Shoulder Active Range Of Motion Research Articles

Arthroscopic Superior Capsule Reconstruction Eliminates Pseudoparalysis In Patients with Irreparable Rotator Cuff Tears

Arthroscopic SCR improved shoulder function and achieved superior stability in patients with previously irreparable rotator cuff tears both with and without pseudoparalysis. We have developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function—particularly deltoid muscle function—and relieving pain. In this study, we evaluated whether arthroscopic SCR reversed preoperative pseudoparalysis in patients with irreparable rotator cuff tears. A series of 100 consecutive patients with irreparable rotator cuff tears that had failed conservative treatment underwent arthroscopic SCR using fascia lata autografts; 7 patients with deltoid weakness due to cervical or axillary nerve palsy and 3 patients with severe shoulder stiffness (passive shoulder elevation, less than 90°) before surgery were excluded from the study population. The remaining 90 patients were allocated into 3 groups according to their preoperative active shoulder elevation: (1) no pseudoparalysis: more than 90° of active shoulder elevation (48 patients; mean age, 66.3 years; mean tear size in anterioposterior direction, 3.5 cm); (2) moderate pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients maintained more than 90° elevation once the shoulder was elevated passively (27 patients; mean age, 68.1 years, mean tear size, 3.5 cm); and (3) severe pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients had a positive drop-arm sign (15 patients; mean age, 62.3 years, mean tear size, 4.9 cm). Physical examination, radiography, and magnetic resonance imaging were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. The American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion, acromiohumeral distance, and healing rate were compared between patients with and without pseudoparalysis as well as between before surgery and at the final follow-up (mean, 48 months; range, 24 to 88 months) by using the t and chi-square tests. A significant difference was defined as P < 0.05. ASES score, active elevation, active external rotation, and acromiohumeral distance increased significantly after arthroscopic SCR in patients with no pseudoparalysis, moderate pseudoparalysis, or severe pseudoparalysis. The graft healing rate was 96% (43 of 45) in patients with no pseudoparalysis, 96% (26 of 27) in those with moderate pseudoparalysis, and 87% (13 of 15) in the severe pseudoparalysis group. Postoperative ASES score, active elevation, active external rotation, acromiohumeral distance, and healing rate did not differ among the 3 patient groups. Pseudoparalysis was reversed in 96% (26 of 27) of patients with moderate pseudoparalysis and in 93% (14 of 15) patients with severe pseudoparalysis. Patients with residual moderate or severe pseudoparalysis had graft tears postoperatively. Arthroscopic SCR improved shoulder function and achieved superior stability in patients with previously irreparable rotator cuff tears both with and without pseudoparalysis. Providing that the graft did not tear postoperatively, arthroscopic SCR reversed preoperative pseudoparalysis. The graft healing rate after arthroscopic SCR did not differ between patients with and without pseudoparalysis.

Arthroscopic Treatment of Shoulder Instability with Glenoid Bone Loss Using Distal Tibia Allograft Augmentation

Objectives:The purpose of this study was to retrospectively analyze prospectively collected data to present the clinical and radiological short term outcomes of patients who underwent anatomic glenoid reconstruction using distal tibia allograft to treat shoulder instability with glenoid bone loss.Methods:Over four years, 44 patients (31 patients were male and 13 female with mean age of 29.73 years) underwent arthroscopic stabilization with capsulelabral Bankart repair and allograft bony augmentation of the glenoid for recurrent shoulder instability with significant bone loss by the same surgeon. 14 patients were revision cases of previous surgery. Preoperative and postoperative functional assessment was performed with the Western Ontario Shoulder Instability Index (WOSI) questionnaire, and radiological assessment was performed with radiographs and CT scans. The Average follow-up was 2 years.Results:97% (43/44) patients had no dislocations or subluxations at the most recent followup. The mean pre and postoperative WOSI scores were 40.54 and 72.65 respectively (p<0.001). No patients developed nerve injury. One patient presented with hardware failure at 3 years post-op. Two other patients had graft absorption and 6 patients had partial graft resorption but none had symptoms of instability. The mean postoperative active shoulder range of motion was forward flexion 170.1o, abduction 168.9o, internal rotation 69.5o and external rotation 57.5o. Grafts positioning was flush with the glenoid in 93% of cases, vertical positioning was excellent in 89% (35 o’clock).Conclusion:Arthroscopic stabilization of the shoulder with distal tibia allograft augmentation is a good safety profile technique with good results at average of two years follow up.

