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Head and Neck Cancer (HNC) is a globally rare cancer that includes a variety of tumors affecting the upper aerodigestive tract. It presents with difficulty breathing or swallowing and is mainly treated with radiation therapy, chemotherapy, or surgery for tumors that have spread locally or throughout the body. Alternatively, exercise can be used during cancer treatment to improve function, including pain relief, increase range of motion and muscle strength, and reduce cancer-related fatigue, thereby enhancing quality of life. Although existing evidence suggests the adjunctive use of exercise in other cancer types, no previous studies have examined the effects on HNC survivors. The aim of this meta-analysis was to quantify the effect of exercise-based rehabilitation on functionality and quality of life in HNC survivors who underwent surgery and/or chemoradiotherapy. A systematic review and meta-analysis were carried out following PRISMA statement and registered in PROSPERO (CRD42023390300). The search was performed in MEDLINE (PubMED), Cochrane Library, CINAHL and Web of Science (WOS) databases from inception to 31st December 2022 using the terms "cancer", "head and neck neoplasms", "exercise", "rehabilitation", "complications", "muscle contraction", "muscle stretching exercises" combining with booleans "AND"/"OR". PEDro scale, Cochrane Risk of Bias Tool and GRADE were used to assess methodological quality, risk of bias and grade of recommendation of included studies respectively. 18 studies (n = 1322) were finally included which 1039 (78.6%) were men and 283 (21.4%) were women. In patients who underwent radio-chemotherapy, overall pain [SMD = − 0.62 [− 4.07, 2.83] CI 95%, Z = 0.35, p = 0.72] and OP [SMD = − 0.07 [− 0.62, 0.48] CI 95%, Z = 0.25, p = 0.81] were slightly reduced with exercise in comparison to controls. Besides, lower limb muscle strength [SMD = − 0.10 [− 1.52, 1.32] CI 95%, Z = 0.14, p = 0.89] and fatigue [SMD = − 0.51 [− 0.97, − 0.057] CI 95%, Z = 2.15, p < 0.01] were also improved in those who receive radio-chemoradiation. In HNC survivors treated with neck dissection surgery, exercise was superior to controls in overall pain [SMD = − 1.04 [− 3.31, 1.23] CI 95%, Z = 0.90, p = 0.37] and, in mid-term, on shoulder pain SMD = − 2.81 [− 7.06, 1.43] CI 95%, Z = 1.76, p = 0.08]. No differences in quality of life were found at any of the follow-up periods. There is evidence of fair to good methodological quality, low to moderate risk of bias, and weak recommendations supporting the use of exercise-based rehabilitation to increase functionality. However, no evidence was found in favor of the use of this modality for improving the quality of life of HNC survivors who underwent chemoradiotherapy or surgery. [ABSTRACT FROM AUTHOR]

Purpose: The relationship between retear that may occur after rotator cuff repair and patient satisfaction is not well established. This study aimed to determine whether the types and size of the retear evaluated by computed tomography arthrography (CTA) influenced patient satisfaction. We also analyzed the patient factors that could affect patient satisfaction. Patients and methods: A total of 50 patients who were diagnosed with rotator cuff retear after undergoing arthroscopic rotator cuff repair were included in this study. All the patients were dichotomously classified into the satisfactory or dissatisfactory groups according to the patients' self-classifications. CTA was used to assess the attachment status of the footprint, detect retear on the medial side of the footprint of the repaired cuff, and determine the retear size. Demographic factors, including sex, age, occupation, dominant upper extremity, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation status, and functional shoulder score, were investigated. Results: Thirty-nine patients were classified into the satisfactory group and 11 patients were classified into the dissatisfactory group. There were no differences in age, sex, occupation, dominant hand, duration of pain, presence of diabetes mellitus, trauma history, history of ipsilateral shoulder surgery, repair technique, worker's compensation, and duration of follow-up between the two groups. However, the postoperative American Shoulder and Elbow Surgeon (ASES) score (P < 0.01), visual analog scale (VAS) pain level (P < 0.01), anteroposterior (AP) length (P < 0.01), and area of the retear site (P < 0.01) were significantly different. Conclusion: The AP length and area of the retear site estimated using CTA were confirmed as the significant risk factors for dissatisfaction. However, the type of repaired rotator cuff judged by the attachment status of the footprint did not correlate with patient satisfaction. In addition, the postoperative VAS pain scale and ASES score was correlated with patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: This investigation aimed to compare the medical efficacy of the knotted and knotless suture-bridge procedures in rotator cuff repair. Methods: The Pubmed, Embase, and Cochrane Library datasets were searched for all available publications comparing the medical results of arthroscopic rotator cuff repairs utilizing knotted or knotless suture-bridge procedures. Two researchers utilized Newcastle-Ottawa Scale and Cochrane risk-of-bias tool to evaluate the included studies. Employing Revman 5.3 software, meta-analysis was conducted following the PRISMA reporting guideline. Results: Eleven investigations with 1083 patients were considered suitable for the final meta-analysis. 522 individuals were assigned to the knotted group, whereas 561 were assigned to the knotless group. No statistical difference was found between the knotted and knotless groups, regarding VAS score (WMD, 0.17; 95% CI, − 0.10 to 0.44; P = 0.21); Constant score (WMD, -1.50; 95% CI, − 3.52 to 0.52; P = 0.14); American Shoulder and Elbow Surgeons Shoulder (WMD, -2.02; 95% CI, − 4.53 to 0.49; P = 0.11); University of California Los Angeles score (WMD, -0.13; 95% CI, − 0.89 to 0.63; P = 0.73); ROM of flexion (WMD, 1.57; 95% CI, − 2.11 to 5.60; P = 0.37), abduction (WMD, 1.08; 95% CI, − 4.53 to 6.70; P = 0.71) and external rotation (WMD, 1.90; 95% CI, − 1.36 to 5.16; P = 0.25); re-tear rate (OR, 0.74; 95% CI, 0.50 to 1.08; P = 0.12), and medical complications (OR, 0.90; 95% CI, 0.37 to 2.20; P = 0.82). Conclusion: For arthroscopic rotator cuff repairs, there were no statistical differences in medical results among knotted and knotless suture-bridge procedures. Overall, both techniques showed excellent clinical outcomes and could be safely utilized to treat rotator cuff injuries. [ABSTRACT FROM AUTHOR]

This study aims to investigate the effect of upper extremities exercise based on mirror therapy in the postoperative recovery of shoulder function in breast cancer patients. A total of 120 patients were selected from January 2021 to December 2021 and randomly divided into the control group (60 cases) and the observation group (60 cases) by random number table method. The control group was given conventional intervention, while the observation group was additionally given mirror therapy. The Constant-Murley Score (CMS), Disability of the Arm, Shoulder and Hand (DASH) Score, compliance of shoulder exercise, and arm circumference were compared between the two groups before the intervention and at 2 weeks, 4 weeks or 8 weeks after surgery. After 2 weeks, 4 weeks and 8 weeks of intervention, patients in the observation group showed higher scores of CMS, lower scores of DASH and better compliance of shoulder exercise than those in the control group. There was no significant difference regarding the bilateral circumference difference of upper limbs between the control group and the observation group. The application of mirror therapy is beneficial to the mobility of shoulder joint, and it promotes the functional recovery of shoulder joint, reduces the occurrence of upper limb dysfunction and increases the compliance of shoulder exercise, whereby preventing lymphedema of the upper extremities in the postoperative shoulder exercise of breast cancer patients. [ABSTRACT FROM AUTHOR]

