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Objective: To culturally adapt and validate the Italian version of the Shoulder Instability—Return to Sport after Injury (SI-RSI-I) scale. Methods: The SI-RSI-I was developed by adapting the Anterior Cruciate Ligament—Return to Sport Index—Italian version and replacing the term "knee" with "shoulder." Subsequently, it underwent validation following COSMIN recommendations. The study involved athletic participants who experienced SI. They completed the SI-RSI-I together with other measurement instruments: Western Ontario Shoulder Instability Index, Kerlan-Jobe Orthopedic Clinic Score, EuroQol-5D-5L, and Numeric Pain Rating Scale. The following psychometric properties were investigated: structural validity, internal consistency, test–retest reliability, measurement error, and construct validity. Results: The study included 101 participants (age mean [SD] 28.5 [7.4] y; 83 males, 18 females). The SI-RSI-I showed a single-factor structure, excellent internal consistency (α =.935), and excellent test–retest reliability (ICC =.926; 95% CI,.853–.964). The standard error of measurement was 6.1 points, and the minimal detectable change was 17.0 points. Furthermore, SI-RSI-I demonstrated moderate to strong correlations with all reference scales, confirming 8 out of 9 (88.0%) hypotheses, thus establishing satisfactory construct validity. Conclusion: The SI-RSI-I has demonstrated robust internal consistency, reliability, validity, and feasibility as a valuable scale for assessing psychological readiness to return to sport in Italian athletes with SI. [ABSTRACT FROM AUTHOR]

Context: To stabilize the humeral head within the glenoid fossa during arm elevation, the rotator cuff muscles may contribute through internal and external rotation. The main purpose of the current study was to compare the acromiohumeral distance between athletes with primary subacromial impingement syndrome who received progressive resistance exercises consisting of either shoulder internal or external rotation. Design: A randomized and controlled clinical study. Methods: Thirty athletes with primary subacromial impingement syndrome were enrolled and randomly divided into 2 experimental groups. The progressive resistance exercise protocol in experimental group I comprised shoulder internal rotation, while in experimental group II consisted of shoulder external rotation. The experimental groups worked out 3 days a week for 6 weeks. The experimental groups were compared with the control group consisting of 15 healthy athletes. The acromiohumeral distance was measured before and after the intervention using an ultrasound machine under the passive and active across no arm elevation and 45°of arm elevation. Results: The acromiohumeral distance significantly increased in both experimental groups under the passive and active arm positions following the intervention (P <.001), with no significant differences detected between the experimental groups (P >.665). The paired comparisons of the acromiohumeral distance discrepancy indicated a significant difference between the control group and each experimental group under the active and passive arm positions (P <.001), while no significant difference was observed between the experimental groups (P >.999). Conclusions: The present study revealed, for the first time, that both progressive resistance exercise protocols involving either the shoulder internal or the external rotation increased the acromiohumeral distance in individuals with primary subacromial impingement syndrome and improved associated pain and disabilities. [ABSTRACT FROM AUTHOR]

Context: The aim of this study was to investigate the effects of 8-week ballistic-strength-training program using a validated specific throwing device (ie, Arm/Shoulder Specific Strength Device), on isokinetic shoulders' rotation muscle-torques and ratios as well as range of motion in team handball players. Design: A repeated-measures experimental design with a randomized controlled trial was used. Methods: Twenty-six high-level competitive male U-19 team handball players were randomly assigned into training (TG, n = 15) and control (n = 11) groups. The TG undertook a twice a week for 8-week periodized throws program with an individually predetermined optimal load. The program incorporated shackled eccentric and concentric exercises using the Arm/Shoulder Specific Strength Device. Peak torques, functional, and conventional ratios for both arms at different angular velocities (60°·s−1, 180°·s−1, and 300°·s−1) were assessed over time and between groups, using an isokinetic dynamometer. Results: A significant improvement for TG (P <.01; d = 1.13 [moderate]; +20.2%) of the concentric peak torques for dominant arm in external rotation was observed at 300°·s−1. Significant (P <.05–.01) increases were also noted for nondominant arm at the 3 studied angular velocities. In addition, 300°·s−1 eccentric peak torques of the dominant arm and nondominant arm have significantly improved for both external and internal rotations (P <.05; d =.99 [moderate] and d = 1.21 [large]; +15.7% and + 17.9%, respectively) with small changes at the other angular assessed velocities. Posttraining, TG's dominant arm showed significant improvements (P <.05–.01) in functional and conventional ratios at all velocities. Notably, significant differences (P <.05–.01) were observed at 60°·s−1 and across all velocities when comparing the TG with the control group. TG showed significant increase for internal rotation and external rotation shoulder range of motions (P <.05; d = 1.22–1.27 [large]), +5.0% and +7.7%, respectively). Conclusions: The specific 8-week throwing training program on the Arm/Shoulder Specific Strength Device showed significant performance improvements in almost all assessed isokinetic concentric and eccentric peak torques as well as internal and external range of motion increase for both arms while ensuring rotator cuff torque ratios and shoulder mobility in team handball real sport-specific condition. [ABSTRACT FROM AUTHOR]

Clinical Scenario: The fascial relationship between scapular muscles and abdominal muscles has been documented from previous studies. However, it is not yet clear whether voluntary abdominal contraction has a beneficial effect on scapular muscle activity during shoulder exercises. Clinical Question: Do scapulothoracic muscle activation levels increase if shoulder exercises are performed with voluntary abdominal activation? Summary of Key Finding: After the literature review, 4 cross-sectional studies met the inclusion criteria and were included in this critically appraised topic. Clinical Bottom Line: There is moderate evidence to support dynamic shoulder exercises with voluntary abdominal contraction can increase trapezius and serratus anterior muscle activation level in asymptomatic shoulders. Strength and Recommendation: Findings from 4 cross-sectional trials indicate that there is moderate evidence supporting that dynamic shoulder exercises performed with voluntary abdominal contraction can increase scapular muscle activity. [ABSTRACT FROM AUTHOR]

Context: Sport-specific adaptations in shoulder rotation range of motion (ROM) and the relationship with humeral torsion have been described in overhead-throwing sports. However, information is lacking for other shoulder-loading sports such as field hockey. Therefore, this study's purpose was to evaluate humeral torsion in elite, male field hockey players and explore its association with shoulder ROM. Design: Cross-sectional study. Methods: Twenty-five male, elite field hockey players were included. Humeral torsion and shoulder external and internal rotation ROM were evaluated bilaterally by ultrasound and an inclinometer smartphone application, respectively. Results: Field hockey players showed a significantly increased humeral retroversion on the dominant compared with the nondominant side (P <.001; Cohen d = 1.75), along with a significantly increased external (P =.004; Cohen d = −0.64) and decreased internal rotation ROM (P =.003; Cohen d = 0.65). This finding illustrates a shift in total shoulder rotational ROM arc. Correlation analysis showed a significant moderate association between the increased humeral retroversion and decreased internal rotation ROM on the dominant side (r =.523). Conclusions: Elite male field hockey athletes show sport-specific adaptations regarding humeral torsion and shoulder rotation ROM, similar to throwing athletes. These findings increase our insight into the field hockey athlete's shoulder, which is essential to optimize performance and assist in correctly interpreting shoulder rotational ROM measurements. [ABSTRACT FROM AUTHOR]

BackgroundThe appropriate amount of cementation at the time of reverse total shoulder arthroplasty with significant proximal bone loss or resection is unknown. Extensive cementation of a humeral prosthesis makes eventual revision arthroplasty more challenging, increasing the risk of periprosthetic fracture. We analyzed the degree of subsidence and torque tolerance of humeral components undergoing standard cementation technique vs. our reduced polymethyl methacrylate (PMMA) protocol. Reduced cementation may provide sufficient biomechanical stability to resist physiologically relevant loads, while still permitting a clinically attainable torque for debonding the prosthesis.MethodsA total of 12 cadaveric humeri (6 matched pairs) underwent resection of 5 cm of bone distal to the greater tuberosity. Each pair of humeri underwent standard humeral arthroplasty preparation followed by either cementation using a 1.5-cm PMMA sphere at a location 3 cm inferior to the porous coating or standard full stem cementation. A 6-degree-of-freedom robot was used to perform all testing. Each humeral sample underwent 200 cycles of abduction, adduction, and forward elevation while being subjected to a physiologic compression force. Next, the samples were fixed in place and subjected to an increasing torque until implant-cement separation or failure occurred. Paired t tests were used to compare mean implant subsidence vs. a predetermined 5-mm threshold, as well as removal torque in matched samples.ResultsFully and partially cemented implants subsided 0.49 mm (95% CI 0.23-0.76 mm) and 1.85 mm (95% CI 0.41-3.29 mm), respectively, which were significantly less than the predetermined 5-mm threshold (P

More than 80% of adult manual wheelchair users with spinal cord injuries will experience shoulder pain. Females and those with decreased shoulder dynamics variability are more likely to experience pain in adulthood. Sex-related differences in shoulder dynamics variability during pediatric manual wheelchair propulsion may influence the lifetime risk of pain. We evaluated the influence of sex on 3-dimensional shoulder complex joint dynamics variability in 25 (12 females and 13 males) pediatric manual wheelchair users with spinal cord injury. Within-subject variability was quantified using the coefficient of variation. Permutation tests evaluated sex-related differences in variability using an adjusted critical alpha of P =.001. No sex-related differences in sternoclavicular or acromioclavicular joint kinematics or glenohumeral joint dynamics variability were observed (all P ≥.042). Variability in motion, forces, and moments are considered important components of healthy joint function, as reduced variability may increase the likelihood of repetitive strain injury and pain. While further work is needed to generalize our results to other manual wheelchair user populations across the life span, our findings suggest that sex does not influence joint dynamics variability in pediatric manual wheelchair users with spinal cord injury. [ABSTRACT FROM AUTHOR]

