, children received different conservative treatments, such as Deso dressing in children under two years old, figure-eight-bandage in children over two years of age. Surgical treatment was open reduction of fragments and fixation with either a Kirschner wire or a titanium elastic nail (TEN); titanium plates were used in several cases. For a comparative assessment of the results of the treatment methods for clavicle fractures, two groups of patients were formed. Results Shortening of consolidated clavicle was not observed in children of the main group treated surgically. In several cases, the elongation of the clavicle was revealed by no more than 1 cm. Patients in the comparison group showed shortening of the broken clavicle in three cases, no more than 1.3 cm. Conclusion After surgical treatment, the length of the shoulder girdle was fully restored; insignificant shortening after conservative treatment did not cause functional disorders.

Complex interactions between dynamic and static stabilizers of the shoulder girdle are critical for a biomechanically complex system, allowing for sufficient range of motion in multiple planes. This study assessed the biomechanical consequences of non-retracted rotator cuff tears (RCT), isolated and massive RCT, and irreparable, retracted posterosuperior RCT on the glenohumeral joint using a validated, dynamic shoulder testing system. Eight fresh-frozen cadaveric shoulders were tested using a dynamic shoulder simulator. Each shoulder was tested in the following conditions: (1) intact state; (2) isolated non-retracted supraspinatus tendon (SSP) defect; (3) isolated non-retracted subscapularis tendon (SSC) defect; (4) isolated non-retracted infraspinatus tendon (ISP) defect; (5) massive non-retracted RCT involving all three tendons; (6) irreparable, retracted posterosuperior RCT. The SSP, SSC, and ISP simulated defects showed a significant increase in total deltoid force, respectively (p = 0.012; p = 0.007; p = 0.001). Compared with the intact state, the massive RCT showed a significant decrease in glenohumeral abduction angle (p 0.001, respectively) compared with the intact state. In a dynamic biomechanical shoulder model, isolated non-retracted RCT, located lateral to the rotator cable, can be sufficiently compensated by the remaining intact cuff. However, in irreparable, massively retracted posterosuperior RCT located medial to the rotator cable, devasting effects on the glenohumeral joint can be expected and surgery should be recommended for these patients.

Background: Specific strength intervention can influence muscle activity during swimming performance and can increase pain. Objective: The aim of this study was to assess the effect of strength intervention on muscle activity and pain during simulated crawl in elite swimmers. Methods: Fifteen elite Czech swimmers (4 females, 11 males) within the age of 22.8 ± 3.4 years participated in this study. At the baseline, muscle activity and pain evaluation was performed. For the shoulder joint pain assessment, the visual numeric scale (VNS) and the Swimmer's Functional Pain Scale (SFPS) questionnaires were used. Participants underwent surface electromyography (SEMG) examination of 8 evaluated muscles (trunk and upper arm) during simulated a 100 metres crawl race on swimming ergometer (VASA SwimErg, Essex Junction, Vermont, USA). After a 30 minutes long strength intervention, 100 metres crawl SEMG, VNS and SFPS were evaluated again. The smallest important change in muscle activation was set to 10%. Results: The effect of strength intervention on muscle activity was not significant in all muscles, however effect size evaluation showed small effect of intervention in biceps brachii (p = .311, d = 0.33), upper part of trapezius (p = .033, d = 0.46) and serratus anterior (p = .103, d = 0.22) and medium effect in lower part of trapezius (p = .053, d = 0.62). Magnitude-based decision analysis showed a highly increased muscle activity in biceps brachii. Also in serratus anterior muscle activity increased as well. Difference in shoulder joint pain before and after intervention of the dominant upper limb according to the SFPS questionnaire and VNS was not statistically significant. Conclusion: A 30 minutes long strength intervention had a significant effect on the muscle activity of the upper part of m. trapezius. There was no significant effect of the intervention on pain.

Clavicle fracture is one of the most common bony injuries. They account for 2.6% to 4% of adult fractures and 35% of injuries to the shoulder girdle. Clavicular fractures have traditionally been treated non-operatively. Surgical treatment of acute midshaft fractures was not favored due to relatively frequent and serious complications. However, the prevalence of non-union or malunion in displaced midshaft clavicular fractures after conservative treatment is higher than previously presumed. Twenty-four patients with displaced clavicle fractures were treated with locking compression plate between October 2018 to September 2020 at Kamineni Institute of Medical Sciences, Narketpally. The duration of radiological union ranged from 12-16 weeks with the majority having union at 12 weeks (66.7%). The remaining (33.4%) had union at 16 weeks. Delayed union and nonunion cases were not observed in our study. The functional outcome assessment according to Constant Murley Scoring system showed excellent functional outcome in 75% and good functional outcome in 25% of the patients.