Shoulder pain is one the most common musculoskeletal complaints. The most common pathological causes of shoulder pain in the general population are subacromial impingement syndrome and adhesive capsulitis, commonly referred to as "frozen shoulder". The purpose of this study was to evaluate the role of the scapulo-thoracic complex, particularly in scapular kinematic functions, in rehabilitative interventions for shoulder pain in patients suffering from these two common conditions. This systematic review was performed using the scientific search engines PubMed, PEDro and Cochrane Library, considering only randomized controlled clinical trials. Selected articles were evaluated according to the level of evidence and methodological quality. Thirteen randomized clinical trials were selected. Interventions have been divided into three macro-categories: (1) manual therapy in patients with subacromial impingement, (2) therapeutic exercise programs including interventions on the scapulothoracic complex in patients with subacromial impingement syndrome, and (3) therapeutic exercise programs including interventions on the scapulothoracic complex in patients with frozen shoulder. Following this, a qualitative analysis was performed according to outcomes such as pain, shoulder function, and scapular kinematics. Physiotherapy exercise programs that included scapular motor control training and scapular mobilizations, in particular, those of the scapulo-thoracic complex in scapular kinematic function, represent valid alternatives in the management of patients with subacromial impingement syndrome. [ABSTRACT FROM AUTHOR]

This study aimed to compare the outcomes of arthroscopic rotator cuff repair (ARCR) surgery between younger and older patients. We performed this systematic review and meta-analysis of cohort studies comparing outcomes between patients older than 65 to 70 years and a younger group following arthroscopic rotator cuff repair surgery. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and other sources for relevant studies up to 13 September 2022, and then assessed the quality of included studies using the Newcastle–Ottawa Scale (NOS). We used random-effects meta-analysis for data synthesis. The primary outcomes were pain and shoulder functions, while secondary outcomes included re-tear rate, shoulder range of motion (ROM), abduction muscle power, quality of life, and complications. Five non-randomized controlled trials, with 671 participants (197 older and 474 younger patients), were included. The quality of the studies was all fairly good, with NOS scores ≥ 7. The results showed no significant differences between the older and younger groups in terms of Constant score improvement, re-tear rate, or other outcomes such as pain level improvement, muscle power, and shoulder ROM. These findings suggest that ARCR surgery in older patients can achieve a non-inferior healing rate and shoulder function compared to younger patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of suprascapular nerve release in arthroscopic rotator cuff repair surgery. Methods: This systematic review was performed to include randomized controlled trials (RCTs) and non-RCTs that compared the outcomes of patients who did and did not receive suprascapular nerve release (SSNR) during arthroscopic rotator cuff repair surgery. MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for relevant studies. Methodological Index for Non-randomized Studies (MINORS) was used for cohort study assessment. The Cochrane risk of bias assessment tool (version 1.0) was used to assess the risk of bias in randomized trials. The primary outcomes were pain and shoulder function. The secondary outcome was the re-tear rate. Results: Two RCTs and three non-RCTs with a total of 187 patients (90 patients received SSNR and 97 patients did not receive SSNR) were included in this systematic review. The meta-analysis revealed that the SSNR group did not had a more pain reduction, assessed by visual analogue scale, compared to the non-SSNR group. Also, the SSNR group did not have a significantly more improvement in the UCLA score, compared to the non-SSNR group. In addition, there was no significant difference between the two groups in terms of Constant score and re-tear rate. Conclusions: The result of this study showed that additional suprascapular nerve release did not provide additional benefit in arthroscopic rotator cuff repair surgery. Routine arthroscopic SSNR is not recommended when treating patients with rotator cuff tear. Level of evidence: Level III [ABSTRACT FROM AUTHOR]

Passive shoulder exercises from birth and ultrasound screening from 3 to 12 months. Botox is given to shoulder internal rotators and a bracing commenced, if alpha-angle exceeds 30°, or passive shoulder external rotation is below 70 degrees. Plexus reconstruction is recommended to children with root avulsion(s) on magnetic resonance imaging or 3-month Toronto Test Score < 3.5. Specific neurotization is recommended to children without avulsions, but lack of progress in healing. Shoulder dysplasia was diagnosed in 49% of 270 patients with permanent brachial plexus birth injury in our catchment area from 1995 to 2021. The age at detection of shoulder dysplasia dropped from mean 5.4 years in children born before 2000 to mean 3.9 months in children born after 2009. Botox was given to 57% of the patients born after 2009. Rate of shoulder relocation decreased from 28 to 7% while mean active shoulder external rotation in adduction increased from 2 to 46°. [ABSTRACT FROM AUTHOR]

Background: Axillary crutches are commonly used in rehabilitation. Inappropriately fit crutches may result in upper limb pain or injury. Objective: To investigate the effects of axillary crutch length on upper limb kinematics to better understand potential injury mechanisms. It was hypothesized that crutches that were longer or shorter than standard‐fit crutches would alter upper limb kinematics. Design: Cross‐sectional. Setting: Gait laboratory. Participants: Fifteen healthy males with no prior crutch experience. Interventions: Participants were fit with axillary crutches using standardized methods, as well as with crutches that were 5 cm longer and 5 cm shorter. Participants performed swing‐through gait (1.20 ± 0.07 ms−1) with all crutch lengths in randomized order. Kinematics were recorded using an optical motion‐tracking system and joint angles for the scapula, shoulder, elbow, and wrist were computed. Main Outcome Measures: The effects of crutch length on joint range of motion (ROM) and joint angles at initial crutch contact were analyzed using multivariate analysis (Hotelling's T2; α =.025) and simultaneous confidence intervals (CI). Results: The long‐standard crutch fit comparison showed effects across all joints (ROM p =.009; initial contact p <.001). Longer crutches resulted in greater scapular upward rotation (mean difference [95% CI] ROM: 1.0 [−0.2 to 2.2]; initial contact: −2.7 [−4.4, −1.1]) and shoulder abduction (ROM: 0.8 [−0.1 to 1.8]; initial contact: −1.9 [−4.1 to 0.3]). Crutch length also had effects across all joints for the short‐standard fit comparison (ROM p =.004; initial contact p =.016). Shorter crutches resulted in greater scapula downward rotation (2.2 [−0.4 to 4.8]) and greater shoulder adduction (2.5 [−0.6 to 5.6]) at initial contact. Shorter crutches also reduced shoulder flexion/extension ROM (−2.5 [−4.4 to −0.6]). Conclusions: Altered crutch length results in scapular and shoulder kinematic deviations that may present risk factors for upper limb injury with crutch‐walking. This may underline the importance of appropriate device fitting to reduce injury risk in crutch users. [ABSTRACT FROM AUTHOR]

Background: Virtual Reality (VR) is an immersive computer-generated environment that provides a multi-sensory experience for the user. Modern technology allows the user to explore and interact with the virtual environment, offering opportunities for rehabilitation. The use of immersive VR in the management of musculoskeletal shoulder pain is relatively new and research is required to demonstrate its feasibility and effectiveness in this field. Aim: The aims of this study were, firstly, to explore physiotherapists' beliefs and perspectives of immersive VR as a platform for rehabilitation in patients with musculoskeletal shoulder pain, secondly, to identify potential barriers and facilitators to using VR in a musculoskeletal setting and thirdly, to gain insight from clinicians that would inform the development of a VR intervention for the rehabilitation of musculoskeletal shoulder pain. Methods: This study used qualitative descriptive design methodology. A series of three focus group interviews were carried out, via Microsoft Teams. Physiotherapists received an Oculus Quest™ headset to use at home prior to the focus group interviews. A six-phase process of reflexive thematic analysis was carried out to identify themes within the data. Atlas Ti Qualitative Data Analysis software was used to facilitate thematic analysis. Results: Five themes were identified within the data. They reflected physiotherapists beliefs that VR provides novel opportunities for shoulder rehabilitation and may offer new avenues for managing movement-related fear and improving concordance with rehabilitation. However, barriers related to safety and practical considerations associated with using VR were also identified in the final themes. Conclusion: These findings provide valuable insight into clinician acceptability of immersive VR as a platform for rehabilitation and the need for further research to answer the questions posed by physiotherapists in the current study. This research will contribute to human-centered design of VR-supported interventions for managing musculoskeletal shoulder pain. [ABSTRACT FROM AUTHOR]

