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Objective To explore the effect of a phased rehabilitation training programme to relieve shoulder dysfunction in patients after neck dissection and to provide effective solutions for postoperative shoulder joint function recovery of patients. Methods This study has been reviewed and approved by the Ethics Committee, and informed consent has been obtained from patients. A phased rehabilitaiton training programme for the shoulder after neck dessection was developed through literature review and discussion, and 70 eligible patients from Hospital of Stomatology, Sun Yat-sen University from December 2020 to April 2021 were selected and randomly divided into the test group and control group (35 patients in each group). The control group underwent motor rehabilitation training from 6 weeks postoperative to 1 year after surgery, such as shoulder mobility and coordination training and small range of motion training of the neck, while the test group took part in a rehabilitation training program that included familiarization maneuver training, protective rehabilitation, exercise rehabilitation, and resistance training in the following four stages: preoperative, postoperative general anesthesia and awake until the removal of stitches, the removal of stitches until 6 weeks after surgery, and 6 weeks after surgery until 1 year after surgery. The frequency of training in both groups was at least 3 days per week, and the length of each training session was 10-15 min. The intensity of exercise was 2-3 points on the Borg Conscious Exercise Intensity Scale (i.e., mild-to-moderate tachypnea or fatigue). The neck dissection injury index (NDII) was used to evaluate the quality of life related to shoulder joint function at four time points: preoperative, postoperative 3 months, postoperative 6 months, and postoperative 12 months. The higher the score, the better the quality of life. Results 28 cases in the test group and 32 cases in the control group completed a one-year follow-up. At 3 and 6 months postoperative, the NDII of the test group was significantly higher than that of the control group [3 months postoperative: test group (93.48 ± 9.36) vs. control group (80.00 ± 11.34) (Pvs. control group (90.70 ± 9.12) (PP = 0.458). The difference in NDII scores among subjects at 3, 6, and 12 months after surgery was statistically significant in each group (P

Objective To investigate the therapeutic effect of remote rehabilitation after glucocorticoid injection in frozen shoulder (FS) patients. Methods A total of 63 FS patients who attended Department of Rehabilitation Medicine, The Affiliated Hospital of Qingdao University, from May 2022 to July 2023 were enrolled, and after glucocorticoid injection for 1 month, they were randomly divided into group A and group B. The patients in group A received rehabilitation treatment in the hospital, and those in group B received remote rehabilitation, once a day, 5 times a week for 4 weeks. The patients in both groups were assessed at the hospital before treatment and at 1, 3, 5, 8, 10, and 12 weeks after treatment, including Visual Analogue Scale (VAS) pain score, range of motion of shoulder joint (intorsion, extorsion, flexion, extension, and abduction angles), Activities of Daily Living score of shoulder joint, and satisfaction score of treatment outcome. Results For both groups, VAS score decreased significantly over the time of treatment (F=175.56, 215.78,P0.05). For both groups, the range of motion of shoulder joint increased significantly over the time of treatment (F=33.84-483.42,P0.05). For both groups, the Activities of Daily Living score of shoulder joint increased significantly over the time of treatment (F=76.46, 92.02,P0.05). For both groups, the satisfaction score of treatment outcome increased significantly over the time of treatment (F=8.10, 12.84,P0.05). Conclusion For FS patients, remote rehabilitation after glucocorticoid injection can achieve a similar therapeutic effect to rehabilitation in hospital, and therefore, remote rehabilitation is a promising treatment regimen.

Synovial osteochondromatosis of the shoulder is a rare condition and its details remains unclear. Aim of this study was to evaluate the clinical results of surgical resection and histopathological characteristic of SOC of the shoulder. Ten shoulders with SOC were retrospectively assessed for demographic characteristic, history of trauma, presence of osteochondral loose bodies, inferior humeral osteophytes and acromial spurs. Visual analog scores for pain and functional scores using Constant scores were compared pre and post operatively. Resected lesions were histo-pathologically differentiated between primary and secondary SOC. The average age of patients was 39.8+/- 15.7 year; four female and six patients was male in our study. Average duration of symptoms was 11.5+/-8.11 months. Three shoulders has osteochondral lesion in subacromial space (30%) and seven in glenohumeral joint (70%). Five shoulders (71%) show inferior humeral osteophytes out of seven shoulders with lesion in glenohumeral joint. All three shoulder (100%) with SOC in the subacromial space had spur formation. One shoulder have primary SOC while other nine had secondary SOC. Average Visual analog scale pain score graded from 0 (no pain) to 100 mm( maximal pain) was 47.5+/-11.32 mm. The Constant score was improved from preoperative score 51.6+/-8.34 points to postoperative score 78.7+/-11.62. No case show recurrence of new loose bodies, acromial spur and inferior humeral osteophytes. Our study showed that resection of SOC successfully relieved the pain and clinical symptoms. Primary SOC is less common than secondary SOC and histopathological identification is needed to differentiate between both types. Thus further investigations required to determine long term prognosis SOC in the shoulder. KEYWORDS: osteochondromatosis, shoulder joint, synovium