Return to Sports and Work after Arthroscopic Superior Capsule Reconstruction in Patients with Irreparable Rotator Cuff Tears

Objectives:Sports and work can be a causative factor in rotator cuff tears, so that these active patients expect to return to sports and work after surgery. However, in case of irreparable rotator cuff tears, it’s not easy to return to sports and work. A new surgical treatment for irreparable rotator cuff tears, arthroscopic superior capsule reconstruction, restores shoulder stability and muscle balance in patients with irreparable rotator cuff tears; consequently, it improves shoulder function—specifically deltoid muscle function—and relieves pain. In this study, we evaluated the rate of return to sports and work in patients treated with arthroscopic superior capsule reconstruction.Methods:From 2007 to 2014, we performed arthroscopic superior capsule reconstruction on 102 shoulders in 100 patients (mean age 66.7 years; range, 43 to 82) with irreparable rotator cuff tears that had failed conservative treatment. Twenty-six patients played sports before surgery (6 golf, 4 table tennis, 4 swimming, 3 martial arts, 2 baseball, 2 yoga, 1 tennis, 1 badminton, 1 skiing, 1 mountain-climbing, and 1 ground golf). Thirty-four patients had been employed before surgery (21 manual workers, 10 farmers, 1 butcher, 1 cook, and 1 athletic trainer). Also physical examination, radiography, and magnetic resonance imaging were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. The return-to-sports and work rate and healing rate were analyzed. The American Shoulder and Elbow Surgeons (ASES) score, and active shoulder range of motion were compared between before surgery and at the final follow-up (mean, 48 months; range, 24 to 88 months) by using the t and chi-square tests. A significant difference was defined as P < 0.05.Results:All 26 patients who had played sport before their injuries returned fully to their previous sports, although most of the patients had been playing at recreational level before their injuries. Thirty-two patients returned fully to their previous jobs, whereas two patients (1 farmer and 1 manual worker) returned with reduced hours and workloads. Ninety-five of 102 shoulders (93.1%) had no graft tear or no re-tear of the repaired rotator cuff tendon during the follow-up period. Three shoulders (2.9%) with severe fatty degeneration of the infraspinatus tendon had re-tear of the repaired infraspinatus tendon at 3 months after surgery. Four shoulders (3.9%) suffered a postoperative graft tear by 3 months (2 patients) or 1 year (2 patients) after surgery. The average preoperative American Shoulder and Elbow Surgeons (ASES) score was 31.6 points (range, 3.3 to 63.3 points). Average clinical outcome scores after arthroscopic superior capsule reconstruction all improved significantly at final follow-up (ASES, 93.3 points) (P < .00001). The shoulder active range of motion improved significantly after arthroscopic superior capsule reconstruction at the final follow-up: by 56.9° (92.4° to 149.3°) for elevation (P < .001), by 15.7° (26.0° to 41.6°) for external rotation (P < .01), and by three vertebral bodies (L4 to L1) for internal rotation (P < .01).Conclusion:Arthroscopic superior capsule reconstruction restored shoulder function and resulted in high rates of return to recreational sport and work. These results suggest that arthroscopic superior capsule reconstruction is a viable surgical option for irreparable rotator cuff tears, especially in patients who work and enjoy sport.

Isolated Subscapularis Repair in Irreparable Posterosuperior Massive Rotator Cuff Tears Involving the Subscapularis Tendon

Background: No previous study has examined whether isolated subscapularis tendon repair in irreparable posterosuperior massive rotator tears involving the subscapularis tendon in relatively young patients without arthritis can yield satisfactory outcomes. Hypothesis: We hypothesized that this procedure would produce favorable outcomes in patients who might otherwise be candidates for reverse arthroplasty. Study Design: Case series; Level of evidence, 4. Methods: This retrospective study included 24 patients in their 50s and 60s, without shoulder arthritis, who underwent arthroscopic isolated subscapularis repair for an irreparable massive rotator cuff tear involving the subscapularis tendon. Preoperative and postoperative visual analog scale (VAS) pain scores, subjective shoulder values (SSVs), University of California at Los Angeles (UCLA) shoulder scores, American Shoulder and Elbow Surgeons (ASES) scores, subscapularis strength (modified bell-press test; maximum of 5), and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) was performed 6 months postoperatively to assess structural integrity of the repaired subscapularis. Results: At a mean 34.8 months (range, 24-49 months) of follow-up, VAS pain scores (improved from 7.1 to 2.5), SSVs (33.3 to 75.2), ASES scores (35.9 to 76.0), UCLA shoulder scores (11.6 to 24.8), subscapularis strength, and ROM were significantly improved compared with preoperative measurements (P < .001). Subscapularis muscle strength improved from 3.7 to 4.2 (P < .001). For active ROM, forward flexion and internal rotation improved significantly (P < .001); however, external rotation exhibited no significant improvement. Follow-up MRA was performed in 22 patients (92%) and showed retear of the repaired subscapularis in 6 (27% of the 22). Conclusion: Isolated repair of the subscapularis tendon in irreparable massive rotator cuff tears involving the subscapularis tendon yielded satisfactory short-term outcomes and structural integrity in patients in their 50s and 60s without arthritis. If patients with irreparable massive rotator cuff tears involving the subscapularis tendon are relatively young or have minimal concomitant arthritis, this repair can be worthwhile.