Objective: To investigate the efficacy of Endobutton plate combined with high-strength suture Nice knot fixation in the treatment of distal clavicular fractures with coracoclavicular ligament injuries. Methods: A retrospective analysis was performed on 43 patients who sustained distal clavicular fractures along with injuries to the coracoclavicular ligament. These patients were treated between January 2017 and December 2023. The fractures were classified according to the fixation method: high-strength Nice knot suture fixation (experimental group, n = 23) and acromioclavicular Kirschner wire fixation (control group, n = 20). The basic information of the two groups of patients, including age, gender, cause of injury, fracture classification, hospitalization duration, fracture healing time and complications, was collected and analyzed. The increase rate of coracoclavicular space on the affected side was collected and analyzed. The pain level of the affected shoulder was assessed using the visual analog scale (VAS). The shoulder joint function was assessed using the American Shoulder and Elbow Surgeons (ASES) scores and Constant-Murley scores before and after surgery. Results: No significant differences were observed in the general demographic data, including age, gender, injury etiology, Craig classification, and hospitalization duration between the two groups (p > 0.05). Both groups were followed for a period ranging from 12 to 33 months, with an average follow-up of 20.53 ± 5.16 months. The bone healing time in the experimental group was significantly shorter than in the control group (12.82 ± 1.12 weeks vs. 17.25 ± 1.71 weeks, p < 0.05). At the final follow-up, The increase rate of coracoclavicular space was (9.25 ± 2.53) % in the experimental group and (8.10 ± 2.53) % in the control group, which was not significantly different (p > 0.05). Both groups demonstrated significant improvements in VAS scores, Constant-Murley scores, and ASES scores post-operatively compared to pre-operative values (p < 0.05). One month after surgery, the Constant-Murley and ASES scores were significantly superior in the experimental group compared to the control group (p < 0.05). However, no statistical difference was observed three months post-surgery or during the final follow-up (p > 0.05). The control group reported one case of infection related to the Kirschner wire and one case of Kirschner wire displacement postoperatively. Conversely, no significant complications were reported in the experimental group. Conclusion: In the management of distal clavicle fractures accompanied by coracoclavicular ligament injuries, particularly oblique fractures or those with butterfly-shaped fragments, the application of a high-strength Nice knot suture in conjunction with Endobutton plate fixation can effectively stabilize the fracture site. This approach not only mitigates complications associated with Kirschner wire fixation but also enhances fracture healing, leading to favorable postoperative outcomes. [ABSTRACT FROM AUTHOR]

Background Interventions using vibration stimulation have been recognized for their potential for increasing range of motion (ROM) without compromising muscle strength. Handheld vibration massagers can efficiently deliver vibration therapy to the shoulder joint and may be a potential treatment. Purpose To evaluate the effects of vibration massage using a handheld device on the soft tissues of the posterior shoulder joint, particularly on internal rotation (IR) passive ROM and external rotation (ER) muscle strength. Study Design Crossover study design. Methods A crossover study with a 5-min vibration massage and passive control condition was conducted in healthy male volunteers (mean age 20.5 ± 1.7 years). Vibration massage was applied to the posterior shoulder soft tissues of the dominant arm, with no intervention under control conditions. IR-ROM (vertebral level and in abduction) and strength of the external rotators (isometric and isokinetic) were measured before and immediately after the intervention. Vertebral levels were calculated as a ratio of lengths (ratio decreases with increased mobility). IR-ROM in abduction, the angle was measured. Statistical analysis was performed with two-way repeated measures ANOVA and paired t-test (Bonferroni correction). Results Vibration application decreased (improved) vertebral level IR ROM by -4.1% (p < 0.01, d = 0.445) and increased abduction position IR ROM by 11.4° (p < 0.01, d = 0.694). These changes exceeded the 95% confidence interval for the minimum detectable change. By contrast, the control condition produced no changes. IR-ROM (vertebral level and abduction) immediately after the intervention showed significant differences between the control and vibration conditions (p = 0.036, d = 0.273; p = 0.048, d = 0.483, respectively). Muscle strength did not show any interaction, time, or between-condition effects. Conclusions A massage using a handheld vibration massager applied to the posterior shoulder soft tissues increased IR-ROM without negatively affecting muscle strength, suggesting its potential use as a means of warming up. Level of Evidence Level 3 [ABSTRACT FROM AUTHOR]

Robotic devices are commonly used to quantify sensorimotor function of the upper limb after stroke; however, the availability and cost of such devices make it difficult to facilitate implementation in clinical environments. Tablets (e.g. iPad) can be used as devices to facilitate rehabilitation but are rarely used as assessment tools for the upper limb. The current study aimed to implement a tablet-based Maze Navigation Task to examine complex upper-limb movement in individuals with chronic stroke. We define complex upper-limb movement as reaching movements that require multi-joint coordination in a dynamic environment. We predicted that individuals with stroke would have more significant spatial errors, longer movement times, and slower speeds compared to controls with increasing task complexity. Twenty individuals with chronic stroke who had a variety of arm and hand function (Upper extremity Fugl-Myer 52.8 ± 18.3) and twenty controls navigated eight pseudorandomized mazes on an iPad using a digitizing stylus. The task was designed to elicit reaching movements engaging both the shoulder and elbow joints. Each maze became increasingly complex by increasing the number of 90° turns. We instructed participants to navigate each maze as quickly and accurately as possible while avoiding the maze's boundaries. Sensorimotor behavior was quantified using the following metrics: Error Time (time spent hitting or outside boundaries), Peak Speed, Average Speed, and Movement Time, Number of Speed Peaks. We found that individuals with stroke had significantly greater Error Time for all maze levels (all, p < 0.01), while both speed metrics, Movement Time and Number of Speed Peaks were significantly lower for several levels (all, p < 0.05). As maze complexity increased, the performance of individuals with stroke worsened only for Error Time while control performance remained consistent (p < 0.001). Our results indicate that a complex movement task on a tablet can capture temporal and spatial impairments in individuals with stroke, as well as how task complexity impacts movement quality. This work demonstrates that a tablet is a suitable tool for the assessment of complex movement after stroke and can serve to inform rehabilitation after stroke. [ABSTRACT FROM AUTHOR]

Background and Purpose Conservative management of anterior shoulder dislocation (ASD) is associated with greater recurrence compared with surgical management. Current rehabilitation protocols may not adequately challenge shoulder stability to encourage adaptive coping strategies. Apprehension-based training (ABT) is a new treatment concept derived from the supine moving apprehension test (SMAT), a previously validated performance measure among patients with ASD. The purpose of this case report is to describe the application of ABT in a patient with recurrent ASD. Study Design Case report Case Description The subject was a 23-year-old male with bilateral recurrent ASD. The subject underwent a 17-week exercise program involving gradual exposure to increased anterior instability loads based on the SMAT movement pattern. The Western Ontario Shoulder Instability Index (WOSI), Patient-Specific Functional Scale (PFPS), Tampa Scale of Kinesiophobia, SMAT, shoulder internal and external rotation muscle strength were measured via hand-held dynomometry before and after training. Outcomes Following treatment, clinically meaningful gains in quality of life (WOSI) and shoulder function (PSFS) were noted. Kinesiophobia decreased, SMAT and shoulder internal rotator strength increased beyond their respective minimal detectable change. Four months after treatment, quality of life and shoulder function remained improved, and the subject reported a reduced rate of ASD. Discussion Apprehension-based training involving gradual exposure to shoulder instability loads may hold potential for improving the management of patients with ASD. Further testing of this concept is warranted. [ABSTRACT FROM AUTHOR]

Background: Tai Chi and Baduanjin are nonpharmacological interventions that are widely applied among cancer patients. Objective: This meta-analysis aimed to assess the effect of Tai Chi and Baduanjin on breast cancer patients by summarizing and pooling the results of previous studies. Methods: The PubMed, Embase, Web of Science, Scopus and Cochrane Library and several databases were searched up to December 1, 2023, to identify high-quality RCTs. Relevant terms such as Tai Chi and Baduanjin were used as keywords. Stata 15.0 software and Review Manager (version 5.3; Cochrane Training) were used to screen the studies, extract the data, code the data, and perform the meta-analysis. The mean differences (MDs) and standardized mean differences (SMDs) with 95% CIs were used to calculate continuous variables. The Cochrane risk of bias assessment tool was used to evaluate the risk of bias. The PICOS framework was used to develop the following eligibility criteria: (i) population - breast cancer patients; (ii) intervention - Tai Chi and Baduanjin intervention; (iii) comparison - Tai Chi and Baduanjin group and different intervention (e.g., regular intervention, routine rehabilitation training, waiting list, sham Qigong, usual care, no intervention); (iv) outcomes - cognitive ability, shoulder joint function, anxiety, depression, fatigue, sleep quality, quality of life; and (v) study design - randomized controlled trial. Results: From January 2013 to December 2023, we included a total of 16 RCTs involving 1247 patients. A total of 647 patients were in the experimental group and were treated with Tai Chi and Baduanjin, while 600 patients were in the control group and were treated with traditional methods. The results of our meta-analysis indicate that Tai Chi and Baduanjin yield outcomes that are comparable to those of traditional treatment methods. Specifically, Tai Chi and Baduanjin significantly increased cognitive function, increased shoulder joint function, improved sleep quality indicators and improved quality of life indicators. Furthermore, Tai Chi and Baduanjin significantly reduced anxiety symptoms, depression symptoms, and fatigue symptoms among breast cancer patients. Sensitivity analysis was performed, a funnel plot was constructed. No publication bias was indicated by Egger's or Begg's test. Conclusion: Overall, Tai Chi and Baduanjin are viable and effective nonpharmacological approaches for treating breast cancer patients, as they yield better results than traditional treatment methods. However, these findings should be interpreted with caution due to the limited number of controlled trials, small sample sizes, and low quality of the evidence. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42023469301. [ABSTRACT FROM AUTHOR]

