Bilateral Shoulder Joints Research Articles

Checkpoint inhibitor immunotherapy induced inflammatory arthritis secondary to Nivolumab and Ipilimumab: a pediatric first

BackgroundImmune checkpoint inhibitors (ICIs) have expanded the arsenal of cancer therapeutics over the last decade but are associated with a spectrum of immune-related adverse events (irAEs), including inflammatory arthritis. While these complications are increasingly recognized in the adult population, no cases of inflammatory arthritis irAEs have been reported in the pediatric literature.Case PresentationA 14-year-old female with metastatic epithelioid mesothelioma was referred to the pediatric rheumatology clinic after developing progressive inflammatory joint pain in her bilateral shoulders, hips, and small joints of hands following the second cycle of Nivolumab and Ipilimumab. Initial examinations showed bilateral shoulder joint line tenderness, positive FABERs test bilaterally, tenderness over bilateral greater trochanters, and bilateral second PIP effusions. Her serological profile was notable for positive HLA-B27, positive anti-CCP, negative Rheumatoid Factor, and negative ANA. PET-CT scan performed for disease response following immunotherapy showed symmetric increased metabolic activity primarily involving the supraspinatus, gluteus medius and minimus, and semimembranosus tendon insertions. Her presentation was consistent with a grade 1 irAE that worsened to a grade 2 irAE despite NSAID therapy, prompting a short course of oral prednisolone. She achieved clinical remission of her mesothelioma following six cycles of Nivolumab and Ipilimumab and her inflammatory arthritis was controlled on Celebrex monotherapy.ConclusionsTo our knowledge, this is the first pediatric case of ICI-induced inflammatory arthritis and enthesitis. This case highlights the importance of increasing awareness of diagnosis and management of irAEs in children.

Rare complication of rheumatoid arthritis: Charcot Neuro-osteoarthropathy

BackgroundRheumatoid arthritis (RA) is an autoimmune disease.However, there are few cases of Charcot Neuro-osteoarthropathy (CN) caused by rheumatoid diseases in clinical reports. It is not easy to pay attention to the diagnosis of CN in the complications of rheumatoid disease, which greatly increases the probability of misdiagnosis and missed diagnosis. This case reported a rare complication of rheumatoid arthritis, Charcot arthritis, and the molecular mechanism and diagnosis and treatment of CN caused by RA were systematically discussed.Case presentationThe patient, a 79-year-old woman, was hospitalized due to bilateral shoulder pain, limited activity for half a year, aggravated for 4 months to the hospital. During this period, the symptoms did not improve after treatment with acupuncture and Chinese medicine. The patient was previously diagnosed with rheumatoid arthritis for more than 3 years and intermittent irregular use of methylprednisolone and methotrexate for 2 years. She had a history of osteoporosis. Physical examination: symmetrical malformed swelling of the finger joints of both hands; Bilateral supraspinatus and deltoid muscle atrophy, tenderness at the acromion, and attachment of the long head tendon of the biceps brachii were observed. The left Dugas test and the right Dugas test were positive.Blood test: anti-cyclic citrullinated peptide antibody (A-CCP) 33.10U/ml (normal range: 0-5RU/ml); antinuclear antibody quantification (ANA) 47.40AU/ml (normal range: Negative or < 32); anti-double stranded DNA IgG antibody quantification (dsDNA) 31.00 IU/ml (normal range: 0-100 IU/ml); D-Dimer 6.43 µg/ml (normal range: 0–0.5 mg/L); erythrocyte sedimentation rate (ESR) was 27 mm/h (normal range: < 20 mm/60 min). C-reactive protein (CRP) 39.06 mg/L(0.068-8 mg/L).MRI 3.0 T enhancement of bilateral shoulder joints, cervical spine and thoracic spine showed: 1.Large bone destruction, cartilage injury, multiple effusion, synovitis, obvious on the right side. 2.Intervertebral disc degeneration, cervical 3/4, 4/5, 5/6, 6/7 disc herniation, with cervical 3/4 obvious, posterior central herniation;ConclusionsRheumatoid arthritis complicated with Charcot's joint is rare. Clinically, patients with rheumatoid diseases should not ignore Charcot's joint complications because of rareness. Early blood inflammatory markers, neuro electrophysiology, and imaging MRI of rheumatoid CN are of great significance for the diagnosis of this mild or early neurovascular inflammation. Early diagnosis and treatment are helpful to prevent further joint injury. The clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed.

