Acute Shoulder Research Articles

A meta-analytic comparison of 8 methods of closed anterior shoulder dislocation reduction

Background: Anterior shoulder dislocation is a common injury, accounting for 95% of all shoulder injuries. However, many doctors and hospitals do not have a fixed protocol for the treatment of dislocations. The current study have compared 8 different techniques for shoulder dislocation reduction in this study. Methods: Eight different methods namely the Scapular Manipulation, Matsen’s Traction-Countertraction, Kocher’s, Spaso, External Rotation, Cunningham, Modified Milch, and the FARES methods were compared on the basis of efficacy, pain experienced during reduction (VAS score), and time taken for reduction. Results: The Matsen’s Traction-Countertraction method had the highest efficacy, while the Scapular Manipulation method had the least VAS scoring. The FARES Method had the fastest reduction time on average. Interpretation and Conclusions: As per the data analyzed, the FARES and Scapular Manipulation method appear to be the most effective in reducing anterior dislocations, having consistently high success rates, and low VAS scores and reduction times. These 2 methods may be recommended to new practitioners to treat acute shoulder dislocations.

Shoulder pain syndrome in patients engaged in physical culture and sports: modern aspects of rehabilitation

The aim of the study was to estimate rehabilitation efficiency in the sportsmen and physical culture professionals with a shoulder pain syndrome. Materials and methods: 980 patients with a shoulder pain syndrome undergo rehabilitation treatment. The reasons of acute or chronic shoulder pain syndrome were: acute trauma (7% of cases) or chronic microtraumatization (93% of cases) of shoulder tissues during the physical culture activities and sport. Rotary cuff pathology was diagnosed in 88% of patients, long head of biceps pathology - in 5%, acromioclavicular joint pathology - in 4%, the subacromial bursitis in 2% of cases, damage of the glenoid labrum (Bankarta) in 1%. Clinical methods (including the quality of life questionnaire -DASH) and instrumental methods (USD and MRI) were used. The differentiated rehabilitation programs (with the use of modern physical therapy methods) were recommended considering features of shoulder pathology, a patients clinical condition and their physical (including sports) activity. Results: Excellent and good results were stated in 98% of patients with a shoulder pain syndrome. 2% of patients were directed for the surgical intervention (rotary cuff and glenoid labrum restoration). Compensation of a shoulder pain syndrome was stated in 82% of patients; in 16% of patients the pain syndrome had significantly decreased. In 87% of patients function of the injured shoulder joint was restored, in 11% of patients - it significantly improved. Strength of shoulder muscles and a humeroscapular rhythm were restored and the quality of life (according to the DASH questionnaire) improved in 98% of patients. Conclusion. Use of the differentiated programs of rehabilitation using modern physical techniques allows to receive excellent and good results in all patients with a shoulder pain syndrome involved physical culture and sport.

Young men in sports are at highest risk of acromioclavicular joint injuries: a prospective cohort study

PurposeTo study the incidence of acromioclavicular joint injuries in a general population.MethodsAll acute shoulder injuries admitted to an orthopaedic emergency department were registered prospectively, using electronic patient records and a patient-reported questionnaire. The regional area was the city of Oslo with 632,990 inhabitants. Patients with symptoms from the acromioclavicular joint without fracture were registered as a dislocation (type II–VI) if the radiologist described widening of the joint space or coracoclavicular distance on standard anteroposterior radiographs. Patients without such findings were diagnosed as sprains (type I).ResultsAcromioclavicular joint injuries constituted 11% of all shoulder injuries (287 of 2650). The incidence was 45 per 105 person-years (95% confidence interval [CI] 40–51). 196 (68%) were diagnosed as sprains and 91 (32%) as dislocations. Median age of all acromioclavicular joint injuries was 32 years (interquartile range 24–44), and 82% were men. Thirty percent of all acromioclavicular joint injuries were registered in men in their twenties. Sports injuries accounted for 53%, compared to 27% in other shoulder injuries [OR 3.1 (95% CI 2.4–4.0; p < 0.001)]. The most common sports associated with acromioclavicular joint injuries were football (24%), cycling (16%), martial arts (11%), alpine skiing and snowboarding (both 9%), and ice hockey (6%).ConclusionOur study suggests that in the general population, one in ten shoulder injuries involves the acromioclavicular joint and young men in sports are at highest risk. A prognostic level II cohort study.

