Abduction Movements Research Articles

Investigation of the Effects of Smartphone Use on the Dominant Thumb and Wrist of University Students

Aim: In this study, the effects of the addiction level of smartphone use in university students on the range of motion and proprioception of the dominant hand, wrist range of motion (ROM), and thumb ROM were investigated. Material and Methods: Wrist and thumb ROMs were measured with a manual goniometer with a sensitivity of 1 degree, and hand grip strength was measured with a hand grip dynamometer in a total of 100 volunteer university students with a mean age of 18-25. Smartphone Addiction Scale-Short Form (SAS-SF) and Patient Rated Wrist and Hand Evaluation (PRWHE) questionnaire were applied to the students. Statistical analyzes were made using the SPSS 25 program. Results: The students’ usage time of smartphones and addiction levels do not affect the hand grip strength; the increase in smartphone addiction statistically correlates with the right thumb flexion (0.016) and abduction ROMs (0.015), statistically correlated with increased pain level in daily life and statistically correlated with the decrease of the wrist radial deviation ROM (0.009). As the duration of smartphone use increases, the error rate in right thumb abduction proprioception statistically increases (0.027). In addition, we determined the statistically correlations in both thumb flexion and abduction movements. Conclusion: We determined that the excessive usage of smartphones affects the ROM of thumb flexion and abduction, the ROM of wrist radial deviation, and the proprioception of thumb abduction, and it does not affect the hand grip strength. The findings of our research will be a source for future studies.

Rotator Cuff Repair in Pediatric and Adolescent Athletes: Indications and Outcomes.

Rotator cuff (RC) tears in pediatric and adolescent athletes are rare events. In these patients, RC tears are more likely to be traumatic or related to overuse among overhead. Repeated movements of abduction and external rotation are frequent mechanisms of injury. The supraspinatus is the most commonly involved tendon and the articular-sided tears are more common than the bursal side. Magnetic resonance imaging is considered the gold standard for diagnosing RC tears. Conservative treatment, arthroscopic, and open repair are all effective treatment methods depending on the type of injury. The risk of growth plate injury in these patients should be always considered when planning surgical interventions. Return to sport for competitive-level throwing athletes represents the greatest challenge in the treatment of these injuries.

Correlation between MOVA3D, a Monocular Movement Analysis System, and Qualisys Track Manager (QTM) during Lower Limb Movements in Healthy Adults: A Preliminary Study.

New technologies based on virtual reality and augmented reality offer promising perspectives in an attempt to increase the assessment of human kinematics. The aim of this work was to develop a markerless 3D motion analysis capture system (MOVA3D) and to test it versus Qualisys Track Manager (QTM). A digital camera was used to capture the data, and proprietary software capable of automatically inferring the joint centers in 3D and performing the angular kinematic calculations of interest was developed for such analysis. In the experiment, 10 subjects (22 to 50 years old), 5 men and 5 women, with a body mass index between 18.5 and 29.9 kg/m2, performed squatting, hip flexion, and abduction movements, and both systems measured the hip abduction/adduction angle and hip flexion/extension, simultaneously. The mean value of the difference between the QTM system and the MOVA3D system for all frames for each joint angle was analyzed with Pearson's correlation coefficient (r). The MOVA3D system reached good (above 0.75) or excellent (above 0.90) correlations in 6 out of 8 variables. The average error remained below 12° in only 20 out of 24 variables analyzed. The MOVA3D system is therefore promising for use in telerehabilitation or other applications where this level of error is acceptable. Future studies should continue to validate the MOVA3D as updated versions of their software are developed.

Fully automatic algorithm for detecting and tracking anatomical shoulder landmarks on fluoroscopy images with artificial intelligence