Abstract Objective To provide a current overview of the Bristow-Latarjet surgery in Brazil. Materials and MethodsThis cross-sectional study was based on an electronic questionnaire with 26 items, which was sent to active members of the Brazilian Society of Shoulder and Elbow Surgery (Sociedade Brasileira de Cirurgia do Ombro e Cotovelo, SBCOC, in Portuguese). The questionnaire addressed training, surgical technique, complications, and postoperative management. Results We sent the questionnaire to 845 specialists from April 20 to May 12, 2021, and 310 of them answered i in full. During their specialization, most specialists participated in up to ten Bristow-Latarjet procedures. The most frequent complication was graft fracture, while the most common technical difficulty was screw positioning. In total, 50.6% and 73.9% reported having experienced intraoperative and postoperative complications respectively; 57.1% declared performing subscapularis suture; 99.7% indicated postoperative immobilization; and 61.9% considered graft consolidation fundamental. Conclusion Most specialists participated in up to ten Bristow-Latarjet procedures during the specialization, but 13.5% of them graduated without participating in the surgery. The most frequent complication was graft fracture. The most common technical difficulty was screw positioning. Most participants prefer postoperative immobilization since they believe graft consolidation is essential to resume the practiced of sports. The highest complication rate occurred with specialists who have obtained their titles 11 to 15 years ago. In Brazil, the Southeast region is the largest producer of specialists and has the highest concentration of these professionals.

Purpose Arthroscopy is one of the most common interventions in orthopedics. Hence it is important to train users early in order to ensure the safest possible identification of access portals (AP). This prospective study aimed to compare a palpatory (PalpMethod) with a sonographic (SonoMethod) method for AP location in the shoulder and knee joints.

Background Strength imbalance between internal and external rotators of the shoulder may increase the risk of sports injury. Research on whether isokinetic eccentric training (IET) could enhance the strength ratio and improve neuromuscular control of shoulder rotators has important implications for injury prevention. Objective To investigate the effects of IET on strength ratio and neuromuscular control of internal and external rotators of the shoulder in healthy young people. Methods From December 2020 to November 2021, 32 healthy young people were recruited as the subjects from Zhongshan Hospital, Fudan University, and they were randomly divided into an experimental group (n=16) and a control group (n=16) . The experimental group received IET for 4 weeks, while the control group received continuous passive motion training for 4 weeks (twice a week) . A Biodex System 4 Pro Dynamometer (Biodex Medical Systems Inc., USA) was used to implement intervention training on internal and external rotators of the dominant shoulder, which was conducted under the velocity of 60 (°) /s, 120 (°) /s and 180 (°) /s, respectively. The functional ratio (FR) , acceleration time (AT) and time to peak torque (TPT) of internal and external rotators of the shoulder of the two groups were evaluated, and compared at 1 week before the intervention and 1 week after the end of the intervention, respectively. Results All subjects in the experimental group completed 4 weeks of training and evaluation, whereas 2 subjects in the control group dropped out. Ultimately, data of 30 subjects were involved in the statistical analysis. Under the velocity of 60 (°) /s, 120 (°) /s, FRs were significantly higher in the experimental group compared with the control group after the intervention (P

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Objective To compare the biomechanical properties of the glenohumeral joint capsule between adhesive capsulitis (AC) after breast cancer surgery and idiopathic AC and demonstrate the effects of hydrodilatation (HD) with corticosteroid injection for AC after breast cancer surgery. Methods Twenty-three prospective patients with AC after breast cancer surgery (BC group) and 44 retrospective patients with idiopathic AC without breast cancer (CON group) underwent HD with corticosteroid injection and home exercise training. We compared their biomechanical characteristics (capsular capacity, maximal pressure, and capsular stiffness). In the BC group, the passive range of motion (ROM) of the affected shoulder and a questionnaire (Shoulder Pain and Disability Index [SPADI]) were evaluated at baseline and 2 and 4 weeks after treatment. Results The BC group showed higher biomechanical characteristics (maximal pressure and capsular stiffness) than did the CON group. The mean maximal pressure and capsular stiffness were 519.67±120.90 mmHg and 19.69±10.58 mmHg/mL in the BC group and 424.78±104.42 mmHg and 11.55±7.77 mmHg/mL in the CON group (p=0.002 and p=0.001, respectively). And, the BC group showed significant improvements in all ROMs (abduction, flexion, and external rotation) and the SPADI pain and disability sub-scores following the treatment. Conclusion The glenohumeral joint capsular stiffness was greater in the patients with AC after breast cancer surgery than in those with idiopathic AC. HD with corticosteroid injection was effective in treating AC after breast cancer surgery.

ABSTRACT Objective Latarjet procedure is often preferred in recurrent shoulder dislocations accompanied by glenoid bone loss. It is observed that the superiority of bone graft fixation methods is still controversial. The aim of this study is to biomechanically compare the bone graft fixation methods in the Latarjet procedure. Methods 15 third-generation scapula bone models were divided into 3 groups. Graft was fixated in the first group with fully-threaded cortical screws of 3.5mm diameter, in the second group two 16 mm partially-threaded cannulated screws of 4.5mm diameter, and in the third group via a mini plate and screw. The hemispherical humeral head was placed on the tip of the cyclic charge device, and thus, the charge applied to the coracoid graft was homogeneous. Results No statistically significant difference was found between paired comparisons (p>0.05). The forces in 5 mm displacement in total vary between 502-857N. Total stiffness measurements ranged between 105 and 625; the mean value was 258.13±53.54 with no statistically significant difference by groups (p = 0.958). Conclusion This biomechanical study showed that there is no difference between three coracoid fixation options in terms of fixation strength. Unlike previous assumptions, plate fixation is not biomechanically superior to screw fixation. Surgeons should consider their personal preferences and experience in choosing fixation methods.