Background and objective: Nice knots have been used as an assisted reduction technique in surgery for displaced and comminuted fractures. This study aims to investigate the clinical efficacy of Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures. Methods: A retrospective study selected 210 patients with comminuted displaced clavicle fractures (January 2017–December 2020) in our hospital. The patients were divided into two groups via the fracture reduction method: the observation group (intramedullary Kirschner's wire fixation combined with modified Nice node-to-end cerclage temporarily fixation-assisted reduction; n = 42) and the control group (including four subgroups with 42 cases in each subgroup, with assisted reduction methods of clamp fixation, screw fixation, square knot fixation and Kirschner wire fixation; each subgroup n = 42). The operation time, intraoperative bleeding, visual analogue scale (VAS) score at 24 h after the operation, healing time, postoperative limb functional activities, patients' self-perception, subjective satisfaction and shoulder joint function were compared. Results: The operation time and the intraoperative blood loss of the observation group was significantly lower than that of each subgroup in the control group (p < 0.05). The VAS score of the observation group 24 h after the operation was significantly lower than that of each subgroup in the control group apart from the screw fixation group (p < 0.05). The Neer score of the observation group was significantly higher than that of each subgroup in the control group apart from the square knot fixation group (p < 0.05). The square knot is relatively better than the other four methods. Patients were generally satisfied with the modified Nice treatment. Conclusion: The use of a Kirschner wire intramedullary fixation combined with improved Nice knot-end cerclage temporarily fixation-assisted reduction before plate osteosynthesis in treating displaced and comminuted clavicle fractures can achieve satisfactory postoperative clinical results. [ABSTRACT FROM AUTHOR]

Glenoid loosening, primarily induced by the “rocking horse” phenomenon from humeral head load on the glenoid rim, is the foremost complication and cause of failure in anatomic total shoulder arthroplasty. The dynamic load exerted by universal fatigue testing machines significantly deviates from the standard ASTM F2028-14 in the rocking test. To accurately conduct the in vitro loosening test on anatomic glenoids, a specialized system and customized test methods are developed to achieve anatomic glenoid rocking and subluxation tests. The horizontal and vertical loading can be achieved synchronously or asynchronously by two self-developed high-performance electromagnetic linear motors. In addition, the subluxation tests on anatomic glenoids are verified by finite element simulation. The results show that the subluxation load and translation of anatomic glenoids in the subluxation tests are consistent with those in numerical simulations. The error of the applied axial force in the rocking tests is only 5N, strictly meeting the standard of ASTM F2028-14. During the rocking tests, the system runs smoothly and the software works well, indicating the feasibility of the in vitro shoulder joint test system. This study provides an approach to accurate dynamic evaluation of glenoid loosening or disassociation. [ABSTRACT FROM AUTHOR]

Introduction: The throwing motion in the javelin throw applies high loads to the musculoskeletal system of the shoulder, both in the acceleration and deceleration phases. While the loads occurring during the acceleration phase and their relationship to kinematics and energy flow have been relatively well investigated, there is a lack of studies focusing the deceleration phase. Therefore, the aim of this study is to investigate how the throwing arm is brought to rest, which resultant joint torques are placed on the shoulder and how they are influenced by the kinematics of the acceleration phase. Methods: The throwing movement of 10 javelin throwers were recorded using a 12-infrared camera system recording at 300 Hz and 16 markers placed on the body. Joint kinematics, kinetics and energy flow were calculated between the touchdown of the rear leg and the timepoint of maximum internal rotation after release +0.1 s. Elastic net regularization regression was used to predict the joint loads in the deceleration phase using the kinematics and energy flow of the acceleration phase. Results: The results show that a significant amount of energy is transferred back to the proximal segments, while a smaller amount of energy is absorbed. Furthermore, relationships between the kinematics and the energy flow in the acceleration phase and the loads placed on the shoulder joint in the deceleration phase, based on the elastic net regularized regression, could be established. Discussion: The results indicate that the loads of the deceleration phase placed on the shoulder can be influenced by the kinematics of the acceleration phase. For example, an additional upper body forward tilt can help to increase the braking distance of the arm and thus contribute to a reduced joint load. Furthermore, the energy flow of the acceleration phase can be linked to joint stress. However, as previously demonstrated the generation of mechanical energy at the shoulder seems to have a negative effect on shoulder loading while the transfer can help optimize the stress. The results therefore show initial potential for optimizing movement, to reduce strain and improve injury prevention in the deceleration phase. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the joint, racket, and ball kinematics between the different levels of male tennis players in tennis serve-return at slow and high serve speeds. Thirty male tennis players were divided into an advanced group (n = 15) and an intermediate group (n = 15) based on skill level. The advanced group and intermediate group matched shake hand-grip players performed serve-receive test at the different serve speeds. Kinematic data were collected on the trunk, upper limbs, racket and ball to compare the differences between the advanced and intermediate groups at different serve speeds. At both serve speeds, the AG has faster racket speed and ball speed, and is closer to the baseline placement (p<0.05). It is characterized by a faster trunk turn, greater speed with the shoulder joint forward and outward and greater angle of wrist flexion and extension during the stroke (p<0.05), and greater speed with the forearm inward and internal rotation during the follow-through swing, at the same time, there is a difference in the angle of the racket to the ground between the advanced group and an intermediate group(p<0.05). Elbow internal rotation and abduction angular velocity in the backswing phase, Timing of peak racket resultant velocity and Wrist extension in the stroke phase, and shoulder and elbow joint activities in the follow-through phase were significantly correlated with the ball speed of the return. With faster serve speeds, higher quality serve-receive can be achieved by shortening the duration of the backswing lifting the upper arm and rotating the forearm inward quickly, accelerating the speed of movement of wrist joints at the impact phase, adjusting the speed of shoulder adduction and elbow internal rotation to complete the follow-through swing. These findings help to improve elite players' serve-receive skills at faster serve speed. [ABSTRACT FROM AUTHOR]

Baseball pitching requires fast and coordinated motions of the whole body to reach high ball speeds, putting considerable strain on the musculoskeletal system, particularly the shoulder and elbow. To describe musculoskeletal symptoms and the functional status of the shoulder and elbow in male high school baseball pitchers. Descriptive epidemiology study. Dutch baseball talent academies. One hundred twenty-five male high school baseball pitchers aged 12 to 18 years who participated in 1 of the 6 Dutch baseball talent academies and the Dutch National U-18 team were recruited and enrolled. Musculoskeletal symptoms, functional status of the shoulder and elbow were registered for each player every 6 months over 2 consecutive baseball seasons through self-assessment questionnaires, including the Kerlan-Jobe Orthopaedic Clinic (KJOC) and the Western Ontario Shoulder Instability Index (WOSI) questionnaires. Five hundred seventy musculoskeletal (MSS) symptoms in 93 of the 125 players were reported. The average 6-month prevalence for symptoms of the throwing shoulder was 37% (95% CI = 33%–41%), and for the elbow 37% (95% CI = 31%–42%), followed by the lower back with 36% (95% CI = 26%–45%). The baseball pitchers who experienced only shoulder symptoms had an average KJOC score of 80.0 (95% CI = 75.3–84.7) points, whereas those with only elbow symptoms reported a score of 90.2 (95% CI = 89.2–95.3). On the WOSI questionnaire, baseball pitchers scored an average of 421.2 (95% CI = 200.1–642.4) points. In a cohort of Dutch high school baseball pitchers, one-third reported shoulder and elbow symptoms on the throwing side, with reduced functional status and lower back symptoms. Future efforts should focus on developing preventive strategies through early symptom detection, aiming to prevent symptom progression and, ultimately, the development of severe injuries. [ABSTRACT FROM AUTHOR]

Objective: To determine if additional pathology is present in low-grade acromioclavicular (AC) joint injuries. Design: Prospective case series. Setting: Patients were assessed by primary care sports medicine physicians at a single institution between 2019 and 2023. Patients: Patients aged 18 to 65 years diagnosed with a type I to III AC injury based on clinical and radiographic evaluation. Intervention: Consenting patients underwent magnetic resonance imaging (MRI) evaluation within 21 days of injury. All injuries were treated nonoperatively. Main OutcomeMeasures: Additional pathologies identified on MRI were reported in a standardized fashion by fellowship-trained musculoskeletal radiologists. Results: Twenty-nine patients (26 men/3 women) were consented with a mean (6SD) age of 28.669.5 years. The mean time from injury to MRI was 8.165.9 days. Twenty-three injuries were sport related, and 6 were accidental traumas. Based on MRI, injury type was reclassified in 16 of 29 patients, and 13 remained unchanged. Additional pathologies identified included 14 muscle injuries, 5 rotator cuff tears, 5 labral tears, 1 nondisplaced fracture, and 1 intra-articular body. Conclusion: MRI evidence suggests that most AC joint injuries are more severe than clinically diagnosed. Identifying additional pathology may alter diagnostic and treatment guidelines for type I to III AC joint injuries. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study was to evaluate determinants of between-person variation in shoulder pain ("yes"/"no") in individuals with spinal cord injury living in Switzerland. Design: This longitudinal study used data from the Swiss Spinal Cord Injury Cohort community surveys 2012, 2017, and 2022. Logistic regression analyses were used to identify determinants of between-person variability in shoulder pain while controlling for within-person variability. Results: The prevalence of shoulder pain was 34.4% (95% CI = 33.0-35.9) when studying 4393 completed questionnaires. Significant determinants for between-subject variability revealed higher likelihoods for shoulder pain in females as compared with males (odds ratio: 1.57; 95%CI = 1.21-2.05), and when spasticity (1.49; 1.14-1.95), contractures (2.77; 2.21-3.48), and depression (1.39; 1.02-3.48) were present. In addition, shoulder pain presented highest likelihoods in individuals with incomplete tetraplegia (1.81; 1.32-2.48) versus incomplete paraplegia, in individuals over 26 yrs since injury (1.65; 1.15-2.37) versus up to 5 yrs since injury, and in individuals using a manual (2.17; 1.53-3.08) or electrical (2.16; 1.41-3.31) wheelchair versus no aids. There were significant interaction effects for gender with time since injury, contractures, and depression. Conclusions: Determinants of between-subject variability in shoulder pain were female gender, lesion severity, time since injury, specific health conditions, and wheelchair use. [ABSTRACT FROM AUTHOR]