Objective: To evaluate if bilateral or unilateral upper limb robot-assisted rehabilitation training using a new three-dimensional end-effector robot that targets shoulder and elbow flexion and abduction is superior to conventional therapy with regard to upper extremity motor function recovery and neuromuscular improvement in stroke patients. Design: Randomized, controlled, parallel, assessor-blinded, three-arm clinical trial. Setting: Southeast University Zhongda Hospital Nanjing, Jiangsu, China. Methods: Seventy patients with hemiplegic stroke were randomly assigned to conventional training (Control, n = 23) or unilateral (URT, n = 23), or bilateral robotic training (BRT, n = 24). The conventional group received routine rehabilitation, 60 min/day, 6 days/week, for 3 weeks. For URT and BRT upper limb robot-assisted rehabilitation training was added. This was 60 min/day, 6 days/week, for 3 weeks. The primary outcome was upper limb motor function assessed with Fugl-Meyer–Upper Extremity Scale (FMA–UE). Secondary outcomes were activities of daily living (ADL) assessed with the Modified Barthel Index (MBI), Motor Evoked Potential (MEP) to assess corticospinal tract connectivity, Root Mean Square (RMS) value, and integrate Electromyography (iEMG) value recorded by surface electromyography to evaluate muscle contraction function. Results: The primary outcome indicator FMA–UE (least square mean (LSMEAN): 31.40, 95% confidence interval (95% CI): 27.74–35.07) and the secondary outcome indicator MBI (LSMEAN: 69.95, 95% CI: 66.69–73.21) were significantly improved in BRT as opposed to control (FMA–UE, LSMEAN: 24.79, 95% CI: 22.23–27.35; MBI, LSMEAN: 62.75, 95% CI: 59.42–66.09); and unilateral (FMA–UE, LSMEAN: 25.97, 95% CI: 23.57–28.36; MBI, LSMEAN: 64.34, 95% CI: 61.01–67.68). BRT also showed greater improvement in the anterior deltoid bundle with regard to muscle contraction function indicated by RMS (LSMEAN: 257.79, 95% CI: 211.45–304.12) and iEMG (LSMEAN: 202.01, 95% CI: 167.09–236.94), as compared to the controls (RMS, LSMEAN: 170.77, 95% CI: 148.97–192.58; iEMG, LSMEAN: 132.09, 95% CI: 114.51–149.68), and URT (RMS, LSMEAN: 179.05, 95% CI: 156.03–202.07; iEMG, LSMEAN: 130.38, 95% CI: 107.50–153.26). There was no statistically significant difference between URT and conventional training for any outcome. There was no significant difference in MEP extraction rate after treatment between groups (p = 0.54 for URT, p = 0.08 for BRT). Conclusions: A 60 min daily training for upper extremities using a three-dimensional end-effector targeting elbow and shoulder adding conventional rehabilitation appears to promote upper limb function and ADL in stroke patients only if delivered bilaterally. URT does not seem to result in better outcomes than conventional rehabilitation. Electrophysiological results suggest that training using a bilateral upper limb robot increases the recruitment of motor neurons rather than improving the conduction function of the corticospinal tract. [ABSTRACT FROM AUTHOR]

The rapid advances in smartphones' technology, reflected in terms of light weight, small size, and easy portability, has rendered an inevitable rapid increase in number of smartphone users and smartphone addicts among ordinary population. Faulty use of smartphones would eventually put an overdue mechanical demand and load on shoulder and scapular muscles, that precipitate minor traumas and consequently shoulder pain and diminished performance. Purposes To investigate the effect of postural correction exercises on shoulder muscle performance in subjects addicting smartphones. Subjects Forty subjects addicting smartphones of both genders were recruited and distributed at random to the control and experimental group. Subjects' age in group (A) and (B) were (28.1±3.8) and (28.8±4) years respectively, their height was (170.1±8.9) and (170.2±8.3) cm respectively, whereas their weight was (73.6±9.5) and (71.3±10.7) kg respectively. Materials and Methods all recruited subjects in both control and experimental group received traditional modalities to relieve pain in the form of infrared radiation and TENS. The experimental group (Group B) including twenty subjects received postural correction exercises in addition to the traditional modalities of relieving pain. Results As compared to the control group, shoulder muscles' performance in the experimental group showed significant improvement. The improvement shown involved improved work, torque and work fatigue at angular velocity of 120°/sec. for shoulder flexors, extensors, abductors and internal rotators. Conclusion Postural correction exercises have significant effect on improving shoulder muscle performance in subjects showing postural deviation owing to smartphones addiction. [ABSTRACT FROM AUTHOR]

Purpose: Epileptic seizures can cause multiple shoulder injuries, the most common of which are dislocations, recurrent instability, fractures, and isolated lesions of the rotator cuff. Currently, only limited literature exists which describes the frequency and types of lesions in cohorts of epileptic patients and the corresponding treatment outcome. This study aims to document the occurrence of shoulder lesions in patients affected by seizures and to provide detailed information on trauma dynamics, specific lesion characteristics and treatment complications. Methods: All patients referring to a tertiary epilepsy center were screened for shoulder injuries and the clinical records of those sustaining them during a seizure were reviewed. Demographic information, lesions' characteristics and trauma dynamics were analysed, as wells as—when carried out—the type of surgical intervention and any postoperative complications. Results: The average age at the time of injury of 106 included patients was 39.7 ± 17.5 years and a male predominance was recorded (65%). Bilateral injuries occurred in 29 patients, simultaneously in 17 cases. A younger age, bilateral shoulder injuries and shoulder dislocations were significantly associated with the occurrence of a shoulder injury solely by muscular activation (p = 0.0054, p = 0.011, p < 0.0001). The complication rate in 57 surgically treated patients with follow-up data was 38.7%, with recurring instability being the most frequently reported complication (62.5%). Conclusions: Uncontrolled muscle activation during a seizure is a distinctive but not exclusive dynamic of injury in epileptic patients, accounting for more than the half of all shoulder lesions, especially in the younger. This can lead both to anterior and posterior dislocations or fracture-dislocations and is frequently cause of bilateral lesions and of instability recurrence after surgery. The high complication rates after surgical treatment in this selected subgroup of patients require that appropriate preventative measures are taken to increase the probability of treatment success. Level of evidence: Cohort study, level III. [ABSTRACT FROM AUTHOR]

In recent years, more and more sports physiotherapists have incorporated several tests, assessment techniques and prevention exercise programmes for overhead athletes at high risk of injury [[2]]. Research papers that examine the risk of injury assessment strategies, injury prevention or rehabilitation programmes in overhead athletes are also welcome. 2011; 39: 90-97. 10.3810/psm.2011.11.1943 13 Al Attar W.S.A., Faude O., Bizzini M., Alarifi S., Alzahrani H., Almalki R.S., Banjar R.G., Sanders R.H. The FIFA 11+ shoulder injury prevention program was effective in reducing upper extremity injuries among soccer goalkeepers: A randomized controlled trial. For example, in the case of assessing an overhead athlete for injury risk, identifying the risk is not sufficient without guiding the athlete on ways to reduce the identifiable risk. [Extracted from the article]

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(a) Schematic illustration of the surgical procedure for transferring the lower portion of the pectoralis major muscle to the deltoid muscle and (b) Intraoperative view of the lower portion of the pectoralis major muscle flipped over the deltoid muscle. The trapezius, long head of triceps, the long head combined with the short head of the biceps, latissimus dorsi and upper pectoralis major muscles have all been proposed for deltoid function reconstruction ([3]). [Extracted from the article]