ObjectivePatients with rotator cuff tears present often with glenohumeral joint instability. Assessing anatomic angles and shoulder kinematics from fluoroscopy requires labelling of specific landmarks in each image. This study aimed to develop an artificial intelligence model for automatic landmark detection from fluoroscopic images for motion tracking of the scapula and humeral head.Materials and methodsFluoroscopic images were acquired for both shoulders of 25 participants (N = 12 patients with unilateral rotator cuff tear, 6 men, mean (standard deviation) age: 63.7 ± 9.7 years; 13 asymptomatic subjects, 7 men, 58.2 ± 8.9 years) during a 30° arm abduction and adduction movement in the scapular plane with and without handheld weights of 2 and 4 kg. A 3D full-resolution convolutional neural network (nnU-Net) was trained to automatically locate five landmarks (glenohumeral joint centre, humeral shaft, inferior and superior edges of the glenoid and most lateral point of the acromion) and a calibration sphere.ResultsThe nnU-Net was trained with ground-truth data from 6021 fluoroscopic images of 40 shoulders and tested with 1925 fluoroscopic images of 10 shoulders. The automatic landmark detection algorithm achieved an accuracy above inter-rater variability and slightly below intra-rater variability. All landmarks and the calibration sphere were located within 1.5 mm, except the humeral landmark within 9.6 mm, but differences in abduction angles were within 1°.ConclusionThe proposed algorithm detects the desired landmarks on fluoroscopic images with sufficient accuracy and can therefore be applied to automatically assess shoulder motion, scapular rotation or glenohumeral translation in the scapular plane.Clinical relevance statementThis nnU-net algorithm facilitates efficient and objective identification and tracking of anatomical landmarks on fluoroscopic images necessary for measuring clinically relevant anatomical configuration (e.g. critical shoulder angle) and enables investigation of dynamic glenohumeral joint stability in pathological shoulders.Key Points• Anatomical configuration and glenohumeral joint stability are often a concern after rotator cuff tears.• Artificial intelligence applied to fluoroscopic images helps to identify and track anatomical landmarks during dynamic movements.• The developed automatic landmark detection algorithm optimised the labelling procedures and is suitable for clinical application.

Load-induced increase in muscle activity during 30° abduction in patients with rotator cuff tears and control subjects

BackgroundRotator cuff muscles stabilise the glenohumeral joint and contribute to the initial abduction phase with other shoulder muscles. This study aimed to determine if the load-induced increase in shoulder muscle activity during a 30° abduction test is influenced by asymptomatic or symptomatic rotator cuff pathologies.Materials and MethodsTwenty-five patients with unilateral rotator cuff tears (age, 64.3 ± 10.2 years), 25 older control subjects (55.4 ± 8.2 years) and 25 younger control subjects (26.1 ± 2.3 years) participated in this study. Participants performed a bilateral 30° arm abduction and adduction movement in the scapular plane with handheld weights (0–4 kg). Activity of the deltoid, infraspinatus, biceps brachii, pectoralis major, latissimus dorsi and upper trapezius muscles was analysed at maximum abduction angle after normalisation to maximum voluntary contraction. Shoulders were classified into rotator cuff tendinopathy, asymptomatic and symptomatic rotator cuff tears, and healthy based on magnetic resonance images. A linear mixed model (loads, shoulder types) with random effects (shoulder identification) was applied to the log-transformed muscle activities.ResultsMuscle activity increased with increasing load in all muscles and shoulder types (P < 0.001), and 1-kg increments in additional weights were significant (P < 0.001). Significant effects of rotator cuff pathologies were found for all muscles analysed (P < 0.05). In all muscles, activity was at least 20% higher in symptomatic rotator cuff tears than in healthy shoulders (P < 0.001). Symptomatic rotator cuff tears showed 20–32% higher posterior deltoid (P < 0.05) and 19–25% higher pectoralis major (P < 0.01) activity when compared with asymptomatic tears.ConclusionsRotator cuff pathologies are associated with greater relative activity of shoulder muscles, even with low levels of additional load. Therefore, the inclusion of loaded shoulder tests in the diagnosis and rehabilitation of rotator cuff pathologies can provide important insight into the functional status of shoulders and can be used to guide treatment decisions.Level of evidence: Level 2.Trial registration: Ethical approval was obtained from the regional ethics committee (Ethics Committee Northwest Switzerland EKNZ 2021-00182), and the study was registered at clinicaltrials.gov on 29 March 2021 (trial registration number NCT04819724, https://clinicaltrials.gov/ct2/show/NCT04819724).

Midterm outcomes of autologous bridging of rotator cuff tears with an autologous tendon patch (TEAR patch)

