BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be u...BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.展开更多
BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated f...BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated for both pathologies,however,outcomes data is limited when examining rotator cuff repair(RCR) in the setting of glenohumeral arthritis(GHOA).Thus,this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017.Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity.Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis.Patients included had a minimum two year follow-up.Rate of conversion to total shoulder arthroplasty,complication rates following initial surgery,and patient-reported outcome measures were collected.RESULTS A total of 142 patients were included.The number of patients that required total shoulder arthroplasty within two years after index surgery was low.2/71(2.8%) patients with GHOA,and 1/71(1.4%) without GHOA.Following rotator cuff repair,both groups showed favorable patientreported outcomes.CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.展开更多
Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability,both with and without surgical stabilization.Classically related to anterior shoulder instab...Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability,both with and without surgical stabilization.Classically related to anterior shoulder instability,the incidence and rates of arthritic progression may vary widely.Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30%after Latarjet procedure,with increasing rates associated with recurrent dislocation history,prominent implant position,non-anatomic reconstruction,and/or lateralized bone graft placement.However,the presence radiographic arthrosis does not predict poor patient-reported function.After exhausting conservative measures,both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors.Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology.For more advanced secondary arthropathy,total shoulder arthroplasty remains the most reliable option,although the clinical outcomes,wear characteristics,and implant survivorship remains a concern among active,young patients.展开更多
The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of instability.Anterior GHJ instability is especially frequent among young,athletic populations during conta...The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of instability.Anterior GHJ instability is especially frequent among young,athletic populations during contact sporting events.Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization.Determination of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical management,clinical history and physical examination techniques,imaging modalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.展开更多
We report the case of a 71-year-old woman, who was treated for intrathoracic migration of a Steinman pin, after glenohumeral fixation of an instable dislocation. A thoracotomy was necessary to retrieve the pin. We bel...We report the case of a 71-year-old woman, who was treated for intrathoracic migration of a Steinman pin, after glenohumeral fixation of an instable dislocation. A thoracotomy was necessary to retrieve the pin. We believe this case can be a reminder of the risks of transarticular fixation around the shoulder. A review of the literature shows very little information regarding glenohumeral pinning.展开更多
BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this inj...BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.展开更多
The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing pa...The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.展开更多
Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year,even though it is more difficult to diagnose than a...Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year,even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare,biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search,including PubMed and Medline,and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The Pub Med/Medline databases were utilized,and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology,biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner,which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabiliza-tion of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability,with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.展开更多
BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck ...BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck fractures are oftenstudied as case reports mostly accompanied by other injuries, thus leading toconfusion. All previous cases of scapular neck fractures are not associated withrotator cuff injuries.CASE SUMMARY A 62-year-old man was admitted to our emergency department 6 h after his rightshoulder and back were impacted by heavy objects. The patient presented chesttightness and shortness of breath. Chest computed tomography (CT) showedpneumohemothorax, multiple rib fractures, and right scapula fractures. ThreedimensionalCT reconstruction of the right shoulder joint showed a trans-spinousscapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injurywas suspected because the patient had a glenohumeral joint dislocation and wasthen confirmed by shoulder magnetic resonance imaging. A staged surgery wasperformed, including open reduction and internal fixation of the right scapulafracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mofollow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSION Fracture of the scapular neck combined with rotator cuff tear is rare and therotator cuff injury should not be ignored in clinical work. Stable internal fixationcombined with secondary arthroscopic repair of rotator cuff tear can achieve goodresults.展开更多
BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used;however, they pose a risk of radiatio...BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used;however, they pose a risk of radiation exposure and are expensive and timeconsuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures.AIM To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography(MRA).METHODS The study included 179 shoulders of patients with recurrent anterior instability(150 patients;103 and 76 right and left shoulders, respectively;160 males and 19 females;average age = 20.5 years;age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 m L lidocaine(1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation(T2)-weighted images of axial planes and classified the intraarticular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage;minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs;and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen’s kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman’s rank correlation coefficient.RESULTS Of the 179 injections, 163 shoulders(91.0%) had no leakage, 10 shoulders(5.6%) had minor leakage, and six shoulders(3.4%) had major leakage. In total, 173 shoulders(96.6%) were intraarticularly injected;thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, indicating consistency in the evaluations by both examiners. Regression analysis of the inaccurate injection rate for assessingtechnical learning showed a logarithmic curve with a downward trend(R;= 0.887, P < 0.001). Three(50%) of the six inaccurate injections classified into “major leakage” were observed in the first 30 injections, indicating that the accurate injection showed a leaning effect.CONCLUSION Ultrasound-guided intra-articular glenohumeral injections using a posterior approach had high accuracy;however, injection accuracy depends on clinical experience.展开更多
AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury.METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residua...AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury.METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head(PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient's parent or guardian during the initial evaluation.RESULTS: Among 87 patients, 9(10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion <-12°, whereas only 1 patient(1.1%) with finger movement had a PHHA > 40%, and retroversion <-8° in study 1. The improvement in glenohumeral deformity(PHHA, 31.8% ± 14.3%; andglenoid retroversion 22.0°± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth(group 1), when compared to those patients, who had primary surgeries(nerve and muscle surgeries), and lacked finger movement at birth(group 2),(PHHA 10.7% ± 15.8%; Version-8.0°± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group.CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.展开更多
The shoulder complex presents unique challenges for measuring motion as the scapula,unlike any other bony segment in the body,glides and rotates underneath layers of soft tissue and skin.The ability for clinicians and...The shoulder complex presents unique challenges for measuring motion as the scapula,unlike any other bony segment in the body,glides and rotates underneath layers of soft tissue and skin.The ability for clinicians and researchers to collect meaningful kinematic data is dependent on the reliability and validity of the instrumentation utilized.The aim of this study was to review the relevant literature pertaining to the reliability and validity of electromagnetic tracking systems(ETS) and digital inclinometers for assessing shoulder complex motion.Advances in technology have led to the development of biomechanical instrumentation,like ETS,that allow for the collection of threedimensional kinematic data.The existing evidence has demonstrated that ETS are reliable and valid instruments for collecting static and dynamic kinematic data of the shoulder complex.Similarly,digital inclinometers have become increasingly popular among clinicians due to their cost effectiveness and practical use in the clinical setting.The existing evidence supports the use of digital inclinometers for the collection of shoulder complex kinematics as these instruments have been demonstrated to yield acceptable reliability and validity.While digital inclinometers pose a disadvantage to ETS regarding accuracy,precision,and are limited to twodimensional and static measurements,this instrument provides clinically meaningful data that allow clinicians and researchers the ability to measure,monitor,and compare shoulder complex kinematics.展开更多
Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the t...Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.展开更多
Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the t...Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.展开更多
Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the t...Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.展开更多
Shoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joi...Shoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joint. This study aimed to explore the effect of immobility on the subscapular bursa (SSB) and the joint capsular content, including the distribution of typesⅠ and Ⅲcollagen, within an immobilized rat shoulder. Methods Forty-six Sprague-Dawley rats were randomly divided into one control group (n=6) and four immobilization groups (n=10 in each group), in which the left shoulders were immobilized with plaster for 1,2, 3 and 4 weeks. At the end of each time point, 2 rats from each group were euthanized and shoulders prepared for serial histological observations of the glenohumeral joints, as well as picrosirius red and immunohistochemical observation of type Ⅲcollagen. Histological sections of the remaining rat shoulders were used for the immunohistochemical detection of the capsular content of types Ⅰand Ⅲcollagen. Results The hyperplastic synovium of the anterior capsule obstructed the communication between the SSB and the glenohumeral joint cavity at 2 and 3 weeks. The adhesion of the SSB appeared at 3 and 4 weeks. The quantitative and qualitative results showed that the capsular contents of types Ⅰand Ⅲcollagen progressively increased at 2, 3 and 4 weeks, and that type Ⅲcollagen was distributed extensively within the joint capsule at 2 and 3 weeks. Conclusion Immobilization of the rat shoulder induced synovial hyperplasia of the joint capsule, adhesion of the SSB and an increase of the capsular content of types Ⅰ and Ⅲcollagen.展开更多