Sprengel deformity is a congenital anomaly arising mainly in the shoulder girdle, associated with elevation of dysplastic scapula. skeletal anomalies, mainly Klippel-Feil syndrome, hemivertebrae, and omovertebral bone may be present along Sprengel anomaly. The omovertebral bone is an abnormal bone that originates from the superomedial edge of the scapula with different insertion points along the posterior cervical spine, seen in about third of the patients with Sprengel anomaly. While cosmetic to functional impairment is a common presentation to the omovertebral bone, cervical myelopathy is a rare presentation. Here, we described our experience, management and follow up of 13-year-old boy presented with cervical myelopathy secondary to the omovertebral bone.

Acute injuries to the shoulder girdle are common and frequently encountered by the practicing radiologist. The type of injury is highly dependent on the age of the patient and mechanism of trauma with injuries occurring at the site of greatest mechanical weakness. In this review, we discuss the main clinical features and key imaging findings for the most common shoulder injuries. For each injury, we also provide a section on the important features that the orthopedic surgeon needs to know in order to guide surgical versus nonsurgical management.

Adhesive Capsulitis (AC) is a common disabling musculoskeletal pain condition of unknown etiology related to the shoulder joint. Literature reported the restricted range of motion (ROM) and pain could be the result of myofascial trigger points (MTrPs) in the muscles of the shoulder girdle. Hence, the objective of this study was to assess the short-term effectiveness of MTrP dry needling (DN) in improving ROM, pain, pressure pain threshold (PPT), and physical disability among patients having AC.In a single group pre-post experimental study design, a total of 70 clinically diagnosed patients (both malefemale, age group between 40 and 65 years) with AC were recruited from three multi-specialty hospitals. The informed consent forms were received from each patient before participating in the study. Each patient received DN for the MTrPs of shoulder girdle muscles for alternative six days. In addition to DN, each patient had received conventional physiotherapy for continuous twelve days which includes electrotherapy modalities and exercises. The pain intensity (visual analog scale), shoulder ROM (Goniometer), disability (shoulder pain and disability index) and PPT (Algometer) were the outcome measures assessed at the baseline and twelfth day of the intervention.There was a statistically significant (p 0.05) improvement in shoulder ROM, pain intensity, shoulder disability, and PPT at the end of the twelve days of intervention as compared to baseline assessment.MTrPs-DN techniques may improve the pain, ROM, disability and PPT along with conventional physiotherapy management among patients with AC.

Objective This investigation measured the reproducibility and discriminant validity of the Posterior Shoulder Endurance Test (PSET) on painful and non-painful populations. Design Reliability and validity study. Setting Laboratory setting. Participants Thirty subjects (male = 11; female = 19). Main outcome measures Time to failure (TTF) was the primary outcome measure to determine reliability of the PSET. Discriminant validity identified with receiver operator characteristic (ROC) curves utilized TTF separately in men and women since they used different loads. Results There were 25/30 subjects (painful = 12; non-painful = 13) tested a second time. ICC, SEM, and MDC90 ranged respectively from 0.77, 13.1 s, 30.6 s in the painful group to 0.85, 7.3 s, 17 s in the non-painful group. The male ROC curve AUC was 0.833 with 47 s resulting in the best combination of sensitivity = 0.833, and specificity = 0.80. The female ROC curve AUC was 0.633 with 46 s resulting in the best combination of sensitivity = 0.600 and specificity = 0.889 at 46 s. Conclusion The PSET is a reliable way to measure shoulder girdle muscular endurance. These data suggest that the PSET discriminates painful and non-painful individuals better in men compared to women.

The aim of this case report was to evaluate the risks of musculoskeletal injuries from manual extraction of manioc roots in a Brazilian family farming production. It was used a lumbar extension isometric dynamometry, electromyography and infrared thermography of the surface at the back of the worker and the whole collection of data was made in loco. The results showed an increased temperature on the surface of the left lower back (+0.6 ℃), the values of isometric strength upon lumbar extension (143 ± 2.66 Kgf) and electromyography alteration in the muscles. The questionnaires indicate that the individual complains of discomfort along all of the back of his torso. The activity of manioc manual extraction can generate an overload on the lumbar and shoulder girdle muscles. It can affect the individual productive state.