Large and massive rotator cuff tears and tears after failed surgical repair are a challenging clinical problem with different treatment options. The purpose of the study was to evaluate the mid-term outcomes following rotator cuff repair (RCR) with autologous hamstring tendon graft bridging (TEAR patch) with the hypothesis, that outcomes would be reasonable and complication rates low. This is a retrospective case series study of patients who underwent open RCR using a TEAR patch from June, 2015 to March, 2019. evidence of cuff tear arthropathy, advanced fatty infiltration, moderate to severe arthropathy and workers compensation board or litigation involved. Clinical outcome measures: Constant score (CS), Disabilities of Arm, Shoulder and Hand score (DASH), Simple Shoulder Test (SST), Subjective Shoulder Value (SSV), range of motion (ROM) and manual muscle test (MMT) for forward elevation, abduction, external and internal rotation, patient satisfaction, willingness to do the operation again. Radiographic outcome measures: MRI, ultrasound and radiographs: Graft integrity and acromiohumeral distance (AHD). 44 patients were followed (89%) for ≥ 2 years (45 shoulders, mean age 60.3 years (48-76), mean follow-up 4.3 years (2-6)). All clinical outcome measures (CS, DASH, SST, SSV, ROM, and MMT) demonstrated significant improvement except active external and internal rotation. At 2 years follow-up, the mean patient satisfaction was high (12.2 out of 15 points) and 33 of 38 patients (73.3%) would do the operation again. A perfect graft integration was observed in n=30 (66.7%) a small gap in n=7 (15.6%), a retear in n=3 (7%) and a complete failure of the tendon patch in n=5 (11%) patients. Graft integrity was strongly correlated with the postoperative AHD (r=0.599 , p=0.001 ) and the gain in AHD (r=0.599 , p=0.001) but not with ROM or PROM's or patient satisfaction. Four patients required revision surgeries (three due to deep infection and one for poor function and pain). Mid-term clinical and radiographic outcomes following RCR with graft bridging using a TEAR patch were reasonable. The procedure resulted in improved shoulder function and a high level of patient satisfaction. The revision rate is acceptable in view of the specific patient group and treatment alternatives. The described technique of the TEAR patch can be a valuable alternative to existing methods and a novel autograft source for rotator cuff surgeries that need bridging of a tendon defect.

Changes in blood flow in the dorsal scapular artery and relationship to shoulder joint function in rotator cuff tears

One of the pain-related factors in rotator cuff tears (RCTs) is abnormal scapular motion, which is thought to be related to the levator scapulae muscle activation. Additionally, attention has recently focused on the peak systolic velocity (PSV) as one of the causes of pain, but blood flow outside of the vessels supplying the rotator cuff has not been clarified. This study aimed to determine the difference in PSV in the dorsal scapular artery (DSA), which is the vessel that supplies the levator scapulae muscles, and the association between PSV and pain and shoulder function in patients with RCTs between the tear and nontear sides. This study included 31 patients with RCTs with tear and nontear sides. Magnetic resonance imaging and radiographic examinations included Cofield classification, Goutallier classification, thickening of the coracohumeral ligament, and measurement of the acromiohumeral interval. Clinical evaluation included an automatic range of motion (ROM) for flexion, abduction, and external rotation (ER), a visual analog scale, and the Shoulder36. PSV was evaluated using ultrasound pulsed Doppler mode to assess PSV of DSA. The PSV of DSA on the first rib was drawn in the medial aspect of the suprascapular angle in the long axis, and the maximum PSV waveform was measured three times. The average value was used for further analysis. The PSV in the DSA was significantly higher (P=.04, 95% confidence interval: 0.2-7.6) on the tear (22.6±7.4 cm/s) than the nontear sides (18.9±6.9 cm/s). In addition, a significant negative correlation (r=-0.46, P=.0087) was found between PSV in DSA and ER on the tear side. This study revealed a significantly increased PSV in the DSA on the tear side in RCTs and negatively correlated with ER ROM. The results suggest that increased PSV in the DSA may contribute to ER ROM limitation in the glenohumeral joint.

Characterizing moment arms of the coracobrachialis and short head of biceps in native shoulders and after reverse total shoulder arthroplasty during elevation and rotation: a modeling study.