Human shoulder joints exhibit stable but highly active characteristics due to a large amount of soft tissues.Finite Element(FE)modelling plays an important role in enhancing our understanding of the mechanism of shoul...Human shoulder joints exhibit stable but highly active characteristics due to a large amount of soft tissues.Finite Element(FE)modelling plays an important role in enhancing our understanding of the mechanism of shoulder disorders.However,the previous FE shoulder models largely neglected the Three-Dimensional(3D)volume of soft tissues and their sophisticated interactions with the skeletons.This study develops a 3D model of the rotator cuff and deltoid muscles and tendons.It also includes cartilage and,for the first time,main ligaments around the joint to provide a better computational representation of the delicate interaction of the soft tissues.This model has potential value for studying the force transfer mechanism and overall joint stability variation caused by 3D pathological changes of rotator cuff tendons.Motion analysis systems and Magnetic Resonance(MR)scans were used to collect shoulder movement and geometric data from a young healthy subject,respectively.Based on MR images,a FE model with detailed representations of the musculoskeletal components was constructed.A multi-body model and the measured motion data were utilised to estimate the loading and boundary conditions.Quasi-static FE analyses simulated four instants of the measured scapular abduction.Simultaneously determined glenohumeral motion,stress/strain distribution in soft tissues,contact area,and mean/peak contact pressure were found to increase monotonically from 0°to 30°of abduction.The results of muscle forces,bone-on-bone contact force,and superior-inferior movement of the humeral centre during motion were consistent with previous experimental and numerical results.It is concluded that the constructed FE shoulder model can accurately estimate the biomechanics in the investigated range of motion and may be further used for the comprehensive study of shoulder musculoskeletal disorders.展开更多
文摘BACKGROUND The minimal clinically important difference(MCID)is defined as the smallest meaningful change in a health domain that a patient would identify as important.Thus,an improvement that exceeds the MCID can be used to define a successful treatment for the individual patient.AIM To quantify the rate of clinical improvement following anatomical total shoulder arthroplasty for glenohumeral osteoarthritis.METHODS Patients were treated with the Global Unite total shoulder platform arthroplasty between March 2017 and February 2019 at Herlev and Gentofte Hospital,Denmark.The patients were evaluated preoperatively and 3 months,6 months,12 months,and 24 months postoperatively using the Western Ontario Osteoarthritis of the Shoulder index(WOOS),Oxford Shoulder Score(OSS)and Constant-Murley Score(CMS).The rate of clinically relevant improvement was defined as the proportion of patients who had an improvement 24 months postoperatively that exceeded the MCID.Based on previous literature,MCID for WOOS,OSS,and CMS were defined as 12.3,4.3,and 12.8 respectively.RESULTS Forty-nine patients with a Global Unite total shoulder platform arthroplasty were included for the final analysis.Mean age at the time of surgery was 66 years(range 49.0-79.0,SD:8.3)and 65%were women.One patient was revised within the two years follow-up.The mean improvement from the preoperative assessment to the two-year follow-up was 46.1 points[95%confidence interval(95%CI):39.7-53.3,P<0.005]for WOOS,18.2 points(95%CI:15.5-21.0,P<0.005)for OSS and 37.8 points(95%CI:31.5-44.0,P<0.005)for CMS.Two years postoperatively,41 patients(87%)had an improvement in WOOS that exceeded the MCID,45 patients(94%)had an improvement in OSS that exceeded the MCID,and 42 patients(88%)had an improvement in CMS that exceeded the MCID.CONCLUSION Based on three shoulder-specific outcome measures we find that approximately 90%of patients has a clinically relevant improvement.This is a clear message when informing patients about their prognosis.
文摘BACKGROUND Rotator cuff pathology is a very common source of shoulder pain.Similarly,osteoarthritis of the glenohumeral joint can cause shoulder pain and produce similar symptoms.Surgical management can be indicated for both pathologies,however,outcomes data is limited when examining rotator cuff repair(RCR) in the setting of glenohumeral arthritis(GHOA).Thus,this study sought to determine outcomes for patients who undergo RCR in the setting of GHOA.AIM To evaluate if a relationship exists between outcomes of RCR in the setting of GHOA.METHODS This was a retrospective analysis of patients who underwent arthroscopic rotator cuff repair with concurrent glenohumeral osteoarthritis between 2010-2017.Patients were stratified based on rotator cuff tear size and glenohumeral osteoarthritis severity.Cohorts were paired 1:1 with patients without glenohumeral osteoarthritis.Patients included had a minimum two year follow-up.Rate of conversion to total shoulder arthroplasty,complication rates following initial surgery,and patient-reported outcome measures were collected.RESULTS A total of 142 patients were included.The number of patients that required total shoulder arthroplasty within two years after index surgery was low.2/71(2.8%) patients with GHOA,and 1/71(1.4%) without GHOA.Following rotator cuff repair,both groups showed favorable patientreported outcomes.CONCLUSION Patients with glenohumeral osteoarthritis who underwent arthroscopic rotator cuff repair showed comparable outcomes to patients without glenohumeral osteoarthritis.