Background: Elliptical shape humeral head prostheses have been recently proposed to reflect a more anatomic shoulder replacement. However, its effect on obligate glenohumeral translation during axial rotation compared to a standard spherical head is still not well understood. The purpose of the study was to compare obligate humeral translation during axial rotation using spherical and elliptical shaped humeral head prostheses. It was hypothesized that the spherical head design would show significantly more obligate translation when compared to the elliptical design. Methods: Six fresh-frozen cadaveric shoulders were utilized for biomechanical testing of internal (IR) and external (ER) rotation at various levels of abduction (0°, 30°, 45°, 60°) with lines of pull along each of the rotator cuff muscles. Each specimen underwent the following three conditions: (1) native; total shoulder arthroplasty (TSA) using (2) an elliptical and (3) spherical humeral head implant. Obligate translation during IR and ER was quantified using a 3-dimensional digitizer. The radius of curvature of the superoinferior and anteroposterior dimensions of the implants was calculated across each condition. Results: Posterior and inferior translation as well as compound motion of spherical and elliptical heads during ER was similar at all abduction angles (P > 0.05, respectively). Compared to the native humeral head, both implants demonstrated significantly decreased posterior translation at 45° (elliptical: P = 0.003; spherical: P = 0.004) and 60° of abduction (elliptical: P < 0.001; spherical: P < 0.001). During internal rotation at 0° abduction, the spherical head showed significantly more compound motion (P = 0.042) compared to the elliptical head. The spherical implant also demonstrated increased anterior translation and compound motion during internal rotation at 60° abduction (P < 0.001) compared to the resting state. This difference was not significant for the native or elliptical head design at this angle (P > 0.05). Conclusion: In the setting of TSA, elliptical and spherical head implants showed similar obligate translation and overall compound motion during axial rotation. A gained understanding of the consequences of implant head shape in TSA may guide future surgical implant choice for better recreation of native shoulder kinematics and potentially improved patient outcomes. Level of evidence: Controlled Laboratory Study. [ABSTRACT FROM AUTHOR]

Objective To explore the effect of modified Constant scale on follow-up evaluation of donor site after latissimus dorsi myocutaneous flap operation. Methods From January 2017 to June 2020, 27 patients with latissimus dorsi skin flap in Department of Hand surgery of Ruihua Hospital of Soochow University were followed up, the surgical cases of wound repair or functional reconstruction with latissimus dorsi myocutaneous flap. The evaluation included appearance (5 points), scar (10 points), sensation (5 points), pain (15 points), daily activities (20 points), range of motion (40 points) and patient satisfaction (5 points). The patients who were followed up for more than 6 months were evaluated by modified Constant scale. The efficacy of the donor site was comprehensively evaluated according to the scoring results. Results All patients were followed up for 6 to 28 months (mean 11.6 months). There were 11 cases of abnormal scar, 2 cases of sunken deformity, no pterygoid shoulder, 1 case of mild pain during daily activities, slightly affected daily life and exercise, and 2 patients were generally satisfied with the donor area. All patients feel good in the donor area, although there were some directions of activity can not reach the maximum, but did not affect daily life and exercise, donor area satisfaction was high. The score of 27 patients was 75 to 99, with an average of (92.6±5.2). The comprehensive evaluation was excellent in 20 cases, good in 6 cases and fair in 1 case. The excellent and good rate was 96.2%. Conclusion The modified Constant scale has a comprehensive content, a moderate proportion of subjective and objective considerations, and is easy to use, which can provide a reference for the evaluation of the curative effect of the donor area after operation of the latissimus dorsi myocutaneous flap [ABSTRACT FROM AUTHOR]

Background: Patients referred to public orthopaedic clinics can experience long waiting times before assessment. This study aims to evaluate the effectiveness of a collaborative Shoulder/Elbow Triage and Assessment (SHELTA) model of care involving orthopaedic surgeons and physiotherapists to reduce the waitlist and improve service and clinical outcomes for patients on an orthopaedic shoulder/elbow clinic waitlist. Methods: Patients on the waitlist were triaged by surgeons and physiotherapists and invited to an assessment by experienced physiotherapists. Patients were treated nonoperatively or transferred to orthopaedic management based on clinical discussion. The primary outcome was the number of patients on the waitlist. Secondary outcomes included adverse events, patient satisfaction, re‐referral and conversion to surgery rates. Pain, function and patient global impression of change were recorded for participants managed nonoperatively. Results: From July 2019 to December 2019, the waitlist reduced from 451 to 298 patients with no adverse events. Seventy‐nine patients could not be contacted and 25 no longer required assessment, and were removed from the waitlist. Nonoperatively managed participants reported satisfaction with the service, a median score of 6 on a 7‐point Patient Global Impression of Change scale, change in pain of −2.5/10 (95% CI −3.3, −1.7; P < 0.001) on a numerical pain rating scale, and change in function of −17.4/100 (95% CI: −24.1, −10.8; P < 0.001) on the QuickDASH, indicating improvement. Conclusions: The SHELTA model of care effectively reduced the number of patients on an orthopaedic shoulder/elbow clinic waitlist with good service and clinical outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Poor ergonomics and acute stress can impair surgical performance and cause work-related injuries. Robotic assistance may optimize these psychophysiological factors during UKA. This study compared surgeon physiologic stress and ergonomics during robotic-assisted UKA (rUKA) and conventional UKA (cUKA). Methods: Cardiorespiratory and postural data from a single surgeon were recorded during 30 UKAs, (15 rUKAs, 15 cUKAs). Heart rate (HR), HR variability, respiratory rate (RR), minute ventilation and calorie expenditure were used to measure surgical strain. Intraoperative ergonomics were assessed by measuring flexion/extension/rotation of the neck and lumbar spine, and shoulder abduction/adduction. Results: Mean operative time was 32.0 ± 7 min for cUKA and 45.9 ± 9 min for rUKA (p < 0.001). Mean neck flexion was − 23.4° ± 13° for rUKA and − 49.1° ± 18 for cUKA (p < 0.001), while mean lumbar flexion was − 20.3° ± 30° for rUKA and − 0.4° ± 68° for cUKA (p = 0.313). Mean lumbar flexion was similar; however, a significantly greater percentage of time was spent in lumbar flexion > 20° during cUKA. Bilateral shoulder abduction was significantly higher for rUKA. Mean calorie expenditure was 154 cal for rUKA and 89.1 cal for cUKA (p < 0.001). Mean HR was also higher for rUKA (88.7 vs. 84.7, p = 0.019). HR variability was slightly lower for rUKA (12.4) than for cUKA (13.4), although this did not reach statistical significance (p = 0.056). No difference in RR or minute ventilation was observed. Conclusion: rUKA resulted in less neck flexion but increased shoulder abduction, heart rate, and energy expenditure. The theoretical ergonomic and physiologic advantages of robotic assistance using a handheld sculpting device were not realized in this study. Level of evidence: II. [ABSTRACT FROM AUTHOR]

Background: Patients with breast cancer undergo various treatments according to their tumor subtype and cancer stages within 1 year after being diagnosed. Each treatment may cause treatment-related symptoms that have negative impacts on patients' health and quality of life (QoL) The symptoms can be mitigated when exercise interventions are appropriately applied to patients' physical and mental conditions. Although many exercise programs were developed and implemented during this period, the effects of tailored exercise programs according to symptoms and cancer trajectories on patients' long-term health outcomes have not yet been fully elucidated. Therefore, this randomized controlled trial (RCT) aims to investigate the effect of tailored home-based exercise programs on short-term and long-term physiological outcomes in patients with breast cancer. Methods: This 12-month RCT includes 96 patients with (stages 1–3) breast cancer randomly assigned to the exercise or control groups. Participants in the exercise group will receive an exercise program tailored to their phase of treatment, type of surgery, and physical function. During post-operative recovery, exercise interventions will be emphasized to improve shoulder range of motion (ROM) and strength. During chemoradiation therapy, exercise intervention will focus on improving physical function and preventing loss of muscle mass. Once chemoradiation therapy is completed, exercise intervention will focus on improving cardiopulmonary fitness and insulin resistance. All interventions will be home-based exercise programs supplemented with once-monthly exercise education and counseling sessions. The main outcome of the study is fasting insulin level at baseline, 6 months, and 1 year post-intervention. Our secondary outcomes include shoulder ROM and strength at 1 month and 3 months, body composition, inflammatory markers, microbiome, QoL, and physical activity levels at 1 month, 6 months, and 1 year post-intervention. Conclusion: This trial is the first tailored home-based exercise oncology trial to better understand the comprehensive phase-dependent short- and long-term effects of exercise on shoulder function, body composition, fasting insulin, biomarkers, and microbiome. The results of this study will inform the development of effective exercise programs tailored to the needs of patients with breast cancer post-operatively. Trial registration: The protocol for this study is registered with the Korean Clinical Trials Registry (KCT0007853). [ABSTRACT FROM AUTHOR]