Bone marrow edema (BME) in the acromioclavicular joint (ACj) may occur after arthroscopic rotator cuff repair (ARCR), resulting in persistent postoperative ACj pain. We investigated the incidence and clinical characteristics of BME in ACj after ARCR. Patients exhibiting ACj-related symptoms prior to ARCR surgery, no BME in the ACj on MRI, and an ability to undergo 2-year postoperative physical and MRI examinations of the ACj were included. Patients who underwent distal clavicle resection or osteophyte resection below the ACj and those unable to achieve primary repair of the rotator cuff were excluded. MRI evaluation was performed preoperatively and at 3, 6, 12, and 24 months postoperatively. Patients who showed BME in ACj on fat-suppressed T2 MRI at 24 months postoperatively were classified into the BME + group, and those with no BME were classified into the BME− group. Patient background, operation time, Japanese Orthopedic Association (JOA) score, re-tear rate, ACj tenderness, and cross-body adduction test were compared between groups. In addition, we examined the time of occurrence of BME. A total of 345 ARCRs were performed during the study period. After the exclusion of 114 shoulders, the remaining 231 shoulders were included in this study. There were 208 cases in the BME− group and 23 cases in the BME + group. The incidence of BME was 9.96 %. Although the JOA scores of both groups showed a significant improvement postoperatively compared to preoperatively, there was no significant difference between the two groups. In terms of re-tear, there was 1 case in the BME + group and 7 in the BME− group. Positive ACj tenderness and cross-body adduction test were significantly higher in the BME + group (P < 0.001). BME occurred in 6 cases at 3 months, 9 cases at 6 months, and 8 cases at 1 year postoperatively. None of the patients developed BME at more than 1 year postoperatively. BME was observed on MRI in all cases at 2 years postoperatively. The rate of occurrence of BME in the ACj after ARCR was 9.96 %. Patients with BME were significantly more likely to have ACj tenderness and positive cross-body adduction test. BME in the ACj often occurs within 6 months to 1 year after ARCR of small-to-medium rotator cuff tears, suggesting a relationship with postoperative functional improvement of the shoulder joint. The ACj should be considered as a potential site of persistent pain after ARCR for small-to-medium rotator cuff tears. [ABSTRACT FROM AUTHOR]

This study aimed to morphologically and histologically examine whether pig is useful as models for rotator cuff tear (RCT). The morphology of the scapula and humerus bones was evaluated by taking X-ray and three-dimensional computed tomography (3D CT) scans of the right shoulders of five female pigs (age: 4 months). The rotator cuff (RC) footprint at the humeral insertion of these was observed and its shape was measured. Next, they underwent general anesthesia and an acute rotator cuff tear/rotator cuff repair (RCT/RCR) model was created using a deltoid split approach. Four weeks after surgery, the animals were euthanized, the shoulder joints were harvested, and the repaired RC was evaluated by hematoxylin and eosin staining and toluidine blue staining. The scapula of the pig had a vestigial acromion, in contrast to that in humans. The supraspinatus and infraspinatus tendons were connected so as to overlap each other and attached to the postero-superior part of the greater tuberosity. These tendons were located extra-articularly, separate from the joint capsule. The average antero-posterior length of the foot print was 17.4 ± 0.7 mm on the medial margin and 19.1 ± 2.2 mm on the lateral margin. The maximum medial-to-lateral width of it was 5.1 ± 0.5 mm. In all RCT/RCR models at 4 weeks after surgery, the repaired RC compound tendon was visually confirmed to be continuous with the footprint. Histologically, it was confirmed that regeneration of the four-layer structure of the bone-tendon junction had occurred. Porcine supraspinatus and infraspinatus attachment to the greater tuberosity have a structure similar to that of sheep and dogs, which is advantageous for creating the RCT/RCR model. It might be used for future in vivo studies of shoulder joint diseases. Pigs could potentially serve as a viable model for rotator cuff tears. [ABSTRACT FROM AUTHOR]

Background/Objectives: Understanding how dual-tasking and Parkinson's disease medication affect gait and balance regularity can provide valuable insights to patients, caregivers, and clinicians regarding frailty and fall risk. However, dual-task gait and balance studies in PD most often only employ linear measures to describe movement regularity. Some have used nonlinear techniques to analyze PD performances, but only in the on-medication state. Thus, it is unclear how the nonlinear aspects of gait or standing balance are affected by PD medication. This study aimed to assess how dopaminergic medication influenced the regularity and determinism of joint angle and anterior–posterior (AP) and medial–lateral (ML) center of pressure (COP) path time-series data while single- and dual-tasking in PD. Methods: Sixteen subjects with PD completed single- and dual-task gait and standing balance trials for 3 min off and on dopaminergic medication. Sample entropy and percent determinism were calculated for bilateral hip, knee, and shoulder joints, and the AP and ML COP path. Results: There were no relevant medication X task interactions for either the joint angles series or the balance series. Instead, the results supported independent effects of medication, dual-tasking, or standing with eyes closed. Balance task difficulty (i.e., eyes open vs. eyes closed) was detected by the nonlinear analyses, but the nonlinear measures yielded opposing results such that standing with eyes closed simultaneously yielded less regular and more deterministic signals. Conclusions: When juxtaposed with previous findings, these results suggest that medication-induced functional improvements in people with PD might be accompanied by a shift from lesser to greater signal consistency, and the effects of dual-tasking and standing with eyes closed were mixed. Future studies would benefit from including both linear and nonlinear measures to better describe gait and balance performance and signal complexity in people with PD. [ABSTRACT FROM AUTHOR]

Rotator cuff tears (RCT) are the most common cause of shoulder pain among adults. "Rotator cuff" refers to the four muscles that cover the shoulder joint: supraspinatus, infraspinatus, subscapularis, and teres minor. These muscles help maintain the rotational movement and stability of the shoulder joint. RCT is a condition in which one or more of these four muscles become ruptured or damaged, causing pain in the arms and shoulders. RCT results from degenerative changes caused by chronic inflammation of the tendons and consequent tendon tissue defects. This phenomenon occurs because of the exhaustion of endogenous tendon stem cells. Tendon regeneration requires rejuvenation of these endogenous tendon stem/progenitor cells (TSPCs) prior to their growth phase. TSPCs exhibit clonogenicity, multipotency, and self-renewal properties; they express classical stem cell markers and genes associated with the tendon lineage. However, specific markers for TSPC are yet to be identified. In this review, we introduce novel TSPC markers and discuss various strategies for TSPC reprogramming. With further research, TSPC reprogramming technology could be adapted to treat age-related degenerative diseases, providing a new strategy for regenerative medicine. [ABSTRACT FROM AUTHOR]

Background: The critical shoulder angle (CSA) has become an important topic of study in patients with rotator cuff tears (RCTs). However, there are conflicting data on whether the CSA can differentiate between patients with normal shoulder pathology and full-thickness RCTs on shoulder radiographs. Purpose/Hypothesis: The purpose of this study was to define the relationship between full-thickness RCTs and the CSA. It was hypothesized that patients with full-thickness RCTs would have an increased CSA compared with matched controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This retrospective case-control study identified patients with magnetic resonance imaging scans showing full-thickness RCTs between 2009 and 2019. A 1 to 1 propensity score match was performed to identify a control group with normal rotator cuffs while controlling for baseline participant characteristics—including age, sex, body mass index, and tobacco use. A total cohort of 532 was identified, with 266 cases and 266 controls. Two independent observers measured CSAs on true anteroposterior shoulder radiographs. Results: There was no difference in baseline participant characteristics between the RCT and the non-RCT groups (P >.05). The mean CSA for the entire cohort was 33.6°± 4.2°. The CSA did not significantly vary by sex (P =.088) or tobacco usage (P =.16). The mean CSA for the RCT case group, 36.2°± 3.3°, was significantly different from the mean CSA for the control group, 30.9°± 3.3° (P <.0001). The receiver operating characteristic curve analysis produced an area under the curve of 0.88 (P <.0001). At CSAs ≥35°, there was a 67.7% sensitivity and 89.4% specificity for having a full-thickness RCT. Last, each degree of increase in the CSA increased the risk of having an associated RCT by 1.7 times (OR, 1.7 [95% CI, 1.551-1.852]; P <.0001). Conclusion: Patients with RCTs had significantly higher CSAs compared with matched controls. Increased CSA was an independent risk factor for RCTs, with an odds ratio of 1.7 per degree. The CSA is an accurate test (area under the curve, 0.88) with good sensitivity (67.7%) and specificity (89.4%) at values ≥35°. The CSA is a simple, reproducible measurement that can assist in clinical decision-making regarding full-thickness RCTs. [ABSTRACT FROM AUTHOR]