Exercises with the StretchPole improve shoulder joint range of motion

The ‘StretchPole’ foam roller product is mainly used to loosen muscle groups and joints in the deeper layers of the body that are normally inaccessible to the human hand, and to realign the skeletal structure by lying on the pole and performing exercises. It is also used to strengthen the core, which plays an important role in postural maintenance and stability. The purpose of this study was to determine the effects of the ‘Solacon’ exercise routine using a StretchPole on shoulder joint range of motion. Forty healthy participants performed Solacon exercises using a StretchPole. The specific method of Solacon comprises six movements: (1) chest slide, (2) crescent, (3) cone, (4) twister, (5) shoulder alternating rotation, and (6) chin-in exercise. The joint range of motion of the bilateral shoulder joint flexion, abduction, horizontal abduction, and external rotation (1st and 2nd) were measured before and after the exercises. All measures were significantly higher after exercise compared to before exercise. Solacon exercises improve thoracic spine and scapular mobility and stretch the anterior thoracic muscle groups. The shoulder joint in the broad sense consists of the humerus, scapula, clavicle, sternum, and ribs. These in turn constitute the scapulohumeral joint, acromioclavicular joint, sternoclavicular joint, scapulothoracic joint and functional second shoulder joint. In addition, costovertebral joints and intervertebral joints are also involved because of the added motion of the ribs and the spine. We considered that the ranges of motion of shoulder joint flexion, abduction, horizontal abduction, and external rotation measured in this study were expanded.

Preliminary application of foldable pedicled latissimus dorsi myocutaneous flap for repairing soft tissue defects in shoulder and back

To explore the feasibility and effectiveness of a foldable pedicled latissimus dorsi myocutaneous flap to repair soft tissue defects in the shoulder and back. Between August 2018 and January 2023, the foldable pedicled latissimus dorsi myocutaneous flaps were used to repair soft tissue defects in the shoulder and back of 8 patients. There were 5 males and 3 females with the age ranged from 21 to 56 years (mean, 35.4 years). Wounds were located in the shoulder in 2 cases and in the shoulder and back in 6 cases. The causes of injury were chronic infection of skin and bone exposure in 2 cases, secondary wound after extensive resection of skin and soft tissue tumor in 4 cases, and wound formation caused by traffic accident in 2 cases. Skin defect areas ranged from 14 cm×13 cm to 20 cm×16 cm. The disease duration ranged from 12 days to 1 year (median, 6.6 months). A pedicled latissimus dorsi myocutaneous flap was designed and harvested. The flap was divided into A/B flap and then were folded to repair the wound, with the donor area of the flap being pulled and sutured in one stage. All 7 flaps survived, with primary wound healing. One patient suffered from distal flap necrosis and delayed healing was achieved after dressing change. The incisions of all donor sites healed by first intention. All patients were followed up 6 months to 4 years (mean, 24.7 months). The skin flap has a good appearance with no swelling in the pedicle. At last follow-up, 6 patients had no significant difference in bilateral shoulder joint motion, and 2 patients had a slight decrease in abduction range of motion compared with the healthy side. The patients' daily life were not affected, and linear scar was left in the donor site. The foldable pedicled latissimus dorsi myocutaneous flap is an ideal method to repair the soft tissue defect of shoulder and back with simple operation, less damage to the donor site, and quick recovery after operation.

Incidental FAPI Localization in Benign Bone Lesions in a Case of Carcinoma Stomach.

Recently developed radiolabeled FAPI (fibroblast-activation protein inhibitors) have attracted researcher's attention in diagnosing various tumors because of its high specificity and better tumor-to-background ratio. Increasing use of 68Ga-FAPI PET/CT has resulted in reporting of incidental benign findings as well. We hereby present a case of suspected carcinoma stomach showing increased uptake in primary tumor in stomach as well as incidental uptake in benign subchondral cysts in bilateral shoulder joints and right hip joint on 68Ga-FAPI PET CT scan.

Two cases of bilateral reverse shoulder arthroplasty performed in patients with rheumatoid arthritis.