Arthroscopic Superior Capsule Reconstruction Eliminates Pseudoparalysis in Patients with Irreparable Rotator Cuff Tears

Objectives:We have developed the superior capsule reconstruction (SCR) technique for surgical treatment of irreparable rotator cuff tears. In these patients, SCR restores shoulder stability and muscle balance, consequently improving shoulder function—particularly deltoid muscle function—and relieving pain. In this study, we evaluated whether arthroscopic SCR reversed preoperative pseudoparalysis in patients with irreparable rotator cuff tears.Methods:A series of 100 consecutive patients with irreparable rotator cuff tears that had failed conservative treatment underwent arthroscopic SCR using fascia lata autografts; 7 patients with deltoid weakness due to cervical or axillary nerve palsy and 3 patients with severe shoulder stiffness (passive shoulder elevation, less than 90°) before surgery were excluded from the study population. The remaining 90 patients were allocated into 3 groups according to their preoperative active shoulder elevation: (1) no pseudoparalysis: more than 90° of active shoulder elevation (48 patients; mean age, 66.3 years; mean tear size in anterioposterior direction, 3.5 cm); (2) moderate pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients maintained more than 90° elevation once the shoulder was elevated passively (27 patients; mean age, 68.1 years, mean tear size, 3.5 cm); and (3) severe pseudoparalysis: no shoulder stiffness, less than 90° of active shoulder elevation, patients had a positive drop-arm sign (15 patients; mean age, 62.3 years, mean tear size, 4.9 cm). Physical examination, radiography, and magnetic resonance imaging were performed before surgery; at 3, 6, and 12 months after surgery; and yearly thereafter. The American Shoulder and Elbow Surgeons (ASES) score, active shoulder range of motion, acromiohumeral distance, and healing rate were compared between patients with and without pseudoparalysis as well as between before surgery and at the final follow-up (mean, 48 months; range, 24 to 88 months) by using the t and chi-square tests. A significant difference was defined as P < 0.05.Results:ASES score, active elevation, active external rotation, and acromiohumeral distance increased significantly after arthroscopic SCR in patients with no pseudoparalysis, moderate pseudoparalysis, or severe pseudoparalysis. The graft healing rate was 96% (43 of 45) in patients with no pseudoparalysis, 96% (26 of 27) in those with moderate pseudoparalysis, and 87% (13 of 15) in the severe pseudoparalysis group. Postoperative ASES score, active elevation, active external rotation, acromiohumeral distance, and healing rate did not differ among the 3 patient groups. Pseudoparalysis was reversed in 96% (26 of 27) of patients with moderate pseudoparalysis and in 93% (14 of 15) patients with severe pseudoparalysis. Patients with residual moderate or severe pseudoparalysis had graft tears postoperatively.Conclusion:Arthroscopic SCR improved shoulder function and achieved superior stability in patients with previously irreparable rotator cuff tears both with and without pseudoparalysis. Providing that the graft did not tear postoperatively, arthroscopic SCR reversed preoperative pseudoparalysis. The graft healing rate after arthroscopic SCR did not differ between patients with and without pseudoparalysis.

Relationship Between Patient-Reported Assessment of Shoulder Function and Objective Range-of-Motion Measurements.

Assessment of function is the cornerstone of clinical shoulder research. This purpose of this study was to answer 3 relevant questions: How does subjective patient assessment of shoulder function correlate with objectively measured active shoulder range of motion? What is the difference in active motion between shoulders that can and those that cannot be used to perform each of the functions of the Simple Shoulder Test (SST)? Does the relationship between subjective and objective assessment of shoulder function differ between male and female patients? We analyzed the relationship between objective range-of-motion measurements recorded by the observer-independent Kinect motion capture system and SST patient self-assessments of shoulder function of 74 male and 30 female patients with osteoarthritis. There was poor correlation between objective measurements of active abduction and total SST scores of osteoarthritic shoulders of patients seen before shoulder surgery: the coefficients of determination (R) were 0.29 for the osteoarthritic shoulders of women and 0.25 for those of men. The relationships between active abduction and total SST score were closer for the contralateral shoulders (R = 0.54 for women and R = 0.46 for men). The difference in active abduction between the osteoarthritic shoulders that allowed and those that did not allow the patient to perform the individual SST functions was significant (p < 0.05) for only 4 of the 12 functions in the female group and 5 of 12 in the male group because of the highly variable relationship between self-assessed function and active abduction. In contrast, when the contralateral shoulders were assessed, this difference was found to be significant for 10 of the 12 functions in the female group and all 12 of the functions in the male group. The relationship between objective motion and subjective function did not differ significantly between male and female subjects. The self-assessed function of osteoarthritic shoulders of women and men is only partially determined by the active range of abduction. Both subjective and objective measurements are important in characterizing the clinical status of shoulders. Studies of treatment outcomes should include separate assessments of these 2 complementary aspects of shoulder function. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Effect of myofascial techniques for treatment of upper limb dysfunctions in breast cancer survivors: randomized controlled trial.