Abstract Much is discussed about the limits of the treatment of anterior shoulder instability by arthroscopy. The advance in understanding the biomechanical repercussions of bipolar lesions on shoulder stability, as well as in the identification of factors related to the higher risk of recurrence have helped us to define, more accurately, the limits of arthroscopic repair. We emphasize the importance of differentiation between glenoid bone loss due to erosion (GBLE) and glenoid edge fractures, because the prognosis of treatment differs between these forms of glenoid bone failure. In this context, we understand that there are three types of bone failure: a) bone Bankart (fracture); b) combined; and c) glenoid bone loss due to anterior erosion (GBLE), and we will address the suggested treatment options in each situation. Until recently, the choice of surgical method was basically made by the degree of bone involvement. With the evolution of knowledge, the biomechanics of bipolar lesions and the concept of glenoid track, the cutoff point of critical injury, has been altered with a downward trend. In addition to bone failures or losses, other variables were added and made the decision more complex, but a little more objective. The present update article aims to make a brief review of the anatomy with the main lesions found in instability; to address important details in arthroscopic surgical technique, especially in complex cases, and to bring current evidence on the issues of greatest divergence, seeking to guide the surgeon in decision making.

Abstract Background and Aims Wearable inertial sensors may offer additional kinematic parameters of the shoulder compared to traditional instruments such as goniometers when elaborate and time‐consuming data processing procedures are undertaken. However, in clinical practice simple‐real time motion analysis is required to improve clinical reasoning. Therefore, the aim was to assess the criterion validity between a portable “off‐the‐shelf” sensor‐software system (IMU) and optical motion (Mocap) for measuring kinematic parameters during active shoulder movements. Methods 24 healthy participants (9 female, 15 male, age 29 ± 4 years, height 177 ± 11 cm, weight 73 ± 14 kg) were included. Range of motion (ROM), total range of motion (TROM), peak and mean angular velocity of both systems were assessed during simple (abduction/adduction, horizontal flexion/horizontal extension, vertical flexion/extension, and external/internal rotation) and complex shoulder movements. Criterion validity was determined using intraclass‐correlation coefficients (ICC), root mean square error (RMSE) and Bland and Altmann analysis (bias; upper and lower limits of agreement). Results ROM and TROM analysis revealed inconsistent validity during simple (ICC: 0.040−0.733, RMSE: 9.7°−20.3°, bias: 1.2°−50.7°) and insufficient agreement during complex shoulder movements (ICC: 0.104−0.453, RMSE: 10.1°−23.3°, bias: 1.0°−55.9°). Peak angular velocity (ICC: 0.202−0.865, RMSE: 14.6°/s−26.7°/s, bias: 10.2°/s−29.9°/s) and mean angular velocity (ICC: 0.019‐0.786, RMSE:6.1°/s−34.2°/s, bias: 1.6°/s−27.8°/s) were inconsistent. Conclusions The “off‐the‐shelf” sensor‐software system showed overall insufficient agreement with the gold standard. Further development of commercial IMU‐software‐solutions may increase measurement accuracy and permit their integration into everyday clinical practice.

Massive rotator cuff tears can lead to large cysts, extending from the subacromial space through the acromioclavicular joint into a subcutaneous cyst, with a typical “geyser sign” on magnetic resonance imaging (MRI). To our knowledge, no cases of transdeltoid pseudo-cyst as first manifestation of septic arthritis have ever been reported. A 79-year-old female presented to the Emergency Department (ED) with a two-day evolution of a painful tumefaction over her right shoulder. She had been admitted to the ED 16 days before, after being bitten by a dog. Tumefaction drainage revealed a total cell count of 50320 cells/mL. MRI revealed glenohumeral joint cavity’s fluid “decompression” through the deltoid. Septic arthritis was presumed as the cause of the pseudo-cyst, configuring a “pseudo-geyser sign” on MRI. Septic arthritis is an orthopedic emergency, whose early diagnosis, ED referral and treatment are crucial.

Introduction: The Western Ontario Shoulder Instability Index (WOSI) is a self-administered questionnaire specifically used to determine the impact of shoulder instability on quality of life. The aim of this study was to translate the WOSI into European Portuguese and analyze its validity and reliability in a population with shoulder instability. Material and Methods: The WOSI was translated and culturally adapted from its original version into European Portuguese (WOSIPT). Internal consistency and test-retest analyses were conducted to determine the level of reliability of the scale. WOSI-PT, Quick-DASH, and SF-12 questionnaires were applied to 81 patients with symptomatic shoulder instability to assess validity, and reliability was tested by randomly selecting 50 patients within 72 hours using a test-retest design. Results: The reliability of the WOSI-PT was very high, with Cronbach´s alpha equal to 0.97 and an intraclass correlation coefficient of 0.98. Regarding the construct validity, the correlation between the WOSI-PT and QuickDASH was high and negative (-0.79). The correlations between WOSI-PT and SF-12 were positive, respectively, moderate with physical (0.66) and low with mental (0.34) health. Conclusion: WOSI-PT is a reliable and valid instrument for assessing the functional impact of shoulder joint instability on quality of life.