Copyright of Journal of the College Of Basic Education is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Augmented reality (AR) tools have been investigated with promising outcomes in rehabilitation. Recently, some studies have addressed the neuroplasticity effects induced by this type of therapy using functional connectivity obtained from resting-state functional magnetic resonance imaging (rs-fMRI). This work aims to perform an initial assessment of possible changes in brain functional connectivity associated with the use of NeuroR, an AR system for upper limb motor rehabilitation of poststroke participants. An experimental study with a case series is presented. Three chronic stroke participants with left hemiparesis were enrolled in the study. They received eight sessions with NeuroR to provide shoulder rehabilitation exercises. Measurements of range of motion (ROM) were obtained at the beginning and end of each session, and rs-fMRI data were acquired at baseline (pretest) and after the last training session (post-test). Functional connectivity analyses of the rs-fMRI data were performed using a seed placed at the noninjured motor cortex. ROM increased in two patients who presented spastic hemiparesis in the left upper limb, with a change in muscle tone, and stayed the same (at zero angles) in one of the patients, who had the highest degree of impairment, showing flaccid hemiplegia. All participants had higher mean connectivity values in the ipsilesional brain regions associated with motor function at post-test than at pretest. Our findings show the potential of the NeuroR system to promote neuroplasticity related to AR-based therapy for motor rehabilitation in stroke participants. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Prescrição e Fisiologia do Exercício is the property of Instituto Brasileiro de Pesquisa e Ensino em Fisiologia do Exercicio and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Macroscopic alterations of the affected rotator cuff (RC) are undoubtedly linked to microscopic changes, but they may underestimate the actual degree of the disease. Moreover, it remains unclear whether preoperative structural RC changes may alter clinical outcomes. Methods: Supraspinatus tendon and muscle samples were collected from 47 patients undergoing RC surgery. Tendons were evaluated histologically according to the Bonar score; fatty infiltration and muscle atrophy were quantified using a software for biomedical image analysis (ImageJ) in percentage of area affected in the observed muscle section. Preoperative shoulder ROM and pain were evaluated. Radiological muscle atrophy was evaluated with the Tangent Sign and Occupation Ratio; fatty infiltration was assessed according to the Goutallier classification. Correlations between histological, radiological and clinical outcomes were assessed. Statistics were performed using the Spearman correlation coefficient. Intraobserver and interobserver agreement was calculated. Results: Histopathologic fatty infiltration (r = 0.007, p = 0.962), muscle atrophy (r = 0.003, p = 0.984) and the total Bonar score (r = 0.157, p = 0.292) were not correlated to preoperative shoulder pain. Muscle atrophy showed a significant but weak negative correlation with the preoperative movement of abduction (r = -0.344, p = 0.018). A significant but weak positive correlation was found between muscle atrophy and the total Bonar score (r = 0.352, p = 0.015). No correlation between histological and radiological evaluation was found for both fatty infiltration (r = 0.099, p = 0.510) and muscle atrophy (Tangent Sign: r = -0.223, p = 0.131; Occupation Ratio: r = -0.148, p = 0.319). Our histological evaluation showed a modal value of 3 (out of 3) for fatty infiltration and an equal modal value of 2 and 3 (out of 3) for muscle atrophy. In contrast, the modal value of the Goutallier score was 1 (out of 4) and 28 patients out of 47 showed a negative Tangent sign. At histology, intraobserver agreement ranged from 0.59 to 0.81 and interobserver agreement from 0.57 to 0.64. On the MRI intraobserver agreement ranged from 0.57 to 0.71 and interobserver agreement ranged from 0.53 to 0.65. Conclusions: Microscopic muscle atrophy appeared to negatively correlate with the movement of abduction leading to functional impairment. Shoulder pain did not show any relationship with microscopic changes. Radiological evaluation of the supraspinatus muscle alterations seemed to underestimate the degree of the same abnormalities evaluated at histology. [ABSTRACT FROM AUTHOR]

High-intensity laser therapy (HILT) is one of the therapeutic approaches used in the treatment of musculoskeletal disorders (MSD). The main objective of this study was to examine the effectiveness of HILT for reducing pain and improving functionality in people with MSD. Ten databases were systematically searched for randomized trials published up to 28 February 2022. Randomized clinical trials (RCTs) assessing the effectiveness of HILT on MSD were included. The main outcome measures were pain and functionality. In total, 48 RCTs were included in the qualitative synthesis and 44 RCTs in the quantitative analysis. HILT showed a decrease on the pain VAS (mean difference (MD) = −1.3 cm; confidence interval (CI) 95%: −1.6 to −1.0) and an improvement in functionality (standardized mean difference (SMD) = −1.0; CI95%: −1.4 to −0.7), with low and moderate quality of evidence, respectively. A greater effect was observed when compared with control than with other conservative treatments, both on pain (χ2 = 20.6; p < 0.001) and functionality (χ2 = 5.1; p = 0.02). Differences in the effectiveness of HILT were found depending on the location (χ2 = 40.1 p < 0.001), with further improved functionality in MSD of the knee and shoulder. HILT is an effective treatment for improving pain, functionality, range of motion, and quality of life in people with MSD, although these findings must be treated with caution due to the high risk of bias in the studies. Further clinical trials should be well designed to lower the risk of bias. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states. Methods: A dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy - MOWHTO) left human cadaveric knee joints. The knee joints were tested in three states (intact, conventional notchplasty, extended notchplasty) while 11 randomised exercises were simulated (jump landing, squatting, tibial rotation and axial ground impacts at 10°, 30° and 60° knee joint flexion) to investigate the knee joint and implant kinematics by means of rigidly attached reflective marker sets and an according motion analysis. Results: The maximum implant translation relative to the tibial plateau was < 13 mm and the maximum implant rotation was < 19° for all exercises. Both, the notchplasties and the valgus knee alignment did not affect the device kinematics. Conclusions: The results of the present in-vitro study showed that the non-anchored free-floating device remains within the medial knee joint gap under challenging dynamic loading situations without indicating any luxation tendencies. This also provides initial benchtop evidence that the device offers suitable stability and kinematic behaviour to be considered a potential alternative to meniscus allograft transplantation in combination with an MOWHTO, potentially expanding the patient collective in the future. [ABSTRACT FROM AUTHOR]