Reverse total shoulder arthroplasty (RTSA) alters the line of action of muscles around the glenohumeral joint. The effects of these changes have been well characterized for the deltoid, but there is limited information regarding the biomechanical changes to the coracobrachialis (CBR) and short head of biceps (SHB). In this biomechanical study, we investigated the changes to the moment arms of the CBR and SHB due to RTSA using a computational model of the shoulder. The Newcastle Shoulder Model, a pre-validated upper-extremity musculoskeletal model, was used for this study. The Newcastle Shoulder Model was modified with bone geometries obtained from 3-dimensional reconstructions of 15 nondiseased shoulders, constituting the native shoulder group. The Delta XTEND prosthesis, with a glenosphere diameter of 38 mm and polyethylene thickness of 6 mm, was virtually implanted in all the models, creating the RTSA group. Moment arms were measured using the tendon excursion method, and muscle length was calculated as the distance between the muscle's origin and insertion points. These values were measured during 0°-150° of abduction, forward flexion, scapular-plane elevation, and -90° to 60° of external rotation-internal rotation with the arm at 20° and 90° of abduction. Statistical comparisons between the native and RTSA groups were analyzed using 1-dimensional statistical parametric mapping (spm1D). Forward flexion moment arms showed the greatest increase between the RTSA group (CBR, 25.3±4.7 mm; SHB, 24.7±4.5 mm) and native group (CBR, 9.6±5.2 mm; SHB, 10.2±5.2 mm). The CBR and SHB were longer in the RTSA group by maximum values of 15% and 7%, respectively. Both muscles had larger abduction moment arms in the RTSA group (CBR, 20.9±4.3 mm; SHB, 21.9±4.3 mm) compared with the native group (CBR, 19.6±6.6 mm; SHB, 20.0±5.7 mm). Abduction moment arms occurred at lower abduction angles in the RTSA group (CBR, 50°; SHB, 45°) than in the native group (CBR, 90°; SHB, 85°). In the RTSA group, both muscles had elevation moment arms until 25° of scapular-plane elevation motion, whereas in the native group, the muscles only had depression moment arms. Both muscles had small rotational moment arms that were significantly different between RTSA and native shoulders during different ranges of motion. Significant increases in elevation moment arms for the CBR and SHB were observed in RTSA shoulders; these increases were most pronounced during abduction and forward elevation motions. RTSA also increased the lengths of these muscles.

Ultrasound-Guided Infiltrative Treatment Associated with Early Rehabilitation in Adhesive Capsulitis Developed in Post-COVID-19 Syndrome.

Background and Objectives: Post-COVID-19 syndrome is commonly used to describe signs and symptoms that continue or develop after acute COVID-19 for more than 12 weeks. The study aimed to evaluate a treatment strategy in patients with adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome. Materials and Methods: The method used was an interventional pilot study in which 16 vaccinated patients presenting with the clinical and ultrasound features of adhesive capsulitis (phase 1) developed during post-COVID-19 syndrome were treated with infiltrative hydrodistension therapy under ultrasound guidance associated with early rehabilitation treatment. Results: Sixteen patients with post-COVID-19 syndrome treated with ultrasound-guided infiltration and early rehabilitation treatment showed an important improvement in active joint ROM after 10 weeks, especially in shoulder elevation and abduction movements. The VAS mean score before the treatment was 6.9 ± 1.66. After 10 weeks of treatment, the VAS score was 1 ± 0.63. Conclusions: The study demonstrated that the management of adhesive capsulitis (phase 1) developed in post-COVID-19 syndrome, as conducted by physiotherapists in a primary care setting using hydrodistension and a rehabilitation protocol, represented an effective treatment strategy.

Manual therapy on the diaphragm is beneficial in reducing pain and improving shoulder mobility in subjects with rotator cuff injury: A randomized trial

BackgroundRotator cuff dysfunction is the main cause of shoulder pain. The shoulder and the diaphragm have an important relationship through the myofascial system and through its innervation. ObjectivesTo analyse the effect of diaphragm manual therapy on the symptoms of patients with rotator cuff injury compared to manual treatment on shoulder muscles. DesignA randomized, controlled, single-blind trial of 45 participants diagnosed with rotator cuff injury. MethodThe sample were divided into 3 groups of treatment.1. Manual treatment over the shoulder by ischemic compression of myofascial trigger points (MTP) (Control/Shoulder group -SG-).2. Diaphragm manual therapy techniques (Diaphragm group -DG-).3. Active diaphragm mobilization by hypopressive gymnastic exercise (Breathing group -BG-).Shoulder pain using a numerical rating scale (NRS), shoulder range of motion (ROM), and pressure pain threshold (PPT) were evaluated, and compared between groups. ResultsBoth the SG and DG showed a clinically significant improvement, as well as a significant effect size, on the NRS in shoulder flexion and abduction movements. Regarding ROM improvement, only the SG obtained a significant effect size (abduction and external rotation). The PPT at the xiphoid process of the sternum showed a clinically significant improvement in the DG. ConclusionIndirect treatment of the shoulder through a protocol of manual therapy techniques on the diaphragm and intervention on MTP of the rotator cuff have been clinically effective in reducing pain on the NRS immediately, in flexion and abduction movements of the shoulder, and more effective compared to the intervention in the breathing group. Clinical trial registration numberNCT03293329.

Mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion lesion

To explore the mid-term effectiveness of arthroscopic "mini incision" transtendon repair for partial articular-sided supraspinatus tendon avulsion (PASTA) lesion. A clinical data of 39 patients with PASTA lesions, who underwent the arthroscopic "mini incision" transtendon repair and met the selected criteria between May 2017 and April 2021, was retrospectively analyzed. There were 13 males and 26 females, with an average age of 63.7 years (range, 43-76 years). Nine patients underwent trauma history, and no obvious inducement was found in the other 30 patients. The main clinical symptom was shoulder pain with positive hug resistance test. The interval from symptom onset to operation was 3-21 months (mean, 8.3 months). The visual analogue scale (VAS) score, University of California Los Angeles (UCLA) shoulder score, American Association of Shoulder and Elbow Surgeons (ASES) score and shoulder range of motion (ROM) of forward flexion, abduction, and external rotation were used to evaluate shoulder function. MRI was performed to assess the structural integrity and tension of reattached tendon. Patient satisfactions were calculated at last follow-up. All incisions healed by first intention with no complications such as incision infection or nerve injury. All patients were followed up 24-71 months (mean, 46.9 months). The VAS, UCLA, and ASES scores significantly improved at 24 months after operation when compared with preoperative ones ( P<0.05). The ROMs of forward flexion and external rotation of the shoulder joint significantly increased at 3 and 24 months, and further increased at 24 months compared to 3 months, with significant differences ( P<0.05). However, the ROM of abduction of the shoulder joint at 3 months did not significantly improve compared with that before operation ( P>0.05), and it was significantly greater at 24 months than before operation and at 3 months after operation ( P<0.05). At last follow-up, the patients were very satisfied with the effectiveness in 30 cases (76.9%), satisfied in 5 cases (12.8%), and dissatisfied in 4 cases (10.3%). At 6 months after operation, 31 patients underwent reviews of MRI scans, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing, and 3 patients underwent tendon re-tear. Arthroscopic "mini incision" transtendon repair in treatment of PASTA lesion could obtain satisfying mid-term effectiveness with low risk of tendon re-tear.

Physiological Tensioning During Lower Trapezius Transfer for Irreparable Posterosuperior Rotator Cuff Tears May Be Important for Improvement in Shoulder Kinematics

Background: Lower trapezius transfer (LTT) has been proposed for restoring the anteroposterior muscular force couple in the setting of an irreparable posterosuperior rotator cuff tear (PSRCT). Adequate graft tensioning during surgery may be a factor critical for sufficient restoration of shoulder kinematics and functional improvement. Purpose/Hypothesis: The purpose was to evaluate the effect of tensioning during LTT on glenohumeral kinematics using a dynamic shoulder model. It was hypothesized that LTT, while maintaining physiological tension on the lower trapezius muscle, would improve glenohumeral kinematics more effectively than undertensioned or overtensioned LTT. Study Design: Controlled laboratory study. Methods: A total of 10 fresh-frozen cadaveric shoulders were tested using a validated shoulder simulator. Glenohumeral abduction angle, superior migration of the humeral head, and cumulative deltoid force were compared across 5 conditions: (1) native, (2) irreparable PSRCT, (3) LTT with a 12-N load (undertensioned), (4) LTT with a 24-N load (physiologically tensioned according to the cross-sectional area ratio of the lower trapezius muscle), and (5) LTT with a 36-N load (overtensioned). Glenohumeral abduction angle and superior migration of the humeral head were measured using 3-dimensional motion tracking. Cumulative deltoid force was recorded in real time throughout dynamic abduction motion by load cells connected to actuators. Results: Physiologically tensioned (Δ13.1°), undertensioned (Δ7.3°), and overtensioned (Δ9.9°) LTT each significantly increased the glenohumeral abduction angle compared with the irreparable PSRCT (P < .001 for all). Physiologically tensioned LTT achieved a significantly greater glenohumeral abduction angle than undertensioned LTT (Δ5.9°; P < .001) or overtensioned LTT (Δ3.2°; P = .038). Superior migration of the humeral head was significantly decreased with LTT compared with the PSRCT, regardless of tensioning. Physiologically tensioned LTT resulted in significantly less superior migration of the humeral head compared with undertensioned LTT (Δ5.3 mm; P = .004). A significant decrease in cumulative deltoid force was only observed with physiologically tensioned LTT compared with the PSRCT (Δ–19.2 N; P = .044). However, compared with the native state, LTT did not completely restore glenohumeral kinematics, regardless of tensioning. Conclusion: LTT was most effective in improving glenohumeral kinematics after an irreparable PSRCT when maintaining physiological tension on the lower trapezius muscle at time zero. However, LTT did not completely restore native glenohumeral kinematics, regardless of tensioning. Clinical Relevance: Tensioning during LTT for an irreparable PSRCT may be important to sufficiently improve glenohumeral kinematics and may be an intraoperatively modifiable key variable to ensure postoperative functional success.