The Prognostic Value of a Novel Magnetic Resonance Imaging-Based Classification for Septic Arthritis of the Shoulder.

The purposes of the present study were (1) to create a magnetic resonance imaging (MRI)-based classification system for septic shoulder arthritis and to show the results of arthroscopic debridement based on the classification in eradicating the infection, and (2) to determine the distribution of the Gächter stages, which are determined on the basis of arthroscopic findings only, in each grade of the novel classification system. The present study included 31 patients who underwent arthroscopic debridement for the treatment of acute septic arthritis of the shoulder between January 2001 and December 2015. The mean duration of follow-up was 2.3 years. The included patients were assessed with use of a novel classification system based on preoperative radiographic and MRI findings. MRI findings were classified as Grade I (only synovitis or joint effusion), Grade II (marrow edema in the bare area of the humeral head), Grade III (cartilaginous erosion), Grade IV (osseous erosion), and Grade V (osseous erosion on MRI also observed on radiographs). No changes on radiographs were observed in Grades I to IV. The intraclass correlation coefficients (ICCs) for interobserver and intraobserver reliability were calculated. The overall reinfection rate was 54.8% (17 of 31). Among patients with Grade-I, II, III, IV, and V involvement, the reinfection rates were 0 of 4, 1 of 6, 2 of 4, 9 of 12, and 5 of 5, respectively. A diverse distribution of Gächter stages were found in each grade of the novel classification system, with the exception of Grade V. The ICCs for interobserver and intraobserver reliability were 0.81 and 0.80 for the novel classification system. The ICCs for interobserver and intraobserver reliability were 0.75 and 0.78 for Gächter stages. This novel classification system for the grading of acute shoulder infections on the basis of radiographs and MRI allows preoperative grading of septic arthritis to be performed objectively. Patients who were classified as Grade III or higher in the novel classification system had higher reinfection rates than those who were classified as Grade I or II and required more aggressive treatment to eradicate the infection.

Acute Reverse Total Shoulder Arthroplasty Treatment for Proximal Humerus Fracture Displays Equal or Superior Outcomes to Delayed Treatment

Acute Reverse Total Shoulder Arthroplasty Treatment for Proximal Humerus Fracture Displays Equal or Superior Outcomes to Delayed Treatment

The Effect of Adding Magnesium to Bupivacaine as an Adjuvant in Continuous Pectoralis Nerve II (PECs) Block in Simple Mastectomy

Acute postoperative pain and shoulder immobility is a usual complication following breast surgeries. Many technique are used to reduce the postoperative pain, thoracic paravertebral.

LOWER EXTREMITY AEROBIC EXERCISE AS A TREATMENT FOR SHOULDER PAIN

Shoulder girdle pain is a common disabling complaint with a high lifetime prevalence. Interventions aimed at decreasing shoulder pain without stressing shoulder girdle structures have the potential to improve participation in multimodal shoulder rehabilitation programs. The aim of this study was to determine the acute effects of moderate intensity lower extremity exercise on mechanically induced shoulder pain in individuals without shoulder injury. It was hypothesized that participants would exhibit less shoulder pain, as indicated by increased pain thresholds, following lower extremity exercise. Repeated measures study. Thirty (30) healthy participants were recruited to participate in this study. Pain pressure algometry was used to mechanically induce shoulder pain over the infraspinatus muscle belly. This was performed on the dominant shoulder before and immediately after performing 10 minutes of moderate intensity lower extremity exercise using a recumbent exercise machine. Heart rate and rate of perceived exertion were measured following exercise. Repeated measures ANOVA was used to compare pain pressure threshold scores between the baseline and post-exercise time points. Significance was set at p ≤ 0.05 a priori. Effect size (ES) was calculated using Glass's Δ. Moderate intensity lower extremity aerobic exercise led to significantly (F = 8.471, p = 0.003) decreased evoked shoulder pain in healthy adults with moderate effect sizes (0.30-0.43). Lower extremity aerobic exercise significantly decreased pain of the infraspinatus in this sample of young healthy participants. Utilization of lower extremity exercise may be of benefit for younger patients to decreased acute shoulder pain. 2b: individual cohort study.