Introduction: A thorough knowledge of the vital structures adds to the safety in approaching the cervicothoracic spine junction. The best described method to reach the spine is via viscero-neurovascular space. We present our experience of 10 cases operated at our institute using the modified transclavicular transmanubrial approach to the cervicothoracic spine pathology.As we gained experience we have used various corridors to the operating field and used a new space to approach the lower cervicothoracic junction spine. Methods: Between February 2011 to August 2015, 10 patients with disease in upper thoracic vertebral body were admitted and evaluated clinically and radiologically. Neurological status in all cases was graded according to Frankel grading system.Patients were followed up with Histopathological reports and treated accordingly. Results: All patients(except metastasis) improved by 1 or 2 grade in post op period. Metastasis patients remained in same grade. Conclusion: Anterior approach with its modifications are the better suited biomechanically for exploring the pathology of cervicothoracic spine,its decompression and stabilization. Also it preserves the stability of shoulder girdle with good neurological and cosmetic outcome.

In the nonoperative treatment of degenerative rotator cuff (RC) tears, exercise therapy is advocated. Exercises focusing on strengthening the anterior deltoid (AD) and the scapular muscles are proposed to compensate for RC dysfunction. However, the amount of electromyographic (EMG) activity in these muscles during these exercises remains unclear. Moreover, it is unknown whether muscle activity levels during these exercises alter with increasing age. Therefore, the purpose of this study was to evaluate EMG activity in the deltoid and scapular muscles during 2 series of commonly used shoulder rehabilitation exercises and assess possible age-related changes in muscle activity.Fifty-five healthy participants (aged 18-60 years) participated in this study. Surface EMG activity was measured in 8 shoulder girdle muscles during a progression of a closed chain elevation program (bench and wall slides) and during a progression of previously published AD exercises. In addition, muscle activity was compared between 3 age categories (18-32 years, 33-46 years, and 47-60 years).The proposed progressions exhibited increasing activity from10% of maximal voluntary isometric contraction to20% of maximal voluntary isometric contraction for the AD for both exercise programs and for the middle deltoid, upper trapezius, and middle trapezius during the closed chain elevation exercises. Activity levels in the other muscles remained20% throughout the progression. Age-related analysis revealed increased activity in the AD, infraspinatus, and middle trapezius and decreased lower trapezius activity during the bench and wall slides. No age-related changes were noted for the AD exercises.These findings may assist the clinician in prescribing appropriate progressive exercise programs for patients with symptomatic RC tears.

Background: The shoulder region is a common area for pain. The shoulder has the largest range of motion and the most complex mechanical anatomy. The shoulder girdle and related tendons allow for numerous painful disorders to occur. Also, given the overall use of the shoulder, arthritic deformities are all too common. Finally, pain from more complex states such as poststroke shoulder pain and status post total shoulder arthroplasty pain have always been a difficult diagnosis to treat with effectiveness. The innervation to the shoulder predominantly comes from the suprascapular and axillary nerves. Both nerves relatively follow an expected anatomic course and whereby they can be targeted with ultrasound or fluoroscopy. Recently, there has been an increase in evidence that suggests peripheral nerve stimulation can make a difference in these patients with shoulder pain. Objectives: To provide a basic overview of peripheral nerve stimulator placement targeting the axillary and suprascapular nerves. Furthermore, to demonstrate the suggested implantation and current evidence of peripheral nerve stimulation for the treatment of shoulder pain. Study Design: Anatomic clinical review. Methods: A comprehensive review was performed regarding the available literature through targeting articles reporting on the use of peripheral nerve stimulation to treat pain of the shoulder region. Results: We compiled and discuss the current evidence available in treating shoulder pain utilizing peripheral stimulation. The strongest evidence currently is for peripheral nerve stimulation targeting either the axillary or suprascapular nerve, as well as placement targeting the motor points of the deltoid. The most common treated pathology is poststroke shoulder pain. Limitations: Peripheral nerve stimulation has been trialed and is promising for several shoulder pain pathologies; however, there remains a need for large-scale, randomized, placebo-controlled clinical trials to further evaluate the efficacy of most treatments. Much of the current data relies on case reports without randomization or placebo controls. Conclusions: Overall there is fair to moderate evidence for peripheral nerve stimulation to treat shoulder pain in hemiplegic poststroke patients. There is limited evidence when treating other shoulder pain etiologies. Utilizing ultrasound or fluoroscopic guidance, the procedure has proven to be safe allowing proper placement of the electrodes near the target nerves. Considering the high prevalence of shoulder pain from degenerative conditions and overuse, future studies are undoubtedly warranted to evaluate whether peripheral nerve stimulation can modify our treatment algorithm for management of these conditions. Key words: Shoulder pain, suprascapular nerve, axillary nerve, ultrasonography, peripheral nerve stimulation, post stroke shoulder, osteoarthritis, rotator cuff, hemiplegic shoulder pain, adhesive capsulitis