Bilateral shoulder joint disorders caused by rheumatoid arthritis significantly impair daily functioning owing to a lack of contralateral compensation. In Japan, reverse shoulder joint prostheses were approved in 2014. This was expected to improve the surgical outcomes of rheumatoid shoulder arthroplasty. We report two patients with rheumatoid arthritis who underwent bilateral reverse shoulder arthroplasty. This study aims to evaluate their postoperative clinical outcomes and activities of daily living. The patients were women in their 70s with stage III class 2 rheumatoid arthritis. Their treatment and postoperative activities of daily living were retrospectively reviewed. The first patient underwent the inlay type and experienced a residual limitation of external rotation postoperatively; therefore, she was restricted to dress with front-open clothes. However, she was able to undress after the lining of the garment was changed to a slippery material. The second patient underwent the onlay type and showed almost no limitations in postoperative activities of daily living. She was able to undress with an external rotation of 40-50°. Bilateral reverse shoulder arthroplasty improved range of motion, the Japanese Orthopaedic Association shoulder score, and functional outcomes. Only a few difficulties were encountered in the activities of daily living.

ROLE OF AYURVEDA IN THE MANAGEMENT OF MYASTHENIA GRAVIS: A CASE STUDY

Myasthenia Gravis (MG) is a neuromuscular junction disease that leads to varying degrees of skeletal muscle weakness with fatigue. The underlying defect in diseases is a decrease in the number of available acetylcholine receptors (AChRs) at postsynaptic neuromuscular junctions due to the binding of autoantibody at acetylcholine receptors. The most commonly and firstly affected muscles are those of the eyes, i.e., ocular muscles leading to drooping of eyelids because of more availability of receptors in less surface area of muscle, later leads to symptoms like difficulty in swallowing leading to (dysphagia), Difficulty to speak (dysarthria), other skeletal muscles fatigability etc. In Ayurveda, we cannot correlate to any particular diseases, but it can be understood in view of upahata dhatu ushma, srotas and marutha, respectively, leading to avarana to the normal functioning of vata. The present study was conducted to determine the efficacy of Ayurvedic management in Myasthenia gravis. In this paper, a case of 47 years old female who was diagnosed with myasthenia gravis (MG) with autoimmune hypothyroidism for 13 years was reported to complain of drooping of eyelids, pain and stiffness at the nape of the neck and bilateral shoulder joints, disturbed sleep, reduced appetite, with occasional diplopia, dysphagia, which got aggravated for six months, hence she approached OPD of SKAMCH&amp;RC, Bengaluru. Considering the signs and symptoms patient was treated on the line of kaphavruta vata, and by considering urdwajatrugata lakshana shirodhara, greevabasti along with nasya line of treatment was adopted, and when a patient got relief in her symptoms, and she was wanted to continue her treatment hence virechana was adopted for sroto shodhanartha. Treatment shows significant improvement in her symptoms without any side effects.

Correlation analysis of national elite Chinese male table tennis players' shoulder proprioception and muscle strength.

BACKGROUNDShoulder is the most injured part in table tennis players, and it takes multiple roles in transmitting power and striking the center of the ball during the stroke. Proprioception is strongly correlated with high level of athletic performance. It is customary to assume that there is a correlation between proprioception and muscle strength and therefore proprioceptive assessment and rehabilitation is often neglected.AIMTo investigate the correlation between isokinetic muscle strength and proprioception in the internal and external rotation muscle groups of elite Chinese male table tennis players, to provide reference for physical training and rehabilitation of elite table tennis players.METHODSA total of 19 national elite table tennis players from the Chinese National Table Tennis Team were recruited in this research. All of them had more than 10 years training experience and had participated major competitions such as the National Games and World Youth Championships. IsoMed 2000 was used to test the peak torque of internal and external rotation isokinetic concentric contraction of the athletes' bilateral shoulder joints at low speed (60°/s) and high speed (180°/s) respectively; IsoMed 2000 was used to conduct the Joint Position Reproduction test to evaluate the athletes' proprioceptive ability capacity at low speed (60°/s) and high speed (180°/s) respectively. If the data satisfied the normal distribution, the correlation between the differences in peak torque s and angles in different directions was analyzed using a Pearson simple linear model; otherwise, Spearman correlation analysis was used. The comparison of proprioceptive ability between the table tennis racket-holding hand and non-racket-holding hands was performed using independent samples t-test if the data satisfied a normal distribution; otherwise, the Mann-Whitney U test was used.RESULTSThere was no direct linear correlation between the strength and proprioceptive correlation analysis at slow speed (60°/s) and fast speed (180°/s) in the racket-holding hand; At the slow speed (60°/s) and fast speed (180°/s), there was no correlation between muscle strength and proprioception in the non-racket-holding hand except for the internal rotation variable error (VE) and external rotation relative peak torque, which showed a moderate positive correlation (r = 0.477, P < 0.05), (r = 0.554, P < 0.05). The internal rotation’s constant error (CE) and VE were 1.06 ± 3.99 and 2.94 ± 2.16, respectively, for the racket-holding hand, and -3.36 ± 2.39 and 1.22 ± 0.93, respectively, for the non-racket-holding hand; the internal rotation’s CE, VE of the racket-holding hand was lower than that of the non-racket-holding hand, and there was a highly significant difference (P < 0.01).CONCLUSIONThere was no correlation between muscle strength and proprioceptive function in the internal and external rotation of the racket-holding hand’s shoulder in elite Chinese male table tennis players. These results may be useful for interventions for shoulder injuries and for the inclusion of proprioceptive training in rehabilitation programs.