Quantitative Assessment of Upper Limb Movement in Post-Stroke Adults for Identification of Sensitive Measures in Reaching and Lifting Activities.

The assumption of this work is the achievement of objective results of the movement structure, which forms the basis for in-depth analysis and, consequently, for determining the upper limb movements that are most affected by stroke compared to healthy people. An analysis of relevant and systematically identified features of upper limb movement in post-stroke adults is presented based on scalable hypothesis tests. The basic features were calculated using movements defined by the x, y, and z coordinates (i.e., 3D trajectory time series) and compared to the results of post-stroke patients with healthy controls of similar age. After automatic feature selection, out of the 1004 common features of upper limb movement, the most differentiated were the upper arm movements in reaching kinematics. In terms of movement type, movements in the frontal plane (shoulder abduction and adduction) were the most sensitive to changes. The largest number of discriminating features was determined on the basis of acceleration time series. In the 3D assessment of functional activities of the upper limb, the upper arm turned out to be the most differentiated body segment, especially during abduction and adduction movements. The results indicate a special need to pay attention to abduction and adduction movements to improve the activities of daily living of the upper limbs after a stroke.

The Influence of Gender on Hip Range of Motion, Hip Muscle Strength, Gluteus Medius Thickness and M-Mode Ultrasound Examination in Asymptomatic University Athletes: A Cross-Sectional Study

IntroductionPhysical activity is a proposed factor int the development of hip pathologies in male and female. The main objectives of this study were to investigate the influence of gender on isometric hip muscle strength, hip range of motion and gluteus medius thickness at rest, during contraction and onset activation.Material and methodsA cross-sectional study was carried out. Hip range of motion, hip muscle strength and gluteus medius thickness at rest, (B-Mode) and onset activation (M-Mode) were measured in thirty asymptomatic university athletes without history hip pain.ResultsA total of fifteen males (30 hips) and fifteen females (30 hips) with a mean age of 22 ± 6.5 and 20 ± 2.75 years old were recruited. Females demonstrated greater hip range of motion in flexion, abduction and internal rotation in dominant and non-dominant legs (p &lt; .05) but no differences were found extension, adduction and external rotation (p &gt; .05). Furthermore, females showed less isometric hip muscle strength in hip flexion, extension, abduction, adduction, internal and external rotation (p &lt; .05) but not in strength ratios (p &gt; .05). In addition, female exhibited less gluteus medius thickness at muscle contraction, less differences in rest-contaction thickness, but no differences were observed for rest thickness or contraction velocity.ConclusionsThis study found that asymptomatic female athletes demonstrated greater hip flexion, abduction and internal rotation ROM, less isometric hip muscle strength and different gluteus medius thickness and onset activation compared with asymptomatic male athletes.

Preoperative Planning for Reverse Shoulder Arthroplasty: Does the Clinical Range of Motion Match the Planned 3D Humeral Displacement?

The functional outcome after reverse shoulder arthroplasty (RSA) is closely linked to how much the humerus shifts because of the implants. While two-dimensional (2D) angle measurements have been used to capture this shift, it can be measured in three dimensions (3D) as the arm change position (ACP). In a previous study, the ACP was measured using 3D preoperative planning software with the passive virtual shoulder range of motion obtained after RSA. The main objective of this study was to evaluate the relationship between the ACP and the actual active shoulder range of motion measured after RSA. The hypothesis was that the ACP and the active clinical range of motion are related such that the ACP is a reliable parameter to guide the preoperative planning of an RSA. The secondary objective was to assess the relationship between 2D and 3D humeral displacement measurements. This prospective observational study enrolled 12 patients who underwent RSA and had a minimum follow-up of 2 years. The active range of motion in shoulder flexion, abduction, and internal and external rotation was measured. At the same time, ACP measurements were taken from a reconstructed postoperative CT scan, in addition to the radiographic measurements of humeral lateralization and distalization angles on AP views in neutral rotation. The mean humeral distalization induced by RSA was 33.3 mm (±3.8 mm). A non-statistically significant increase in shoulder flexion was observed for humeral distalization beyond 38 mm (R2 = 0.29, p = 0.07). This "threshold" effect of humeral distalization was also observed for the gains in abduction, as well as internal and external rotations, which seemed better with less than 38 mm or even 35 mm distalization. No statistical correlation was found between the 3D ACP measurements and 2D angle measurements. Excessive humeral distalization seems to be detrimental to joint mobility, especially shoulder flexion. Humeral lateralization and humeral anteriorization measured using the ACP seem to promote better shoulder range of motion, with no threshold effect. These findings could be evidence of tension in the soft tissues around the shoulder joint, which should be taken into consideration during preoperative planning.