Besides pain, myofascial dysfunctions may contribute to the presence of upper limb impairments such as impaired range of motion, decreased strength, lymphedema, and altered postures and kinematics. Therefore, the aim of this study was to investigate the effect of myofascial therapy in addition to a standard physical therapy program for treatment of upper limb dysfunctions in breast cancer survivors. Fifty women treated for a unilateral breast cancer with pain and myofascial dysfunctions at the upper limb region. The intervention group received 12 sessions of myofascial therapy consisting of release techniques on myofascial trigger points and adhesions in addition to a standard physical therapy program for 3months. The control group received 12 sessions of a placebo intervention in addition to the same standard physical therapy program during the 3months. Outcome parameters are active shoulder range of motion (inclinometer); arm lymphedema (perimeter); upper limb strength (handheld dynamometer); scapular statics and dynamics (acromion-table and pectoralis minor index, inclinometer); shoulder function (Disability of Shoulder, Arm and Hand questionnaire); and quality of life (Short Form 36). Measures were taken before and after the intervention at 6 and 12months follow-up. No differences between groups were found for all outcome parameters over the course of 1year. However, overall beneficial effects of the standard physical therapy program for active shoulder range of motion and shoulder function were found in both groups up to 1year follow-up. Myofascial therapy has no additional beneficial effect for improvement of upper limb function in breast cancer survivors.

The impact of robot-mediated adaptive I-TRAVLE training on impaired upper limb function in chronic stroke and multiple sclerosis

Purpose: The current study aimed to investigate proof-of-concept efficacy of an individualized, robot-mediated training regime for people with MS (pwMS) and stroke patients.Method: Thirteen pwMS and 14 chronic stroke patients performed 36 (stroke) or 40 (pwMS) training sessions with the I-TRAVLE system. Evaluation of upper limb function was performed at baseline, after training and at 3 months follow-up. Clinical outcome measures consisted of active range of motion (ROM), Motricity Index, Jamar handgrip strength, perceived fatigue and strength, Wolf Motor Function Test (WFMT) and ABILHAND. Robot-generated outcome measures consisted of movement velocity, ROM and actual covered distance compared to straight-line distance.Results: In pwMS, significant improvements were found after training in active shoulder ROM, handgrip strength, perceived strength and WMFT activities. No significant change in clinical outcome was found in stroke patients, except for perceived strength. Significant improvement in speed and movement duration was found after training in both groups. At follow-up, clinical outcome deteriorated in pwMS and was maintained in stroke patients.Conclusions: Robot-mediated training resulted in improved movement coordination in both groups, as well as clinical improvement in pwMS. Absence of functional improvements in stroke patients may relate to severe upper limb dysfunction at baseline.Implications for RehabilitationRobot-mediated training improved strength, active range of motion and upper limb capacity in pwMS.Robot-mediated therapy allows for adapted training difficulty.

Relation Between Subacromial Bursitis on Ultrasonography and Efficacy of Subacromial Corticosteroid Injection in Rotator Cuff Disease: A Prospective Comparison Study

ObjectiveTo evaluate the correlations between subacromial bursitis (bursal thickening and effusion) on ultrasonography and its response to subacromial corticosteroid injection in patients with rotator cuff disease. DesignProspective, longitudinal comparison study. SettingUniversity-affiliated tertiary care hospital. ParticipantsPatients with rotator cuff disease (N=69) were classified into 3 groups based on ultrasonographic findings; (1) normative bursa group (group 1, n=23): bursa and effusion thickness <1mm; (2) bursa thickening group (group 2, n=22): bursa thickness >2mm and effusion thickness <1mm; and (3) bursa effusion group (group 3, n=24): bursa thickness <1mm and effusion thickness >2mm. InterventionA single subacromial injection with 20mg of triamcinolone acetonide. Main Outcome MeasuresVisual analog scale (VAS) of shoulder pain, Shoulder Disability Questionnaire (SDQ), angles of active shoulder range of motion (flexion, abduction, external rotation, and internal rotation), and bursa and effusion thickness at pre- and posttreatment at week 8. ResultsThere were no significant differences between the 3 groups in demographic characteristics pretreatment. Groups 2 and 3 showed a significant difference compared with group 1 in changes on the VAS and abduction; group 3 showed a significant difference compared with group 1 in changes of the SDQ, internal rotation, and external rotation; and all groups showed significant differences when compared with each other (groups 1 and 3, 2 and 3, and 1 and 2) in changes of thickness. ConclusionsA patient with ultrasonographic observation of subacromial bursitis, instead of normative bursa, can expect better outcome with subacromial corticosteroid injection. Therefore, we recommend a careful selection of patients using ultrasonography prior to injection.