No Sedation, No Traction, and No Need for Assistance: Analysis of New Prakash’s Method of Shoulder Reduction

Materials and Methods A total of 19 patients who were admitted to the emergency department with the diagnosis of anterior shoulder dislocation participated in this study. The diagnosis of shoulder dislocation was established in the emergency department with physical examination and anteroposterior shoulder radiography. The method was applied only once to the patients in the sitting position by the same physician without using any help, traction, anesthesia, analgesia, and myorelaxant. Results The mean age of the patients was 37.3 ± 13.1 years. Among them, 36.8% (n=7) were female and 63.2% (n=12) were male. Recurrent dislocations were observed in 21.1% (n=4) of the patients. The success rate of the method was 94.7% (n=18). No complication was noted in the patients. The mean procedure time was 243 ± 38 seconds. Conclusion Prakash's method is a safe method for anterior shoulder dislocations that can be quickly performed with no need for sedation, assistance, and traction and has a high success rate.

The Evidence for Common Nonsurgical Modalities in Sports Medicine, Part 1: Kinesio Tape, Sports Massage Therapy, and Acupuncture.

Objective:There are a number of nonsurgical modalities used by athletes in attempts to improve performance or prevent, treat, and rehabilitate musculoskeletal injuries. A concise review of available evidence on common nonsurgical modalities used today is necessary so that practitioners may appropriately counsel patients.Methods:A comprehensive review of relevant publications regarding Kinesio taping, sports massage therapy, and acupuncture from 2006 through 2019 was completed using PubMed and Google Scholar.Results:There have been numerous investigations evaluating the efficacy of nonsurgical modalities for a myriad of musculoskeletal conditions. There is some low level evidence to suggest the use of Kinesio tape for athletes with acute shoulder symptoms and acupuncture for carpal tunnel syndrome and as an adjunct treatment for low back pain. There is a need for higher quality research to better elucidate the effect of sports massage therapy on sports performance, recovery, and musculoskeletal conditions in general.Conclusions:Nonsurgical modalities are low-cost treatment strategies with very few reported adverse outcomes that will likely continue to increase in popularity. High-quality studies are needed to effectively evaluate these treatments, so that care providers can provide appropriate guidance based on evidence-based medicine.

Clinical and Ultrasound Features Associated with the Presence or Absence of Calcification in Patients with Symptomatic Shoulders

Background: Acute and chronic shoulder symptoms can be due to calcifications but also to other lesions well detected by Ultrasound (US). Objective: The present study’s objectives were to determine whether, some demographic, clinical and ultrasound features were associated with the presence or absence of calcifications in symptomatic shoulders patients. Methods: As part of this retrospective, transversal, case-control study of 490 patients, the 125 patients with calcifications were compared to 125 patients without calcification randomly extracted from the cohort. Subgroups were defined according to types and durations of symptoms. The frequency and types of associated lesions in the two groups, as well as the different US appearances of the calcifications were compared according to their different clinical presentations. Results: Calcific tendinitis was present in 26% of patients. Demographic characteristics or clinical manifestations, significantly associated with calcifications were: being a woman (p = 0.002), a shorter delay between symptoms and diagnosis (p = 0.007 and have acute symptoms. The presence of calcifications was associated with the absence of associated (42% vs. 6%, p = 0.0001) or less severe associated US lesions, particularly total rotator cuff rupture (5% vs. 18%, p = 0.001). Soft and cystic calcifications without shadowing were found more frequently in patients with hyperalgesic shoulders (p = 0.005) compared to chronic shoulders. Conclusions: Only few demographic and clinical features were significantly more frequent in the presence of calcifications. US revealed fewer additional lesions when calcifications were present and, some US aspects of the calcification suggested the type of symptoms.