文摘Post-instability arthropathy may commonly develop in high-risk patients with a history of recurrent glenohumeral instability,both with and without surgical stabilization.Classically related to anterior shoulder instability,the incidence and rates of arthritic progression may vary widely.Radiographic arthritic changes may be present in up to two-thirds of patients after primary Bankart repair and 30%after Latarjet procedure,with increasing rates associated with recurrent dislocation history,prominent implant position,non-anatomic reconstruction,and/or lateralized bone graft placement.However,the presence radiographic arthrosis does not predict poor patient-reported function.After exhausting conservative measures,both joint-preserving and arthroplasty surgical options may be considered depending on a combination of patient-specific and anatomic factors.Arthroscopic procedures are optimally indicated for individuals with focal disease and may yield superior symptomatic relief when combined with treatment of combined shoulder pathology.For more advanced secondary arthropathy,total shoulder arthroplasty remains the most reliable option,although the clinical outcomes,wear characteristics,and implant survivorship remains a concern among active,young patients.
文摘The glenohumeral joint(GHJ)allows for a wide range of motion,but is also particularly vulnerable to episodes of instability.Anterior GHJ instability is especially frequent among young,athletic populations during contact sporting events.Many first time dislocators can be managed non-operatively with a period of immobilization and rehabilitation,however certain patient populations are at higher risk for recurrent instability and may require surgical intervention for adequate stabilization.Determination of the optimal treatment strategy should be made on a case-by-case basis while weighing both patient specific factors and injury patterns(i.e.,bone loss).The purpose of this review is to describe the relevant anatomical stabilizers of the GHJ,risk factors for recurrent instability including bony lesions,indications for arthroscopic vs open surgical management,clinical history and physical examination techniques,imaging modalities,and pearls/pitfalls of arthroscopic soft-tissue stabilization for anterior glenohumeral instability.
文摘We report the case of a 71-year-old woman, who was treated for intrathoracic migration of a Steinman pin, after glenohumeral fixation of an instable dislocation. A thoracotomy was necessary to retrieve the pin. We believe this case can be a reminder of the risks of transarticular fixation around the shoulder. A review of the literature shows very little information regarding glenohumeral pinning.
文摘BACKGROUND Glenohumeral dislocation is a common injury that may predispose patients to chronic pain and instability.However,there is a paucity of current data available regarding the epidemiological trends of this injury.AIM To provide an updated,comparative assessment of the epidemiology of shoulder dislocations presenting to emergency departments in the United States.We also sought to analyze patient demographic risk factors and consumer products associated with dislocation events.METHODS Data were obtained from the national electronic injury surveillance system database for glenohumeral dislocations between 2012 and 2021.Incidence,age,sex,and injury characteristics were analyzed using weighted population statistics as well as incidence rates and 95%confidence intervals(CI).RESULTS In total,an estimated 773039 shoulder dislocations(CI:640598-905481)presented to emergency rooms across the United States during the study period.The annual incidence rate was 23.96 per 100000 persons and the average patient age at the time of injury was 37.1 years.Significantly more male patients sustained dislocations than female patients(537189,69.5%,vs 235834,30.5%,P<0.001).With regard to associated consumer products,sports and recreation equipment were involved in the highest proportion of incidents(44.31%),followed by home structures and construction materials(21.22%),and home furnishings,fixtures,and accessories(21.21%).Regarding product sub-groups,stairs,ramps,landings,floors was cited in the greatest number of cases(131745).CONCLUSION The national annual incidence rate of glenohumeral dislocations throughout the study period was approximately 23.92 per 100000 persons.Male adolescents sustained the highest proportion of dislocations,with a peak incidence in age group 15-20 years,predominantly secondary to participation in sporting and recreational activities.Conversely,women experienced a relatively consistent incidence of dislocation throughout their lifespan.After age 63,the incidence rate of dislocations in females was found to surpass that observed in males.