Libération antérieure de l’épaule associée à la neurotisation du nerf suprascapulaire par le nerf spinal accessoire chez les enfants présentant une paralysie obstétricale du plexus brachial – résultats préliminaires à propos de 10 cas

Introduction Children with obstetric brachial plexus palsy (OBPP) have usually a motor weakness of shoulder external rotation, which results into a contracture of the internal rotators muscles and deformity of the glenohumeral joint. The aim of this study was to assess results of anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve in children with OBPP. Material and methods Between 2012 and 2015, ten children (mean age: 2.5 years) were operated for a limitation of passive and active external rotation and a limitation of shoulder abduction. Pre and postoperative passive and active shoulder range of motion were measured. Shoulder strength and function were respectively assessed by the Medical Research Council (MRC) score and the Mallet score. MRI was performed to evaluate the glenohumeral joint. Results At mean follow-up of 2.7 years, mean passive external rotation significantly increased from −20° to 70° postoperatively ( P = 0.008). Mean postoperative active external rotation was 50°, while no patient had an active external rotation preoperatively ( P = 0.004). Mean active abduction recovery was 110°. According to MRC score, external rotation strength was graded M4, M3 and M2 in respectively 3, 4 and 3 patients. Similarly, shoulder abduction strength was graded M4, M3 and M2 in respectively 4, 5 and 1 patients. Mallet score demonstrated significant improvements. Joint alignment was obtained with a remodeling of the deformity. Discussion Spinal accessory nerve is a purely motor nerve whose function is similar to the suprascapular nerve. Anterior release is a minimally invasive procedure, which aims to restore external rotation and abduction of the shoulder. Conclusion Anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve improves significantly shoulder function in children with OBPP.

Anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve in children with upper brachial plexus birth palsy – preliminary results of 10 retrospective cases

Introduction Children with obstetric brachial plexus palsy (OBPP) have usually a motor weakness of shoulder external rotation, which results into a contracture of the internal rotators muscles and deformity of the glenohumeral joint. The aim of this study was to assess results of anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve in children with OBPP. Material and methods Between 2012 and 2015, ten children (mean age: 2.5 years) were operated for a limitation of passive and active external rotation and a limitation of shoulder abduction. Pre and postoperative passive and active shoulder range of motion were measured. Shoulder strength and function were respectively assessed by the Medical Research Council (MRC) score and the Mallet score. MRI was performed to evaluate the glenohumeral joint. Results At mean follow-up of 2.7 years, mean passive external rotation significantly increased from −20° to 70° postoperatively ( P = 0.008). Mean postoperative active external rotation was 50°, while no patient had an active external rotation preoperatively ( P = 0.004). Mean active abduction recovery was 110°. According to MRC score, external rotation strength was graded M4, M3 and M2 in respectively 3, 4 and 3 patients. Similarly, shoulder abduction strength was graded M4, M3 and M2 in respectively 4, 5 and 1 patients. Mallet score demonstrated significant improvements. Joint alignment was obtained with a remodeling of the deformity. Discussion Spinal accessory nerve is a purely motor nerve, whose function is similar to the suprascapular nerve. Anterior release is a minimally invasive procedure, which aims to restore external rotation and abduction of the shoulder. Conclusion Anterior shoulder release combined with neurotization of suprascapular nerve by spinal accessory nerve improves significantly shoulder function in children with OBPP.

A Preliminary Randomized Clinical Trial on the Effect of Cervicothoracic Manipulation Plus Supervised Exercises vs a Home Exercise Program for the Treatment of Shoulder Impingement