Background: Nonoperative management of posterior shoulder instability is common. However, limited data are available to assess the pathomorphologic factors associated with its failure. Purpose/Hypothesis: The purpose of this study was 2-fold: (1) to determine glenohumeral pathomorphologic features predictive of nonoperative management failure of posterior instability; and (2) to determine the relationship between nonoperative management failure and posterior glenoid bone loss (pGBL) progression. It was hypothesized that greater posterior acromial height (PAH) would adversely affect nonoperative survivorship and that shoulders treated nonoperatively would have pGBL progression compared with those undergoing surgical stabilization. Study Design: Case-control study; Level of evidence, 3. Methods: This was a retrospective review of a consecutive series of patients with isolated posterior shoulder instability, defined as isolated posterior labral tear on magnetic resonance imaging (MRI) with corresponding physical examination findings, who underwent nonoperative management for 6 months and had no previous related surgical history. The primary outcome of interest was the failure of nonoperative management, defined as the inability to return to full military duty or requiring surgical intervention. The morphologic features assessed for association with nonoperative management failure included pGBL, glenoid version, acromial morphology, and posterior humeral head subluxation. We secondarily sought to determine the progression of pGBL on serial MRI scans. Cox proportional hazard analysis was used to evaluate risk factors for failure. Results: In this study, 42 of 90 (46.7%) patients had failed nonoperative management and went on to receive an arthroscopic stabilization procedure. The group with failed treatment demonstrated a greater humeral head subluxation ratio than those with successful nonoperative management (0.65 ± 0.2 vs 0.62 ± 0.2; P =.038). Cox proportional hazard analysis identified pGBL, greater PAH, less posterior acromial coverage, and posterior humeral subluxation as significant risk factors for failure. Of those with failed nonoperative management, 17 had repeat MRI scans at a mean of 488.2 ± 87 days after index MRI for comparison, demonstrating a statistically significant progression of pGBL (index MRI, 2.68% ± 1.71%) versus after nonoperative treatment failure (6.54% ± 1.59%; P =.003). Conclusion: Failure occurred 47% of the time in patients who underwent nonoperative management for isolated posterior glenohumeral instability for a minimum of 6 months, and it was associated with a greater posterior humeral head subluxation, less posterior acromial coverage, greater PAH, and greater amounts of glenoid retroversion on index MRI. Additionally, those who had repeat MRI approximately 1 year after the index MRI demonstrated greater pGBL compared with the index MRI. [ABSTRACT FROM AUTHOR]

Background: Injuries to the glenoid labrum have been recognized as a source of joint pain and discomfort, which may be associated with the inflammatory responses that lead to the deterioration of labral tissue. However, it is unclear whether the torn labrum prompts mast cell (MC) activation, resulting in synovial inflammatory responses that lead to labral tissue degeneration. Purpose: To determine the potential influence of activated MC on synovial inflammatory responses and subsequent labral tissue degeneration and shoulder function deterioration in a rat model by monitoring MC behavior and sequential inflammatory responses within the synovial tissue and labral tissue after injury, suture repair, and MC stabilizer administration. Study Design: Controlled laboratory study. Methods: Anteroinferior glenoid labral tears were generated in the right shoulder of rats (n = 20) and repaired using a tunneled suture technique. Synovial tissue inflammatory responses were modulated in some rats with intraperitoneal administration of an MC stabilizer—cromolyn (n = 10). At weeks 1 and 3, MC activation, synovial inflammatory responses, and labral degeneration were histologically evaluated. Simultaneously, gait analysis was performed before and after surgical repair to assess the worsening of the shoulder function after the injury and treatment. Results: Resident MC degranulation after labral injury (50.48% ± 8.23% activated at week 1) contributed to the initiation of synovial tissue inflammatory cell recruitment, inflammatory product release, matrix metalloproteinase-13, and subsequent labral tissue extracellular matrix degeneration. The administration of cromolyn, an MC stabilizer, was found to significantly diminish injury-mediated inflammatory responses (inflammatory cell infiltration and subsequent proinflammatory product secretion) and improve shoulder functional recovery. Conclusion: MC activation is responsible for labral tear–associated synovial inflammation and labral degeneration. The administration of cromolyn can significantly diminish the cascade of inflammatory reactions after labral injury. Clinical Relevance: Our findings support the concept that MC stabilizers may be used as a complementary therapeutic option in the treatment and repair of labral tears. [ABSTRACT FROM AUTHOR]

Pectoralis major injuries are uncommon, typically affecting young male athletes engaging in high-intensity activities like weightlifting. A 62-yr-old man, who previously suffered a stroke leading to left hemiparesis, hemisensory loss, and spasticity, exhibited a left chest swelling during a rehabilitation clinic visit. Subsequent inquiries revealed his recent incorporation of a home-based pulley system for stretching exercises. On examination, the swelling was diffuse, firm, and nontender, located at the midclavicular line of his left chest, with a positive dropped nipple sign and loss of the left anterior axillary fold sign. An ultrasound confirmed a low-grade injury to the left pectoralis major tendon. Spastic muscle ruptures are extremely rare, with only three published reports linked to traumatic brain injury, multiple sclerosis, and spinal cord injury. Spasticity increases muscle vulnerability due to structural and mechanical changes to the skeletal muscles. This is the first report of a spastic pectoralis major tendon rupture and the first after a stroke. This case highlights the need for optimized multimodal spasticity management and reinforces the importance of comprehensive patient education on the safe execution of home-based stretching exercises. [ABSTRACT FROM AUTHOR]

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(1) Background: This case study analyzed the successful performances of female gymnasts in the finals of the 39th and 40th World Cup in Maribor (SLO). The aim was to identify variations in their execution of the Clear Hip Circle to Handstand (CHCH) on uneven bars based on kinematic parameters. (2) Methods: This study involved elite female gymnasts from the 39th (n = 5, age: 17 ± 6 months) and 40th (n = 8, age: 17.5 ± 6 months) World Cups, totaling 13 gymnasts. Kinematic analysis was performed on 15 successful routines using the Ariel Performance Analysis System (Ariel Dynamics Inc., San Diego, CA). The analysis focused on 16 anthropometric reference points and 8 body segments, including the body mass center of gravity (CG). The main reference points analyzed were the hip joint, the shoulder joint, and the CG along the xy-axes. Trajectory, velocity, angle, and angular velocity of the hips and shoulders were calculated. Pearson correlation analysis was employed to assess the relationships between the kinematic variables. (3) Results: High intercorrelations between the reference points along the xy-axes (0.81–0.99) and optimal movement velocity were found. Dispersed results were observed for kinematic parameters of angle (0.10–0.16) and angular velocity of the hip joints (0.60–1.00), with similar dispersions for shoulder joints (0.51–1.00). Three distinct techniques were identified: (1) stretched body with minimal hip joint flexion throughout; (2) extended body with a short, quick hip joint extension during shoulder movement; and (3) hyperextension in the hip joint. (4) Conclusions: The kinematic analysis revealed three different performance styles of the CHCH among finalists. These variations in technique do not affect the success of the performance. This research contributes to a better understanding of the technique but does not prefer one style over another. [ABSTRACT FROM AUTHOR]

Background/Objectives: Individuals with spinal cord injuries have a higher incidence of chronic conditions such as hypertension and cardiovascular diseases due to a sedentary lifestyle and low levels of physical activity caused by their disability. Additionally, their physical fitness levels are lower compared to those without disabilities. This cross-sectional study aimed to investigate the relationship between hypertension and the fitness of individuals with spinal cord injuries in South Korea while considering differences across sexes and spinal cord injury levels. Methods: This study used data for 835 individuals with spinal cord injuries aged 20–64 years who visited the Korea Paralympic Committee fitness standard test centers from 2018 to 2022, obtained from the Korea Culture Information Sports Association's big data market. The data were analyzed using a series of t-tests, a one-way analysis of variance, a logistic regression analysis, and the four-quartile method. Results: The prevalence of hypertension was 24.4%, and it was different according to the spinal cord injury impairment level. A lower grip strength, a lower arm curl, and a higher body mass index were associated with increased blood pressure. Conclusions: Therefore, a high level of physical strength in people with spinal cord injuries is thought to contribute to lowering blood pressure. [ABSTRACT FROM AUTHOR]

Background: Due to its deep position and complex surrounding anatomy, the scapular glenoid fracture was relatively difficult to deal with especially in cases of severe fracture displacement. Improper treatment may lead to failure of internal fixation and poor fracture reduction, severely affecting the function of the shoulder joint. Inferior scapular glenoid fracture was Ideberg type II fracture, and posterior approach was commonly used to deal with inferior scapular glenoid fracture. However, there are shortcomings of above surgical approach for inferior scapular glenoid fracture, such as insufficient exposure of the operative field, significant trauma, and limited screw fixation direction. This study adopts the axillary approach for surgery, which has certain advantages. Methods: The clinical data of 13 patients with Ideberg type II scapular glenoid fractures treated from December 2018 to January 2024 were retrospectively analyzed. There were 8 males and 5 females, with an age range of 19 to 58 years and an average age of 38 years. The causes of injury were falls from heights in 7 cases and car accidents in 6 cases. There were 5 cases on the left side and 8 cases on the right side. The time from injury to surgery was 2 to 11 days, with an average of 5.5 days. All cases underwent open reduction and internal fixation through the axillary approach. Postoperative X-ray and CT three-dimensional reconstruction were performed on the next day to evaluate the fracture reduction and the position of internal fixation. During the follow-up period, follow-up examinations were performed every two months in the first half of the year and every three months in the second half. CT scans were performed during the examinations to assess the glenohumeral joint congruence, fracture healing, and position of internal fixation. The shoulder joint function was evaluated at 6 months postoperatively according to the Constant-Murley value score. Results: The patients all achieved primary wound healing after surgery, without any complications such as infection or nerve injury. Re-examination on the second day after operation, all fractures obtained excellent reduction, and the internal fixation was in excellent position, and no screw was found to enter the joint cavity. All patients in this group were followed up for 6 to 25 months, with an average follow-up time of 11.7 months. All fractures were bony unioned, and the healing time ranged from 4 to 6 months, with an average healing time of 4.8 months. At 6-month follow-up, according to the Constant-Murley score, 11 cases were excellent and 2 case was good. Conclusion: Open reduction and internal fixation through the axillary approach is an feasible and safe surgical method for the treatment in scapular Ideberg type II glenoid fractures with less stripping of soft tissue, minimal surgical trauma, and the incision is concealed and beautiful. It can provide a strong internal fixation for fractures, so patients can perform functional exercise early after operation, and the clinical results is satisfactory. [ABSTRACT FROM AUTHOR]