文摘The purpose of this review article is to discuss the clinical spectrum of recurrent traumatic anterior shoulder instability with the current concepts and controversies at the scientific level. Because of increasing participation of people from any age group of the population in sports activities, health care professionals dealing with the care of trauma patients must have a thorough understanding of the anatomy, patho-physiology, risk factors, and management of anterior shoulder instability. The risk factors for recurrent shoulder dislocation are young age, participation in high demand contact sports activities, presence of Hill-Sachs or osseous Bankart lesion, previous history of ipsilateral traumatic dislocation, ipsilateral rotator cuff or deltoid muscle insufficiency, and underlying ligamentous laxity. Achieving the best result for any particular patient depends onthe procedure that allows observation of the joint surfaces, provides the anatomical repair, maintains range of motion, and also can be applied with low rates of complications and recurrence. Although various surgical techniques have been described, a consensus does not exist and thus, orthopedic surgeons should follow and try to improve the current evidence-based treatment modalities for the patients.
文摘Posterior instability of the shoulder is a rare condition and represents about 10% of shoulder instability. It has become more frequently recognized in the last year,even though it is more difficult to diagnose than anterior shoulder instability. As this form of shoulder pathology is somewhat rare,biomechanical knowledge is limited. The purpose of our study was to perform an extensive literature search,including PubMed and Medline,and to give an overview of the current knowledge on the biomechanics of posterior shoulder instability. The Pub Med/Medline databases were utilized,and all articles related to posterior shoulder instability and biomechanics were included to form a comprehensive compilation of current knowledge. A total of 93 articles were deemed relevant according to our inclusion and exclusion criteria. As expected with any newly acknowledged pathology,biomechanical studies on posterior shoulder instability remain limited in the literature. Current biomechanical models are performed in a static manner,which limits their translation for explaining a dynamic pathology. Newer models should incorporate dynamic stabiliza-tion of both the rotator cuff and scapulothoracic joint. There is a current lack of knowledge with regards to the pathomechanism of posterior shoulder instability,with no consensus on appropriate treatment regimens. Further investigation is therefore required at both basic science and clinical levels.
文摘BACKGROUND Scapular fracture has a low incidence rate, accounting for 0.4%-0.9% of allfractures, and scapular neck fractures are extremely rare, comprisingapproximately 7%-25% of all scapular fractures. Scapular neck fractures are oftenstudied as case reports mostly accompanied by other injuries, thus leading toconfusion. All previous cases of scapular neck fractures are not associated withrotator cuff injuries.CASE SUMMARY A 62-year-old man was admitted to our emergency department 6 h after his rightshoulder and back were impacted by heavy objects. The patient presented chesttightness and shortness of breath. Chest computed tomography (CT) showedpneumohemothorax, multiple rib fractures, and right scapula fractures. ThreedimensionalCT reconstruction of the right shoulder joint showed a trans-spinousscapular neck fracture with a glenohumeral joint dislocation. Rotator cuff injurywas suspected because the patient had a glenohumeral joint dislocation and wasthen confirmed by shoulder magnetic resonance imaging. A staged surgery wasperformed, including open reduction and internal fixation of the right scapulafracture and repairing of rotator cuff by right shoulder arthroscopy. At the 5-mofollow-up, the fracture line was blurred and the shoulder joint function was good.CONCLUSION Fracture of the scapular neck combined with rotator cuff tear is rare and therotator cuff injury should not be ignored in clinical work. Stable internal fixationcombined with secondary arthroscopic repair of rotator cuff tear can achieve goodresults.