Objective: To compare the efficacy of intra-articular injection of methyl prednisolone with ketorolac for improvement in range of motion in various shoulder joint disorders. Study Design: Quasi-experimental study. Place and Duration of Study: Departments of Internal and Rehabilitation Medicine, Combined Military Hospital Mangla, from Nov 2018 to May 2019. Methodology: Through non-probability consecutive sampling, patients with shoulder disorders were enrolled in the study and divided into two groups. Group A received intra articular corticosteroid injection and group B received intra-articular Ketorolac injection. Outcome was measured in terms of improvement in shoulder range of motion. Results: A total of 60 patients were selected, 40 (66.7%) male and 20 (33.3%) female. 30 (50%) patients had adhesive capsulitis, 24 (40%) had rotator cuff syndrome and 6 (10%) had impingement syndrome. 24 patients received methyl prednisolone acetate injection while 36 received ketorolac injection. There was no significant difference in the mean gain in flexion, extension, abduction, internal or external rotation between both groups (p=0.224, p=0.261, p=0.884, p=0.238, and p=0.584 respectively). Conclusion: There was no significant difference in efficacy of corticosteroid and ketorolac when injected intra-articularly in shoulder joint disorders.

Abstract Objective To evaluate the feasibility of magnetic resonance imaging (MRI) to obtain the critical shoulder angle (CSA) comparing the results obtained through radiography and MRI, and assess the learning curves. Methods In total, 15 patients were evaluated in a blinded and randomized way. The CSA was measured and compared among groups and subgroups. Results The mean angles measured through the radiographic images were of 34.61 ± 0.67 and the mean angles obtained through the MRI scans were of 33.85 ± 0.53 (p = 0.29). No significant differences have been found among the groups. The linear regression presented a progressive learning curve among the subgroups, from fellow in shoulder surgery to shoulder specialist and radiologist. Conclusion There was no statistically significant difference in the X-rays and MRI assessments. The MRI seems to have its efficacy associated with more experienced evaluators. Data dispersion was smaller for the MRI data regardless of the experience of the evaluator.

No abstract is available.

Abstract Painful shoulder syndrome is a common condition of the musculoskeletal system in adults. This disorder affects your ability to work, overall body function, sleep, and quality of life. The treatment of shoulder syndrome is multifaceted and covers a broad spectrum of physiotherapy options. These include progressive strengthening exercises, laser therapy, electrotherapy and magnetotherapy. There are a number of treatments available that are reimbursed by the National Health Fund (NFZ). Aim of the research: The aim of the research was to assess the impact of rehabilitation on the treatment of shoulder pain syndrome. Material and methods: The method used in the study was a diagnostic survey. The research was supplemented with an author's questionnaire to compare demographic data and assess the quality of life. The ranges of mobility were assessed before and after 10 series of treatments and the level of pain using the VAS scale. The study involved 80 patients presenting with the diagnosis of painful shoulder syndrome, 60% of whom were women and 40% men. The most numerous age group was between 50-60 years old (31 people) and 30-40 years old (24 people). Results: The treatment process was successful in patients. Out of the studied population, 95% of patients experienced an improvement in their health compared to the baseline. A significant reduction in pain was observed with the use of physiotherapeutic procedures. The patients most favorably assessed massage, kinesiotherapy and cryotherapy. Conclusions: Conservative treatment reimbursed under the National Health Fund is an effective method of improving mobility and reducing to a large extent discomfort in the shoulder joint.

Latarjet procedure is one of the relevant surgical techniques for the anterior and antero-inferior type of recurrent instability in the shoulder joint with a defect in the articular surface of the glenoid. The existence of an arthroscopic modification of Latarjet surgery requires more in-depth study on the level of its clinical effectiveness and comparison with the results of open interventions with the aim of introducing practically significant decisions on improving the quality of these types of shoulder joint pathology treatment. The purpose of the work is to conduct a comparative analysis of the open and the arthroscopic Latarjet procedure, to evaluate intraoperative and postoperative complications as well as side effects of these surgical techniques. Materials and methods. A prospective randomized study was carried out, and included 30 people: after open Latarjet surgery – 16 (53.3 %) people and after arthroscopic Latarget surgery – 14 (46.7 %) people. A result was evaluated at 3 and 6 weeks, 3–4 and 6–9 months after surgical procedure using X-ray examination, computed tomography, the Walch–Duplay and Rowe scales, and analysing the intraoperative and postoperative complications. Results. Applying both the arthroscopic and open methods of Latarjet procedure operation, there is a decrease in both active anterior elevation and internal rotation with a slightly greater restriction when performing the open procedure. At the same time, providing the arthroscopic technique, an increase in the range of motion in shoulder adduction and abduction is observed. Conclusions. Applying the arthroscopic and open Latarjet procedures, there are statistically significant equally improved outcomes in recurring instability of the shoulder joint. The results indicate the clinically significant advantages of restoring the shoulder function, especially external rotation when using the arthroscopic procedure of Latarjet surgery in comparison with the open technique.