A case of rheumatoid arthritis with bilateral shoulder bursitis accompanied by gas image.

We experienced a case of bilateral shoulder bursitis with gas images in a rheumatoid arthritis (RA) patient. A 60-year-old man with RA had been treated with weekly methotrexate 10 mg and daily prednisolone (PSL) 10 mg for 7 months. Generalized pain, especially in the bilateral shoulder joints, developed and exacerbated daily with increased C-reactive protein (CRP) level. Despite the initiation of biweekly sarilumab 200 mg, joint symptoms and CRP level continued to worsen. Computed tomography (CT) scan to determine the cause of severe shoulder inflammation revealed low absorption areas with contrast effects at the margins around the bilateral shoulder joints, accompanied by internal gas images. In addition, magnetic resonance imaging demonstrated subacromial bursae and coracoid bursae and bursitis, leading to the suspicion of abscess formation depending on the presence of gas image. In spite of antimicrobial therapy, arthralgia did not improve, and a CT-guided arthrocentesis of the left shoulder joint resulted in negative findings of infection in culture and pathological examinations. Switching treatment to intensive anti-inflammatory therapy with high-dose steroids and etanercept finally improved symptoms and CRP levels associated with the reduction of low absorption areas and disappearance of gas images at bilateral shoulder joints. Our case indicated that bursitis with gas image in RA patients involves unusual pathophysiology and requires intensive anti-rheumatic treatment.

Rehabilitation of the Shoulder Subluxation Based on Ultrasonographic Findings among Post Stroke Subjects: A Case Series.

Up to three-fourths of the poststroke subjects may experience shoulder subluxation as a challenging complication. The existing rehabilitation management is based on the clinical assessment. Ultrasonographic evaluation demonstrates findings, which cannot be discerned by the usual methods. To determine the effect of rehabilitation protocol based on the sonographic findings of the subluxed shoulder on reduction of the subluxation and upper limb motor recovery. Setting: Department of Occupational therapy of a Rehabilitation Institute. Study Design: A prospective case series. Subjects: 08 Poststroke hemiparetic patients with subluxed shoulder. Outcome measure: Ultrasongraphy of the bilateral shoulder joints, Fingerbreadth palpation method, Visual analog scale (VAS), Fugl-Meyer assessment of upper extremity (FMA-UE). Intervention: As per the findings of the sonography, management in the form of shoulder support, physical agent modalities, motor therapy, and precautions and positioning was provided to the subjects for the period of 3 months. Post intervention, the participants showed 1 to 6 mm of reduction of acromion-greater tuberosity distance in addition to the reduction of atrophy and soft tissue or joint effusion. Furthermore, the participants also exhibited FMA-UE change ranging from 5 to 21. The ultrasonographic evaluation explores objective measurement and involvement of specific soft tissues among poststroke subject with the shoulder subluxation. The management based on the sonographic findings is an objective and valid approach.