Purpose: Changes in the position of the scapula due to its multiple roles, including acting as a muscle binding site and stabilization in this area can reduce the physiological and biomechanical efficiency of the shoulder, which ultimately increases shoulder injury. Therefore, the purpose of this study was to compare the functional stability of shoulder girdle between asymmetric and symmetric scapula. Methods: This was conducted on 156 male students in Tehran who were selected by purposeful cluster and enrolled in the research after obtaining informed consent. Kibler test was used to examine the symmetry of the scapula; 78 subjects had symmetrical and 78 asymmetrical scapula. We used Davis and Y tests to evaluate the stability of the shoulder girdle. To study the difference between groups, an independent t-test was used at a significant level of P≤0.05 using SPSS software. Results: The mean scores of the two groups in the Davis test were significant (P=0.0001) and also there was a significant difference between the symmetric and asymmetrical scapular groups in the normalized scores of each direction and the combined score of each hand (P=0.0001). Conclusion: Asymmetry of the scapular bones due to disruption of the position of the scapula, and consequently a decrease in functional stability and quality of the optimal function can be considered to predict shoulder injuries.

Lipoma is slow growing tumors and often occurs under the skin on the neck, shoulders,arms, back, abdomen and thighs. However, occasionally lipoma may be present in deep locationor originate within muscle.Lipoma affected only 1% of population, and commonly found in adults and is higher in manthan in women. The most common benign mesenchymal tumors composed of fat cell of adulttype, diffused or encapsulated type. Surgical removal is indicated when causing trouble assite, size, appearance and presence of pain. The study was carried on 35 male patients presentedby lipoma around shoulder girdle operated in Kobry El-Kobba Military Medical Campus.The patients were divided into four groups, G1:25 patients with primary subcutaneous lipoma,G2: 8 patient with subscapular lipoma, G3: 1 patient with giant submascular left shoulderlipoma, and G4: 1 patient with giant subscapular lipoma “diagnosed before operation”including complete surgical excision was done under general anesthesia in all the patientswithout any recurrence.

Introduction: The temporo mandibular dysfunction is a biomechanical change in the temporomandibular joint that has a multifactorial origin. The masticatory muscles has a great relationship with the body posture through neuromuscular connections. The correct posture is maintained by a harmony in muscle mechanism involving the muscles of the head, neck and shoulder girdle. Therefore changes in these structures may lead to a postural imbalance mainly related to cranio-cervical disorders causing forward head, cervical spine rectification and asymmetric shoulders established in the ATM dysfunction patients. Objective: To investigate the influence of temporomandibular disorders in neck pain and posture as well as the incidence postural changes. Method: This is a literature review article carried in databases such as Lilacs, Scielo, Medline and Bireme. The studied period was from 2004 to 2015 were used as search terms: temporomandibular joint, the temporomendibular joint syndrome and posture. Among 21 articles initially selected by electronic search in databases, 4 were excluded for the title. We selected 17 studies for a more detailed analysis through the summary, with 3 of them deleted. The remaining 14 articles were evaluated from the text reading. Result: It can be observed that there is a relationship between TMD and postural changes, patients with this disorder have postural deviations such as forward head, increased cervical lordosis and not leveling between his shoulders. Conclusion: Postural changes may be associated with temporomandibular dysfunction, although there are few studies that address physical therapy on the conduct of temporomandibular disorders in pain and posture, we can see that physical therapy is of great importance with positive results in the lives of these individuals .