Background. Large, massive irreparable rotator cuff tears lead to a significant decrease in the function of the shoulder joint together with the development of a pronounced pain syndrome. Such injuries are difficult to treat, and the number of relapses, when trying to restore them, is quite high. The installation of a subacromial balloon is the method of choice for this group of patients and allows restoring the function of the shoulder joint fairly successfully. Aim: to evaluate the results of the treatment of patients with massive irreparable rotator cuff tears injuries in a prospective study from 2016 to 2018. Methods. The results of the arthroscopic treatment of large, irreparable rotator cuff injuries in 25 patients (with the average age of 67 5 years) with the installation of a subacromial balloon are presented. In all the clinical cases, there was a pronounced (grades 34, according to the Goutallier classification) fatty dystrophy of the rotator cuff muscles (supraspinatus or in combination with subaspinatus). All the patients underwent the subacromial space release with a thorough bursectomy and subsequent installation of a subacromial balloon. Results. The average score on the UCLA scale was 14 3 points (1117) before the operation and 312 points (2933) 12 months after the operation, the results were considered good and excellent. Conclusion. The results obtained allow us to evaluate the described technique as low-traumatic, simple and fast in its accomplishment, aimed at the reduction of the pain syndrome and restoration of the upper extremity function.

Abstract Objective To verify the results of 27 patients submitted to surgery from 1990 to 1997 by the Bristow-Latarjet technique for the treatment of anterior traumatic instability of the shoulder. The analysis included the possible complications, especially the appearance of arthropathy. Methods The subjective clinical evaluation was performed through a questionnaire answered by the patients, and the objective evaluation was performed using the Rowe et al score. The radiographic evaluation was performed using the anteroposterior (true) incidence to detect signs of shoulder arthrosis, according to the classification of Samilson and Prieto, as well as the apical oblique and the Bernageau and Patte incidences to verify the consolidation of the bone graft, the position of the screw and of the graft, and signs of the release of the synthesis material. These evaluations were performed by two examiners at different times without interference between them. Results In the subjective assessment of the patients, 93% were fully recovered, and, in the objective evaluation, the average was 95 points on the Rowe et al score. Complications related to coracoid placement were not found. The degree of arthropathy of the shoulders, according to the Samilson and Prieto classification, presented an average of seven mild cases, two moderate cases and one severe case. In total, 17 patients did not present arthropathy. Conclusion Between the first and second evaluations, there was no change in the efficacy of the Bristow-Latarjet technique. The careful observation of the criteria of the technique was fundamental to avoid complications. The occurrence of arthropathy in the long term was not relevant in our evaluation. Based on the evidences of the present study, the surgical procedure alone is not the cause of the onset of the arthropathy, but the failure in its execution.

Abstract Objective To check if shoulders with acetabularization have better functional results in cases of rotator cuff arthropathy. Methods A clinical and radiological cross-sectional evaluation of 65 shoulders with rotator cuff arthropathy by measuring the range of motion (RoM) of the shoulder, the Constant-Murley score, and the radiological classifications of Hamada and Seebauer. The clinical findings were compared with the radiographic findings. Results According to the classification of Seebauer, we observed better results regarding the RoM in type-A shoulders. There was a statistically significant difference regarding anterior elevation and medial rotation between types A and B (p< 0.05). Lateral rotation did not show a statistically significant difference between types A and B. The Constant-Murley score presented better results in type A, and there was a statistically significant difference between groups A and B (p< 0.05). According to the classification of Hamada, we observed that the RoM had better results in types 3, 2 and 1, and there was a statistically significant difference regarding anterior elevation and medial rotation (p< 0.05) compared with groups 4A, 4B and 5. There was no statistically significant difference between the Hamada groups regarding lateral rotation. According to Hamada, the Constant-Murley score showed better results in types 3, 1 and 2, and there was a statistically significant difference between groups 3 and 5. Conclusion The RoM and shoulder function were better in patients with acetabularization (Seebauer 1A and Hamada 3), and worse in those with glenohumeral arthrosis (Seebauer 1B, 2B and Hamada 4A, 4B and 5).

ABSTRACT BACKGROUND: Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE: The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING: Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS: This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS: Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS: The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation. Protocol registration number in the PROSPERO database: ID - CRD42018096578.

The rotator cuff is a complex anatomical and biomechanical structure which allows stabilization of the shoulder joint in the correct position and movements in it. The rotator cuff tears remain the most frequent injury as compared to those of other anatomical structures of the shoulder joint and reach the incidence of 21%, according to a number of authors. Such injuries are prone to inducing a fat replacement of muscle tissues in elderly patients against the background of degenerative changes in the structure of the rotator cuff. These injuries are hard-to-heal, and the incidence of relapses after the surgical treatment reaches 2090%, according to several authors. Based on the investigation of the postoperative treatment failures, alternative methods for the replacement, transfer or surgical repair of damaged tendons are adopted, but there is still no single approach and method in the treatment of this pathology. In this literature review, we have analyzed the data on the anatomical structure and biomechanics of the rotator cuff, the role of the rotator cuff damage in the dysfunction of the shoulder joint and possible methods for its recovery.