Navigation in reverse shoulder arthroplasty: how the lateralization of glenosphere can affect the clinical outcome.

One of the main causes of RSA failure is attributable to the malpositioning of the glenoid component. Initial experiences with computer-assisted surgery have shown promising results in increasing the accuracy and repeatability of placement of the glenoid component and screws. The aim of this study was to evaluate the functional clinical results, in terms of joint mobility and pain, by correlating them with intraoperative data regarding the positioning of the glenoid component. The hypothesis was that the lateralization more than 25mm of the glenosphere can led to better stability of the prosthesis but should pay in term of a reduced range of movement and increased pain. 50 patients were enrolled between October 2018 and May 2022; they underwent RSA implantation assisted by GPS navigation system. Active ROM, ASES score and VAS pain scale were recorded before surgery. Preoperative data about glenoid inclination and version were collected by pre-op X-Rays an CT. Intraoperative data-inclination, version, medialization and lateralization of the glenoid component-were recorded using computer-assisted surgery. 46 patients had been further clinically and radiographically re-evaluated at 3-months, 6-months, 1-year, and 2-years follow-up. We found a statistically significant correlation between anteposition and glenosphere lateralization value (DM - 6.057mm; p = 0.043). Furthermore a statistically significant correlation has been shown between abduction movement and the lateralization value (DM - 7.723mm; p = 0.015). No other statistically significant associations were found when comparing the values of glenoid inclination and version with the range of motion achieved by the patients after reverse shoulder arthroplasty. We observed that the patients with the best anteposition and abduction results had a glenosphere lateralization between 18 and 22mm. When increasing the lateralization above 22mm or reducing it below 18mm, on the other hand, both movements considered decreased their range. Level IV; Case Series; Treatment Study.

Long-term effectiveness of arthroscopic partial repair for massive irreparable rotator cuff tears

To explore the long-term effectiveness of arthroscopic partial repair in treatment of massive irreparable rotator cuff tears from both the radiological and clinical perspectives. A retrospective analysis was conducted on the clinical data of 24 patients (25 sides) with massive irreparable rotator cuff tears who met the inclusion criteria between May 2006 and September 2014. Among them, there were 17 males (18 sides) and 7 females (7 sides) with an age range of 43-67 years (mean, 55.0 years). There were 23 cases of unilateral injury and 1 case of bilateral injuries. All patients were treated with the arthroscopic partial repair. The active range of motion of forward elevation and abduction, external rotation, and internal rotation, as well as the muscle strength for forward flexion and external rotation, were recorded before operation, at the first postoperative follow-up, and at last follow-up. The American Association of Shoulder and Elbow Surgeons (ASES) score, the University of California at Los Angeles (UCLA) shoulder scoring, and Constant score were used to evaluate shoulder joint function. And the visual analogue scale (VAS) score was used to evaluate shoulder joint pain. MRI examination was performed. The signal-to-noise quotient (SNQ) was measured above the anchor point near the footprint area (m area) and above the glenoid (g area) in the oblique coronal T2 fat suppression sequence. The atrophy of the supraspinatus muscle was evaluated using the tangent sign. The global fatty degeneration index (GFDI) was measured to assess fat infiltration in the supraspinatus muscle, infraspinatus muscle, teres minor muscle, upper and lower parts of the subscapularis muscle. The mean GFDI (GFDI-5) of 5 muscles was calculated. The incisions healed by first intention. All patients were followed up with the first follow-up time of 1.0-1.7 years (mean, 1.3 years) and the last follow-up time of 7-11 years (mean, 8.4 years). At last follow-up, the range of motion and muscle strength of forward elevation and abduction, ASES score, Constant score, UCLA score, and VAS score of the patients significantly improved when compared with those before operation ( P<0.05). Compared with the first follow-up, except for a significant increase in ASES score ( P<0.05), there was no significant difference in the other indicators ( P>0.05). Compared with those before operation, the degree of supraspinatus muscle infiltration worsened at last follow-up ( P<0.05), GFDI-5 increased significantly ( P<0.05), and there was significant difference in the tangent sign ( P<0.05); while there was no significant difference in the infiltration degree of infraspinatus muscle, teres minor muscle, and subscapularis muscle, upper and lower parts of the subscapularis muscle ( P>0.05). Compared with the first follow-up, the SNQm and SNQg decreased significantly at last follow-up ( P<0.05). At the first and last follow-up, there was no correlation between the SNQm and SNQg and the ASES score, Constant score, UCLA score, and VAS score of the shoulder ( P>0.05). Arthroscopic partial repair is effective in treating massive irreparable rotator cuff tear and significantly improves long-term shoulder joint function. For patients with severe preoperative fat infiltration involving a large number of tendons and poor quality of repairable tendons, it is suggested to consider other treatment methods.