文摘BACKGROUND Intra-articular glenohumeral joint injections are essential procedures for treating various shoulder disorders. Fluoroscopy-guided injections have been extensively used;however, they pose a risk of radiation exposure and are expensive and timeconsuming. Recently, it has been suggested that ultrasound-guided injections are accurate and cost effective procedures.AIM To evaluate the accuracy of ultrasound-guided glenohumeral injections using a posterior approach that is confirmed using magnetic resonance arthrography(MRA).METHODS The study included 179 shoulders of patients with recurrent anterior instability(150 patients;103 and 76 right and left shoulders, respectively;160 males and 19 females;average age = 20.5 years;age range: 14-63 years) who underwent MRA for preoperative diagnosis. They were injected with 12 m L lidocaine(1%) using the ultrasound-guided posterior approach and then underwent magnetic resonance imaging. Two shoulder surgeons, except for the injector, evaluated the transverse relaxation(T2)-weighted images of axial planes and classified the intraarticular condition of injected contrast into three groups based on one of the three following scenarios: no leakage, injection into the glenohumeral joint without leakage;minor leakage, practical intra-articular injection with some leakage outside the posterior rotator cuffs;and major leakage, inaccurate injection with mass leakage without any contrast into the joint. The inter-rater reliability between two assessors was also evaluated by calculating Cohen’s kappa coefficient. The learning curve was assessed regarding the inaccurate injection rate by analyzing Spearman’s rank correlation coefficient.RESULTS Of the 179 injections, 163 shoulders(91.0%) had no leakage, 10 shoulders(5.6%) had minor leakage, and six shoulders(3.4%) had major leakage. In total, 173 shoulders(96.6%) were intraarticularly injected;thus, we could detect anterior labrum and capsular pathologies. Regarding the inter-rater reliability, the kappa coefficient was 0.925, indicating consistency in the evaluations by both examiners. Regression analysis of the inaccurate injection rate for assessingtechnical learning showed a logarithmic curve with a downward trend(R;= 0.887, P < 0.001). Three(50%) of the six inaccurate injections classified into “major leakage” were observed in the first 30 injections, indicating that the accurate injection showed a leaning effect.CONCLUSION Ultrasound-guided intra-articular glenohumeral injections using a posterior approach had high accuracy;however, injection accuracy depends on clinical experience.
文摘AIM: To investigate whether the finger movement at birth is a better predictor of the brachial plexus birth injury.METHODS: We conducted a retrospective study reviewing pre-surgical records of 87 patients with residual obstetric brachial plexus palsy in study 1. Posterior subluxation of the humeral head(PHHA), and glenoid retroversion were measured from computed tomography or Magnetic resonance imaging, and correlated with the finger movement at birth. The study 2 consisted of 141 obstetric brachial plexus injury patients, who underwent primary surgeries and/or secondary surgery at the Texas Nerve and Paralysis Institute. Information regarding finger movement was obtained from the patient's parent or guardian during the initial evaluation.RESULTS: Among 87 patients, 9(10.3%) patients who lacked finger movement at birth had a PHHA > 40%, and glenoid retroversion <-12°, whereas only 1 patient(1.1%) with finger movement had a PHHA > 40%, and retroversion <-8° in study 1. The improvement in glenohumeral deformity(PHHA, 31.8% ± 14.3%; andglenoid retroversion 22.0°± 15.0°) was significantly higher in patients, who have not had any primary surgeries and had finger movement at birth(group 1), when compared to those patients, who had primary surgeries(nerve and muscle surgeries), and lacked finger movement at birth(group 2),(PHHA 10.7% ± 15.8%; Version-8.0°± 8.4°, P = 0.005 and P = 0.030, respectively) in study 2. No finger movement at birth was observed in 55% of the patients in this study group.CONCLUSION: Posterior subluxation and glenoid retroversion measurements indicated significantly severe shoulder deformities in children with finger movement at birth, in comparison with those lacked finger movement. However, the improvement after triangle tilt surgery was higher in patients who had finger movement at birth.
文摘The shoulder complex presents unique challenges for measuring motion as the scapula,unlike any other bony segment in the body,glides and rotates underneath layers of soft tissue and skin.The ability for clinicians and researchers to collect meaningful kinematic data is dependent on the reliability and validity of the instrumentation utilized.The aim of this study was to review the relevant literature pertaining to the reliability and validity of electromagnetic tracking systems(ETS) and digital inclinometers for assessing shoulder complex motion.Advances in technology have led to the development of biomechanical instrumentation,like ETS,that allow for the collection of threedimensional kinematic data.The existing evidence has demonstrated that ETS are reliable and valid instruments for collecting static and dynamic kinematic data of the shoulder complex.Similarly,digital inclinometers have become increasingly popular among clinicians due to their cost effectiveness and practical use in the clinical setting.The existing evidence supports the use of digital inclinometers for the collection of shoulder complex kinematics as these instruments have been demonstrated to yield acceptable reliability and validity.While digital inclinometers pose a disadvantage to ETS regarding accuracy,precision,and are limited to twodimensional and static measurements,this instrument provides clinically meaningful data that allow clinicians and researchers the ability to measure,monitor,and compare shoulder complex kinematics.