Objective To determine the efficacy of concentric vs. eccentric exercise in improving shoulder function, pain, and tendon characteristics for patients with rheumatoid arthritis and rotator cuff tendinopathy. Methods Forty patients with rheumatoid arthritis and rotator cuff tendinopathy were divided into either concentric or eccentric exercise groups, with 20 patients in each group. Patients received 12 sessions at a pace of 3 sessions per week. Shoulder Pain and Disability Index (SPADI), the visual analogue scale (VAS), supraspinatus and subscapularis thickness, echo pixels, and the Disease Activity Score-28-erythrocyte sedimentation rate (DAS-28-ESR) were assessed at baseline and post-treatment. Results There was a significant difference between the concentric and eccentric groups regarding SPADI and VAS scores in favor of the eccentric group. However, there was no significant difference between the two groups regarding tendon thickness, echo pixels, or DAS-28-ESR. Conclusion Eccentric exercises were more effective than concentric exercises in improving shoulder function and pain intensity. However, neither of the two types of exercises was superior in improving tendon characteristics or disease activity. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the influence of game features and practice type on human kinematic and muscular performance in a virtual reality exercise (VRE). Participants demonstrated changes in shoulder flexion angle and muscle activation under different virtual scenarios. Background: Conventional VRE studies often compared the outcomes between an experimental group that underwent exercise in VR and a real-world exercise control group, whereas comparisons between VRE programs are lacking. Besides, the attributes of VREs received little attention. Method: Thirteen able-bodied participants performed upper extremity exercise movements in immersive VR using a head-mounted display. Participants performed task-oriented and imitation-oriented movements with different game features. Shoulder muscle activity (the deltoid, supraspinatus, and infraspinatus) and shoulder motion were collected. Results: Practice type (task-oriented, imitation-oriented) significantly influenced the flexion angle of the shoulder complex (F (1,11) = 9.53, p =.01), and the muscle activity of the supraspinatus (F (1,9) = 12.61, p =.006) and the infraspinatus (F (1,9) = 12.71, p =.006). Game features did not have a statistically significant effect on shoulder flexion angle or shoulder muscles' activations. Conclusions: Compared to imitation-oriented practice, task-oriented practice elicited more intensive shoulder movements and muscular efforts but also induced greater movement variations. Substantial differences across game features levels should be further investigated to have significant effects. Applications: This research may help guide the design of future VREs. For strength training or rehabilitation where intensive practice is required, task-oriented practice should be considered; for movement learning where movement consistency is required, imitation oriented practice should be adopted. [ABSTRACT FROM AUTHOR]

Background: Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods: Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results: The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Conclusions: Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM. [ABSTRACT FROM AUTHOR]

Background: Reparation of C5 by proximal selective ipsilateral C7 transfer has been reported for the treatment of neurogenic shoulder abduction limitation as an alternative to the reparation of the suprascapular nerve (SSN) and the axillary nerve (AXN) by distal nerve transfers. However, there is a lack of evidence to support either strategy leading to better outcomes based on long-term follow-up. Objective: The purpose of the study was to investigate the safety and long-term outcomes of the posterior division of ipsilateral C7 (PDIC7) transfer to C5 in treating neurogenic shoulder abduction limitation. Methods: A total of 27 cases with limited shoulder abduction caused by C5 injury (24 cases of trauma, 2 cases of neuritis, and 1 case of iatrogenic injury) underwent PDIC7 transfer to the C5 root. A total of 12 cases (11 cases of trauma and 1 case of neuritis) of C5 injury underwent spinal accessory nerve (SAN) transfer to SSN plus the triceps muscular branch of the radial nerve (TMBRN) transfer to AXN. The patients were followed up for at least 12 months for muscle strength and shoulder abduction range of motion (ROM). Results: In cases that underwent PDIC7 transfer, the average shoulder abduction was 105.9° at the 12-month follow-up. In total, 26 of 27 patients recovered at least M3 (13 reached M4) (Medical Research Council Grading) of the deltoid. In cases that underwent SAN transfer to SSN plus TMBRN to AXN, the average shoulder abduction was 84.6° at the 12-month follow-up. In total, 11 of 12 patients recovered at least M3 (4 reached M4) of the deltoid. Conclusion: Posterior division of ipsilateral C7 transfer is a one-stage, safe, and effective surgical procedure for patients with neurogenic shoulder abduction limitation. [ABSTRACT FROM AUTHOR]

Some pathologies can affect individuals who practice physical activity and highintensity exercises, such as those related to bones and joints. In this sense, this article aims to characterize the shoulder impingement syndrome (SIO), identifying its implications, and analyzing training protocols that provide prevention and treatment of this disease. The reasons and reasons that led to the choice of this topic are due to the need to deepen the subject, in view of the lack of studies on, as well as bringing to the debate issues related to the practice of physical activity and some diseases related to it. Specifically, the study aims to identify which are the exercise protocols aimed at preventing this syndrome and analyze their content in terms of their characteristics. The methodological course was based on the types of qualitative and quantitative method approaches. The research was configured as a literature review, produced from the selection of theoretical productions that contained the following keywords in their titles: shoulder and shoulder girdle; shoulder exercises; and shoulder impingement syndrome. Scientific evidence proves that resistance training is effective in preventing and treating OIS, in addition to treating injuries caused by repetitive strain and joint wear. The main conclusions are. [ABSTRACT FROM AUTHOR]

Access to healthcare, including physiotherapy, is increasingly occurring through virtual formats. At-home adherence to physical therapy programs is often poor and few tools exist to objectively measure participation. The aim of this study was to develop and evaluate the potential for performing automatic, unsupervised video-based monitoring of at-home low-back and shoulder physiotherapy exercises using a mobile phone camera. Joint locations were extracted from the videos of healthy subjects performing low-back and shoulder physiotherapy exercises using an open source pose detection framework. A convolutional neural network was trained to classify physiotherapy exercises based on the segments of keypoint time series data. The model's performance as a function of input keypoint combinations was studied in addition to its robustness to variation in the camera angle. The CNN model achieved optimal performance using a total of 12 pose estimation landmarks from the upper and lower body (low-back exercise classification: 0.995 ± 0.009; shoulder exercise classification: 0.963 ± 0.020). Training the CNN on a variety of angles was found to be effective in making the model robust to variations in video filming angle. This study demonstrates the feasibility of using a smartphone camera and a supervised machine learning model to effectively classify at-home physiotherapy participation and could provide a low-cost, scalable method for tracking adherence to physical therapy exercise programs in a variety of settings. [ABSTRACT FROM AUTHOR]

Currently, various minimally invasive surgical techniques are applied for total hip arthroplasty (THA). There are few studies comparing the early postoperative clinical outcomes of minimally invasive THA between anterolateral and posterolateral approaches. In this retrospective study, 62 patients underwent minimally invasive THA via either the anterolateral approach with an intermuscular exposure using the modified Watson–Jones approach (MIS-AL, 34 hips) or mini-incision THA with a posterolateral approach (MIS-PL, 28 hips). We analyzed intraoperative data, postoperative hematological data, postoperative radiographic findings, and the postoperative recovery of muscle strength. The mean surgical time was significantly longer in the MIS-PL than in the MIS-AL group. The mean postoperative serum C-reactive protein level was significantly higher in the MIS-PL group than in the MIS-AL group only on postoperative day 3. There were no significant between-group differences in the postoperative recovery rate of muscle strength during hip abduction. The recovery rate of muscle strength during hip extension was better in the MIS-AL group than in the MIS-PL group only on postoperative day 3. In conclusion, we found no obvious advantage in early postoperative recovery between the MIS-AL and MIS-PL approaches. Therefore, the benefit of rapid postoperative recovery was comparable between the MIS-AL and MIS-PL approaches. [ABSTRACT FROM AUTHOR]

Background: The glenohumeral joint’s rotational range of motion (ROM) and muscle strength are essential to execute the cricket bowling action. Performing shoulder rotation exercises may increase the rotator cuff muscle strength and rotational ROM. Objectives: The aim of this study was to test the effect of a sixweek exercise programme on shoulder rotational ROM and muscle strength. Methods: Twenty-one healthy male cricket fast bowlers were recruited, ranked and pair-matched on initial shoulder rotator muscle strength and assigned to either a shoulder exercise (SE) group or cricket training (CT) only group. The SE group incorporated Indian clubbell exercises in addition to their cricket training. Results: Bowlers in both groups displayed a large increase on the dominant shoulder’s internal rotation (IR) ROM, but only the SE group’s bowlers displayed ROM improvements (p<0.001) bilaterally for both internal and external rotation. The CT group’s fast bowler’s non-dominant shoulder IR ROM significantly decreased (p=0.02) during the six weeks. Between groups, only the SE group’s bowler’s internal rotator muscle strength improved (p<0.001) bilaterally. The observed kinematic changes were statistically significantly greater at a 5% level for the SE group’s bowlers (bilateral internal rotators muscle strength, non-dominant shoulder IR ROM and horizontal adduction ROM). Conclusion: Maintenance of the shoulder’s rotational ROM and muscle strength is vital for a fast bowler. Cricket bowlers who perform regular clubbell exercises might increase their shoulder’s ROM and internal rotator cuffs’ muscle strength, which may aid in stabilising their glenohumeral joint while bowling [ABSTRACT FROM AUTHOR]