ObjectiveThe purpose of this study was to investigate changes in pain, disability, and range of movement after cervicothoracic manipulation plus exercise therapy in individuals with unilateral shoulder impingement syndrome. MethodsForty-one patients (30 men, 11 women; aged 47 ± 9) diagnosed with unilateral shoulder impingement syndrome attended 10 sessions for 5 weeks (2 sessions/wk). Eligible patients were randomly allocated to 2 study groups: cervicothoracic manipulation plus exercise therapy (n = 21) or home exercise program (n = 20). The outcomes measures included the visual analog scale (VAS); the Disabilities of the Arm, Shoulder, and Hand score; Shoulder Disability Questionnaire; subacromial impingement syndrome (Hawkins-Kennedy Test and Neer Test); and shoulder active range of motion (movements of flexion, extension, rotation, adduction, and abduction). Assessments were applied at baseline and 24 hours after completing 5 weeks of related interventions. ResultsAfter 5 weeks of treatment significant between-group differences were observed in the Disabilities of the Arm, Shoulder, and Hand score (P = .012); however, no statistically significant differences were achieved for Shoulder Disability Questionnaire (P = .061) and pain intensity (P = .859). Both groups improved with regard to disability and clinical tests for detecting subacromial impingement syndrome. ConclusionsThis clinical trial suggests that cervicothoracic manipulative treatment with mobilization plus exercise therapy may improve intensity of pain and range of motion compared with the home exercise group alone; the home exercise group had significant changes for flexion, extension, adduction, and abduction, but not for external and internal rotation movement in patients with shoulder impingement.

Concomitant coracoplasty during arthroscopic subscapularis repair does not yield better clinical outcomes and structural integrity.

Few studies have examined whether concomitant coracoplasty is necessary to improve clinical and radiological outcomes after arthroscopic subscapularis repair. The purpose of this study was to compare clinical outcomes and structural integrity after arthroscopic repair of isolated subscapularis full-thickness tear, either with or without concomitant coracoplasty. This study included 62 patients who underwent arthroscopic subscapularis repair either with coracoplasty (Group A, 35 patients) or without coracoplasty (Group B, 27 patients). Preoperative and postoperative visual analog scale pain scores, subjective shoulder values, University of California at Los Angeles shoulder scores, American Shoulder and Elbow Surgeon scores, subscapularis strength, and shoulder active range of motion (ROM) were assessed. Postoperative magnetic resonance arthrography (MRA) or computed tomographic arthrography (CTA) was performed 6months postoperatively for structural integrity assessment. At 2-year follow-up, all functional scores and ROM improved significantly in both groups compared with preoperative values (p<0.001). However, none of these values differed significantly between groups. On follow-up MRA or CTA images, although postoperative coracohumeral distance was significantly greater in Group A (8.4mm±2.3mm versus 7.0mm±2.0mm) (p=0.018), the re-tear rates were not significantly different between groups (5/35 (14%) in Group A and 4/27 (15%) in Group B). For isolated subscapularis full-thickness tears, concomitant coracoplasty with arthroscopic repair did not produce better clinical outcomes or structural integrity than repair without coracoplasty. This suggests that concomitant coracoplasty may not be imperative during arthroscopic repair of isolated subscapularis full-thickness tears. III.

Relationship between Spinal Alignment and Glenohumeral Joint Elevation in Kyphotic Elderly Women

The purpose of this study was to evaluate the relationship between spine alignment and shoulder elevation in a kyphotic elderly population. Twenty-three consecutive female patients who underwent balloon kyphoplasty for spinal compression fractures without shoulder symptoms were examined (mean age, 76 ± 6.3 years). Thoracic kyphosis angle (TK), lumbar lordosis angle (LL), and pelvic tilt angle (PT) were measured on standing true lateral radiographs of the whole spine. The shoulder active range of motion with or without scapular fixation was measured in the sitting position. The University of California Los Angeles (UCLA) Shoulder Score was recorded as the functional evaluation. The total elevation angle was 128.9° ± 22°, the glenohumeral angle was 80.7° ± 10.9°, and the UCLA Shoulder Score was 32.4 ± 2.1. The TK was 36.7°, the LL was −29.1°, and the PT was 30.5°. The total elevation angle was significantly negatively correlated with LL. TK and PT were not significantly correlated with any parameter. The total shoulder elevation angle was limited in the kyphotic elderly women in this study, and kyphotic change appeared to interfere with spinal extension and reduced the total elevation arc with no glenohumeral motion deficit. A reduction in total shoulder elevation was negatively correlated with LL.

Clinical and radiologic outcomes of the second-generation Trabecular Metal™ glenoid for total shoulder replacements after 2-6years follow-up.