The primary aims of the study were to perform a descriptive analysis of hitting energetics off a pitching machine and to compare between the rear- and lead-side lower and upper extremities. Eighty-five high school to minor league baseball athletes participated. Five full-effort swings off a pitching machine with the fastest exit velocity were used for analysis. Energy flow was quantified using a segment power analysis. Wilcoxon signed-rank test revealed significant differences between rear- and lead-side energetics during both swing phases. During the stride, the rear knee and shoulder generated more energy than the lead side. Throughout the swing phase the lead knee, hip, and elbow generated more energy than the rear side, but at the shoulder the rear side generated significantly more energy than the lead. Most intriguing, differing energy transfer directions between the rear and lead knee and shoulder joints were reported. Furthermore, descriptive results revealed energy is predominantly transferred across the knee, shoulder, and elbow joints, while the hips primarily display energy generation. The descriptive nature of the study provides a foundation for future research and can be used as a resource for training personnel to design effective training protocols aimed at maximizing performance. [ABSTRACT FROM AUTHOR]

Background: Data regarding fungal PJIs of the shoulder are scarce. The present systematic review aims to identify and evaluate all published shoulder fungal PJIs in an effort to better understand the diagnostic and therapeutic approach to these infections. Methods: A systematic review according to the PRISMA guidelines was conducted, locating all shoulder fungal PJIs. The initial search located 1435 articles. Data were collected on demographics, the causative fungus, antifungal treatment (AFT), surgical interventions, and infection outcomes. Results: After screening and implementation of the inclusion criteria, a total of 10 articles, including 10 cases, were eligible. The sample's mean age was 62.44 years. Diabetes mellitus was the most common comorbidity (30%), while 70% were immunocompromised. Candida spp. was the most common causative fungus (nine cases; 90%), while all cases were confirmed with cultures. In three cases (30%), there was bacterial co-infection. The mean duration of antifungal treatment (AFT) was 8.4 weeks, while the preferred agent was fluconazole (60% of cases), followed by amphotericin B (30%). Most cases (50%) underwent resection arthroplasty as part of the treatment, while two-stage revision arthroplasty was performed in 30%. Infection's eradication was reported in 90% of the studied cases. Conclusions: The diagnosis and management of fungal periprosthetic shoulder infections are particularly challenging and require a multidisciplinary approach. The combination of antifungal therapy and tailored surgical strategies is crucial, but further research is needed to refine treatment protocols and address the unique considerations in shoulder PJIs. [ABSTRACT FROM AUTHOR]

Background: Treatment of rotator cuff diseases often involves various arthroscopic procedures but their combined effectiveness remains contentious, especially in complex cases. Methods: We focused on patients with degenerative shoulder cuff diseases requiring arthroscopic rotator cuff repair. Searches covered multiple databases (Medline, Embase, Web of Science, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Cochrane Clinical Answers) up to April 1, 2024. Bias risk was assessed using RevMan (v 5.4), and a network meta-analysis was conducted with netmeta (v 2.8). Result: From 16 studies, 1232 patients (average age, 56.2 years; balanced sex ratio) were included. Arthroscopic rotator cuff repair ranked highest in functional score networks, surpassing other interventions. Physiotherapy was superior for pain relief compared to arthroscopic procedures combined with platelet-rich plasma (mean, 2.5; 95% confidence interval, 4.48–0.52). Arthroscopic rotator cuff repair and subacromial decompression were significantly superior to arthroscopic rotator cuff repair and subacromial decompression combined with platelet-rich plasma (MD, 1.80; 95% CI, 3.39–0.21). Discussion: Moderate bias risks were noted in both networks due to blinding issues and methodological quality reporting. Arthroscopic rotator cuff repair is favored for improving shoulder function, while other procedures or intra-articular treatments offer no significant benefits. Regarding pain management, physiotherapy is preferred; however, more evidence is needed to support this recommendation and caution is advised. Other: Systematic review registration PROSPERO CRD42023450150. [ABSTRACT FROM AUTHOR]

Purpose: To explore patient experiences of rotator cuff-related shoulder pain, and their views on the role and value of diagnostic shoulder imaging. Materials and methods: Semi-structured interviews were conducted with 20 patients with shoulder pain exploring the impact and management of their shoulder condition, reasons for and experiences of diagnostic imaging, and feelings about and responses to diagnostic imaging findings. Framework analysis was used to analyse the dataset. Results: Five themes were identified [1]: Lived experience and beliefs about pain and movement [2]; Contextualisation of imaging findings by health professionals is more important than the imaging report [3]; Factors influencing whether and when to have imaging [4]; Imaging can identify the actual problem and guide treatment; and [5] Treatment responses and treatment decision making. Conclusion: Patients commonly believe imaging is needed to formulate a diagnosis. There was minimal concern about potential indirect harms that could arise (e.g., inappropriate diagnosis leading to unnecessary treatments). The context of the diagnostic imaging reports (i.e., what needed to be done) was perceived as more important than the exact meaning of the imaging findings. Patients felt that the diagnostic imaging confirmed their existing biomedical beliefs, and these beliefs were not challenged by their healthcare professionals. IMPLICATIONS FOR REHABILITATION: Patients with shoulder pain may believe imaging is necessary for diagnosis and defining treatment yet do not consider potential indirect harms (e.g., unnecessary treatment for findings that are not relevant). Health professionals should ensure patients are aware of imaging limitations and harms and facilitate shared decision-making about whether to have imaging. Health professionals also have an important role in the appropriate contextualisation of imaging findings (i.e., they do not necessarily relate to pain nor guide treatment). [ABSTRACT FROM AUTHOR]

Wheelchair basketball players often develop shoulder pain due to repetitive wheelchair propulsion motion. Wheelchair propulsion involves two phases, push and recovery, with several different muscles simultaneously active in each phase. Although differences in the coordinated activity of multiple muscles may influence the mechanism of injury occurrence, there have been no studies investigating muscle synergy in wheelchair propulsion motion. Twelve healthy adult males with no previous wheelchair driving experience were included. The surface electromyography data of 10 muscles involved in shoulder joint movements were measured during a 20 m wheelchair propulsion motion. Muscle synergies were extracted using non-negative matrix factorization analysis of the electromyography data. Four muscle synergies were identified during wheelchair propulsion. Synergy 1 reflects propulsion through shoulder flexion and elbow flexion, while Synergy 2 involves shoulder flexion and elbow extension. Synergy 3 describes shoulder extension returning the upper limb, which has moved forward during the push, back to its original position, and Synergy 4 relates to stabilize the shoulder girdle during the recovery phase. This study is the first to explore muscle synergy during wheelchair propulsion, and the data from healthy participants without disabilities or pain will provide a baseline for future comparisons with data from wheelchair basketball players. [ABSTRACT FROM AUTHOR]

Objective By comparing with arthroscopic rotator cuff repair alone, to explore the efficacy and difference of leukocyte poor platelet-rich plasma (LP-PRP) and leukocyte rich platelet-rich plasma (LR-PRP) in arthroscopic rotator cuff repair. Methods Sixty patients with total rotator cuff tear accompanied by arthroscopic rotator cuff repair admitted to the Affiliated Hospital of North China University of Science and Technology from October 2021 to September 2022 were included and randomly divided into control group (n = 20), LP-PRP group (n = 20) and LR-PRP group (n = 20). The control group only received arthroscopic rotator cuff repair. The LP-PRP group was injected with leukocyte poor platelet-rich plasma (LP-PRP) into the sutured torn tendon after the same operation, and the LR-PRP group was injected with leukocyte rich platelet-rich plasma (LR-PRP) into the sutured torn tendon after the same operation. The postoperative rehabilitation training plan of the three groups was the same, and the postoperative follow-up and evaluation were conducted for 1 year. It included pain score (VAS score), shoulder joint function score (CMS, UCLA, ASES score), retear rate and related complications. Results All patients were followed up. (1) VAS score: Compared with the LR-PRP group and the control group, the results were statistically significant only at 1,3 and 6 weeks after surgery (P < 0.05) ; There was no statistical significance between the LR-PRP group and the control group at 1 week, 3 weeks, 6 weeks, 3 months, 6 months and 12 months after surgery(P > 0.05). (2)CMS, UCLA and ASES scores: There were no significant differences between the LP-PRP group and the LR-PRP group at 3 months, 6 months and 12 months after surgery(P > 0.05); Compared with LP-PRP group and LR-PRP group, there were significant differences in each follow-up time point of control group (P < 0.05). (3) Retear rate: In the LP-PRP group, there was 1 retear in the LR-PRP group (tear rate 5%), and 3 in the control group (tear rate 15%). There was no statistically significant difference between the three groups (P > 0.05). (4) There were no postoperative complications in 60 patients. Conclusions Compared with arthroscopic rotator cuff repair alone, although the application of LP-PRP and LR-PRP could not reduce the rate of retear, it could significantly improve the shoulder joint function of patients, and LP-PRP could significantly reduce the pain of patients with rotator cuff injury in the early postoperative period (within 6 weeks), with no postoperative complications, and the short-term clinical results of patients were satisfactory. [ABSTRACT FROM AUTHOR]