Background: The axillary lymph node dissection (ALND) is essential for staging, prognostic assessment and local control in patients of breast cancer with the clinically evident nodal disease in the axilla. A prospective study conducted by us evaluated the effect of infiltrative anesthesia injected along the nerve bundles exposed during surgery in reducing the restriction of the range of motion of the arm and pain scores following ALND. Further to our pilot study we conducted this nonrandomized comparative trial for evaluation of range of movement, reduction in pain and long-term complications like paresthesia and occurrence of lymphedema post-ALND. Methods: A prospective nonrandomized comparative study was done on 97 patients undergoing ALND, who were distributed into two groups. One who received intraoperative infiltration of local anesthesia along the nerve bundles with postoperative conventional shoulder exercises (II + CSE) and the other group who received postoperative conventional shoulder exercises only (CSE). Mobility in the form of range of movements (flexion, extension and abduction at ipsilateral shoulder), pain parameters, paresthesia and lymphoedema were compared among the two groups. Results: The range of motion measured by the degree of flexion, extension and abduction on Day 0 (postoperative evening) and Days 3, 7 and 28 after surgery were significantly more in II + CSE gp till post-op Day 7. Pain in the arm was assessed by Visual Analog Scale (VAS) on Days 0, 1, 3, 7 and 28 and was significantly lower on Days 0, 1, 3 and 7 in the test group. Incidence of paresthesia was statistically insignificant while lymphedema was significantly less in the intervention group. Conclusion: Our study reinforces that infiltrative anesthesia with local anesthetic along the nerve bundles exposed during ALND is effective in improving the range of motion restriction of the shoulder and pain relief. The incidence of lymphedema was also found to be significantly less in the interventional group. [ABSTRACT FROM AUTHOR]

Introduction: Shoulder pain is one of the most common complications after laparoscopy. Previous studies have found a number of methods to reduce shoulder pain after laparoscopic surgery, but these methods have not been targeted to specific populations. The purpose of this study was to identify people who are more likely to develop shoulder pain. Material and methods: A total of 203 patients underwent laparoscopy for benign gynecological diseases between July 2020 and February 2021. Patients were divided into two groups according to the Chinese overweight standard, body mass index less than 24 kg/m2 group and 24 kg/m2 or more group. The baseline characteristics and intraoperative data between the two groups were compared. The intensity of the shoulder pain was quantified using a visual analog scale (VAS). Results: The incidence and the VAS scores of shoulder pain were significantly higher in the less than 24 kg/m2 group (63.64% vs 38.03%, p < 0.001 in incidence; median 5 (interquartile range [IQR] 3–7) vs 3 (IQR 2–5), p < 0.001 in VAS scores), and the chance of shoulder pain within 24 hours after laparoscopy was higher in the less than 24 kg/m2 group (89.29% vs 66.67%, p = 0.013). In univariate and multivariate logistic regression analysis, BMI less than 24 kg/m2 was an independent risk factor of shoulder pain after laparoscopic surgery (p = 0.001, p = 0.031, respectively). Shoulder pain scores were inversely correlated with BMI (r = −0.300, p = 0.001). Conclusions: Patients with low body mass index are more likely to develop shoulder pain after laparoscopy, with earlier onset and higher pain scores. [ABSTRACT FROM AUTHOR]

Background: Besides the traditional physical therapy interventions (infrared and strengthening exercises for scapular and shoulder muscles), recently, low-level laser (LLL) and mobilization with movement (MMM) gained more attention in the management of shoulder impingement syndrome (SIS). Aim: To examine the effects of adding LLL to MMM in patients having SIS. Design: A prospective double-blinded randomized trial. Settings: Physical therapy outpatient clinic of Heliopolis University. Participants: Forty patients complaining of unilateral shoulder impingement syndrome for not less than three months and not more than twenty-four months were included. Methods: The patients were randomly assigned to group A (n=20, received the active LLL, MMM, and the abovementioned traditional physical therapy interventions), and group B (n=20, received the same treatments as group A but the LLL was sham). All treatments were applied 3 times per week, for 6 successive weeks. The shoulder pain severity, (assessed via visual analog scale, VAS) and shoulder range of motion (ROM) (flexion, abduction, and internal rotation). Results: The within-group analysis revealed a significant enhancement in all parameters relative to the baseline (P < 0.05). Conclusion: LLL could magnify the gained improvements in pain and ROM when added to MMM and traditional physical therapy interventions in patients with SIS. [ABSTRACT FROM AUTHOR]

Copyright of Revista Brasileira de Medicina do Esporte is the property of Redprint Editora Ltda. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers information on the decision-making process for appropriate care and treatment of shoulder instability, particularly for athletes and those wishing to return to play. Topics discussed include risk factors; treatment options; and considerations for safe return to physical activity and sports after non-operative or surgically treated shoulder instability.

Purpose: Reverse shoulder prosthesis is a method used after massive rotator cuff tears. It is a surgical method used to improve shoulder functions and to cope with pain. Long-term results of physiotherapy programs applied after surgery are insufficient. The aim of this study is to investigate the long-term results of reverse shoulder prosthesis applied to both shoulders. Methods: A 66-year-old female patient with a rotator cuff tear on both shoulders was included in the study. After surgery, 40 sessions of physiotherapy were applied to the left shoulder and 45 sessions of physiotherapy to the right shoulder, and the right shoulder was followed for 6 years and the left shoulder for 8 years. VAS for pain, goniometer for active range of motion, and constant shoulder score questionnaire for functionality were used in the evaluations. Results: Significant differences were found in the preoperative and postoperative evaluation in terms of pain, activities of daily living and active range of motion of the patient. While the preoperative Constant scores were 32 for the left shoulder and 34 for the right shoulder, the postoperative Constant scores were calculated as 84 for both shoulders. [ABSTRACT FROM AUTHOR]

This study developed a wearable sensor device featuring biomimetic structures inspired by tree frog toe pads to measure shoulder joint movements effectively. A PVA/PAA double-network hydrogel was formulated by mixing PVA and PAA in a 3:7 ratio, resulting in a Young's modulus of 7.2 kPa, closely matching human skin's mechanical properties. To enhance moisture retention, the hydrogel was supplemented with 20 mL glycerin, increasing its weight retention rate to 95 % after 28 days, a 5.6-fold improvement over glycerin-free hydrogels. Additionally, the incorporation of 0.2 wt% cellulose nanocrystals (CNC) increased the cross-linking density, reducing the swelling ratio from 124 % to 106 % and minimizing the impact of swelling cycles on mechanical properties from 22 % to 4 %. Treefrog-inspired microstructures were fabricated on the sensor surface using laser cutting and casting techniques, significantly enhancing adhesion under humid conditions, with normal, lateral, and peel-off adhesion forces improving by 500, 700, and 700 %, respectively. The sensor demonstrated accurate measurement of shoulder joint movements with an error margin of 6.3 % for polar angles (45°-135°) and 7.8 % for azimuth angles (0°-45°). The accompanying smartphone application provided real-time feedback, helping to prevent exercise injuries and improve user awareness and control of shoulder movements, making it suitable for both rehabilitation and athletic training. [Display omitted] • This study introduces a PVA/PAA hydrogel inspired by tree frog toe pads to enhance adhesion in humid environments. • The hydrogel patch mimics human skin's mechanical properties with young's modulus of 7.2 kPa. • Adding cellulose nanocrystals (CNC) enhances both the anti-swelling properties and mechanical strength of the hydrogel. • The smartphone app provides real-time feedback on shoulder joint movements, reducing the risk of exercise injuries. [ABSTRACT FROM AUTHOR]