A porous tantalum glenoid component for total shoulder replacements was introduced in 2003 to promote biologic ingrowth. However, reports of component failure prompted design modifications. The purpose of this study is to present the largest series to date, of TSR with the second-generation Trabecular Metal™ glenoid component. A radiologic and clinical evaluation of the second-generation TM glenoid was conducted in consecutive cases of 76 shoulders (66 patients) with a mean follow-up of 43.2months (range 24-72months). Pre-operative VAS score, patient self-assessed ASES score, active shoulder range of motion, and radiologic assessment were recorded. Patients were recalled for latest follow-up clinical and radiologic evaluation. On latest follow-up, the mean VAS scores (pre-op: 6.4-latest: 0.9) and ASES scores (pre-op: 36.9-latest: 88.5) improved. Active range of motion improved in all planes. There was no report of glenoid component migration, loosening, or humeral stem subsidence. The incidence of non-progressive radiolucency in the glenoid was 6.6% (Franklin 1: 3 cases, Franklin 2: 2 cases). Post-operative complications involved dislocation (n=2) which were reduced in ED, post-operative stiffness (n=1), transient axillary nerve neuropraxia (n=1), and supraspinatus tear which underwent arthroscopic repair at 16months post-op. There were no revision surgeries for implant loosening nor glenoid component fracture at the peg-base plate junction. The modifications established in the second-generation TM glenoid resulted to improve early to mid-term survivorship and clinical outcomes in TSR, with promise of long-term implant stability through bony ingrowth. Level IV, case series, treatment study.

Ability of electrical stimulation therapy to improve the effectiveness of robotic training for paretic upper limbs in patients with stroke

We investigated whether untriggered neuromuscular electrical stimulation (NMES) can increase the effectiveness of shoulder and elbow robotic training in patients with hemiparesis. Thirty subacute stroke patients were randomly equally allocated to robot only (RO) and robot and electrical stimulation (RE) groups. During training, shoulder and elbow movements were trained by operating the robotic arm with the paretic arm, and the robotic device helped to move the arm. In the RE group, the anterior deltoid and triceps brachii muscles were electrically stimulated at sub-motor threshold intensity. Training was performed (approximately 1h/day, 5 days/week for 2 weeks) in addition to regular rehabilitation. Active range of motion (ROM) values of shoulder flexion and abduction, and Fugl-Meyer assessment (FMA) scores were measured before and after training. Active shoulder ROM was significantly better after than before training in the RE group; however, no such improvement was noted in the RO group. FMA scores were significantly better in both groups, and there was no significant difference between the groups. Untriggered NMES might increase the effectiveness of shoulder and elbow robotic training in patients with hemiparesis. Additionally, NMES at a sub-motor threshold during robotic training might facilitate activation of paretic muscles, resulting in paralysis improvement.

Outcomes of Arthroscopic Decompression of Spinoglenoid Cysts Through a Subacromial Approach

To describe a spinoglenoid cyst decompression technique through a subacromial approach and its clinical outcomes after 2years of follow-up. From March 2008 to October 2013, 26 patients underwent arthroscopic decompression of a spinoglenoid ganglion cyst with and/or without superior labral anterior to posterior repair, and patients who were available for minimum of 2years of follow-up were included. For functional assessments, the visual analog scale (VAS) pain score, subjective shoulder value (SSV), University of California at Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeon (ASES) score, and shoulder active range of motion were used to compare preoperative and postoperative follow-up values. Follow-up magnetic resonance arthrography was taken at 6months postoperatively to evaluate incomplete decompression or recurrence of the cyst. In total, 21 patients were included in this study. At the 2-year follow-up, the VAS, SSV, ASES, and UCLA shoulder scores significantly improved compared with preoperative values (P < .001): VAS improved from 3.5 to 0.7 (P < .001); SSV improved from 62.9 to 93.1 (P < .001); ASES score improved from 64.3 to 94.4 (P < .001); UCLA shoulder score improved from 21.6 to 32.9 (P<.001). Also, active forward flexion improved from 153° to 158° (P= .014), and external rotation improved from 55° to 57° (P= .042) significantly, with the exception of internal rotation. The follow-up magnetic resonance arthrography was performed in 18 patients (86%), and there was no recurrence of the spinoglenoid notch cyst. For spinoglenoid cyst decompression, the subacromial approach was found to be effective, yielding satisfactory clinical outcomes without recurrence. Level IV, therapeutic case series.

The immediate effects of soft tissue mobilization versus therapeutic ultrasound for patients with neck and arm pain with evidence of neural mechanosensitivity: a randomized clinical trial