Background: Three‐dimensional gradient‐echo (3D‐GRE) sequences provide isotropic or nearly isotropic 3D images, leading to better visualization of smaller structures, compared to two‐dimensional (2D) sequences. The aim of this study was to prospectively compare 2D and 3D‐GRE sequences in terms of key imaging metrics, including signal‐to‐noise ratio (SNR), contrast‐to‐noise ratio (CNR), glenohumeral joint space, image quality, artifacts, and acquisition time in shoulder joint images, using 1.5‐T MRI scanner. Methods: Thirty‐five normal volunteers with no history of shoulder disorders prospectively underwent a shoulder MRI examination with conventional 2D sequences, including T1‐ and T2‐weighted fast spin echo (T1/T2w FSE) as well as proton density‐weighted FSE with fat saturation (PD‐FS) followed by 3D‐GRE sequences including VIBE, TRUEFISP, DESS, and MEDIC techniques. Two independent reviewers assessed all images of the shoulder joints. Pearson correlation coefficient and intra‐RR were used for reliability test. Results: Among 3D‐GRE sequences, TRUEFISP showed significantly the best CNR between cartilage‐bone (31.37 ± 2.57, p < 0.05) and cartilage‐muscle (13.51 ± 1.14, p < 0.05). TRUEFISP also showed the highest SNR for cartilage (41.65 ± 2.19, p < 0.01) and muscle (26.71 ± 0.79, p < 0.05). Furthermore, 3D‐GRE sequences showed significantly higher image quality, compared to 2D sequences (p < 0.001). Moreover, the acquisition time of the 3D‐GRE sequences was considerably shorter than the total acquisition time of PD‐FS sequences in three orientations (p < 0.01). Conclusions: 3D‐GRE sequences provide superior image quality and efficiency for evaluating articular joints, particularly in shoulder imaging. The TRUEFISP technique offers the best contrast and signal quality, making it a valuable tool in clinical practice. [ABSTRACT FROM AUTHOR]

AbstractThis paper presents the design and optimization process of a Virtual Biomechanical Shoulder Robot Model (VBSRM) based on a 6-4 parallel mechanism. To address the challenges posed by parallel manipulators and the specific biomechanical constraints of the shoulder joint, a comprehensive design analysis is conducted. First, a kinematic model of the VBSRM is developed, followed by an investigation of its geometric model. To obtain an optimal VBSRM design, performance objectives such as condition number, norm of actuator force, and stiffness are identified and optimized. Initially, only condition number of the robot mechanism is optimized using Genetic Algorithm and performance objectives from the optimal design are analyzed. Later, the three objectives are grouped to form a single function and a single objective-based optimization is also conducted. However, further investigation revealed the conflicting nature of the objectives and hence these were simultaneously optimized using the Non-dominated Sorting Genetic Algorithm (NSGA II). The results obtained from various optimization routines are compared and it is found that the results from the NSGA II provide a better tradeoff between the performance objectives. The motion trajectories from the optimal design of the VBSRM are later analyzed vis-à-vis human shoulder motions for its intended use as a robotic model of the human shoulder joint in various applications. [ABSTRACT FROM AUTHOR]

Objective: The objective of the case report is to analyze the clinical manifestations and imaging features of gouty long head of biceps tendinitis, and to summarize the methods and effects of shoulder arthroscopic surgery. Clinical presentation and intervention: The clinical data of a 39-year-old Han Chinese female with gouty long head of the biceps tendinitis was retrospectively analyzed, and the clinical manifestations, imaging features, and diagnosis and treatment were analyzed. The patient presented with pain and limited movement of right shoulder joint. Computed tomography showed irregular high-density shadows above the glenoid and adjacent to the coracoid process of the right shoulder. Magnetic resonance imaging revealed superior labrum anterior and posterior injury with edema in the upper recess and axillary sac. After arthroscopic surgery, the "tofu residue" tissue of the long head of the biceps was removed, and the postoperative pathological examination proved that it was gout stone. Conclusion: Gouty long head of the biceps tendinitis is a rare disease. Arthroscopic surgery can probe the structural lesions of shoulder cavity in all aspects, improve the surgical accuracy, and reduce the trauma. [ABSTRACT FROM AUTHOR]

Background: The integration of Virtual Reality (VR) with Case-Based Learning (CBL) has the potential to revolutionise undergraduate medical education, particularly in complex subjects such as the anatomy and rehabilitation of the shoulder joint. This study aimed to explore the effectiveness of this innovative approach in enhancing learning outcomes and knowledge retention. Methods: This study employed a parallel-group, assessor-blinded randomised controlled trial (RCT) design. A comprehensive five-week educational programme was developed, combining traditional lecture-based learning with VR-enhanced CBL. The study involved 82 undergraduate students from China Medical University, who were divided into groups receiving different combinations of VR and CBL. Student performance was evaluated through tests and questionnaires. Results: In the anatomy-related courses, the integration of VR technology with CBL yielded significantly higher results (87.71 ± 5.60) compared to traditional methods (82.59 ± 6.64), with a statistically significant difference (P < 0.05). This provides compelling evidence of VR's potential to enhance student engagement and knowledge retention. In the context of physiotherapy-related courses, however, while the test scores of the VR-combined CBL group (81.85 ± 5.99) were marginally higher than those of the traditional CBL group (79.02 ± 7.57), this difference was not statistically significant (P > 0.05). Conclusion: The present study provides preliminary evidence for the benefits of incorporating VR into medical education, particularly in anatomy. While the results are promising, further research is needed to explore the optimal integration of VR and CBL in rehabilitation studies and to assess their long-term impact on student learning and clinical performance. Trial registration: The study was registered with Chinese Clinical Trials Registry (Registration Number: ChiCTR2400089295) on 05/09/2024. [ABSTRACT FROM AUTHOR]

Introduction: The shoulder joint's stability is largely provided by the rotator cuff muscles and tendons, crucial for dynamic stabilization. Pathologies in these muscles are major causes of shoulder pain and disability. USG and MRI are non-invasive, radiation-free imaging methods with high sensitivity for diagnosing rotator cuff disorders, offering complementary diagnostic insights. Methodology: Patients presenting with complaints of pain in shoulder joint, restricted movements or clinical suspicion of RC disorders were referred to Radiodiagnosis Department of Muzaffarnagar Medical college. In this study, 30 patients of both genders were studied in age between 20 to 60 years. HRUSG followed by MRI of the affected side shoulder was performed. Result: In this study, 60% of males and 40% of females were affected, primarily in the 41-50 age group. The supraspinatus tendon was most commonly impacted, with MRI outperforming USG in detecting pathologies. USG showed high specificity and moderate sensitivity and accuracy in identifying rotator cuff tears, particularly full-thickness tears (FTT). However, USG was less effective in detecting infraspinatus and subscapularis tendon issues. Both imaging modalities have limitations, with USG unable to properly evaluate abnormalities of the glenoid labrum, various ligaments, and bones. Tears were associated with subacromial-subdeltoid and Sub coracoid bursitis. Conclusion: Clinical examination, X-ray, and CT scans offer limited insight into shoulder joint pathologies, particularly for soft tissues like the rotator cuff. HRUSG, being affordable, non-invasive, and real-time, is the first-line diagnostic tool for screening rotator cuff disorders. MRI serves as a problem-solving modality, offering detailed evaluation in complex cases involving glenoid labrum, ligaments, bones, and muscle atrophy, especially when USG results are inconclusive. [ABSTRACT FROM AUTHOR]

Background: Excessive glenoid retroversion is a known risk factor for posterior shoulder instability and failure after soft tissue stabilization procedures. Whether excessive glenoid retroversion is a risk factor for failure after posterior glenoid bone grafting is unknown. Purpose: To evaluate the biomechanical effectiveness of posterior iliac crest bone grafting (ICBG) for posterior shoulder instability with increasing glenoid retroversion. Study Design: Controlled laboratory study. Methods: Six fresh-frozen cadaveric shoulders had a posterior glenoid osteotomy allowing the glenoid retroversion to be set at 0°, 10°, and 20°. At these 3 preset angles, 4 conditions were simulated consecutively on the same specimen: (1) intact glenohumeral joint, (2) posterior Bankart lesion, (3) 20% posterior glenoid bone defect, and (4) posterior ICBG. Stability was evaluated in the jerk position (60° of glenohumeral anteflexion, 60° of internal rotation) by measuring (A) posterior humeral head (HH) translation (in mm) and (B) peak translational force (in N) necessary for translation of the HH over 25% of glenoid width. Results: At 0° of retroversion, the ICBG restored posterior HH translation and peak translational force to values comparable with those of the intact condition (P =.649 and P =.979, respectively). At 10° of retroversion, the ICBG restored the peak translational force to a value comparable with that of the intact condition (22.3 vs 24.7 N, respectively; P =.418) but showed a significant difference in posterior HH translation in comparison to the intact condition (4.5 vs 2.0 mm, respectively; P =.026). There was a significant increase in posterior HH translation and significant decrease in peak translational force with the ICBG at 20° of glenoid retroversion compared with the intact condition (posterior HH translation: 7.9 vs 2.0 mm, respectively; P <.006; peak translational force: 15.3 vs 24.7 N, respectively; P =.014). Conclusion: In this cadaveric study, posterior ICBG was able to restore stability to a level comparable to that of the native condition at 0° and to some extent at 10° of retroversion. However, posterior ICBG was not able to provide adequate stability at 20° of glenoid retroversion. Clinical Relevance: Posterior glenoid bone grafting with ICBG should be used with caution when performed in isolation in the setting of posterior instability associated with glenoid bone loss and combined glenoid retroversion of >10°. [ABSTRACT FROM AUTHOR]