By establishing a three-dimensional finite element model of ankle injury arising from supination and external rotation, the stress characteristics of the posterior malleolar surface can be obtained, and analysis of the corresponding stress on the lateral ankle can be conducted. Thin-layer computed tomography images of normal ankle joint in the supination and external rotation nonweight-bearing states was selected, to construct a three-dimensional data model of each ankle joint. A load was applied to examine different ankle joint stress values and pressure distributions on the surface of the posterior ankle joint. A 600 N vertical compressive and 10 Nm internal rotation load was applied in Stage III (removing the anterior tibiofibular ligament and the posterior tibiofibular ligament) of SER (supination-external rotation). When the lateral malleolar was intact, the maximum stress (132.7 MPa) was located at the point of attachment of the posterior tibiofibular ligament to the fibula, and the maximum pressure of the posterior malleolar surface was lower than 4.505 MPa. When a lateral malleolar fracture was present, the maximum stress (82.72 MPa) was located on the fibular fracture surface, and the maximum pressure of the posterior malleolar surface was 8.022 MPa. This study shows that reconstruction of the lateral malleolus in supination-external rotation ankle injuries significantly affects the stress distribution at the posterior malleolar joint surface. Through this reconstruction, the pressure distribution of the posterior malleolar joint surface can be significantly reduced. [ABSTRACT FROM AUTHOR]

Background: In this study, we wanted to compare clinical and functional outcomes of Rockwood's type III, IV, V, VI AC joint dislocation treated with open reduction and internal fixation via modified Weaver- Dunn procedure and autogenous tendon graft reconstruction approach. Materials and methods: This was a hospital based prospective comparative study conducted among 30 patients who presented with painful, chronic complete AC joint dislocation, aged between 18 and 60 years irrespective of sex in the Department of Orthopaedics, M.K.C.G. Medical College and Hospital, Berhampur, over a period of 24 months from November 2019 to November 2021 after obtaining clearance from Institutional Ethics Committee and written informed consent from the study participants. Results: The difference between semitendinosus graft procedure and modified Weaver-Dunn procedure was statistically significant with regard to the mean operative time of surgery, the mean pre-operative range of abduction, post-operative range of abduction, the mean pre- operative range of flexion, post-operative range of flexion, the mean pre-operative range of external rotation and post-operative range of external rotation, and the mean CC distance. Conclusion: MWD is one of the most popular methods but anatomic reconstruction of CC ligament with autogenous STT graft is increasingly getting popular as it provides better stability, diminishes pain and better function as well as better strength is achieved with STT graft technique procedure. Statistically significant difference between the two groups was found in relation to operative time. The average operating time was more in STT group due to graft harvesting from the patient and strength of this graft obviates the need for augmentation with other non-biological devices. In the study we have seen that there is a statistically significant difference between the MWD and STT group in terms of final outcome as STT graft has better OSS, NCS and UCLA score. [ABSTRACT FROM AUTHOR]

Background: Various maneuvers have been introduced to address anterior shoulder dislocations. Chair method allows the patient to sit comfortably and feel less pain during the reduction procedure. However, the rarity of comparative studies led to a lack of evidence to popularize. The present study aimed to introduce a modified chair (MOC) reduction method for anterior shoulder dislocation and explore its effectiveness compared with the traditional Hippocratic approach.Methods: This is a single-center retrospective study of 257 patients with anterior shoulder dislocation from September 2020 and July 2021. Patients were divided into two groups according to the reduction method they received (either the Hippocratic method or the MOC method). Success rate, reduction time, visual analog scale (VAS) pain score, satisfaction level, and a new indicator, pain index (reduction time (s)* VAS/ 10), were compared.Results: One hundred sixteen patients (43 females, 73 males) underwent the Hippocratic method, and 141 (65 females, 76 males) MOC method. A significantly higher success rate was seen in the MOC group (96.5%(136/141) vs. 84.5%(98/116) in the Hippocratic group; OR 5, 95%CI 1.79 ~ 13.91; p = 0.002). Pain index of the patients in the MOC group was much lower than that in the Hippocratic group (3.20 (2.10, 4.53) vs. 36.70 (22.40, 47.25), p <  0.001). The reduction time, VAS pain score, and satisfaction level also favored the MOC method.Conclusions: The MOC method is an easy and efficient reduction method with minimum assistance for anterior shoulder dislocations. Physicians can skillfully perform this procedure with the help of their body weight. The MOC method could be attempted for shoulder dislocations in the emergency department. [ABSTRACT FROM AUTHOR]

Rehabilitation robotics aims to facilitate the rehabilitation procedure for patients and physical therapists. This field has a relatively long history dating back to the 1990s; however, their implementation and the standardisation of their application in the medical field does not follow the same pace, mainly due to their complexity of reproduction and the need for their approval by the authorities. This paper aims to describe architecture that can be applied to industrial robots and promote their application in healthcare ecosystems. The control of the robotic arm is performed using the software called SmartHealth, offering a 2 Degree of Autonomy (DOA). Data are gathered through electromyography (EMG) and force sensors at a frequency of 45 Hz. It also proves the capabilities of such small robots in performing such medical procedures. Four exercises focused on shoulder rehabilitation (passive, restricted active-assisted, free active-assisted and Activities of Daily Living (ADL)) were carried out and confirmed the viability of the proposed architecture and the potential of small robots (i.e., the UR3) in rehabilitation procedure accomplishment. This robot can perform the majority of the default exercises in addition to ADLs but, nevertheless, their limits were also uncovered, mainly due to their limited Range of Motion (ROM) and cost. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the effects of different shoulder orthoses on the neuromuscular activity of superficial and deep shoulder muscles during activities of daily living (ADL) and physiotherapeutic exercises. Methods: Ten participants with healthy shoulders (31 ± 3 years, 23.1 ± 3.8 kg/m2) were randomized to receive a "shoulder sling", an "abduction pillow" and a "variably adjustable orthosis" on the dominant side. With each orthosis, they completed seven ADL with and four physiotherapeutic exercises without wearing the orthoses. An electromyographic system was used to record the neuromuscular activity of three superficial (trapezius, deltoid, pectoralis major) and two deep shoulder muscles (infraspinatus, supraspinatus) using surface and intramuscular fine-wire electrodes. Results: The neuromuscular activity differs between the orthoses during ADL (p ≤ 0.045), whereby the "variably adjustable orthosis" mostly showed the highest activation levels associated with the worst subjective wearing comfort rated on a visual analog scale. In addition, differences exist between the physiotherapeutic exercises (p ≤ 0.006) demonstrating the highest activations of the infra- and supraspinatus muscles for assistive elevation and wipe across a table, middle for pendulum and lowest for continuous passive motion exercises. Conclusions: The neuromuscular activity of superficial and deep shoulder muscles differs between the orthoses during ADL and also between the physiotherapeutic exercises. [ABSTRACT FROM AUTHOR]

Background: Cutibacterium acnes (C. acnes) is the most common pathogen responsible for post-operative shoulder infections. The purpose of this study was to evaluate the effectiveness of skin preparation methods against C. acnes in shoulder surgery. Methods: A systematic review was conducted evaluating the effectiveness of skin preparation methods in the reduction of C. acnes in patients undergoing shoulder surgery. Outcomes were assessed based on the effectiveness of the method used; side effects and cost were also analysed. Results: Of the 19 included studies, 9 evaluated pre-surgical home treatments: 8 assessed benzoyl peroxide (BPO) and 6 concluded it is effective in reducing C. acnes. Nine studies assessed surgical skin preparation and concluded that Chlorhexidine gluconate (CHG) was not effective; in contrast hydrogen peroxide reduced C. acnes. Finally, one study evaluated an aseptic protocol using CHG and concluded that it was not effective. Conclusions: It was demonstrated that BPO as home treatment is effective in reducing C. acnes load on skin ; it rarely causes side effects and is also cost-effective. This study highlights non-effectiveness of CHG. There was some evidence that the addition of hydrogen peroxide could have a positive effect in the reduction of C. acnes skin load; however, more studies are required. [ABSTRACT FROM AUTHOR]