文摘Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.
文摘Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.
文摘Eleven male university team hand-ball players (22 shoulders) with 5 or more years of competitive team hand-ball experience who had no history of injuries were included in this study. We compared the thickness of the trapezius muscle between their dominant arm and non-dominant arm, to clarify the correlation between the muscle thickness and muscular strength during internal and external rotation in the shoulder joints used to throw a handball. We measured the thickness of the middle and lower trapezius muscles at an abduction angle of 90° descending by the ultrasonic LOGIQ e and measured internal and external rotational muscular strength of the glenohumeral joint by BIODEX. The players showed significantly greater thickness of the lower trapezius muscle during constriction in the dominant arm than that in the non-dominant arm. Furthermore, a positive correlation was observed between muscle thickness of the lower trapezius muscle and the muscular strength during internal rotation of the glenohumeral joint. It is highly probable that the height of the constricting ability in the lower trapezius muscle in the dominant arm is related to the prevention of throwing injuries.
文摘Shoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joint. This study aimed to explore the effect of immobility on the subscapular bursa (SSB) and the joint capsular content, including the distribution of typesⅠ and Ⅲcollagen, within an immobilized rat shoulder. Methods Forty-six Sprague-Dawley rats were randomly divided into one control group (n=6) and four immobilization groups (n=10 in each group), in which the left shoulders were immobilized with plaster for 1,2, 3 and 4 weeks. At the end of each time point, 2 rats from each group were euthanized and shoulders prepared for serial histological observations of the glenohumeral joints, as well as picrosirius red and immunohistochemical observation of type Ⅲcollagen. Histological sections of the remaining rat shoulders were used for the immunohistochemical detection of the capsular content of types Ⅰand Ⅲcollagen. Results The hyperplastic synovium of the anterior capsule obstructed the communication between the SSB and the glenohumeral joint cavity at 2 and 3 weeks. The adhesion of the SSB appeared at 3 and 4 weeks. The quantitative and qualitative results showed that the capsular contents of types Ⅰand Ⅲcollagen progressively increased at 2, 3 and 4 weeks, and that type Ⅲcollagen was distributed extensively within the joint capsule at 2 and 3 weeks. Conclusion Immobilization of the rat shoulder induced synovial hyperplasia of the joint capsule, adhesion of the SSB and an increase of the capsular content of types Ⅰ and Ⅲcollagen.
基金This work was supported by the Grant of Bio-technology and Biological Sciences Research Council of GB(No.BB/H002782/1)the Project of National Natural Science Foundation of China(Nos.51475202 and 51675222).
文摘Human shoulder joints exhibit stable but highly active characteristics due to a large amount of soft tissues.Finite Element(FE)modelling plays an important role in enhancing our understanding of the mechanism of shoulder disorders.However,the previous FE shoulder models largely neglected the Three-Dimensional(3D)volume of soft tissues and their sophisticated interactions with the skeletons.This study develops a 3D model of the rotator cuff and deltoid muscles and tendons.It also includes cartilage and,for the first time,main ligaments around the joint to provide a better computational representation of the delicate interaction of the soft tissues.This model has potential value for studying the force transfer mechanism and overall joint stability variation caused by 3D pathological changes of rotator cuff tendons.Motion analysis systems and Magnetic Resonance(MR)scans were used to collect shoulder movement and geometric data from a young healthy subject,respectively.Based on MR images,a FE model with detailed representations of the musculoskeletal components was constructed.A multi-body model and the measured motion data were utilised to estimate the loading and boundary conditions.Quasi-static FE analyses simulated four instants of the measured scapular abduction.Simultaneously determined glenohumeral motion,stress/strain distribution in soft tissues,contact area,and mean/peak contact pressure were found to increase monotonically from 0°to 30°of abduction.The results of muscle forces,bone-on-bone contact force,and superior-inferior movement of the humeral centre during motion were consistent with previous experimental and numerical results.It is concluded that the constructed FE shoulder model can accurately estimate the biomechanics in the investigated range of motion and may be further used for the comprehensive study of shoulder musculoskeletal disorders.