Background: Temporomandibular disorder (TMD) is a set of disorders involving the masticatory muscles, the temporomandibular joint (TMJ) and/or the associated structures. Objectives: To evaluate the occurrence of cervical and scapular instability in subjects with TMD. Methods: A total of 22 patients participated in the study, being 11 of them with TMD, selected using the RDC/TMD criteria, and 11 in the control group. The stabilization capacity of the neck muscles was evaluated through StabilizerTM and the muscles of the shoulder girdle through specific tests. Cervical mobility data from both groups were provided using the accelerometer while for cervical disability was used the Neck Disability Index (NDI) questionnaire. Results: Cervical instability was higher in the TMD group (20.36 ± 3.2) than in the control group (28.54 ± 0.8), revealing significant difference (p= 0.03). The highest percentages of scapular stabilization tests were found in subjects with TMD, (n= 9; 81.81%) when compared with control subjects (n= 5; 45.45%). The NDI results showed that the TMD group presented mild cervical incapacity (11.18 ± 2) and the control presented no disability (2.27 ± 0.4; p= 0.001). Conclusion: Cervical disability, and cervical and scapular instability were more frequent in subjects with TMD.

Background: Myofascial trigger points (MTP) are palpable painful nodules in a shortened area of a given muscle. The ischemic compression technique (IC), which consists of pressing the painful nodule until the elimination of tension or pain, has been shown to be an alternative for the treatment of MTP. The objective of this study was to analyze the influence of the IC technique on the level of pain to the palpation and electrical activity of the right upper trapezius (RUT) muscle during the elevation of the shoulder girdle and abduction of the shoulder in subjects with MTP. Methods: The sample consisted of ten subjects with mean age of 25.9 ± 2.68 years, who performed scapula elevation and right shoulder abduction up to 180º before and after the IC technique on the RUT muscle. The pain level was measured before and after the application of the IC technique and the myoelectric activity during the movements. Data analysis and processing were performed using the BIOMEC-SAS software and were presented in percentage values of the maximum voluntary isometric contraction (%MVIC). Statistical analysis were performed using the Wilcoxon test (α

Background Facioscapulohumeral muscular dystrophy (FSHD) is a rare condition affecting 1/20,000 persons and the third most common muscular dystrophy condition, with an autosomal dominant pattern of inheritance characterized by progressive muscular weakness primarily involving the face, shoulder girdle, and upper arm. The condition is associated with atrophic musculature of the trunk and core leading to difficulties with gait, posture, and function. FSHD leaves as many as 20% of patients wheelchair-bound and most commonly presents with low back, neck, and shoulder pain. Case Description We present the case of a patient with FSHD who underwent multiple spinal fusion surgeries without relief in her back pain. Imaging studies serve to highlight the extent of paraspinal muscle atrophy and provides the basis for a discussion on the preoperative factors that may predict patients most likely to benefit from surgery. We then provide a brief review of the literature on the role of paraspinal muscle atrophy in back pain. Conclusions This case adds to our understanding of the surgical management of patients with FSHD and patients with atrophic core musculature as a whole.

Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.

The pilot study on changes of selected muscles tension caused by vertical and horizontal whole-body vibration focused on employees belonging to two professional (occupational) groups. One of these groups consisted of men aged 50 years professionally exposed to vibration and the second were men not exposed to vibration at the workplace. Tests have been conducted in two series on special designed laboratory test bench for simulation of exposure to whole-body vibration. During the I series of tests, vertical vibration had acted on subjects and during II series horizontal lateral vibration had acted. The EMG signals were registered from muscles of the shoulder girdle and lower back, both sites of the body. Muscles tension values obtained during I and II series indicates that there are no statistical significant differences between reaction of subjects on vertical and horizontal vibration. However slightly lower EMG RMS values during II series were noticed. Exposure to whole-body vibration may cause changes in muscle tension both in employees (aged 50 years and older) occupationally exposed to vibration and not exposed to vibration. The observed changes vary in both groups of subjects. In occupationally exposed to vibration subjects the impact of exposure to vibration on muscle tension is less than in reference group.

