EXPRESS: Shoulder Arthrodesis as a Treatment for Severe Shoulder Deformity Secondary to Septic Arthritis in Two Cats

Background: Shoulder joint is the most freely moveable, but a relatively unstable joint in the body. The most commonly used currently prevalent diagnostic tools for shoulder joint disorders are clinical examination, Magnetic Resonant Imaging (MRI) and the gold standard arthroscopy. All have their inherent advantages and disadvantages and none is an all-inclusive tool. Furthermore, the current literature lacks studies comparing all the three diagnostic tools together or has just included one or two of the wide array of shoulder joint disorders. Therefore, this study was undertaken to identify correlation between all three diagnostic methods in arriving at a diagnosis in various shoulder disorders taking arthroscopy as a gold standard. Methods: The study was a prospective descriptive study carried out at a tertiary care hospital over period of 2 years. 33 symptomatic shoulder patients underwent standardized history, physical examination and MRI prior to diagnostic/therapeutic arthroscopy procedure. Shoulder arthroscopy considered as the gold standard, was used as a benchmark for comparing and confirming the results of clinical and radiological findings using the standard statistical data analysis. Results: Amongst clinical and radiological (MRI) findings; clinical examination was found to be superior to MRI in diagnosing adhesive capsulitis and bicipital tendinitis; MRI was found to be superior to clinical examination for diagnosing rotator cuff tears and Gleno-Humeral (GH) arthritis; both were equivocal in diagnosing Sub-Acromial Impingement Syndrome (SAIS), GH instability and Superior Labrum Anterior Posterior (SLAP) lesions. Conclusions: No modality in isolation is accurate and a combination of various available diagnostic tools gives the best precision in diagnosing shoulder joint disorders.

Shoulder joint disorders are a major cause of forelimb lameness in dogs, and osteochondrosis, degenerative joint disease, and bicipital tenosynovitis are common joint disorders that have been reported in dogs. Many studies have investigated pain management after arthroscopy in human medicine, but reports from veterinary medicine are rare. Ropivacaine is a new amide local anaesthetic drug and a single isomer drug that is used more widely than bupivacaine in human medicine because it has fewer side effects. The present study was conducted to evaluate the analgesic effect of intra-articular injection of ropivacaine after arthroscopic surgery in dog shoulder joints. To accomplish this, ten dogs were randomly divided into two groups of five who underwent the same anaesthesia protocol and shoulder arthroscopic examination. After shoulder arthroscopy, ropivacaine or 0.9% NaCl was injected into the shoulder joint cavity and the dogs were evaluated at one hour, two hours, four hours, six hours, 12 hours and 24 hours after surgery. The evaluated parameters were heart rate, respiratory rate, lameness score, visual analogue scale and the short form of the Glasgow composite measure pain scale. Ropivacaine showed a higher analgesic effect than 0.9% NaCl, indicating that it may be useful for pain management following arthroscopic surgery in dogs.

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

The shoulder joint is the most flexible joint in the body with the largest range of motion, and the movement pattern is more complex. Accurate capture of three-dimensional motion data of the shoulder joint is crucial for biomechanical evaluation. Optical motion capture systems offer a non-invasive and radiation-free method to capture shoulder joint motion data during complex movements, enabling further biomechanical analysis of the shoulder joint. This review provides a comprehensive overview of optical motion capture technology in the context of shoulder joint movement, including measurement principles, data processing methods to reduce artifacts from skin and soft tissues, factors influencing measurement results, and applications in shoulder joint disorders.