Acute osteomyelitis is pyogenic infection of the bone and bone marrow. We report a case of successful diagnosis and treatment in a 12-year-old boy with right shoulder joint osteoarthritis. On admission, he was febrile (39.0 ºC) with pain in his right shoulder. Laboratory and biochemistry findings were as follows: leukocytes 10.9x109/L; hemoglobin 122 g/l; fibrinogen 34.7; C-reactive protein 56.8. No changes were observed using conventional radiography. Computed tomography (CT) scan was conducted on the right limb using LightSpeed 16 slices in native and contrast series. The area of interest was shown on axial section, less dense fluid within the joint cavity with a thickened capsule and joint soft tissue swelling around the joint. On bone structures, CT morphological changes were not observed. After deterioration of the condition despite antibiotic therapy, surgery had to be performed. The purulent content was removed by surgery. Prolonged antibiotic therapy and rehabilitation led to improvement of the condition. At two-month follow-up, ultrasonography and CT scan showed that there were no pathologic changes, while magnetic resonance imaging showed minimal tissue fibrosis that did no require surgical treatment.

Background In arthroscopic shoulder surgery, a mechanical fluid-irrigation system is used to wash out blood from the joint. If used at high pressure, it can cause side effects such as fluid extravasation, leading to airway obstruction after surgery. Desflurane is prone to increasing sympathetic nerve activity and plasma catecholamine release more than another inhalation anesthetics. The objective of this study was to determine whether desflurane could increase in the irrigation pump pressure than sevoflurane in shoulder arthroscopy. Methods Patients were randomized into a sevoflurane group (group S) and a desflurane group (group D). Each included 20 patients. For group S, sevoflurane 1.2 MAC and intravenous remifentanil were administered for anesthesia maintenance. Group D received desflurane 1.2 MAC and intravenous remifentanil. Starting at 20 mmHg of pump pressure, the surgeon estimated the visibility of the surgical field (grade I–IV). After that, the pressure was freely adjusted by the surgeon to obtain clear vision with the arthroscope during the surgery. Results The maximum pressure of the mechanical water pump was higher in group D than group S (54.0 ± 6.8 mmHg vs. 48.9 ± 5.7 mmHg, P = 0.017), but the difference was not statistically significant at a significance level of 0.01. The arthroscopic visibility at the surgical site did not differ significantly between the two groups (P = 0.284). Conclusions When desflurane is used in arthroscopic shoulder surgery, it does not require more pressure from the irrigating-fluid pump to secure a clear vision of the surgical site, compared to sevoflurane.

INTRODUCTION: the aim of this study was to compare the impacts of all-arthroscopic repair and mini-open repair for rotator cuff tendon tear on post-operative pain, shoulder joint range of motion and physical function. METHODS: the study was a retrospective comparative analysis of rotator cuff repair between the January 2013 and January 2018. The patients included in the study were enrolled into all-arthroscopic surgery or mini-open surgery groups. Patients were assessed with a 10mm visual analog scale for pain in the 7hday post-operatively. The physical function was assessed with Quick Disabilities Arm Shoulder and Hand (DASH) questionnaire at 12th month. The flexion and abduction ROM of the involved site were measured preoperatively and 12 months after the surgery. RESULTS: a total of 40 patients were included in the study. The mean age of the all-arthroscopic surgery group was significantly lower than the open surgery group (46,9±6,9 vs. 52,45±4,0 years).While no complication was seen in the arthroscopic group, 5 patients had superficial infection in the open surgery group.The patients in the all-arthroscopic surgery group experienced significantly less pain in the 7th day of the surgery. Improvement in Quick Dash score and shoulder flexion after surgery were significantly higher in the all-arthroscopic surgery group. None of the patients needed revision surgery in both groups. CONCLUSION: according to the results of this study, arthroscopically operated patients with rotator cuff tear had less pain in the first week after surgery. Patients in this group had better shoulder flexion and function in long-term follow-up with no post-operative complication.

A 60-year-old diabetic male patient presented with persistent left shoulder joint pain for the last 6 months following coronary artery bypass graft (CABG) surgery. The pain was insidious onset, non-radiating, and dull which aggravated by movement as well as on left lateral position during sleep. However, the pain was not associated with morning stiffness. He had been treated with oral anti-diabetic medications for diabetes mellitus for the last 15 years. However, recently he required to switch to premixed insulin injection for good control of his glycemic status. Apart from post CABG status and diabetes mellitus, he was relatively well and had no other significant medical records like direct trauma over the shoulder joint.