Periprothetische Frakturen des Schultergurtels werden aufgrund der deutlich gestiegenen Implantationszahl von Schulterprothesen und des demographischen Wandels zunehmend Teil des klinischen Alltags. Diagnostisch sind neben dem Status der Rotatorenmanschette und dem einliegenden Implantat insbesondere der Infektausschluss und der Sitz der Prothese (stabil oder gelockert) fur die Therapie ausschlaggebend. Technische Neuerungen wie das Dual-Energy-Computertomogramm bieten hier verbesserte Planungsmoglichkeiten. Das Unified Classification System beschreibt die Frakturlokalisation, Qualitat des Knochens und Stabilitat der Prothese. Wahrend die konservative Therapie Patienten mit schweren Vorerkrankungen und geringer Dislokation vorbehalten ist, sind bei festem Prothesensitz die Fixation mittels Cerclagen und winkelstabilen Platten moglich. Moderne Implantatsysteme mit polyaxialer Winkelstabilitat, Flugelplatten oder „attachment plates“ bieten verbesserte Verankerungsmoglichkeiten. Bei gelockertem Prothesenschaft ist die Implantation einer Revisionsendoprothese notwendig. Aktuell beschreiben nur wenige Studien mit geringer Fallzahl klinisch-radiologische Ergebnisse, sodass gesteigerte Forschungsanstrengungen zur Verbesserung der Behandlungsqualitat und Vergleichbarkeit der Therapieoptionen unabdingbar sind.

Background. The study of the musculoskeletal disorders is relevant not only due to the limitation of the motor activity of patients and possible disability, but also due to the widespread prevalence of this pathology. Aim: to study the effect of neuromuscular electrical stimulation in patients with moderate adhesive capsulitis with subcompensated type 2 diabetes mellitus in order to develop a new comprehensive treatment. Methods. The study included two groups of patients with adhesive capsulitis with subcompensated type 2 diabetes mellitus, in which, before treatment, reduced spastic type electroexcitability in the infraspinatus muscle and the supraspinous muscle was predominant without qualitative changes; the group 1 (control) included 30 patients, the group 2 (main) included 120 patients. All patients had limited movement in the shoulder joint, pain syndrome, the presence of trigger points in the muscles of the shoulder girdle. To determine impaired muscle function, we used the classical electrodiagnostics method with the determination of electroexcitability of the infraspinatus and supraspinatus muscles. Results. The state of electroexcitability of the muscles under consideration, having trigger points, reflected the presence of spasticity in them, which was accompanied by an increase in the performance of all types of currents used. Currently, a wide range of drugs is known, which efficiency is limited by their side effects, therefore, in this work, for the group 2 of patients, the standard treatment additionally included neuromuscular electrical stimulation using the OMRON E-4 device. It has a wide range of frequencies, which creates an analgesic effect in the treatment, normalizes the electroexcitability of the neuromuscular apparatus, and increases the range of motion in the shoulder joint. A comparative analysis of the treatment efficiency in two groups of patients revealed the advantage of a course of comprehensive treatment (using the electrical stimulation indicated) with compensation in 86.7% of patients of the group 2, which was confirmed by clinical, electrodiagnostic and regression analysis, with a positive long term prognosis. Conclusion. The inclusion of neuromuscular electrical stimulation in the comprehensive treatment enables to reduce the pain syndrome and restore the movement pattern in the shoulder joint, as well as achieve overall compensation for the clinical condition.

Background The ball impact position during spiking in volleyball may influence the pattern of activation of shoulder girdle muscles and, therefore, could be a significant risk factor for shoulder injury. Methods Activation of 10 muscles in the dominant shoulder was evaluated using surface electromyography (EMG) in 11 male volleyball players, during spiking in a static standing position, with the goal being to precisely control the specified ball impact positions, without a run-up or ball setting. The following 4 ball impact positions were evaluated: standard, posterior, medial, and lateral. The EMG amplitude, normalized to the maximal voluntary isometric contraction of the respective muscles, was compared for each phase of the spiking movement between the standard position and the other 3 different impact positions, using the Dunnett test. Results The following between-position differences were noted for the deltoid muscle: increased activation of the anterior deltoid during the acceleration phase for the posterior position (P = .041), increase in the posterior deltoid during the acceleration phase for the lateral position (P = .04), and increase in the middle deltoid during the deceleration phase for the lateral position (P = .005). Conclusion A posterior or lateral shift in the position of ball impact may cause an increase in the activity of the deltoid muscle that would cause a decrease in the centripetal force of the humeral head through the acceleration and deceleration phases. As such, neuromuscular exercises, combined with strengthening of the rotator cuff muscle, might reduce the risk of shoulder injury during performance of the volleyball spiking movement.