Study design:Randomized clinical trial.Objectives:To investigate the immediate effects of soft tissue mobilization (STM) versus therapeutic ultrasound (US) in patients with neck and arm pain who demonstrate neural mechanical sensitivity.Background:While experts have suggested that individuals with neck and arm pain associated with neural tissue mechanical sensitivity may benefit from STM, there has been little research to investigate this hypothesis.Methods:Twenty-three patients with neck and arm pain and a positive upper limb neurodynamic test (ULNT) were randomly assigned to receive STM or therapeutic US during a single session. Outcome measures were collected immediately before and after treatment, and at 2–4 day follow-up. Primary outcomes were the Global Rating of Change (GROC), range of motion (ROM) during the ULNT, and pain rating during the ULNT. Secondary measures included the Neck Disability Index (NDI), Patient-Specific Functional Scale (PSFS), Numeric Pain Rating Scale (NPRS), and active range of shoulder abduction motion combined with the wrist neutral or wrist extension.Results:A greater proportion of patients in the STM group reported a significant improvement on the GROC immediately after treatment (P = 0·003, STM = 75%, US = 9%), and at 2–4 day follow-up (P = 0·027, STM = 58%, US = 9%). Patients who received STM demonstrated greater improvements in ROM during ULNT (P = 0·026), PSFS (P = 0·007), and shoulder active ROM combined with wrist extension (P = 0·028). Improvements in Numeric Pain Rating Scale and pain during the ULNT were observed only in the STM group. There was no difference between groups for the NDI or shoulder abduction ROM with wrist neutral.Conclusion:Patients with neck and arm pain demonstrated greater improvements in ULNT ROM, GROC, and PSFS, and pain following STM than after receiving therapeutic US.Level of evidence:Therapy, level 1b.

Shoulder Pain in a Swimmer

HISTORY: A 17 year old male, right hand dominant, competitive swimmer presented to clinic with a 2 week history of right shoulder pain. Initial pain was associated with coughing secondary to an upper respiratory infection and localized to the right upper trapezius and scapula. Several days later, he playfully lifted a heavy friend, felt more pain in the same area, and dropped his friend due to severe pain. Pain occasionally radiated down posterior arm. Exacerbating factors included overhead activities including swimming, shoulder abduction, cross body reaching, deep breathing and coughing. Past history included possible right shoulder dislocation in fifth or sixth grade, when shoulder “popped in and out”. PHYSICAL EXAM: Peripheral pulses intact, normal capillary refill. Breathing unlabored; pain with deep breathing. Strength, reflexes, and sensation normal. No evidence of atrophy, scapular winging, or swelling. No obvious tenderness to palpation. Full active shoulder range of motion with pain at terminal arc of forward flexion and abduction. No glenohumeral internal rotation deficit. Pain with horizontal cross-body adduction, Neer’s maneuver and resisted shoulder external rotation. DIFFERENTIAL DIAGNOSIS: 1. Rotator cuff injury 2. Shoulder impingement 3. Labral tear 4. Myofascial pain 5. Cervical strain or radiculopathy 6. Brachial plexitis/Parsonage turner 7. Spontaneous pneumothorax 8. Rib injury TEST AND RESULTS: Shoulder radiograph - Complete transverse fracture right 1st rib with associated soft tissue swelling. - Flattening of greater tuberosity of right humerus posterolaterally suspicious for a Hill-Sachs fracture. Slight deformity of tuberosity on external rotation view raises possibility of fracture. FINAL/WORKING DIAGNOSIS: Right first rib fracture TREATMENT AND OUTCOMES: 1. Initial treatment: No swimming. Encouraged rest, analgesia with Tylenol and avoidance of overhead activities and activities that caused pain including lifting. 2. Return visit 5 weeks after initial pain onset: Right rib radiograph showed a slightly comminuted and displaced fracture of the lateral aspect of the right 1st rib. On physical exam, full non-painful range of motion and strength of shoulder. 3. At 6 weeks, he gradually re-introduced upper body activity. 4. Returned successfully to competitive swimming.

Effects of functional and analytical strength training on upper-extremity activity after stroke: a randomized controlled trial.

ABSTRACTObjectiveTo investigate the effects of functional strengthening (using functional movements) and analytical strengthening (using repetitive movements) on level of activity and muscular strength gain in patients with chronic hemiparesis after stroke.MethodA randomized, assessor-blinded trial was conducted in a therapist-supervised home rehabilitation program. Twenty-seven patients with chronic stroke were randomly allocated one of two groups: functional strengthening (FS) (n=13) and analytical strengthening (AS) (n=14). Each group received a five-week muscle strengthening protocol (30 minutes per day, three times per week) including functional movements or analytical movements, respectively. Pre-, post-, and ten-month follow-up outcomes included the Upper-Extremity Performance Test (primary outcome), Shoulder and Grip Strength, Active Shoulder Range of Motion (ROM), the Fugl-Meyer Assessment, and the Modified Ashworth Scale (MAS) (secondary outcomes).ResultsThere was significant improvement in the Upper-Extremity Performance Test for the combined unilateral and bilateral task scores in the FS Group (mean difference 2.4; 95% CI=0.14 to 4.6) in the 10-month follow-up. No significant difference was observed between groups in the other outcomes (p>0.05).ConclusionA five-week home-based functional muscle strengthening induced positive results for the upper-extremity level of activity of patients with moderate impairment after chronic stroke.