The objective of this study was to determine the diagnostic value of magnetic resonance imaging for shoulder joint pathologies and then compare the results with arthroscopy, the standard for joint diagnosis. In this cross-sectional study, 80 patients with shoulder joint disorders, who underwent final arthroscopy, were studied. Based on patients' medical history and physical examinations, shoulder MRI was requested if paraclinical investigations were. If non-surgical therapies failed, arthroscopy of the affected shoulder was done and the same structures were inspected. Subsequently, sensitivity, specificity, and positive and negative predictive values (PPV) and (NPV) of MRI were determined by arthroscopy comparisons. The highest sensitivity, specificity, PPV and NPV were found in MRI pathology reports that included: Hill-Sach lesion (0.910), infraspinatus tendon (0.985), supraspinatus tendon (0.930), and biceps tendon (0.954), respectively. Rotator interval (0.250), biceps labrum complex (0.805), subscapularis tendon (0.538) and anterior labrum lesions (0.604) had the lowest sensitivity, specificity, PPV and NPV, respectively. The results showed that MRI can be a useful tool in ruling out possible abnormalities in the shoulder and to give clues to the most probable diagnosis. Although knowing some practical skills in order to successfully perform the procedure and experience of the radiologist with suitable feedback by surgeon is necessary.

Background and purpose There have been few reports on the long-term function after shoulder arthrodesis. We report the outcome after shoulder arthrodesis with plate fixation in 18 patients who were followed for 3–15 years.Methods 25 patients with a median age of 64 (19–75) years were operated with a shoulder arthrodesis between 1982 and 2003. Standard AO surgical technique with plating was used in all patients. 18 of the patients were examined retrospectively after a mean of 8 (3–15) years. 6 of the other patients had died and 1 refused examination.Results Radiologically, all but two arthrodeses fused completely. The remaining two were partially fused, within the glenohumeral joint or between humerus and acromion. The mean Oxford shoulder score was 32 and the mean ASES shoulder index was 59. Nine patients had intermittent or continuous pain; their mean pain score on a visual analog scale was 3. One patient had been re-operated after 4 months because of severe pain and 1 was operated due to a humeral shaft fracture after 8 months. 1 patient suffered from a complex regional pain syndrome. No infections occurred.Interpretation In this patient series there were few complications after shoulder arthrodesis, and the longterm functional results were acceptable.

Some patients are simultaneously affected with carpal tunnel syndrome and shoulder joint disorders. The authors operated on seven cases with these indications using arthroscopy, and carried out a study on the effectiveness of the procedure, which showed good results in all patients. It is useful to apply arthroscopic surgery to patients suffering from carpal tunnel syndrome and shoulder joint disorders at the same time.

The effect of rotator cuff physical exercise combined with electrically stimulated antagonist on shoulder rotator cuff strength

The outcomes of radical neck dissection have recently improved considerably; postoperative sequelae such as shoulder joint disorders have become a problem. Sequelae of radical neck dissection include decreased range of motion of the upper limbs/neck caused by trapezius muscle disorders, muscular weakness, and impaired ability to elevate the upper limbs. Numbness and pain in the neck/shoulders can also arise.We describe a case of severe, unmanageable cervical pain that arose in a 49-year-old man immediately after total neck dissection for late cervical lymph node metastasis 6 months after undergoing partial tongue dissection to treat cancer of the left side of the tongue.Immediately after surgery, the patient complained of intolerable pain at the site of the cervical skin incision. An anti-inflammatory analgesic drug did not relieve the pain. An antidepressant agent together with physical rehabilitation and trapezius muscle massage were prescribed as supportive therapies for the cervical and shoulder joint disturbances. The cervical pain then subsided. Our experience suggests that the early administration of antipsychotic agents and rehabilitation might be effective for the management of pain after radical neck dissection.