Remplissage Procedure: When and How?

Hill-Sachs lesions were first described in 1940 as grooved defect in the posterior aspect of the humeral head associated with traumatic anterior glenohumeral dislocation. The reported incidence of ...

Acute Symptoms on Rotator Cuff Calcific Tendinitis is Effectively Relieved by Ultrasound Guided Percutaneous Needle Lavage Procedure: a Case Report

Introduction:Rotator cuff calcific tendinitis (RCCT) frequently manifests as acute shoulder pain during the acute resorptive phase. Pain typically worse at night and limited range of motion (ROM) with muscle spasm. Several treatment options have been proposed. In this case, a single needle ultrasound-guided percutaneous lavage (UGPL) combined with corticosteroid subdeltoid bursa injection (SDBI) with a good outcome.Case Presentation:A Female, 59 years old, presents with left RCCT acute pain (VAS 7/10) for 2 days and limited painful shoulder ROM. Inflammation and local tenderness found on the left shoulder, ultrasonography shows calcification in the left infraspinatus tendon with sub-deltoid bursa fluid. Patient in sitting position, ultrasound probe placed at long axis of infraspinatus tendon. Using a 23G needle 5 ml syringe, 1% lidocaine infiltrated until the needle penetrates the calcification site. Then a small amount of normal saline (NaCl) with lidocaine injected in a pulsating manner, observed until chalky matter backflows, mixed with NaCl in the syringe. Repeat this procedure until chalky backflow is minimal. Finally, 10 ml of Triamcinolone Acetonide 40 mg mixed with 2 ml lidocaine 2% SDBI using the same needle. Dramatic shoulder pain relieve (VAS 2/10) is immediately achieved after the procedure. One week follow up, the patient is pain-free and regains full ROM of her left shoulder.Discussion:Several methods are proposed for the treatment of acute RCCT, including corticosteroid injection and arthroscopy debridement. UPGL is an attractive option because it is minimally invasive, can be performed in-office setting, and pain relief is obtained immediately by decompressing and removing inflamed calcified sites.Conclusion:The treatment in acute pain RCCT using UGPL combined with corticosteroid SDBI provides a good outcome.