Severe erosive lesion of the glenoid in gouty shoulder arthritis: a case report and review of the literature

BackgroundGout is a metabolic disease characterized by recurrent episodes of acute arthritis. Gout has been reported in many locations but is rarely localized in the shoulder joint. We describe a rare case of gouty arthritis involving bilateral shoulder joints and leading to severe destructive changes in the right shoulder glenoid.Case presentationA 62-year-old male was referred for pain and weakness in the right shoulder joint for two years, and the pain had increased in severity over the course of approximately nine months. A clinical examination revealed gout nodules on both feet and elbows. A laboratory examination showed a high erythrocyte sedimentation rate (ESR), high levels of C-reactive protein and hyperuricemia, and an imaging examination showed severe osteolytic destruction of the right shoulder glenoid and posterior humeral head subluxation. In addition, the left humeral head was involved and had a lytic lesion. Because a definite diagnosis could not be made for this patient, a right shoulder biopsy was performed. The pathological examination of the specimen revealed uric acid crystal deposits and granulomatous inflammation surrounding the deposits. After excluding infectious and neoplastic diseases, the patient was finally diagnosed with gouty shoulder arthritis.ConclusionsGout affecting the bilateral shoulder joints is exceedingly uncommon, and to our knowledge, severe erosion of the glenoid has not been previously reported. When severe erosion is present, physicians and orthopedic surgeons should consider gouty shoulder arthritis according to previous medical history and clinical manifestations.

Modified Double-Endobutton technique combined with Nice knot in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation

To explore the clinical effect of the modified double Endobutton technique combined with Nice node in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation. From March 2016 to January 2019, 23 patients with Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation were treated with modified double Endobutton technique to reconstruct coracoclavicular ligament and Nice node to repair acromioclavicular ligament, including 18 males and 5 females, aged 31 to 53 (43.2±5.4) years, 9 on the left and 14 on the right, and the time from injury to operation was 1 to 10 days. Before operation, X-ray films and CT three-dimensional reconstruction of bilateral shoulder joint were performed. Postoperative complications were observed. Six months after operation, DASHand Constant-Murley scores were used to evaluate the treatment effect. The incision healed in one stage after operation, and no complications such as vascular and nerve injury and stress fracture occurred. All patients were followed up for 6 to 24 (12.0±4.9) months. At 6 months follow-up, the DASH score was 0.40±0.10 lower than that of 19.80±4.50 before operation, and the Constant-Murley score was 94.20±4.20 higher than that of 38.60±3.90 before operation. The treatment of Rockwood Ⅲ-Ⅴ dislocation of acromioclavicular joint with double Endobutton technique and nice knot is satisfactory in the early stage. The long-term effect and complications need further follow-up.

Bilateral symmetrical anterior fracture dislocation of shoulder

&lt;p&gt;The incidence of simultaneous bilateral shoulder joint dislocation is rare and is almost always posterior usually caused by violent muscle contraction as in patients with seizure disorders or who experience electric shock or undergo electroconvulsive therapy. simultaneous bilateral fracture-dislocation is even rarer, with a few cases reported in the literature. We report an unusual case with dislocation of the both shoulder joints in anterior direction after a seizure episode, With symmetrical unifocal 2-part extraarticular vertical fracture of proximal end segment of humerus (11A3) both sides. Although there have been a few reports of bilateral symmetrical fracture dislocations of the shoulder in the past, an injury pattern resembling our case has, to the best of our knowledge, not been described in the literature so far. Our report describes regarding the mechanism of injury in a case of a bilateral symmetrical anterior fracture dislocation following a seizure episode that treated with open reduction internal fixation using proximal humerus internal locking system (PHILOS). At final follow-up, the patient had healed fractures, painless near normal range of motion.&lt;/p&gt;

Musculoskeletal Ultrasonography Assessment of Functional Magnetic Stimulation on the Effect of Glenohumeral Subluxation in Acute Poststroke Hemiplegic Patients.