Objective: to assess functional results and quality of life in patients with rheumatoid arthritis (RA) after reverse shoulder joint replacement.Patients and methods. Examinations were made in 37 patients with RA involving the shoulder joint, who underwent shoulder joint replacement using a reverse DeltaX-tend DePuy prosthesis in 2006–2017. The investigators studied the volume of movements, the level of pain using the visual analogue scale, the function of the shoulder joint using the American Shoulder and Elbow Surgeons (ASES) Shoulder Score and the upper limb as a whole by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire, a patient's functional status by the Health Assessment Questionnaire (HAQ), quality of life (QL) by EQ-5D (Euro Quolish instrument) and analyzed shoulder X-ray films before and in the late periods after surgery.Results. The volume of shoulder joint movements was found to increase. At 28.7 months postsurgery, the mean volume of flexion, abduction, and external rotation was 107.4Ѓ}15.2, 128.3Ѓ}8.5, and 46.4Ѓ}5.5°; respectively (p≤0.05). The patients experienced no pain in the late periods following surgery. Prior to surgery and at control examination, the mean ASES scores were 25.0Ѓ}4.7 and 79.4Ѓ}6.4, respectively (p≤0.05). Before surgery, the mean DASH score was 63.8Ѓ}4.2; in the late periods it decreased to 18.2Ѓ}8.6 (p ≤ 0.05). The mean preoperative HAQ score was 2.81; following surgery, it also decreased to 1.39 (p≤0.05). The postoperative EQ-5D QOL index score increased from 0.41 to 0.72. The rate of complications reached 10.8%.Conclusion. Reverse endoprosthetic replacement for end-stage shoulder joint damage (Larsen 4–5) with rotator cuff defect makes it possible to increase the volume of movements, to reduce pain, and to improve upper limb function, functional status, and quality of life in patients with RA.

Various joint pain syndromes are one of the frequent causes of treatment of patients not only to a traumatologist, but also to a neurologist. The urgency of the problem of pain syndromes in the shoulder is discussed in the article. Detailed anatomical and physiological features of the shoulder joint and periarticular soft tissues are highlighted. The characteristic of the most common etiological and pathogenetic mechanisms of the development of pain syndrome in the region of the shoulder joint is given. Part of the article is devoted to the clinical features and diagnosis of pain in the shoulder region, depending on the etiological factor of pain. In the article discussed modern pharmacological and non-pharmacological methods of treatment of shoulder pain. A clinical example of differential diagnosis of pain and treatment with drug Nimesil is considered.

ABSTRACT Objective: To evaluate the choice of surgical approach among Brazilian orthopedists and whether shoulder surgery specialty training or duration of experience influences the decision-making. Methods: A questionnaire on the preferred approach and complications was administered to orthopedic surgeons with and without shoulder specialization training. The chi-square test or Fisher's exact test was applied. Results: We interviewed 114 orthopedists, 49 (43.0%) traumatologists, 36 (31.5%) specialist surgeons, and 29 (25%) shoulder surgery specialist residents. In cases of fracture without dislocation, specialized training and duration of experience did not influence the approach used (primarily deltopectoral). In cases of fracture/dislocation, 97.2% of the specialists versus 82.1% of the traumatologists opted for the deltopectoral approach (p = 0.034). In cases of fractures/dislocation, 92.5% of surgeons with more than 5 years of experience and 78.7% with less than 5 years of experience opted for the deltopectoral approach (p = 0.032). Conclusion: Specialization in shoulder surgery did not influence surgeons' approaches to manage fractures without dislocation. In cases of fracture/dislocation, shoulder surgery specialization training and duration of experience were associated with selection of the deltopectoral approach. Level of Evidence V, Expert opinion.

The aim of the study was to identify and compare the results of conservative and surgical treatment of the calcific tendinitis of the shoulder supraspinatus muscle tendon. Materials and methods. The clinical group consisted of 120 patients with calcific tendinitis of supraspinatus tendon. All patients were divided into two groups, according to the operative or conservative treatment, each of these groups have been subdivided into two (with calcific deposits less or more than 1.5 cm in length) according to Bosworth radiological classification. Conservative treatment ("needling") included: evacuation of calcific deposits with saline under ultrasound control with subsequent injection of prolonged corticosteroid into the subacromial space, use of nonsteroid anti-inflammatory drugs, physiotherapy. Surgical treatment included: evacuation of calcium deposits from the tendon followed by rotator cuff repair and biceps tendon tenodesis at the proximal third of the intertubercular groove. Results. In the majority of patients, after the "needling" of little - 1.5 cm calcific deposits (55 patients - 45.8%) clinical and radiographic healing occurred in 2 weeks after procedure. The level of pain in average was 2,39 ± 0,39 points according to VAS scale and function of the shoulder joint has increased in average to 40,26 ± 4,39 points on Oxford Shoulder Score. In 3 months after treatment begining, the best average results were obtained in patients with calcific deposits less than 1.5 cm - 43 ± 3,8 points on Oxford Shoulder Score, the worst 26 ± 4,8 points - in patients with calcific deposits bigger than 1.5 cm who underwent conservative treatment (р≤0,05). Conclusions. In group of patients after surgical treatment, size of calcific deposits did not significantly affect the treatment result (р≤0,01). Slightly better results were obtained in patients with calcific deposits size less than1.5 cm - 39 ± 3,8 points on Oxford Shoulder Score.