2469 Extracapsular Hepatocellular Adenoma: A Diagnostic Dilemma

INTRODUCTION: Hepatocellular adenoma (HCA) is a benign tumor of the liver and almost always located intracapsular. Bleeding (25%), and malignant transformation (5%) can complicate the disease course if left untreated. Herein, we present a case of extracapsular HCA of ectopic liver in the omentum complicated with intraperitoneal hemorrhage. CASE DESCRIPTION/METHODS: A 43-year-old lady with no past medical history presented to emergency department with two-day history of left shoulder pain and epigastric discomfort. Her only medication was an oral contraceptive pill (OCP). On physical exam, the patient had persistent sinus tachycardia, and epigastric tenderness. Initial labs were unremarkable except for mildly elevated AST at 58 IU/L (10-37). CT of the abdomen with IV contrast showed a heterogeneously enhancing mass likely arising from the anterior wall of the stomach. T2-weighted MRI abdomen demonstrated a hypoenhancing mass measuring 4 × 7 × 8 cm with adjacent hemorrhage (Figure 1). Exploratory laparotomy revealed an infarcted, hemorrhagic mass between the fundus of the stomach, spleen, and diaphragm with a large amount of clots and free blood occupying the greater curvature. The mass was separated from surrounding viscera however, slightly attached to the diaphragm. The mass was removed with the completely resolved tachycardia and epigastric pain postoperatively. Initially, the lesion was thought to be an accessory spleen based on location and gross examination. Microscopically, an infarcted, hemorrhagic mass composed of cords of degenerated epithelioid cells with vacuolated cytoplasm was surrounded by reactive fibro- and myofibroblastic tissue. Epithelioid cells were diffusely stained for HerPar-1 (hepatocyte origin), and CK AE1/AE3 (Figure 2). These findings were consistent with HCA. DISCUSSION: HCA is an overlooked diagnosis and can result in serious complications if unrecognized. Among the well-known risk factors of HCA are OCPs or anabolic steroids, pregnancy, and steatohepatitis. The prevalence of these lesions has been rising parallel to increasing use of OCP and abdominal imaging. In females, lesions &lt;5 cm with no associated symptoms or complications can be managed conservatively by terminating OCP use, and surveillance. Our patient presented with acute left shoulder pain which was likely due to phrenic nerve irritation by bleeding (Kehr's sign). To best of our knowledge, there are only three cases of extracapsular HCA reported in the English literature.

Differential diagnosis of acute shoulder girdle weakness

Neuralgic amyotrophy (NA), also known as Parsonage-Turner syndrome, is a disease characterized by pain and subsequent muscle weakness. NA appears in the form of mononeuropathy such as anterior interosseous nerve syndrome, posterior interosseous nerve syndrome, long thoracic neuropathy, and isolated neuropathy of suprascapular nerve, or multiple mononeuropathy, a combination of these. It is also present in aspects of cervical nerve root involvement. It is a diagnosis of exclusion which does not have a clear diagnosis or classification criteria. Therefore, the objective of this study was to compare clinical features, images, and electrodiagnostic studies (EDX) of compressive C5 radiculopathy and NA, and to establish the basis for diagnostic criteria of NA. Electronic medical records of 131 patients with shoulder girdle weakness without trauma at our institution between August 2011 and January 2019 were reviewed. According to the grouping criteria, we analyzed 12 patients with C5 radiculopathy and 15 patients with NA We found that left-side weakness and pain were more common in NA group and the range of pain was wider in compressive C5 radiculopathy group significantly. However, there was no laboratory, neurophysiological, or image findings to help differentiate compressive C5 radiculopathy and NA. In conclusion, neither MRI nor EDX were significantly helpful in distinguishing compressive C5 radiculopathy and NA. The abnormality of distal peripheral nerve may present on MRI in patients with compressive radiculopathy. NA should be considered if the proximal portion of nerve root is normal or morphologic change or nerve is found.

Complete brachial plexus palsy following shoulder dislocation due to sneeze: a case report

BackgroundTraumatic shoulder dislocation is a frequent condition presenting to the emergency department. Due to the anatomy of the shoulder, associated neurovascular damage is not uncommon. Although clinical intuition may suggest that a higher-energy mechanism is required to produce neurovascular sequelae, the existing literature does not support this supposition.Case presentationA 55-year-old woman presented to the emergency department with a complete brachial plexus palsy from an acute anterior shoulder dislocation following a violent sneeze. The shoulder was reduced without difficulty in the emergency department within 90 min of dislocation, and the patient was discharged. Her neurologic deficits gradually improved through a program of supervised therapy and orthopedic care. Follow-up at 1 year revealed marked improvement of motor and sensory function of the affected extremity with mild residual weakness and paresthesias in the affected hand.ConclusionNeurovascular injuries in the setting of shoulder dislocation may be present despite low-energy injury mechanisms.

A new name for Altivasum typicum Hedley, 1916 fide Dekkers and Maxwell, 2018 and the description of Altivasum clarksoni n. sp.