Background Glenohumeral subluxation (GHS) is common in patients with acute hemiplegia caused by stroke. GHS and upper limb function are closely related. Objective Using musculoskeletal ultrasonography (MSUS) to objectively evaluate the efficacy of functional magnetic stimulation (FMS) in the treatment of GHS in acute hemiplegic patients after stroke. Methods The study used prospective case control study. Stroke patients with GHS were recruited and assigned to control group and FMS group. Control group received electrode stimulation at the supraspinatus and deltoid muscles of the hemiplegic side, while FMS group was stimulated at the same locations. Before and after treatment, the distances of the acromion-greater tuberosity (AGT), acromion-lesser tuberosity (ALT), acromiohumeral distance (AHD), supraspinatus thickness (SST), and deltoid muscle thickness (DMT) in patients' bilateral shoulder joint were measured by MSUS, respectively. Meanwhile, Fugl-Meyer Assessment (FMA) was used to evaluate the improvement of upper limb function. Results 30 patients were recruited. After FMS treatment, there was a significant decrease in the difference value between ipsilateral side and contralateral side of AGT [t = 8.595, P < 0.01], ALT [t = 11.435, P < 0.01], AHD [t = 8.375, P < 0.01], SST [t = 15.394, P < 0.01], and DMT [t = 24.935, P < 0.01], and FMA score increased [t = −13.315, P < 0.01]. Compared with control group, FMS group decreased more significantly in the difference value between ipsilateral side and contralateral side of AGT [t = 2.161, P < 0.05], ALT [t = 3.332, P < 0.01], AHD [t = 8.768, P < 0.01], SST [t = 6.244, P < 0.01], and the DMT [t = 3.238, P < 0.01], and FMA score increased more significantly in FMS group [t = 7.194, P < 0.01]. Conclusion The study preliminarily shows that the MSUS can objectively and dynamically evaluate the treatment effect of GHS in hemiplegic patients. Meanwhile, compared with control group, the FMS is more effective and has fewer side effects, and the long-term effect of FMS is worth further study. This trial is registered with ChiCTR1800015352.

Prevalence of and risk factors for shoulder osteoarthritis in Japanese middle-aged and elderly populations

The purpose of this study was to determine the prevalence of shoulder osteoarthritis (OA) in populations older than 40years and to examine risk factors and the relationship with shoulder function. The respondents in this study consisted of 541 patients who underwent general medical examinations in April 2012 as residents of a single village. The mean age was 65.2±11.0years (range, 40-89years), and 341 (63.0%) of the respondents were women. Anteroposterior radiographs of the bilateral shoulder joints were obtained, and the subjects were classified into 3 groups (non-OA, mild OA, and moderate-severe OA) according to the Samilson-Prieto method. With respect to risk factors for shoulder OA, a logistic regression analysis was performed. Shoulder OA was detected in 17.4% (94 of 541) of the patients. The incidence of OA in both shoulders was 3.1% (17 of 541), and the prevalence of shoulder OA among the respondents 65years of age or older (20.3%) was significantly higher than that observed among the respondents younger than 65years (11.1%). The risk of shoulder OA increased according to age, with an odds ratio of 5.59 in the respondents 60 to 69years of age (P=.027), 11.59 in the respondents 70 to 79years of age (P = .004), and 10.77 in the respondents 80years of age and older (P = .004). The prevalence of shoulder OA was 17.4%, and the risk factor for shoulder OA was age.

AB0729 Correlative analysis of handy rheumatoid activity score, with 38 joints (hras38) and musculoskeletal ultrasound for rheumatoid arthritis.

BackgroundThe disease activity score 28 (DAS28), clinical disease activity index (CDAI) and simplified disease activity index (SDAI) are all used in the clinical assessment of rheumatoid arthritis (RA). A consensus...

Surgeons’ Static Posture and Movement Repetitions in Open and Laparoscopic Surgery

There is increasing concern about the surgeon maintaining a static posture during laparoscopic surgery, which can contribute to musculoskeletal disorders. A series of studies are being conducted in Hong Kong examining the surgeons' real-time movements and electromyography in the operating theater during different operations. The present paper examines the postures and movements of surgeons during real-time open and laparoscopic procedures. Fourteen surgeons participated in the study (12 men, 2 women). Cervical spine movements were measured using a biaxial inclinometer attached to the surgeon's head via a headband. Biaxial electrogoniometers were attached to the surgeon's bilateral shoulder joints. Real-time joint movements in sagittal and coronal planes were recorded during open and laparoscopic surgeries for periods ranging from 30 to 80 min. Surgeons generally maintained a flexed neck posture during open surgery and a more extended neck posture during laparoscopic procedures. There were statistically significant differences in mean neck posture and mean left shoulder abduction posture between the two types of surgery. Laparoscopic procedures showed a trend for longer duration in static posture in the neck, while open procedures showed trends for higher frequencies of movements. This study presented a novel approach to quantify the physical workload of surgeons using biomechanical parameters to describe duration of static posture and repetitiveness of movements. Resultsshowed that long durations of static postures in laparoscopic surgery were closely associated with low-level muscle tension, which may contribute to an increased risk of surgeons developing musculoskeletal disorders.