Occupational medical preventive health examinations of the upper extremities of workers in the construction industry should represent findings and their relationship to occupations and physical stress. The age-, load-and job-related evaluation of results is a cross-sectional study from screening tests to 103.913 (1991-1999) and 108.963 (1994-2003) predominantly male employees.Occupational physicians determine abnormal medical findings at the shoulder joints in men 2.6% / 1.6% in women, elbow joints 1.5% / 1.0% and wrists 0.8% / 0.7% as well as the finger joints 1,2% / 0.6%. All findings steady increase in age. At the shoulders are scaffolders, glaziers / window installers and carpenters with 3.5, 2.9 and 2.5% on the highest level. At the elbows stove builder, pavers and plasterer (2.1, 2.1 and 2.0%) have highest rates of findings. Both regions show dominance at the right site over left. Findings in wrists are most common in concrete block manufacturers, crane operators and glaziers (2.9% / 1.5% / 1.3%). Shoulder joint disorders are the most common problem and highly specific to age. There is evidence for the influence of occupational stress on the elbow joints. Forced postures and vibration loads are the most common causes. Also repetitive strain must be considered as risk factor.

Purpose To know the role of Ultrasonography and MR Arthrogram in detection of shoulder joint disorders Methods and material Thirty patients with suspected shoulder joint disorders underwent US,MRI ,MR arthrography shoulder. Results All cases with ALAPSA, Bankert, reverse bankert, hillsachs, perthes and SLAP are diagnosed accurately by MR arthrography with sensitivity of (100%) in GLAD ,Supraspinatus tendenopathy ,Supraspinatus tendon tear and IGHL injury sensitivity was decreased to 75%,in cases of paraglenid cysts arthrography did not diagnose any of them as there are no communication between the cyst and the joint Conclusion MR arthrography shoulder has a golden rule in diagnosis ,classification of cases of shoulder dislocation ,SLAP injuries and rotator cuff impingement

MR imaging of septic arthritis and rheumatoid arthritis of the shoulder

SUMMARY To investigate whether arthrographic findings had any prognostic value with respect to treatment and outcome of bilateral osteochondrosis, shoulder arthrograms (n = 80) from 40 dogs with bilateral lesions were evaluated. Arthrography was performed, using 1.5 to 4 ml of a 25% solution of meglumine-sodium diatrizoate, with admixture of 0.2 mg of epinephrine. A shoulder with signs of pain and lameness was surgically treated. The contralateral shoulder was treated conservatively, and the final outcome was compared with the arthrographic findings. In 37 dogs, signs of lameness and pain were associated with a loose cartilage flap and, in 3, with a detached cartilage flap. In 2 dogs, admitted with bilateral lameness, a loose cartilage flap was detected in both shoulders. Of 12 dogs with a detectable loose cartilage flap in the contralateral shoulder joint, 6 became lame 2 to 4 months after initial surgical intervention and needed bilateral surgery. In the contralateral joint, development of thick articular cartilage over the subchondral defect or a detached cartilage flap lodged in the caudal pouch of the shoulder joint was a favorable prognostic sign. Such dogs had no signs of lameness on the contralateral side during a follow-up period that ranged from 1 to 7 years.

Bacteroides fragilis arthritis in a patient with sickle cell disease

BACKGROUNDPatients with a shoulder arthrodesis generally experience restriction in range of motion and limitations in activities of daily living. In addition, up to one-third of the patients deals with serious peri scapular pain. The conversion of a shoulder arthrodesis in a reverse shoulder arthroplasty (RSA) has been described as an effective treatment to achieve better function and decreased pain, although literature is sparse. We present the case of a conversion from a painful shoulder arthrodesis to RSA, after a 51 years interval.CASE SUMMARYA 71-year-old male presented with severe peri scapular pain and limited function 51 years after shoulder arthrodesis. Preoperative workup showed a normal bone stock of the glenoid and an intact axillary nerve, but atrophic posterior part of the deltoid muscle. The shoulder arthrodesis was successfully converted to RSA. Twelve months postoperative the patient was very satisfied. He has no pain at rest, nor with exercise and experienced definite improvements in activities of daily living, despite his limited range of motion.CONCLUSIONConversion from shoulder arthrodesis to a RSA can be performed safely, with a high chance of peri scapular pain relief; even after a longstanding arthrodesis.