Background: Softball pitchers frequently pitch at high volumes. Previous research has demonstrated changes in mechanics, range of motion, and perceived levels of fatigue and pain at high workloads. To date, little research has assessed changes in kinetics at high workloads across pitch types to understand the injury risk. Purpose: To examine changes in peak kinetics of the shoulder, elbow, and wrist of the pitching arm throughout a simulated game and doubleheader inning. Study Design: Descriptive laboratory study. Methods: A total of 19 high school softball pitchers (mean age, 15.1 ± 1.5 years; mean height, 1.6 ± 0.2 m; mean weight, 76.3 ± 16.9 kg) participated. Pitchers threw 4 innings of 25 randomly assigned pitches to mimic a game's high pitch count. Participants then rested for 30 minutes before subsequently proceeding to pitch the first inning of a doubleheader. Each pitcher threw a fastball, drop ball, curveball, and changeup. Peak shoulder, elbow, and wrist kinetics were compared across the first, last, and doubleheader innings and pitch types. Results: Compared with the first inning, significant decreases in kinetics were observed at the shoulder, elbow, and wrist in the last (P <.016) and doubleheader (P <.016) innings, particularly for shoulder and elbow compression force during the drop ball and curveball pitch types and wrist net force for all pitch types but the changeup. Significant decreases in elbow and wrist kinetics were observed during the changeup between the last and doubleheader innings (P <.016). Furthermore, differences in kinetics were observed between pitch types (P <.008); notably, the changeup had reduced kinetics compared with the fastball and breaking ball pitch types (drop ball, curveball) across innings. Conclusion: Across innings, attenuations in select joint kinetics of the pitching arm occurred that were specific to the pitch type. Across pitch types, peak kinetics was often greater during the fastball, while the changeup displayed the lowest peak kinetics. Clinical Relevance: The joints examined in this study are common sites of overuse injuries in pitchers. This work adds to previous findings on decrements in neuromuscular function as well as self-reported fatigue and pain with tournament-style pitching that may increase the injury risk. Collectively, these findings support developing a protocol combining functional testing and player-reported outcomes to aid sports specialists' decisions for pitchers to continue to pitch or return to play, which may help prevent musculoskeletal injuries and time loss from sports participation. [ABSTRACT FROM AUTHOR]

Workers in factories, construction sites, and farms are often exposed to the risk of physical disability and injury. Particularly, the lower back and shoulders require assistance, as injuries can make it difficult to continue working. While social concern about back injuries is high and preventive measures are taken, lesser attention is paid to shoulders, resulting in inadequate assistance and prevention mechanisms. Therefore, wearable, low-cost, and lightweight upper limb assistive devices that can be used in multiple scenarios are desired by workers. In this study, we proposed a device that uses a remote center of motion (RCM) mechanism, enabling the device to support user's upper arm from below, and the rotational center of device to correspond with shoulder joint. The theoretical assist torque is designed to be sufficient for arm gravity compensation of Japanese males of standard body size. The calculated theoretical assist torque for each shoulder joint is about 8 Nm and maximum assist force for each arm was about 36.3 N (3.7 kgf). Experimental evaluation using a prototype of this device on three healthy adult males demonstrated a decrease in muscle activity of approximately 38% in the anterior deltoid, 31% in the middle deltoid, and 11% in the posterior deltoid as an average of all results in a dynamic experiment in which the participants performed the indicated movements. [ABSTRACT FROM AUTHOR]

Background: An obstetric brachial plexus injury (OBPI) occurs when the brachial plexus is subjected to severe traction during the labor and delivery procedure. These individuals may see considerable improvements in shoulder function and glenohumeral congruity after undergoing the triangle tilt operation. This research aimed to assess the clinical, functional as well as radiological outcomes of managing obstetric brachial plexus injury using triangle tilt surgery. Methods:Eighteen patients who were treated for obstetric brachial plexus injury using triangle tilt surgery technique in this prospective clinical study with follow up period of at least 2 years clinically and radiological by x-ray and CT of shoulder joints. Postoperative evaluation was performed according to Mallet Score. Results: Posterior supination significantly increased after intervention from 14.16±2.25 to 25.50±2.72 (p<0.001). The measurements of the glenoid version showed significant improvement which was about 29.55±3.27 and improved to be about 22.66±2.95 (p<0.001). There was significant improvement in the abduction angle while preoperative was 78.05±10.72 and became post operative 149±9.85 (p<0.001). There was significant improvement in SHEAR deformity grades while preoperative was grade 3 and grade 4 and became post operative grade 2 (p<0.001). Glenoid version significantly improved from preoperative compared to post operative (p<0.001). Abduction angle significantly increased from pre to post as 78.05±10.72 to 149±9.85 (p<0.001). Nonunion of the clavicular osteotomy happened in 3 cases only and was managed by wire fixation. Conclusions: This study underscores that triangle tilt surgy could be a safe as well as effective method for management of secondary deformities of obstetric brachial plexuses injury in children in different ages. [ABSTRACT FROM AUTHOR]

Manual wheelchair propulsion represents a repetitive and constraining task, which leads mainly to the development of joint injury in spinal cord-injured people. One of the main reasons is the load sustained by the shoulder joint during the propulsion cycle. Moreover, the load at the shoulder joint is highly correlated with the force and moment acting at the handrim level. The main objective of this study is related to the estimation of handrim reactions forces and moments during wheelchair propulsion using only a single inertial measurement unit per hand. Two approaches are proposed here: Firstly, a method of identification of a non-linear transfer function based on the Hammerstein–Wiener (HW) modeling approach was used. The latter represents a typical multi-input single output in a system engineering modeling approach. Secondly, a specific variant of recurrent neural network called BiLSTM is proposed to predict the time-series data of force and moments at the handrim level. Eleven subjects participated in this study in a linear propulsion protocol, while the forces and moments were measured by a dynamic platform. The two input signals were the linear acceleration as well the angular velocity of the wrist joint. The horizontal, vertical and sagittal moments were estimated by the two approaches. The mean average error (MAE) shows a value of 6.10 N and 4.30 N for the horizontal force for BiLSTM and HW, respectively. The results for the vertical direction show a MAE of 5.91 N and 7.59 N for BiLSTM and HW, respectively. Finally, the MAE for the sagittal moment varies from 0.96 Nm (BiLSTM) to 1.09 Nm for the HW model. The approaches seem similar with respect to the MAE and can be considered accurate knowing that the order of magnitude of the uncertainties of the dynamic platform was reported to be 2.2 N for the horizontal and vertical forces and 2.24 Nm for the sagittal moments. However, it should be noted that HW necessitates the knowledge of the average force and patterns of each subject, whereas the BiLSTM method do not involve the average patterns, which shows its superiority for time-series data prediction. The results provided in this study show the possibility of measuring dynamic forces acting at the handrim level during wheelchair manual propulsion in ecological environments. [ABSTRACT FROM AUTHOR]

Background: Septic arthritis of shoulder is a rare clinical entity as the metaphysis is extracapsular and there is no communication between epiphyseal and metaphyseal vessels. Septic arthritis of the shoulder joint is a diagnostic and surgical emergency because joint destruction develops rapidly and can cause significant morbidity and mortality. Unusual complications of septic arthritis of the shoulder joint may include extra‐articular abscess extension to the upper arm through the biceps groove and osteomyelitis of the greater tuberosity. Case Presentation: Septic arthritis of the shoulder, if left untreated, can lead to complications such as extra‐articular abscess extension and osteomyelitis. Three patients with septic arthritis of the shoulder joint with no clear history of trauma were reported in this study. The initial presentation was pseudoparalysis with upper arm swelling. MRI diagnosed septic arthritis of shoulder joint together with an upper arm abscess. Arthroscopic debridement with through irrigation and open drainage of the extra‐articular abscess extension to the upper arm improved both the shoulder pain and abscess completely. However, if shoulder pain or abnormalities in laboratory findings continue after initial treatment, uncontrolled septic arthritis or secondary osteomyelitis are possibilities that should be concerned. MRI is a useful tool for detecting those atypical complications. Conclusions: Rarely, septic arthritis of the shoulder joint can extend to the upper arm through the biceps tendon groove and cause an abscess. Also, acute osteomyelitis of the tuberosity should be considered in patients with long‐standing refractory septic arthritis of the shoulder joint who have continued pain and uncontrolled laboratory findings after initial treatment. [ABSTRACT FROM AUTHOR]

The article presents complementary strategies to improve the qualitative analysis of physiotherapy in patients with shoulder problems. Topics discussed include the integration of quantitative and qualitative methods, the development of a three-stage model for data processing, and the significance of two-way thinking in constructing comprehensive models.

Background: The purpose of this study was to evaluate the advantages of robot navigation system-assisted intramedullary nail treatment for humeral shaft fractures and compare it's efficacy with that of traditional surgical intramedullary nail treatment. Materials and methods: This was a retrospective analysis of patients with humeral shaft fractures who received intramedullary nail treatment at our centre from March 2020 to September 2022. The analysis was divided into a robot group and a traditional surgical group on the basis of whether the surgery involved a robot navigation system. We compared the baseline data (age, sex, cause of injury, fracture AO classification, and time of injury-induced surgery), intraoperative conditions (surgery time, length of main nail insertion incision, postoperative fluoroscopy frequency, intraoperative bleeding), fracture healing time, and shoulder joint function at 1 year postsurgery (ASES score and Constant–Murley score) between the two groups of patients. Results: There was no statistically significant difference in the baseline data or average fracture healing time between the two groups of patients. However, the robotic group had significantly shorter surgical times, longer main nail incisions, fewer intraoperative fluoroscopies, and less intraoperative blood loss than did the traditional surgery group (P < 0.001). Conclusion: Robot navigation system-assisted intramedullary nail fixation for humeral shaft fractures is a reasonable and effective surgical plan. It can help surgeons determine the insertion point and proximal opening direction faster and more easily, shorten the surgical time, reduce bleeding, avoid more intraoperative fluoroscopy, and enable patients to achieve better shoulder functional outcomes. [ABSTRACT FROM AUTHOR]