Arthroscopic Treatment of Pigmented Villonodular Synovitis Involving Bilateral Shoulders

Pigmented villonodular synovitis (PVNS) is a lesion of benign proliferative synovium that invades joint, tendon sheath, and bursa. It mainly occurs in 1 joint, the knee joint or hand, and multi-joint invasion is reported to be <1%. Rare cases have been reported of PVNS occurring in the shoulder joint. Generally, total synovectomy is a standard treatment of PVNS. However, complete synovectomy is sometimes impossible because of difficulty of visualization and access to the whole joint and subacromial space. Therefore, recurrence of the disease is always of concern. This article presents a case of 64-year-old patient with pain and swelling of bilateral shoulder joints of 4 months' duration. Physical examination showed atrophy of the deltoid and infraspinatus and a mass-like protrusion on the anterior portion of left shoulder. Active forward elevation was limited to 30 degrees on the right and 90 degrees on the left. Overall synovial hyperplasia and nodular mass was observed on magnetic resonance imaging. Massive rotator cuff tear and invasion of the lesion toward the subacromial space and deltoid muscle was noted as well. Arthroscopic examination revealed a typical finding of PVNS: yellowish brown pigmentation over the overall joint capsule and subacromial space. Arthroscopic total synovectomy without rotator cuff repair was performed for both shoulders. Clinical outcomes showed good pain relief and no recurrence of the disease, although range of motion and muscle strength was not significantly improved, possibly due to accompanied massive rotator cuff tear. Arthroscopic total synovectomy in the treatment of PVNS of the shoulder joint is a minimally invasive and effective method, which makes it possible to access the whole joint space and subacromial space.

The study of the resin adsorption on patients of dialysis-related amyloidosis in clinical efficacy and quality of life

目的 探讨树脂吸附对维持性血液透析(MHD)患者透析相关性淀粉样变(DRA)的防治作用及生活质量的影响.方法 将40例合并DRA患者随机分为树脂吸附+血液透析组(HP+HD)和常规血液透析组(HD).HP+HD组在每周3次常规血液透析的同时,接受每2周1次的HP治疗;HD组行每周3次常规血液透析.分别于治疗前、治疗3个月时应用SF-36量表进行生活质量评分,检测血清β2-M、Hs-CRP的变化;并用磁共振(MRI)检查患者双侧肩关节,检测肩关节MRI阳性征象,观察临床症状改变情况.结果 HP+HD组治疗后患者生活质量评分由(86.39±26.46)升到(104.30±20.69)(P<0.05) β2-M从(13.48±4.69)mg/ml降至(5.91±1.73)mg/ml(P<0.01);Hs-CRP从(15.86±5.12)pg/ml降至(8.86±3.36)pg/ml(P<0.01),MRI影像学征像和临床症状治疗后均明显改善(P<0.05),治疗前后比较差异均有显著性.结论 DRA患者在常规HD治疗的同时接受HP治疗能有效的改善或缓解其DRA,并提高其生活质量。

Sonography of Patients with Hemiplegic Shoulder Pain After Stroke: Correlation with Motor Recovery Stage

This study was performed to clarify the cause of shoulder pain using sonography and to evaluate the relationship between the sonographic findings and the motor recovery stages in stroke patients with hemiplegic shoulder pain. Between March 2005 and January 2007, 71 consecutive stroke patients with hemiplegic shoulder pain underwent shoulder sonography. For comparison, bilateral shoulder joints were evaluated in 20 of the 71 patients. The interpretations of the sonographic findings were based on the findings of previously published studies. Whether a correlation existed between the sonographic findings and the motor recovery stages was determined. Subacromial-subdeltoid (SA-SD) bursal effusion (n = 36) was the most common abnormality seen on sonography. Tendinosis of the supraspinatus tendon (n = 7), partial-thickness tear of the supraspinatus tendon (n = 6), and full-thickness tear of the supraspinatus tendon (n = 2) were also noted. Biceps tendon sheath effusion (n = 39) and normal findings without any biceps tendon sheath effusion (n = 13) were detected. Clinicians managed each patient's shoulder pain on the basis of the sonographic findings. No statistically significant correlation was found between the grade of sonographic findings and Brunnstrom stage (p = 0.183). A shoulder with hemiplegia had a higher number of abnormal sonographic findings than a noninvolved shoulder (p = 0.007). The cause of shoulder pain was variable and there was no correlation between the stages of motor recovery and the grades of sonographic findings in patients with hemiplegic shoulder pain.