This paper addresses the taxonomy irregularity concerning Altivasum typicum Hedley, 1916 fide Dekkers and Maxwell, 2018 that has historically been synonymized under Altivasum flindersi Verco, 1914. We introduce the erection of Altivasum hedleyi n. sp. correcting this taxonomical conundrum that originated from the Hedley (1916) paper. Furthermore, this paper presents a new morph of Altivasum restricted to Esperance in Western Australia. Altivasum clarksoni n. sp. morphologically differs from Altivasum flindersi Verco, 1914 having solid pyramidal knobs on an acute shoulder and a form that is much more equi-biconic. Altivasum hedleyi nov. sp. is also sympatric in part with Altivasum clarksoni n. sp. but is much smaller and the early teleoconch differs in structural form. This paper brings the number of described Altivasum and their forms to four.

Sports-related acute shoulder injuries in an urban population

ObjectivesMore than a third of sports injuries involve the upper extremity. The primary aim was to quantify and describe sports-related shoulder injuries in a general population cohort. A secondary aim...

Treatment of acute shoulder infection: can osseous lesion be a rudder in guideline for determining the method of débridement?

There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement.

Comparison between new modified external rotation method and external rotation method for reduction of ASD

IntroductionDislocation of the shoulder joint is common and is mainly anterior. Several reduction methods have been described and the external reduction method (ERM) is one of the newest. We modified the ERM by making some additions in hopes to develop a less painful, quick and simple method. The aim of this study was to compare the new modified external rotation reduction method (MERM) with ERM in acute anterior shoulder dislocations (ASD). MethodsA total of 62 patients with ASD were classified randomly into 2 groups. The reduction was performed with MERM in one group and with ERM in the other group and the results were compared. Patients' pain scores, reduction time, success rate of the reduction methods, age, sex, dislocation side, dislocation time, previous dislocations history, injury mechanism, any complications, reduction time and neurovascular examination were collected. Parametric and nonparametric analyses were used to compare MERM and ERM. ResultsThe study cohort consisted of 62 patients (52 males, 10 females; mean age, 35 years; age range, 18–73 years) who were randomly assigned to treatment with the MERM (n = 32) or the ERM (n = 30). There was a statistically significant difference between the two methods in terms of time, and the MERM can be applied much faster than ERM (1.34 ± 1.41 min vs 3.05 ± 1.93 min; p < 0.001). The intra-reduction VAS pain score was not significantly in patients who were treated with MERM (85.31 ± 10.39 vs. 78.33 ± 16.54; p = 0.122). ConclusionMERM can be an alternate method compared to the ERM for the reduction of ASD.

The Effects of Active Shoulder Exercise with a Sling Suspension System on Shoulder Subluxation, Proprioception, and Upper Extremity Function in Patients with Acute Stroke.

BackgroundThe aim of this study was to investigate the effect of active shoulder exercise with a sling suspension system on shoulder subluxation, proprioception, and upper extremity function in patients with acute stroke.Material/MethodsThirty-six patients with acute stroke and shoulder subluxation were randomly assigned into two groups. The study group (n=18) received active shoulder exercise with a sling suspension system, and the control group (n=18) received bilateral arm training for 40 minutes, for five days a week, for four weeks. The outcome measures before and after the intervention included measurement of shoulder subluxation distance, shoulder proprioception, the Fugl-Meyer assessment (FMA) scale, and the manual function test (MFT).ResultsComparison of the study group with the control group showed significant differences in all outcome scores post-intervention (p<0.05). The study group had significant improvement in shoulder subluxation distance, shoulder proprioception, the FMA score, and the MFT compared with the control group. There was a significant difference in shoulder subluxation (p=0.001), shoulder proprioception (p=0.046), the FMA score (p=0.002), and the MFT (p=0.007) between the two groups, which favored the study group.ConclusionsActive shoulder exercise with a sling suspension system may be effective in reducing shoulder subluxation, improving proprioception, and upper extremity function in patients following acute stroke.