Cementless total hip arthroplasty for treatment of acetabular protrusion secondary to rheumatoid arthritis

BackgroundTo explore the surgical technique and clinical outcomes of cementless total hip arthroplasty (THA) combined with impacted bone grafting for the treatment of moderate and severe acetabular protrusion with rheumatoid arthritis (RA).MethodsFrom January 2010 to October 2020, 45 patients (56 hips), including 17 men (22 hips) and 28 women (34 hips) with acetabular impingement secondary to RA, were treated with bioprosthetic THA combined with autologous bone grafting at our hospital. According to the Sotello-Garza and Charnley classification criteria, there were 40 cases (49 hips) of type II (protrusio acetabuli 6–15 mm) and 5 cases (7 hips) of type III (protrusio acetabuli > 15 mm). At the postoperative follow-up, the ROM of the hip joint, the VAS score, and the Harris score were evaluated. The healing of the bone graft, the restoration of the hip rotation center, and the prosthesis loosening were assessed by plain anteroposterior radiographs.ResultsThe average operation time was 95.53 ± 22.45 min, and the mean blood loss was 156.16 ± 69.25 mL. There were no neurovascular complications during the operation. The mean follow-up duration was 5.20 ± 1.20 years. The horizontal distance of the hip rotation center increased from preoperative 10.40 ± 2.50 mm to postoperative 24.03 ± 1.77 mm, and the vertical distance increased from preoperative 72.36 ± 3.10 mm to postoperative 92.48 ± 5.31 mm. The range of flexion motion of the hip joint increased from 39.48 ± 8.36° preoperatively to 103.07 ± 7.64° postoperatively, and the range of abduction motion increased from 10.86 ± 4.34° preoperatively to 36.75 ± 3.99° postoperatively. At the last follow-up, the Harris score increased from 37.84 ± 4.74 to 89.55 ± 4.05. All patients were able to move independently without assistance.ConclusionsCementless THA combined with impacted grafting granule bone of the autogenous femoral head and biological acetabular cup can reconstruct the acetabulum, restore the rotation center of the hip joint, and achieve good medium-term outcomes in the treatment of moderate to severe acetabular herniation secondary to RA.

Abduction Arthro-Fluoroscopy in Adhesive Capsulitis of the Shoulder.

This technical note describes a method of diagnosing adhesive capsulitis of the shoulder based on the real-time study of abduction movement under fluoroscopy control after opacification of the joint cavity with contrast media. This movement passively or actively shows a limitation of the abduction, a scapulohumeral block, or a weak or even an absence of rolling of the humeral head in the glenoid cavity, transforming the abduction into a shoulder elevation.

Idiopathic axillary web syndrome: a case-based review of an unusual disorder

Axillary web syndrome (AWS), which frequently develops following axillary lymph node dissection, can also be caused by several other conditions, such as infection or strenuous exercise. In recent years, idiopathic cases have also been reported. We report the case of a 27-year-old female who presented with pain, tension and a taut rope-like structure in the left armpit area. She also had a limited shoulder range of motion in abduction and forward flexion. We diagnosed the patient with idiopathic AWS based on a detailed clinical history and manifestations. The patient completely recovered without any sequelae by therapeutic interventions, including nonsteroidal anti-inflammatory drugs and physical therapy. Through a systematic review of the literature, four additional cases of idiopathic AWS were identified. This study aimed to investigate the similarities and differences between idiopathic and typical AWS cases.