Aim - to determine a rational method for the treatment of patients with anterior-inferior and inferior habitual shoulder dislocation based on the results of examination of patients. Material and methods. The study involved analysis of the treatment results of 98 patients with anterior-inferior and inferior chronic instability of the shoulder joint. Patients were divided into two clinical groups. The first group consisted of 52 patients, and the choice of treatment was based only on the diagnosis and did not take into account the peculiarities of pathology in each particular patient, which led to unsatisfactory results. To improve the results of treatment of patients with anterior-inferior and inferior chronic instability of the shoulder joint, a set of diagnostic measures was proposed, which made it possible to choose the proper method and volume of intervention taking into account the direction of the dislocation and the plane ofjoint displacement. The second clinical group consisted of 46 patients who underwent examination and treatment according to the proposed complex. A detailed description of the proposed diagnostic complex is presented, including a number of clinical and instrumental methods for examining patients, and a self-administered questionnaire for the patients. Based on the results of the survey, taking into account the direction of the dislocation, the patients underwent surgical intervention, which made it possible to achieve stability of the joint and restore the function of the limb. Conclusion. The choice of optimal diagnostic complex with regard to the direction of dislocation and the plane of shoulder head displacement in habitual shoulder dislocation helps to choose pathogenically justified surgical method and contributes to the full functional restoration of the limb.

Background and Objective: Proprioception an important role in shoulder joint function. Exercise and throat of the upper extremity are complex and skinny movements that apply a great deal of stress on the shoulder joint. This study was done to evaluate the relationship between proprioception and rotator muscles strength in dominant and non-dominant side with shoulder pain of wheelchair basketball athletes. Methods: In this descriptive-analytic study, 50 wheelchair basketball athletes were selected in non-random sampling way from wheelchair basketball gyms from Alborz and Tehran in Iran. WUSPI, MMT system and repositioning error test with felexometere were used for assessment of shoulder pain, rotator muscles strength and proprioception respectively. Results: There was a significant difference between dominant and non-dominant side rotators strength and proprioception (P

Introduction: Adhesive Capsulitis (AC) causes musculoskeletal disorder of shoulder which is a common reason for loss of function and disability in patients. Several interventions have been used for treatment of AC but very few of them have taken into consideration “Myofascial Origin” as a probable cause of pain. Aim: To review the current literature related to prevalence, diagnosis, and treatment of “Myofascial Trigger Points (MTrPs) in AC”. To compare the prevalence of MTrPs in Diabetic and Non-Diabetic patients. Materials and Methods: Google Scholar, Pubmed, Cochrane library, Central register for clinical trial were searched for published randomised controlled trials, systematic or literature reviews, case study, pilot study and book references in English language from inception till December 2018. Out of total 1833 results identified, 7 relevant studies with a total of 190 patients were finally selected for the review. Four studies were analysed for methodological quality using Pedro tool for randomised controlled trial and National Institutes of Health tool for observational study and case reports. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement (PRISMA). Results: Among all the articles, three of them discussed about the prevalence of MTrPs in AC. These studies showed the greater prevalence of MTrPs in subscapularis muscle which may be the cause for pain and restricted shoulder movements. There was no study on diagnosis of MTrPs in AC. The studies (four in number) which showed the efficacy of treatment of MTrPs included techniques like Myofascial release technique+deep stroking (Niel Asher Technique), Ischaemic Compression of MTrPs, Dry Needling, Infiltration of Subscapularis TrPs with Subscapularis nerve block. Conclusion: MTrPs acts as an important contributing factor for causing pain, movement restriction and disability in the patients. Interventional studies have found significant improvement in shoulder pain and function but the exact method and the muscles which received the treatment were not mentioned. This review suggests that, there is need for good quality studies related to the prevalence, diagnosis and treatment of MTrPs in AC subjects with Diabetes Mellitus as well as without Diabetes Mellitus.

Introduction: The Shoulder pain and disability index (SPADI) is a commonly used patient rated outcome measure to assess the impact of shoulder disorders on pain and disability. The Shoulder impingement syndrome (SIS) is patho-mechanical disorder frequently affecting overhead athletes. Aim: The aim of this study was to determine the psychometric properties of the Hindi version SPADI using Confirmatory factor analysis (CFA) in overhead athletes with SIS. Materials and Methods: In this cross-sectional study, the athletes were first familiarised with the Hindi SPADI scale and then asked to complete the Hindi version SPADI scale. Construct validity using CFA method and Composite reliability (CR) with help of derived factor loadings and average error variance was calculated. Results: A total of 80 overhead male athletes with SIS were recruited after standardised clinical diagnosis. The athletes had an age range of 17-25 years The results showed that five factor thirteen item Hindi version SPADI demonstrated acceptable levels of fit indices (Comparative fit index=0.93, Goodness of fit index=0.87 and Absolute goodness of fit index=0.80, Root mean square of approximation=0.065 and chi-squared degree of freedom=1.34). The CR value of each factor ranged from 0.60 to 0.74 indicating satisfactory reliability. Conclusion: The five factor thirteen items Hindi SPADI has acceptable psychometric properties and composite reliability and is suitable for use in overhead athletes with SIS. This will help in addressing disability causing health issue.